Heart of a nurse, brain of a doctor thread

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wrenhal

Territorial Marshal
Aug 11, 2011
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#21
I’m agreeing with both of you.

I thought I was being treated by an MD. I wasn’t.

Nobody ever told me he was an MD, but there wasn’t anything ever said or hanging on a wall that said he wasn’t either. I wonder how many people get seen by a NP in either a walk up clinic or an ER that think they’re seeing a doc?

I could tell a long winded story about getting bucked off a horse and seeing a NP in a little ER in Colorado for a shattered wrist. She was going to reduce it and cast it and send me back up the mountain before an X-ray tech called a surgeon in Durango and had him talk her out of it. When she went to take the call the tech told me she wasn’t an MD and if she put a cast on my wrist I might have lost my arm. I think that might have been when I learned everyone in a white coat wasn’t a Dr. When she got back she put a sugar splint on it and told me to go see a surgeon as soon as I could get to one.

I’m not sure we should be letting NP’s practice the same ER medicine as a doc with close to a dozen years of training.
I'm on a doctor group where people report the cases that have come to them from NPs and it is shocking.
And, I'm not being all high and mighty as I know that docs can screw up at times also. But some of these things are just insane. For example from today. A newborn baby brought to the ER because of a rash for a second opinion. The day prior had seen an NP in the urgent care and was diagnosed with poison ivy. Now, poison ivy in a newborn is all but impossible because the rash occurs on secondary exposure after primary exposure. A rash in the winter on a newborn.... well duh. Luckily the mother was smart enough to realize that made no sense and took the baby back in. She was diagnosed with the obvious neonatal herpes and was admitted to pediatric infectious disease for IV antivirals to prevent the devastating illness that would have been.
Thank you for the clarification of your initial post. This really does seem to be a problem.

Sent from my Moto Z (2) using Tapatalk
 

llcoolw

Territorial Marshal
Feb 7, 2005
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#22
Yes, yes they do:

WASHINGTON — President Donald Trump today ordered federal officials to consider pegging Medicare reimbursement more closely to time spent with patients, seeking to address potential pay disparities between physicians and other healthcare professionals.

President Donald Trump

These directives are among the tasks Trump gave to the Department of Health and Human Services (HHS) in an executive order. The order also demanded HHS develop several proposals related to insurer-run Medicare Advantage, including one regarding payments for new technologies.

Trump signed the executive order after giving a speech at a rally in Florida.

The executive order gives HHS a 1-year deadline to propose a regulation that Trump describes as intended to let healthcare professionals spend more time with patients.

This regulation is meant to ensure that services, whether done by physicians, physician assistants (PAs), or nurse practitioners, "are appropriately reimbursed in accordance with the work performed rather than the clinician's occupation," the order said.

The order also tasks HHS with proposing a regulation to end what Trump called Medicare's "burdensome" requirements that are "more stringent" than federal and state laws require. The president intends to remove barriers that keep some personnel "from practicing at the top of their profession."


https://allnurses.com/huge-step-forward-nps-t707774/
Outside my sandbox. Is this a good thing or bad?
 
Aug 16, 2012
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#23
Outside my sandbox. Is this a good thing or bad?
Looks like he is supporting the status quo with the language about reimbursement based on task, not title. Would appear to me that indicates if an NP does a job a DR would do, the reimbursement would be the same.

Open for correction if I read that wrong
 

steross

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#24
Looks like he is supporting the status quo with the language about reimbursement based on task, not title. Would appear to me that indicates if an NP does a job a DR would do, the reimbursement would be the same.

Open for correction if I read that wrong
Actually the status quo is that they are paid a little less than a doctor. He put forth an executive order to make CMS pay them equally.

I just wish it was a real market. If it was a real market, I would be happy to explain my skills and training and put my price out there. If the actual patient wanted to pay an NP the same, I'd have no problem with that. But, obtaining the same pay through lobbying politicians despite far less training, education expense, malpractice expense and risk really rubs me the wrong way. I'm surprised Trump went with this. Somebody got in his ear.
 
Aug 16, 2012
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#25
Actually the status quo is that they are paid a little less than a doctor. He put forth an executive order to make CMS pay them equally.

