Effective Use of NPPs in Long Term Care

William Hovland, MD, CMDMarc Nevin, MD, CMD

Angel Rivera, BSHA

A passing phase or an evolving reality?

Changing regulations to allow greater autonomy

Pressure from cooperate chains Evolving models of practice: Evercare and

signature care Medicare managed care Physician manpower issues

Pressures to include NPPs

SNF and NF closer working relationship ALF: greater autonomy House Calls

Locations of practice in long term care

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

What's required

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

Supervision

Collaborative practice will benefit many, but not necessarily all long term care physician practices

Nurse Practitioner ◦ Board of Nursing

Licenses Registered Nurse Nurse Practitioner Prescriptive Authority

Physician Assistant◦ Board of Medicine

License Physician Assistant

Non Physician Provider -NPP

Expands the overall expertise of the practice

Collaboration between NPPs and Physicians shown to improve resident out come

Why Collaborate

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

State Regulations

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

NP- Scope of Practice

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

PA- Scope of Practice

Admissions in SNF

NPPs Cannot…

ALF NF Death Certificates DNRs Call Schedule II – IV

NPPs Can….

“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”

Liability

Physician NOT automatically liable

Patient –Physician Relationship

The “Master- Servant” relationship

Four Factor Test

Physician Liability

Selection and engagement of the ‘servant’

Payment of compensation Power of dismissal Power of control

Virginia Law-Four Factor Test

Confirm licensure and professional qualification

Become familiar with Virginia Laws and regulations

Mutually agree upon scope of practice Communication!!!! Continuous Evaluation

Risk Management

◦ NPPs reimbursed 85% of Medicare allowable

◦ Can bill most insurance directly

◦ Check with various carriers

Compensation

Hourly Salary Productivity

◦ Full◦ Training◦ Starting◦ Experienced◦ Expert

Compensation Models

Foster best patient outcomes

Skills & Competencies Interactive Process Shared responsibility of

Care

Collaboration in Practice