Any suggestion for LTC NP?

Trauma Columnist · Apr 17, 2016

Here's what I found: http://www.medscape.org/viewarticle/464725

Clearly, Medicare defers to State law with regard to scope of practice and the nature of collaboration. State laws regarding scope of practice vary significantly and are often vague. They may contain "only a general statement about responsibilities, educational requirements and...duties, and do not explicitly identify services that are...beyond their scope."^[3] In Michigan, for example, state law provides a definition of the "practice of nursing" that serves as the legal scope of practice for nurses; state law does not delineate a scope of practice specific to NPs.^[4] NPs must have a thorough understanding of their state's scope of NP practice and may obtain this information through the State Board of Nursing. Contact information is available online athttp://www.ncsbn.org/.

Some states do not require NPs to practice in collaboration with a physician. However, the absence of this requirement by a state does not negate the Medicare requirement for collaboration.^[1] Medicare defines collaboration as "a process whereby a NP works with a physician to deliver health care services within the scope of the NP's professional expertise with medical direction and appropriate supervision as provided for in jointly developed guidelines or other mechanisms as defined by Federal regulation and the law of the state in which the services are performed."

NPs are encouraged to document their individual scope of practice, which reflects specialized education and training, the individual's knowledge base and specific role, and the patient population served. This scope of practice complements, or may be part of, a collaborative agreement that outlines the relationship between the NP and physician and specifies how issues that are outside of the NP's scope of practice are managed.^[1]

[h=4]The NP's Role in Nursing Facilities[/h]Medicare requires that the initial visit (history and physical), for the purpose of certifying that the patient requires skilled care, must be performed by a physician. An NP may, however, make a "medically necessary" visit without an initial physician visit; this could occur when a newly admitted Medicare patient in a skilled nursing facility develops a problem that requires medical evaluation and intervention, before being seen by the physician. Girvin-Reisser advised cautious use of this practice because it could be viewed as an unnecessary visit (ie, if the physician were available to see the patient at the time of admission, only one visit would have been needed). All subsequent visits may be performed by an NP (or other nonphysician), alternating with the physician.

NPs may perform the initial history and physical for new long-term care (nonskilled) admissions. NPs may also make additional visits, which must be substantiated based on the patient's need (ie, acute illness). Medicare provisions permit 1.5 visits per month; more than this frequency may invite increased scrutiny in the form of an audit. Medical necessity must be documented!

Assuming state law permits, Medicare allows NPs to help with monitoring and managing patient conditions, counseling patients and families, performing certain procedures, annual physical examinations, communication with hospital and community physicians, and discharge visits.

Misskala · Apr 23, 2016

Yes, this is what happens at the skilled care facility and sub-acute rehab unit I work in. The NP and MD do the initial admission together, then the NP does follow-up rounds and progress notes. We only have Medicare beds on the rehab unit however, but both sides are admitted with with both the NP and MD. HTH!