NP in long term care

Editorial Team / Admin · Dec 27, 2006

Hello, twalker,

I think what you are referring to is the Medicare Reimbursement(s) when utilizing an NP. This is Federal guidelines and it is all spelled out clearly and concisely regarding the required physician collaboration in every situation, when NPs can visit and how often, when the physician must visit, etc. Even if a state has no physician collaboration requirements for the NP, the NP (working with Medicare reimbursement) must have physician collaboration in LTC.

Each state has delineated the NP scope of practice and I'm not aware of it being broken down into LTC SOP in any state. Some states are very vague regarding NP SOP. Some are very clear.

Here is a link to Log In Problems ...(although this states log in problems it is a link to Medscape article on Medicare Reimbursements and NP).

Here is a link to discussion regarding NP SOP: Log In Problems ...(again, although states log in problems, it is link to article from Medscape on NP SOP).

You might have to register to view these links (free registration at Medscape), but well worth your time and effort.

Hope this helps.

Trauma Columnist · Dec 28, 2006

I did some clinical time with an NP who worked in a large (300 bed) LTC. She took care of the everyday matters of things and the MD visited once per month to address concerns. She took very good care of the residents.

twalker · Dec 28, 2006

Thank you. Did she work for the facility? That is interesting. I work in the ER now and receive a lot of patients from surrounding nursing homes just because they can not do IV medicines. It would seem that an APN would eliminate that as well as save the facility and residents money.

Advanced Practice Columnist / Guide · Dec 28, 2006

I need a little help please. I am working on "another" project in my NP program. However I am not really finding any good sites or literature on the topic. Do anyone know how to find out what a NP scope of practice in long term care. Meaning, what they can and can not do. My preceptor had made a comment on the fact that NPs can actually round in the nursing homes and the MDs will have to see the patients every 3 months. I have not found any literature to support this statement. Please help.
Thank you and Happy New Year

Hi twalker! Believe it or not, I just did a google search on your topic and found this article:

Literature Review and Synthesis of Physician Practices in Nursing Homes

It appears that the regulations do require physician visits once every 30 days but also adds that the physician should be available for emergency consultation 24 hours a day. The article also discusses physician extender utilization in nursing facilities.

As far as NP's, I agree that Medicare and Medicaid rules will impact the regulation surrounding NP utilization in nursing homes

I agree, it can be hard to find literature at times even with Medline and CINAHL. What I used to do in grad school is if I find just a single article, I look at the references and ask the campus librarian to find the referenced articles for me.

twalker · Dec 28, 2006

Thank you so much, this really helped.:roll :icon_biggrin: