William Hovland, MD, CMD
Marc Nevin, MD, CMD
Angel Rivera, BSHA
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Changing regulations to allow greater
autonomy
Pressure from cooperate chains
Evolving models of practice: Evercare and
signature care
Medicare managed care
Physician manpower issues
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SNF and NF closer working relationship
ALF: greater autonomy
House Calls
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Collaboration : a process where a NPP works
with one or more physicians to deliver health
care services within the scope of practitioners
expertise, provided for in jointly developed
guidelines or other mechanisms as provided
by State law
The collaborating physician does not need to
be present with the NPP or make as
independent evaluation of each patient
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Shared responsibility
Both the NPP and the MD in a team to ensure
that patients are being cared for
appropriately
Supervision evolves with the skill level of both
the NPP and the MD
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Collaborative practice will benefit many, but
not necessarily all long term care physician
practices
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Nurse Practitioner
◦ Board of Nursing
 Licenses
 Registered Nurse
 Nurse Practitioner
 Prescriptive Authority
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Physician Assistant
◦ Board of Medicine
 License
 Physician Assistant
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Expands the overall
expertise of the practice
Collaboration between
NPPs and Physicians
shown to improve resident
out come
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NPP scope of practice is
regulated at the state level and
varies widely
NPPs and Physicians should
know their state regulates prior
to constructing a collaborative
agreement
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NP must practice as part of care
team
Appropriate collaboration and
consultation
Maintain a written or electronic
practice agreement
Must disclose that he or she is a
Nurse Practitioner
Can prescribe Schedule II through
IV controlled substances
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Similar to NP
Must see and evaluate any pt
presenting for the same
complaint twice in a single
episode of care and having failed
to improve significantly.
Must wear identification when
seeing patients that clearly
indicates that he or she is a PA.
Schedule II- IV
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Admissions in SNF
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ALF
NF
Death Certificates
DNRs
Call
Schedule II – IV
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“The law also provides that service on a
patient care team by a member of the team
does not, by the existence of such alone,
establish or create liability for actions or
inactions of other team members”
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Physician NOT automatically liable
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Patient –Physician Relationship
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The “Master- Servant” relationship
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Four Factor Test
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Selection and engagement
of the ‘servant’
Payment of compensation
Power of dismissal
Power of control
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Confirm licensure and professional
qualification
Become familiar with Virginia Laws and
regulations
Mutually agree upon scope of practice
Communication!!!!
Continuous Evaluation
◦ NPPs reimbursed 85% of
Medicare allowable
◦ Can bill most insurance
directly
◦ Check with various carriers
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Hourly
Salary
Productivity
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Full
Training
Starting
Experienced
Expert
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Foster best patient
outcomes
Skills & Competencies
Interactive Process
Shared responsibility of
Care