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Question on boilerplate text in chart notee
For some reason I can't quote the OP. However, what about inserting a .phrase "the text below is automatically generated and may or may not reflect services performed"
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This is why...
https://www.medpagetoday.com/meetingcoverage/acep/106708
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Comparing NP and MD Earning First 10 Years
Interesting. In theory, a fellowship is not needed so that would change the tipping point for the psychiatrist closer to 9 years. I didn't think that most psychiatrists did fellowships, but the American Psychiatrist data shows more than 1/2 of residents do fellowships (primary child/adolescent).
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Anyone prescribing Ivermectin or Hydroxychloriquine?
He also lost his license and his job. He no longer has a license to practice medicine in the United States.
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The economics of PA vs. NP
Considering the first PA program was established in 1965 and the first NP Program was announced in 1967 clearly the PA profession was a response to the Original NP Program that would be established in 2 years. The rest of your information is equally valid.
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Earning a PhD in Nursing after a JD and MSN
I normally tell someone to follow their dreams, but the route you have charted doesn't make any sense. I will put a caveat that if you have a full ride or mostly full ride to a top 10 law school then you should absolutely take it. Otherwise the reason that you get a JD is to practice law. If you want to engage in health policy or services research through the framework of law there are many other ways to do this including nursing, public health and even economics. All of those degrees can be tailored to look at health policy through the law. If you don't want to practice law but want a better understanding of legal issues a Juris Master (JM) or Master of Studies in Law (MSL) will give you understanding of the law and can be tailored to health specifically. There are a number of institutions that offer combined PhD/JM or DPH/JM degrees that would get let you understand the law and also give you the research skills to for academic pursuits. The biggest issue with the JD is cost. Any of the top ten programs are going to be north of $50,000 and with fees and tuition you are looking at around $240,000 for your JD. If you do a PhD afterwards then you are deferring interest and its not like academic health policy jobs are going to pay enough to pay off that loan. A JD is a professional doctorate. You learn research skills in finding and understanding case law. In addition you learn how to write very well. All of these skills come in handy but there are ways to learn them without spending a quarter million dollars. A JD does not prepare you for academics. Generally law school academics will have a second degree in their area of expertise or increasingly a PhD in Law. If you want to practice law go for it. You have been given a golden ticket. An NP from a top 10 law school can pretty much write their ticket in malpractice, healthcare or compliance law (assuming you finish out of the bottom 10%). There are people that end up in healthcare policy or academia with a JD but they usually arrived there after being dissatisfied with law or by going a much cheaper route through law school.
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NP residency and salaries
They are both in the abstract supplement of Critical Care Medicine. Presented at the last SCCM conference. https://journals.lww.com/ccmjournal/FullText/2020/01001/111__MEASURING_ADVANCED_PRACTICE_PROVIDER_CRITICAL.79.aspx https://journals.lww.com/ccmjournal/Fulltext/2020/01001/57__DIFFERENCES_IN_ADVANCE_PRACTICE_PROVIDER.60.aspx
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NP residency and salaries
1. Depends on your organization. Our organization gives you 1 year experience - which leads to a raise one year earlier and $20k a year for the first two years (which sort of makes up the difference between the resident salary and the normal starting salary). The bonus also serves as a retention mechanism to help ensure we get our costs back. 2. For Medicare, the reimbursement is 85% of the physician fee. APP residency doesn't change this. 3. Most are a year. Some are six months. We published data this year that knowledge skills were similar between the two groups but confidence was much higher for the 12 month group. The confidence was also higher for residents compared to OJT Abide, A., Carpenter, D., Xu, K., Gregg, S., Byrd, C., Stein, D., & Meissen, H. (2020). 57: DIFFERENCES IN ADVANCE PRACTICE PROVIDER RESIDENCY LENGTH: 12-MONTH VERSUS 6-MONTH TRAINING. Critical Care Medicine, 48(1), 29. Carpenter, D., Abide, A., Meissen, H., Xu, K., Byrd, C., Stein, D., & Gregg, S. (2020). 111: MEASURING ADVANCED PRACTICE PROVIDER CRITICAL CARE KNOWLEDGE AND CONFIDENCE: OJT VERSUS RESIDENCY. Critical Care Medicine, 48(1), 38. 4. I doubt anyone has an answer for this. In our specialty its not necessarily about salary jump. It's about a guaranteed job and opportunities that the residency gives you. For example US instructor, Running the infectious disease ICU, doing research. We pretty much guarantee a job for anyone that comes out of our residency (as long as they are a personality fit).
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NP's how are you these days?
We are using Remdesivir in trial. Most of our other patients are getting Hydroxychloroquine (dosing 400 mg PO 12h x 2 doses, then 200 mg PO q12h x 5-10 days (tablets can be crushed & dispersed in water; preferred to remove film coat w/ alcohol before crushing) We are usually adding Azithromycin to Hydroxychloroquine. Watch the QTc on these. Kaletra is an option but I haven't seen anyone getting it, especially with the negative trial. ID is seeing all these patients. Everyone understands these are all theoretical. The Chinese recommendations should be released this week which will be interesting.
