Need some help from my fellow APNs - interviewing for hospitalist position....

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Specializes in Nephrology, Cardiology, ER, ICU.

Okay - so I've got a phone interview for a hospitalist position at a very rural, very small (115 bed) hospital that utilizes a contracted hospitalist service. They are wanting an APN to join the practice (3 12 hr shifts) as a hospital employee. The hospitalists cover M-F 0700-2000 and the rest of the time the ER MD covers.

This is a position located about 60 miles from my house but as I travel an average of 100-250 miles/day now this is not an issue.

It is a very very rural area but this is NOT a critical access hospital.

What types of questions should I ask?

I've been an APN for almost 9 years but only in nephrology except for a brief locums (6 months) position in a community hospital ER.

I've scoured their website and know the hospital mission statement, who's who in the hospital and kinda how the hospital works but is there any hospitalist-specific questions I should ask??

Thanks so much...

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Looks like you're ready to move on from Nephrology? actually, this sounds exciting. I have no experience working in rural hospitals (both as a bedside RN or NP). I'd be wondering about what cases are admitted and kept in the hospital vs sent out to tertiary facilities. I'd imagine that would depend largely on the availability of services and specialties. We get a lot of transfers from community hospitals for neurosurgery (bleeds), solid transplant evals, vascular surgery, etc but I noticed some of these places are able to do coronary stents and even uncomplicated CABG's. Looks like your back up physician is the hospitalist during the day and the ED physician on off hours -- that sounds reasonable. Would you cover all units including the ICU?

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Specializes in Nephrology, Cardiology, ER, ICU.

Thanks Juan thats a good question to ask.

Yes, I'm ready to move on - this working 60 hrs/week and driving on average 400 miles/week is getting old. I am excited to try something new

I know for sure they do not do dialysis in the hospital as all of my pts are sent out about 80 miles away to the big tertiary hospital where I used to work.

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Specializes in AGNP.

Do you know if the position is rounding on the floor or only admissions? The 2 hospitalist services is my area only use NP/PAs for admissions and they do not round on any patients.

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If your job duties are going to be similar to the contracted hospitalists, then you might ask to shadow one of them to get an idea what the job is really going to be like.

Since this will be a new position for the hospital a big concern would be having a clear description of your job and how receptive the other providers and nursing staff will be to you. What experience does the hospital have with working with APNs?

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Specializes in Family Nurse Practitioner.

Definitely get a feel for their knowledge and attitudes about NPs abilities especially if you are going to be the first NP. I have been the first NP in a department and it took clarification of my duties at times as well as firm boundaries although only with nurse managers and nurse house supervisors not with the physicians. I would definitely want to check things out by shadowing to see if you fit in with the team. In my experience with Hospitalist Groups with PAs or NPs they seem to either be an excellent partnership or a train wreck.

Good luck!

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Okay - so I've got a phone interview for a hospitalist position at a very rural, very small (115 bed) hospital that utilizes a contracted hospitalist service. They are wanting an APN to join the practice (3 12 hr shifts) as a hospital employee. The hospitalists cover M-F 0700-2000 and the rest of the time the ER MD covers.

This is a position located about 60 miles from my house but as I travel an average of 100-250 miles/day now this is not an issue.

It is a very very rural area but this is NOT a critical access hospital.

What types of questions should I ask?

I've been an APN for almost 9 years but only in nephrology except for a brief locums (6 months) position in a community hospital ER.

I've scoured their website and know the hospital mission statement, who's who in the hospital and kinda how the hospital works but is there any hospitalist-specific questions I should ask??

Thanks so much...

There are a number of problems with this. The biggest problem is you won't be able to bill. You need to have a W-2 or 1099 relationship with the physician group to bill. Also there a number of issues medicare issues. Finally if the hospitalist group bills for your services without reimbursing the hospital, its a Stark violation. Overall a bad idea.

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Specializes in Nephrology, Cardiology, ER, ICU.

Thanks so much everyone - this is great information and lots of stuff that I didn't consider. Thanks again everyone....

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Specializes in Family Nurse Practitioner.
There are a number of problems with this. The biggest problem is you won't be able to bill. You need to have a W-2 or 1099 relationship with the physician group to bill. Also there a number of issues medicare issues. Finally if the hospitalist group bills for your services without reimbursing the hospital, its a Stark violation. Overall a bad idea.

