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

[traumaRUs]

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...

[traumaRUs, MSN, APRN]

okay so after 1.5 hr phone interview this is what I got out it (condensed version):

hospital employee tied to a hospital employee hospitalist MD

some type of call system (I would be first call) 2 days/week

worst case scenario: 1 weekend day every 3rd weekend

billed as "shared" visits versus "supervised" visits - gonna have to do more research on this one

They have one NP in place now since Feb but she is new grad

So...next step - they will touch base with me Monday and if we both feel that it would be mutually beneficial to move forward, then 4 hr in-person interview

Thanks again everyone - I so appreciate everyone's input

[core0]

For what its worth, shared visit allows the physician to participate in one part of the E/M then bill the entire visit under the physician NPI at 100%.

Shared/Split Service - The Hospitalist

The ins and outs of billing for shared visits

[Corey Narry, MSN, RN, NP]

What is "supervised" billing? I haven't heard of that term before. I always thought that in the in-patient setting billing can occur in one of two ways: (1) Shared/Split as explained above (100% reimbursement) or (2) billing under the NP's provider number (85% reimbursement).

[core0]

What is "supervised" billing? I haven't heard of that term before. I always thought that in the in-patient setting billing can occur in one of two ways: (1) Shared/Split as explained above (100% reimbursement) or (2) billing under the NP's provider number (85% reimbursement).

You are correct. It isn't a Medicare term. I'm guessing that its either their term for shared billing or trying to bill under the physician NPI without seeing the patient (ie fraud).

[Corey Narry, MSN, RN, NP]

I would ask how that call works. As it sounds, the hospital-employed hospitalist is your collaborating physician. The other hospitalists who are outside contractors should have their own panel of patients that you don't ever see or hear from. I would imagine, there's a way for nurses to know which patients are yours in case you need to be called about them.

[traumaRUs, MSN, APRN]

The way I'm understanding this is (and this is a tiny hospital) with only 18-30 pts in-pt at any one time. The hospitalist service seems to have both hospital-employed AND hospitalist-company (outsourced) MDs. They work one week on and they seem to only work one week a month as there is only one that lives locally, one that comes from Chicago and the others are all from out of state.

[LaurieCRNP2002, MSN, RN, APRN]

Good luck to you, I hope this position works out for you! :)

Laurie

[NP2015]

AnnaN5, I have been asked to apply for a hospitalist job but would you please distinguish between rounding and admissions as I am a new AGNP graduate......

[Dranger]

AnnaN5, I have been asked to apply for a hospitalist job but would you please distinguish between rounding and admissions as I am a new AGNP graduate......

How do you not know the difference? Just curious. Have you never been an inpatient RN before?

Rounding- day to day plan of care changes and literal rounding on each patient with the team. Controls discharge, acuity of care, consults etc

Admitting- Admitting patient to inpatient from ED with initial dx, labs, meds, H&P etc

[synaptic]

My position is mostly admitting people and putting our fires at night, but we do round occasionally. And the glorious discharge summaries. Rounding isn't much different except your adjusting things here and there and changing acuity, writing consults if needed and trying to get the patient back out on the street again.

[NP2015]

I have been an inpatient RN for many years off and on; but I have never been in the advanced role's circle of influence or ever knew or watched what they did because I was too busy caring for my patients. Rounding can mean rounding via report over patients admitted ect.,. or actual physical rounding/patient visits at the bedside. Admitting turns out to be pretty much just as it sounds. I know this may be hard to believe but I have never functioned in this role before hence the question.....And each role could mean different responsibilities in different environments....This is the nursing profession we're talking about---a profession that lacks uniformity across the nation; again, hence the valid question. Some support on your part would have been nice......

[Sha-Sha RN]

I have been an inpatient RN for many years off and on; but I have never been in the advanced role's circle of influence or ever knew or watched what they did because I was too busy caring for my patients. Rounding can mean rounding via report over patients admitted ect.,. or actual physical rounding/patient visits at the bedside. Admitting turns out to be pretty much just as it sounds. I know this may be hard to believe but I have never functioned in this role before hence the question.....And each role could mean different responsibilities in different environments....This is the nursing profession we're talking about---a profession that lacks uniformity across the nation; again, hence the valid question. Some support on your part would have been nice......

I don't think you were not getting supported; I think the question was valid, getting an assessment of your background. I have been an inpatient nurse for 10 years and even when I was caring for my patients, sometimes 5-7 at a time, I would find a spare moment to join that circle of influence as you call it because as a RN I considered myself the center of that circle (along with the pt). I was the only one with the patients all day and have something to contribute the the information being shared. Plus I was able to find out what the teams or consults were planning.