TX RN

How did salary in NM fare compare to the first place you practiced after leaving?

Don't know about Ohio. Despite Texas' practice restrictions there are plenty of opportunities in the metro areas. Best of luck.

+1 on this.

Negotiate for productivity bonus.

Best you take this to an attorney. Trust me, best $300 you can spend.

The IM job gets my vote. I have a question. Were you told the IM position is 1099? Because being under contract doesn't translate to 1099, especially since you mention they offer benefits.

I self-contract with a physician that has patients at a several nursing homes. I'll be happy to answer your question: Start to finish. Since I am self-contracted I don't have a minimum number of encounters I need to make. This makes my rounds extremely flexible. I can see as many or as few pt's as I want/need. So with that said, the hours are whatever I choose to make them. I can start early, like say 0600 and be done by noon. For the most part I average about 3.5 pt's per hour. And there have been days where patient condition necessitates an encounter, and there have been 10-14 hour days where I see 25-30 patients. My productivity declines as the work day hours increase, so I try to keep my work day to no more than 8 hours the majority of the time. New encounters typically are about 30-40 minutes. F/u's can vary between 10 minutes to 30 minutes. Depends how complex the patient is. My experience in this line of work has given me some insight on things I know now that I didn't know when I started. I'll share them with you and post them as questions for you. 1. Will you be taking call? Call can impact your productivity dramatically. If you haven't been told if the position involves call, I would ask how much and how often. Night call blows too. 2. How many patients are in each nursing home? Driving to a place for less than 5 patients is not ideal. Windshield time can grow long in the tooth with low census facilities. 3. Are these skilled pt's or long term patients? Skilled pt's can at times be a bit more complex. The trend from hospitals continues to push pt's out earlier and discharge sooner in the course of illness. You will find a very high emphasis on prevention of readmissions and a need to develop high acumen for picking up on subtle changes in condition. It becomes challenging especially when taking into account the disparity of nurse staffing when compared to hospital units.

Thanks!

Thank you. I'll make sure and do that.

Yes. You are credentialed through the groups number. You essentially receive a billing number that is tied to the groups practice. If you leave the practice you will need to restart the credentialing process for your individual number.

Ask your employer for a copy of EOB's. This should list each patient and what rate is reimbursed by payor source. You can review each charge.

I practice as wound care and hyperbaric medicine NP. I follow pts in hospital, LTACH, rehab, snf's and clinic. It's a great gig. It has a lot of upside. PM me with any questions. FYI, I also practice as a Hospitalist NP part time.

I'm not familiar with the state. I may just have to vacation there with the family. It will give me an opportunity to get a feel for the area.Anyone familiar with the state have recommendations?

Military? Maybe reserves?

This is not unusual as a new provider. I've been there, as I'm sure many others have as well. The learning curve is different for everyone, so don't be too hard on yourself. Best advice I can tell you is to focus on eliminating the diagnosis that are of greatest risk to your patient. Rule out the MI, CHF exac., stroke, etc., etc. My experience working primary care is that patients sometime will bunch up their symptoms from chronic but controlled conditions and their acute symptoms. Like a patient that shows up with c/o headaches and nausea with abdominal pain. A little digging may reveal chronic cluster headaches that have nothing to do with new onset of GI symptoms. Sounds easy to do but patients sometimes make it difficult to sort through the details. Getting to the core issues takes skill that develops over time. Pair up with a more senior provider and run your more challenging cases with them.

Seems the governor of New Mexico is looking to recruit NPs to her state. The pitch seems to be what most on this board are after, less practice restrictions. Here's the article. http://www.santafenewmexican.com/news/local_news/governor-seeks-money-to-recruit-more-nurses/article_57669e61-d567-5d46-bea8-c6df42e32f04.html

I hear what you're saying Jeanette. But there's a few things that need correcting. 1. Not all responders have overhead costs, i.e., clinic. I for one see my patients at various inpatient facilities. They include hospitals, LTACH's, Acute rehab facilities and SNF's. In these settings, there is no overhead for the provider. But something to remember is the reimbursement can be less per E&M visit when compared to clinic E&M reimbursement. 2. As mentioned above, reimbursement in an outpt clinic is on average about 30-40% higher than that of an in-patient facility charge. If the bulk of your visits are level 1's and 2's then yes, you are billing at about an average of $40-50 per pt, but chances are your leaving money on the table and under billing.

I had that type of patient load a few years back in an adult/geri clinic. Loved it. 15-17/day is awesome. Trauma, you are a machine! 42/day? Jeez. My highest mark for daily encounters is 37. The other mid-level was out one day on a family emergency and I offered to pick up her inpatient load. No one else was available to help that day, it was the perfect storm. 4 hospitals and 14 hours later I closed the note on my 37th encounter. My brain was fried. Not sure how you do that. But I guess we all have our strengths.

I would think the MSN is more competitive than the DNP right now. Most nurses I know pursuing NP cert look for MSN programs first, DNP second. They mostly list the shorter program duration as a top reason.

I have never nor would ever self-prescribe. No matter how benign the drug may be. Don't do it. Texas DPS does random monitoring of controlled substances. DPS will search for last names that match, an easy way to find if you're prescribing to friends or family, even oneself I guess. Don't open yourself up to scrutiny.

1. Texas 2. Hospital inpatient setting 3. 2-4/hr depending on complexity 4. Hours are start to finish.

Hospice and palliative care is going to be the next BIG thing. Many of the ACO's are ramping up by recruiting palliative and hospice trained providers. Congrats on the new job. I think it can be a great opportunity.

Juan, you area wealth of knowledge. You are correct on the taxonomy issue. However, I believe the commercial insurance part of 100% reimbursement is somewhat more complicated. I don't know if the ACA is partially or fully responsible for NP reimbursement rates through commercial insurers. What I do know is that with the taxonomy not distinguishing what NP specialization one performs, commercial insurers that reimburse at the 100% rate do so without regard to what your specialty is. I know this because I have my own practice in a non-inde state. (My state requires collaborative practice for those who are wondering how I do this.) It is a specialty practice. But because my NPI taxonomy is general and there is no longer E&M consultant codes, insurers cannot distinguish what service you are rendering. I don't know which payors reimburse at the 100% rate but I can tell you I haven't had many. Still, it's worth mentioning since we're on topic.

It's preferred treatment for hemochromatosis. Chelation if anemic. But I'm just messing with you. My tool bag doesn't have anything close to those you carry in yours sir. Cheers.

Hey now, us other NP's still do blood letting techniques to treat certain blood disorders. LOL