I just wish it was a real market. If it was a real market, I would be happy to explain my skills and training and put my price out there. If the actual patient wanted to pay an NP the same, I'd have no problem with that. But, obtaining the same pay through lobbying politicians despite far less training, education expense, malpractice expense and risk really rubs me the wrong way. I'm surprised Trump went with this. Somebody got in his ear.
My mistake. By status quo I meant the developing situation as you described.
 

cowboyinexile

Have some class
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#26
So is this becoming a really big deal with rural medicine?

Rural medical care is becoming an issue where I live. Mayo runs all of the hospitals and their business model is a problem. They are closing small hospitals and reducing services at medium sized ones. In Fairmont they've been cutting staff for years. Most of the doctors have left and it's more PA's and NP's now. I've always assumed they had MD's in emergency but reading this I'm less sure. The larger rural hospitals are here and Albert Lea-they shut down after hours surgery here and closed the birth wing in Albert Lea. Services in Lamberton and Springfield, sorry go to the ER in New Ulm or Sioux Falls if you need immediate assistance. Meanwhile they are building a modern hospital in Abu Dhabi because that will be a cash cow for them.

People around here are pissed. When I first moved here Mayo had doctors coming in just to get in the Mayo system. The local hospital was basically AA ball. Do good and you get a shot at the mothership. Then they started bailing because they were being forced out with PA's who would do the same job for less. Now we're losing services because the business model says it's better for them to take their services to high end clients instead of having them come here. If they want to make bank building hospitals in the UAE that's fine, but it's wrong to dump rural services because it doesn't fit their business model.

First do no harm my ass.
 
Nov 16, 2013
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tractor
#27
I’m agreeing with both of you.

I thought I was being treated by an MD. I wasn’t.

Nobody ever told me he was an MD, but there wasn’t anything ever said or hanging on a wall that said he wasn’t either. I wonder how many people get seen by a NP in either a walk up clinic or an ER that think they’re seeing a doc?

I could tell a long winded story about getting bucked off a horse and seeing a NP in a little ER in Colorado for a shattered wrist. She was going to reduce it and cast it and send me back up the mountain before an X-ray tech called a surgeon in Durango and had him talk her out of it. When she went to take the call the tech told me she wasn’t an MD and if she put a cast on my wrist I might have lost my arm. I think that might have been when I learned everyone in a white coat wasn’t a Dr. When she got back she put a sugar splint on it and told me to go see a surgeon as soon as I could get to one.

I’m not sure we should be letting NP’s practice the same ER medicine as a doc with close to a dozen years of training.
Exactly,
 
Aug 16, 2012
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#28
So I am assuming the influx of venture capital firms into medical clinics is complicit with this new direction as well?
 

steross

Bookface/Instagran legend
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#29
So is this becoming a really big deal with rural medicine?

Rural medical care is becoming an issue where I live. Mayo runs all of the hospitals and their business model is a problem. They are closing small hospitals and reducing services at medium sized ones. In Fairmont they've been cutting staff for years. Most of the doctors have left and it's more PA's and NP's now. I've always assumed they had MD's in emergency but reading this I'm less sure. The larger rural hospitals are here and Albert Lea-they shut down after hours surgery here and closed the birth wing in Albert Lea. Services in Lamberton and Springfield, sorry go to the ER in New Ulm or Sioux Falls if you need immediate assistance. Meanwhile they are building a modern hospital in Abu Dhabi because that will be a cash cow for them.

People around here are pissed. When I first moved here Mayo had doctors coming in just to get in the Mayo system. The local hospital was basically AA ball. Do good and you get a shot at the mothership. Then they started bailing because they were being forced out with PA's who would do the same job for less. Now we're losing services because the business model says it's better for them to take their services to high end clients instead of having them come here. If they want to make bank building hospitals in the UAE that's fine, but it's wrong to dump rural services because it doesn't fit their business model.

First do no harm my ass.
Honestly, one of the huge thinks that I noticed from when I left in 2009 to coming back now is that it is simply all about the money.

It is conceptually similar to me to the story from when I lived in Vegas (I don't know the veracity) where the old timers said that the casinos were far more fair and fun to play in when it was the mob running them. The mob would beat up a cheat and would usually take the money of the regular player but would give them a fighting chance. The corporate side is to squeeze every last dollar out that they can.

