Don't remember the exact reason the patient was there, but it was ENT related. ENT uncovered HTN and wrote the script.
Your obfuscating. What sort of reimbursement does the ENT deserve relative to an FP or cards physician?
This is not directly related to the conversation at hand, but if you are referring to the study I think you are, the study only found statistical significance in 3/17 items measured and did not account for the lower labor costs of NP's. It also did not include PA's in the study.
The bigger question, in all of this, which I have not really seen addressed before is the right of NP's to refer to specialists. Personally, I believe that the ONLY person an NP should be able to refer to is a n IM/FP/PEDS practitioner. Period.
What usually happens is this (at least in my field) -
A person presents to their NP with epistaxis. NP looks at the nosebleeds, says "yep, there is a nose bled - you need to see an ENT". Referral written. No other issues addressed. Level III or IV new patient billed.
ENT see's the patient, realised that the BP is 190/110 -indicates that the the epistaxis is caused by HTN, does not want to cauterise the vessels since this may actually cause more bleeding, prescribes a antihypertensive. Can only bill a level III consult (which if seeing a medicare pt is only a level III visit, not consult). Thus, the SPECIALIST care is a level III, the NP care can be a level IV. Thus, the NP, who does nothing more than refer something that SHOULD have been handled by a competent MD/DO PCP received a higher level of reimbursement for the same diagnosis and did ABSOLUTELY NOTHING for the patient. Period. I see this daily - and have refused to see any NP consults who have not seen an MD/DO first. As it is my practice, I can see whom I choose to see - and I find the care given to patients who require specialist care to be substandard from an NP standpoint.
I know the data that indicates that for common complaints, NPs provide a comparable care. That being said, there are many PCPs who prescribe antibiotics for symptoms that should be managed WITHOUT antibiotics - but it is better to give someone a script for Augmentin for their sore throat since they paid their $40 at Walmart. Who cares if it is viral. We can still bill a level III/IV new patient visit as the PCP, right? And the patient feels much better when their symptoms resolve in 2-3 days (as they would if they were given sugar pills).
Look - I have no issue with subspecialty NPs who have spent a decade in their chosen field (cards, ENT, Psych, Neuro, etc) who are honed in on a set of guidelines that are evidence used - but the bottom line is that the vast majority are in the PCP trenches with a few years on the wards as a nurse with an online degree that allows them to prescribe and diagnose on a level equivalent with a board verified physician/surgeon.
In all honesty - I feel that should an NP feel that their qualifications are equivalent to a PCP MD/DO - then they, and their children, and any relatives should ONLY be allowed to see NPs for their care - let's face it - only they can provide equivalent care for a fraction of the cost.
Should they, or their family need any specialised care- then only an MD/DO can refer them on.
Like I said, my comment was an FYI.
