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  1. core0

    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.
  2. core0

    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.
  3. core0

    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
  4. core0

    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.
  5. Three issues: 1. The RVU bonus should be based on 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 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 don'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.
  6. 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
  7. Interesting what the NC board of nursing says about NP scope: "The population-focused Nurse Practitioner scope of practice is defined by the Nurse Practitioners formal academic, graduate educational preparation, national certification, and maintained competence. The scope of practice is operationalized by the Collaborative Practice Agreement (CPA)."
  8. There are actually two or three states that list scope of critical care. The real issue is risk. Our internal insurance was unwilling to cover liability for non-ACNPs working in the ICU.
  9. core0

    ICU Nurse Practitioners

    What we have published so far is that residency trained APPs reach full productivity (as measured by billing) 3 month sooner than non residency trained APPs. The issue with financial benefit is a trickier one. The cost of a residency is tremendous (north of $500,000 for us). The benefits are hard to quantify, but when you have 150 APPs (most likely expanding to near 180 in the next few years) having a guaranteed pipeline of well trained providers is invaluable. It also goes to mission. As an academic medical center training providers is part of the mission.
  10. core0

    ICU Nurse Practitioners

    We have 150 APPs across 4 hospitals and around 15 ICUs. We get hires from 2 pathways. 1. APP residency. We have 3-4 slots every six months (6-8 per year). The residency is a year long and includes ICU rotations as well as OR for intubation, ID, and nephrology. There are also optional rotations in interventional pulmonology, CV surgery, transplant medicine and palliative care. The residency requires a contract to work at the institution for one year (penalty if you don't accept a job offer). There is a bonus for first year graduates that about equals the amount of money you miss due to the lower residency salary. 2. Direct hires - orientation is highly variable but generally 3-6 months (trying to standardize). It generally includes only the ICU you are hired for. We have been experimenting with putting new grads from our community ICU in a 6 month mini residency (n=1). We have started to publish our results (hopefully at SCCM next year). Previously published research show residents are quicker to optimal billing compared to OJT. New research addresses both confidence and medical knowledge comparing 6 vs 12 month residencies as well as OJT vs Residency.
  11. 25% of base salary is the standard amount businesses budget for benefits. On smaller businesses its more like 40%. Also if you are going to work 45 to 50 hours either bill them for that or add it into the premium. Going that way I would look at 50% premium.
  12. core0

    Ok TEXAS NP's, wake up and smell the coffee!!!

    You have a dramatic misunderstanding of what happens in medicine and are missing the entire point of this rule. 1. The rule does not say a radiologist must read the xray simply a physician. So a Family practice physician who has minimal training in xray can read and interpret an Xray but an FNP cannot. If the regulation said only a radiologist can read and interpret a radiological study then I would agree. But it doesn't its simply an anti competitive measure to try to ensure physician primacy. 2. The road to hell is paved with good intentions. This is especially obvious in an acute care setting. Specifically:  The problem is with number 2. If I look at an xray and see a problem such as a pneumothorax, I can't act on it until its read by a physician. Even in an tertiary care hospital it regularly takes several hours to get reads on x rays. I can't imagine what its like in a tertiary hospital. For example, I'm asked to look at a KUB for feeding tube placement. I notice that not only is the feeding tube in the lung but there is a pneumothorax on the same side. I put in a chest tube on that side and get a CXR which shows resolution of the pneumothorax. Three hours later I get a call from radiology that there is a pneumothorax. Just sayin.
  13. core0

    Can't get ACNP job

    They are fairly competitive depending on when you apply. Emory takes 6-8 per year in two classes and gets around 50 applications total. So fairly competitive. But when you count in the fellowships in heme/onc, cardiology and transplant there are a lot more. Also there are fellowships at Piedmont in a number of specialties.
  14. core0

    Can't get ACNP job

    I will add something else. At 2 years without practice is something else you have to think about. Its one thing if someone with years of experience takes a year or so off. But you never practiced after school. If you are given the choice between someone with fresh learning and experience and someone who's learning and experience is two years old who would you choose? I would strongly consider an ANCP residency. Both Piedmont and Emory have a number of NP residencies. Some come with attached jobs and this will address your lack of experience.
  15. core0

    Medical billing and coding for NPs

    You could also look at this one: https://store.sccm.org/SearchResults.aspx?searchterm=integrating&searchoption=ALL Although I have an authors bias.
  16. We have 2 APPs and a resident (PGY 2-4) for 23 beds. All of our ICUs have at least 1 APP depending on the size the larger ones are 2-3 at night.