Missouri committee hears bill to let hospitals hold collaborative practice agreements for physician assistants

The House Committee on General Law held a hearing on House Bill 2749, which would permit hospital systems to sign collaborative practice agreements for physician assistants (PAs) so those agreements continue when individual physicians depart. Rep. Bishop Davidson, who carried the bill, framed it as a narrow administrative change intended to reduce paperwork with a $0 fiscal note.

"What we're doing here is saying that in the instance of a hospital system, the hospital can sign that collaborative practice agreement so that as physicians leave ... physician assistants are still operating within that agreement," Rep. Bishop Davidson said during his opening remarks. He emphasized the bill would not change the scope of practice for PAs.

Supporters at the hearing said the change reflects how modern hospital employment is structured and would ease an administrative burden on physicians and hospital credentialing offices. Paul Winter, a practicing PA with 38 years' experience, described large hospital systems where a single PA may need dozens of individual collaborative agreements signed and maintained. "This isn't a scope change," Winter said. "It's literally just allowing to depart that hospital system, that everything can keep on going just as normal instead of them having to hunt down ... a dozen ... physicians to re-sign a new collaborative practice agreement." Jamie Murphy of the Missouri Hospital Association said centralizing paperwork could let physicians spend more time with patients and would not directly affect insurance reimbursement.

Opponents urged caution. Rachel Bauer, representing the Missouri State Medical Association and the Missouri Association of Osteopathic Physicians and Surgeons, argued collaborative practice agreements are "physicians' agreements" and warned the measure could do more than reduce paperwork. "This bill goes far beyond paperwork," she said, cautioning that master hospital agreements could be imposed on physicians and potentially increase malpractice exposure.

Committee members pressed both sides on accountability and oversight. Supporters said the Board of Healing Arts would continue to have oversight over collaborative practice arrangements and that hospitals remain liable for care delivered in their facilities. Murphy noted existing chart-review requirements would not change under the bill (committee discussion referenced a current practice of about 10% chart reviews generally and 20% for controlled substances).

Members also raised questions about how many PAs would be affected and whether the change would have any effect on access to care in rural areas; sponsors and witnesses said they did not have statewide breakdowns available at the hearing and characterized the proposal as a narrowly tailored administrative accommodation.

The hearing concluded with no vote. Committee members asked to receive more input from practicing physicians across the state before any further action.