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Acute Care NP Schedule?
For our ICUs it all 3 x 13.33 usually 630a to 800p or the reverse. Usually get out by 730 but sometimes there until 9. Most of our specialty APPs are Monday through Friday 8 hours although some are going to 4 x 10s with rotating weekends. Most of the floor staff is 3 x12 hours .
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Writing help
Presumably you have word. Next you need to get Endnote. This is a bibliography manager. When you install Endnote it will attach itself to Word and work inside Word. You select the citation style and it will do the style (such as APA) automatically. Check with your school they probably have a site license otherwise the student price is very reasonable. The nice thing about Endnote is that if you are submitting for publication you can select the journal and it formats the citations correctly for the journal. https://endnote.com/ I wouldn't consider this cheating just working with the technology.
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Question re APP billing
So the only way that a physician can bill for a APP service is split/shared billing. Here'e what Medicare has to say about that (via the hospitalist): "However, shared/split rules restrict the services reported under this billing model, recognizing only evaluation and management (E/M) services (and not procedures) provided in the ED, outpatient hospital clinics, or inpatient hospital (i.e. facility-based services). Shared/split rules do not involve all types of E/M services. For hospitalist programs, critical-care services (99291-99292) are excluded." This is from Palmetto: "Question: Can you bill split/shared services for skilled nursing facility (SNF) and nursing facility (NF)? Answer: No. Split/shared services cannot be performed for nursing facility services, critical care services or procedures." https://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~JM Part B~Browse by Topic~Frequently Asked Questions~Incident to~AK3F6A4053?open
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Question re APP billing
It depends on how they are credentialed. Generally in our institution they are licensed NPs and PAs. As such you can't have their procedures billed under the collaborating physician. Either you don't bill for the procedures or you credential them like any other APP and bill for them. We choose not to bill for APP resident procedures or notes. For notes we have them mixed with the resident service so they can bill under shared billing for non critical care E/M by the attending.
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Bonus based on RVU. How do I earn the practice $ with only 85% reimbursement for RVUs?
Three issues: 1. The RVU bonus should be based on the RVUs you earn. The deduction comes on the payment per RVU, not the RVU, so they shouldn't make you earn more. 2. Since you don't work full-time, the RVU bonus structure should be adjusted. 3. Your math is off. The 0.97 is the wRVU, and there is practice expense RVU and malpractice RVU, so the practice gets 2.09 RVUs, of which 0.97 is work RVUs and usually credited to the provider. This varies slightly by practice location. In addition, you assume all RVUs are paid the same. Medicare reimburses around $37 per RVU (depending on location). Other insurance may pay more (or occasionally less). You need to know what the blended RVU is for your practice (the average reimbursement for all insurances per RVU). In our market for inpatient work, blended RVUs range between $16 per RVU and $60 per RVU depending on the amount of Medicare, Medicaid (which pays less), private insurance (which pays more), and uninsured (which doesn't pay). My guess is that if your practice management knows what they are doing, 2275 RVUs is somewhere around 125% of your salary, and if you go above that, then both sides make money. Finally, this ignores other areas, such as in-house labs and procedures, which can add quite a bit to the bottom line.
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ACNP vs FNP: My Summarization of the Great Debate
Apparently you don't work with internal medicine residents. While there are primary care focused IM residencies, most IM residencies are heavily concentrated on inpatient services. What this does point out is that primary care specialties are not generally qualified for inpatient services. You can see this born out in the use of Family Practice Physicians in hospital medicine. At one point there was a significant FP presence in hospital medicine. However as FP residencies emphasized outpatient ambulatory care it became harder and harder to show training and expertise in inpatient medicine. In most healthcare systems FP cannot be credentialed for inpatient services without a hospital medicine fellowship. The same split occurred in emergency medicine which was largely the domain of FP. With the establishment of EM residencies there are fewer and fewer FP physicians in the ER. Does that mean that FP doesn't do ER or inpatient, of course not. On the other hand the more standardized an organization becomes the less likely they are to credential FP for inpatient or EM. It doesn't matter how long they have been doing something or talented they are, from a liability standpoint the system would assume tremendous liability if they credential them. You wouldn't credential a family practice physician for critical care. They don't have the education, training or credentials to perform critical care just like you wouldn't credential a infectious disease physician to do spine surgery. Are there family practice docs rounding in ICUs and performing surgery in the hinterlands. Absolutely. Is it dependable if something goes wrong. Absolutely not. As far as scope I defer to Carolyn Buppert: "What is the level of care required for my patients? If primary care, hire an adult-gerontologic, pediatric, or family NP, or a PA. If practicing psychiatry, hire a mental health NP or a PA who has specialized in mental health. If the practice is gynecology, hire a women's healthcare NP or PA who has specialized. If the practice is hospitalist, hire an NP certified in acute care or a PA." https://www.medscape.com/viewarticle/917260#vp_3