Interesting point and I missed that it is a hospital employee position. OP, are you sure this is how they plan to pay you? It sounds like you won't be joining their practice but instead working as supplemental help paid for by the hospital? I would imagine the hospitalist group will not be billing for the NPs services if in fact the NP is an employee of the hospital.

This is possibly a point to negotiate and would make for another excellent thread. Hospital employee vs. Hospitalist group member. Hint, hint I vote for hospitalist group. ;) The further I can get from nursing staff and the closer to physician services the better in my experience. They will likely treat you better and you will be afforded more protection if a member of their group.

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Hi Core0,

So does she need to have a W-2 or 1099 with the contract hospitalist group to bill?

Would there be a difference in how she would bill if she were 1099 vs W-2? If so, what's the difference?

I'm going through a similar hiring process (with a physician's group), and have questions about how the contracted hospitalist group (or physician's group) bills on behalf of an NP or MD.

There are a number of problems with this. The biggest problem is you won't be able to bill. You need to have a W-2 or 1099 relationship with the physician group to bill. Also there a number of issues medicare issues. Finally if the hospitalist group bills for your services without reimbursing the hospital, its a Stark violation. Overall a bad idea.
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I discovered this link:

https://www.todayshospitalist.com/How-to-ace-the-job-interview-process/

It has some questions for interviewees to ask the interviewer about the position. I'll post the list of questions (you could ask them) here:

-What is the daily census and number of patient encounters?

-How many hospitals or other facilities does the program cover—and would you have to cover more than one?

-What schedules do hospitalists work, and would you have a say in putting your schedule together?

-What new services is the program planning on adding?

-What kind of access do physicians have to specialists?

-What kind of financial package does the program offer in terms of benefits and incentives?

-Are there opportunities for part-time work? If you wanted more income, could you increase your number of shifts?

-How involved are hospitalists in ICU duties and responsibilities?

-How is the program managed, and who do the hospitalists report to? What is their involvement in decisions that affect them?

-How are hospitalists received in the hospital?

-Do the hospitalists act as a team, and how often do they meet?

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Jen477 said:
Hi Core0,

So does she need to have a W-2 or 1099 with the contract hospitalist group to bill?

Would there be a difference in how she would bill if she were 1099 vs W-2? If so, what's the difference?

I'm going through a similar hiring process (with a physician's group), and have questions about how the contracted hospitalist group (or physician's group) bills on behalf of an NP or MD.

For Medicare to bill shared billing you have to have a 1099 or W-2 relationship with the same group that employs the physicians. Most private insurances do not credential PAs or NPs so billing is done under a physician. Theoretically, you can be employed by the hospital and then the hospital be reimbursed by the physician group for your services. However, in practice this is really difficult.

As for 1099 there are plenty of posts on that here. I would maintain that its almost impossible for an NP to satisfy 1099 requirements especially in a hospitalist position.

As far as how a hospitalist group bills, it depends on how they are contracted. Some places the hospitalists are employees of the hospital. In that case the hospital bills for their services and they assign collections to the hospital. In others they are contracted for certain coverage and given a supplement (or not) for that coverage. They keep all billing from the patients. In either case all the participants must align themselves. If the hospitalists are employees then the NP is an employee and assigns billing to the hospital. If the hospitalists are contracted then the hospitalist group bills for the NP and the NP assigns billing to the group.

The problem comes when the NP or PA works for the hospital and the hospitalists are contracted. In this case if the hospital bills for the NPs work it creates friction for the hospitalist and can lead to double billing (where both the hospitalist and the NP bill for the same patient). In addition the hospitalists are unlikely to want to give up the billing for the patients.

If the NP or PA is working but not billing the hospital is usually wondering why they are paying them. If the NP or PA is working for the hospital and the hospitalist group is billing for them, then it is a Stark violation. Even if the hospitalist is not billing for them, they may be performing services of value and still be a Stark violation.

Operators Of University Of Louisville Hospital To Pay $2,833,408.60 To Settle False Medicare Billings | USAO-WDKY | Department of Justice

I have seen some situations where a small hospital contracts for 7a to 7p hospitalist coverage then hires employees to cover patients overnight. This invariably leads to problems. For example if an NP admits a patient during he early AM then the hospitalist can't bill for the patient even though there will be significant work.

Overall, the best situation is to either have everyone work for the hospital or everyone work for the hospitalist group.

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