In the past when I was treasurer of a very small EM company, we would sit in our meetings and have discussions like, "You know, if we dictated a full reading on every pulse oximetry, we could bill for it." Then someone else would say, "Yea we can't really bill a 20 year old with a twisted knee for a oxygen measurement reading when everyone knows his oxygen level is fine."

Well, they are now billing mothers for "skin contact time" when they let the mother hold the baby after giving birth. The entire culture has changed post-Obamacare and with the massive corporate takeover.
 

RxCowboy

Has no Rx for his orange obsession.
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#30
Yes, yes they do:

WASHINGTON — President Donald Trump today ordered federal officials to consider pegging Medicare reimbursement more closely to time spent with patients, seeking to address potential pay disparities between physicians and other healthcare professionals.

President Donald Trump

These directives are among the tasks Trump gave to the Department of Health and Human Services (HHS) in an executive order. The order also demanded HHS develop several proposals related to insurer-run Medicare Advantage, including one regarding payments for new technologies.

Trump signed the executive order after giving a speech at a rally in Florida.

The executive order gives HHS a 1-year deadline to propose a regulation that Trump describes as intended to let healthcare professionals spend more time with patients.

This regulation is meant to ensure that services, whether done by physicians, physician assistants (PAs), or nurse practitioners, "are appropriately reimbursed in accordance with the work performed rather than the clinician's occupation," the order said.

The order also tasks HHS with proposing a regulation to end what Trump called Medicare's "burdensome" requirements that are "more stringent" than federal and state laws require. The president intends to remove barriers that keep some personnel "from practicing at the top of their profession."


https://allnurses.com/huge-step-forward-nps-t707774/
You notice that pharmacists were left out of that equation. For the work I do in the clinic I can bill Medicare about the same as a medical assistant, despite the fact that what I do requires far more training, is far more complex, and incurs far greater liability (not to mention that it takes longer than, say, a blood pressure check).
 

RxCowboy

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#31
Honestly, one of the huge thinks that I noticed from when I left in 2009 to coming back now is that it is simply all about the money.

It is conceptually similar to me to the story from when I lived in Vegas (I don't know the veracity) where the old timers said that the casinos were far more fair and fun to play in when it was the mob running them. The mob would beat up a cheat and would usually take the money of the regular player but would give them a fighting chance. The corporate side is to squeeze every last dollar out that they can.

In the past when I was treasurer of a very small EM company, we would sit in our meetings and have discussions like, "You know, if we dictated a full reading on every pulse oximetry, we could bill for it." Then someone else would say, "Yea we can't really bill a 20 year old with a twisted knee for a oxygen measurement reading when everyone knows his oxygen level is fine."

Well, they are now billing mothers for "skin contact time" when they let the mother hold the baby after giving birth. The entire culture has changed post-Obamacare and with the massive corporate takeover.
When government fills the trough, it's hard to blame the pigs for lining up. It's not like no one predicted that would happen.

That's precisely why there are NP programs crawling out the woodwork. The government has filled the trough, and their accrediting body has lax standards. So, a school can put an NP program together cheap and make tons of money. They are cash cows.
 

RideEm

Greenhorn
Aug 31, 2009
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#36
Just perusing the articles, seems like the general impression is that primary care is all about giving people medicine for their cold. From the primary care physicians that I know, those visits are seen as a relief that they really could pass off. NPs are right, you don't need a medical degree to give a flu or strep test, then give proper medication; a robot will be doing that before too long. Acute visits do not demand the majority of the time that MDs/DOs are giving.

My (highly-biased) view of a primary care physician's job is to be the long-term health adviser, and help determine if a visit to a specialist is necessary.

I'd say the longer that health care is for-profit and reports to stockholders, DRs will be less common and will instead take a role as NP managers.
 

RxCowboy

Has no Rx for his orange obsession.
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#37
I'd say the longer that health care is for-profit and reports to stockholders, DRs will be less common and will instead take a role as NP managers.
Two things that you're missing. First, NPs are pushing for independent practices, which means no physician managers. The second is that they are also pushing to be reimbursed the same as physicians. My guess is that there are enough nurses and they have enough clout that they'll get both. When they get the latter they may price themselves out of the market.
 

Bowers2

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#38
This thread reminds me of a picture I saw floating around on Facebook. These nurses got out of nursing because....