Charting only under an MD

[DiverseNP]

So here is my question.

Im a recent NP graduate who has obtained a position with an old school provider (has worked for greater than 40 years) who has hired me to round with him in two SNF.

We we split the SNF in half, I take 20 he takes 20, then we convine review all my patients together along with my plan of care then he goes and "sees" them and I then alter the plan of care and assessment as required.

Here is is my question. All the notes are done under him, we use a transcription service due to volume. I've been assured that this is fine by the practice multiple times.

Does anyone know if this is the case with specific references or does anyone know whom I can contact anonymously to get better clarification?

Thanks

[DizzyJ DHSc PA-C]

If he is indeed seeing the patient and doing an exam, reading the note, and making changes as needed, then you are essentially scribing for him. I think having a statement in the note reflecting the patient was seen and examined by both of you would be ideal, but will need to reflect a statement similar to that attendings do with residents. Here is an example for shared service. It sounds like you don't examine the patient together in the room at the same time.

"Shared" service: The resident sees the patient unaccompanied and documents the corresponding care provided. The teaching physician sees the patient at a different time but performs only the critical or key portions of the service. The case is subsequently discussed with the resident. The teaching physician must document their presence and performance of the critical or key portions of the service, along with any patient management. Using CMS-quoted statements ensures regulatory compliance:3

•"I saw and evaluated the patient. I reviewed the resident's note and agree, except that the picture is more consistent with pericarditis than myocardial ischemia. Will begin NSAIDs."

•"I saw and evaluated the patient. Discussed with resident and agree with resident's findings and plan as documented in the resident's note."

•"See resident's note for details. I saw and evaluated the patient and agree with the resident's finding and plans as written."

•"I saw and evaluated the patient. Agree with resident's note, but lower extremities are weaker, now 3/5; MRI of L/S spine today."

Documentation, CMS-Approved Language Key to Getting Paid for Hospitalist Teaching Services | The Hospitalist

[Jules A, MSN]

No autonomy, minimal responsibility so not a bad thing if you are ok with it. I would hope that as he becomes comfortable with your skills he will allow more autonomy because he isn't utilizing you to your full potential. Hopefully the wages don't reflect the above.