NPs doing MD reg visits in LTC

[FNPinLTC]

Is this a thing where you work in LTC facilities? NPs doing all the work (assessment, charting under MD name, plan, writing orders under MD name), then MD popping their head in the patients room later and "looking over the chart/plan" to agree or disagree. MDs are behind on reg visits so that is why this is being done. Job states the NPs are still getting the credit for the RVUs.

Tell me more about the pros/cons of this, who else is doing this, what should I be aware of? Ethically it feels....icky.

[Oldmahubbard]

Just no, not where I work.

Although I hear of very similar things that go on in different settings.

On the other hand, the physicians with the practice group I am with are full time employees. They are not trying to do LTC after a long day at a private office. I am not saying they are never behind, but they have a schedule and they know what they have to do.

If I am correct, there is a requirement that LTC patients be seen q 2 months by a physician.

Most of the rest of the work is handled by NPs. Which may mean that the patient is seen 80% of the time by an NP or a PA. But never writing orders or charting under someone else's name.

I have heard of scenarios where the NP essentially does the work and the MD "sees" the patient briefly, and somehow both get paid, but I have never understood it, and find it very questionable.

I am interested in other NP experiences.

[FNPinLTC]

57 minutes ago, Oldmahubbard said:

If I am correct, there is a requirement that LTC patients be seen q 2 months by a physician.

Most of the rest of the work is handled by NPs. Which may mean that the patient is seen 80% of the time by an NP or a PA. But never writing orders or charting under someone else's name.

Yes, you are correct about Medicare requirements- q2 months but can be alternating with APP. So the MD sees q4months. And yes, the NP is seeing most of the time because we are doing our reg visits but also all follow-ups. So, what is happening now is we are doing our APP reg visits, follow-ups for acute issues/changes, and now the MD reg visits but charting under the MD.

[Joy16Sarah]

On ‎8‎/‎27‎/‎2019 at 9:13 AM, FNPinLTC said:

Yes, you are correct about Medicare requirements- q2 months but can be alternating with APP. So the MD sees q4months. And yes, the NP is seeing most of the time because we are doing our reg visits but also all follow-ups. So, what is happening now is we are doing our APP reg visits, follow-ups for acute issues/changes, and now the MD reg visits but charting under the MD.

I am being hired by a nursing home because the MD is having trouble keeping up with charting. I believe this all gets billed under the MD as he will oversee and approve all my visits. Is it common that the nursing home pays the APP directly, but the MD still bills for all visits he oversees personally. I don't care about what he bills, I'm just confused as to why the nursing home would take on this additional financial responsibility. I do not see how the nursing home will get reimbursed if the MD is already claiming the visit. This is all new to me, but I'm excited about the position as I enjoyed the same nursing home during my clinicals. Thank-you to anyone that has insight to share!