Financial Justification of Staff Nurse

[PG2018]

Perhaps there's an administrative forum I'm not aware of where this could be better placed.

I'm entering a multi-state practice, designed around a very incentivized business model (that also offers a generous base salary), but the site I'll be working out of does not presently employ a nurse. There's already a psychiatrist on site, surprisingly, and the office ladies are tasked with running interference with pharmacies, addressing prior authorizations, finding hospital placement for patients in our outpatient practice, etc. They also coordinate labs and, I'm told, will take weight, vitals, etc., and do whatever else it is that I want them to. However, the old psychiatrist already on site takes his own vitals, weighs patients himself, and does a lot of work that it does not take a prescriber/diagnostician to do.

That said, numbers will readily sell the local practice manager on hiring a nurse. His goal is for us to see more patients, as I want to as well (remember the financial incentives), and so I'm trying to devise a quantified rationale on how the good doctor and I not doing anything besides "doctoring" will improve flow and productivity.

Having said that, I cannot lawfully delegate the phone order of prescriptions in my state to a non-licensed person. You could circumvent that easily, but I also don't want to burden my time with talking to pharmacies, scrutinizing PAs, being front runner on labs, etc. I could see walking a patient back to the office, taking vitals, etc. using up at least 5 minutes, and in a practice running 20+ patients a day that's over 1.5 hours of time consumed with duties it doesn't require a doctor or APRN to do. That 1.5 hours (120 mins) impedes as many as six 20 minute med checks. I think hiring a LPN for around 28k/yr (going rate for them in this area) will allow us to see more patients, see them more effectively, and pull more reimbursement for the organization. I also need other duties for them to task themselves with in between. We do not prescribe or administer depo medications.

Do any of you know of a formula that expounds on this? Or a better way to explain this to a MBA-type?

[Jules A, MSN]

Off topic but: Why are you not prescribing or offering long acting injection administration?

[Psychcns]

Could they see patients on antipsychotics for metabolic monitoring? Screen phone calls for

side effects. Maybe put together a job description. Depot injections would likely be billable. Collect urines for drug screens, too.

[inthepipeline, LPN]

I'm an LPN and do all that stuff except the PA's. How you utilize your LPNs and MA's largely depends on your workflow and nature of your practice. So if you have more injections, infusions, procedures, and higher risk triage questions (chest pain, low BS, heavy duty med side effects/reactions) then an LPN/RN would be better. However, if you're mostly doing med management/internal med then MA's may be more cost effective. You can train either to how you need. Also, do you function off of paper or have an EMR like EPIC, eclinical, or Meditech? As for verbal orders to a pharmacy if you need a licensed person then LPN would be the cheapest. However, could the MA's set up the orders for your to sign and then they fax them so that all you have to do is review and sign with them doing the prep? Or you could do e prescribe through an EMR or service and your MA's/office staff could set up the order and you just review and send. If its a multistate practice they must have some sort of EMR or workflow system to address this. As for documenting an EMR is priceless for providers because you can use smart phrases/ formats which can cut down documentation time dramatically. I guess I'd need more information on your workflow to really offer valuable suggestions.

[Jules A, MSN]

Or you could do e prescribe through an EMR or service and your MA's/office staff could set up the order and you just review and send. If its a multistate practice they must have some sort of EMR or workflow system to address this..

At the OP practice where I work our refill requests come through the computer and we can even order schedule II meds through the EMAR.

[PG2018]

Off topic but: Why are you not prescribing or offering long acting injection administration?

The company doesn't. None of the other clinics do it, and I take it this one never has because they don't have a staff member trained to do so.

[PG2018]

Could they see patients on antipsychotics for metabolic monitoring? Screen phone calls for

side effects. Maybe put together a job description. Depot injections would likely be billable. Collect urines for drug screens, too.

Those are some things I had on my mental list - urine drug screens and "phone health" types of things. Thank you for reminding me. I suppose the injections would come after the nurse, and I think giving them is great. Just no one has yet done that here yet.

[Jules A, MSN]

The company doesn't. None of the other clinics do it, and I take it this one never has because they don't have a staff member trained to do so.

Not perscribing them and not offering the actual injection are two totally different issues. There is a ton of data out there indicating the severity of relapses increase and prognosis decrease with each psychotic episode. The long acting antipsychotic meds are becoming more of a first line treatment. I'd seriously question a practice that doesn't advocate them as indicated.

Below is a heartbreaking story that anecdotally illustrates the downward spiral we can expect when patients with psychotic disorders aren't medication adherent something that injections hopefully offset to some extent.

My daughter, who lost her battle with mental illness, is still the bravest person I know - The Washington Post

[PG2018]

Woah! I support long-acting IM antipsychotics. I'd planned on prescribing them as often as patient will agree to take them, yet if the business doesn't "do" this then I'm not either. I'd wager the underlying issues is that they're not on our state's Medicaid formulary, and this practice is grounded on Medicaid reimbursement. And they've got it down to such precision that they're booming financially.

Not perscribing them and not offering the actual injection are two totally different issues. There is a ton of data out there indicating the severity of relapses increase and prognosis decrease with each psychotic episode. The long acting antipsychotic meds are becoming more of a first line treatment. I'd seriously question a practice that doesn't advocate them as indicated.

Below is a heartbreaking story that anecdotally illustrates the downward spiral we can expect when patients with psychotic disorders aren't medication adherent something that injections hopefully offset to some extent.

My daughter, who lost her battle with mental illness, is still the bravest person I know - The Washington Post

[Jules A, MSN]

Woah! I support long-acting IM antipsychotics. I'd planned on prescribing them as often as patient will agree to take them, yet if the business doesn't "do" this then I'm not either. I'd wager the underlying issues is that they're not on our state's Medicaid formulary, and this practice is grounded on Medicaid reimbursement. And they've got it down to such precision that they're booming financially.

Wow. Ok then.