General Questions about LPN Practices

[jrdn1284]

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I am very uneducated about this area, so please forgive me.

In states that allow nurse practitioners to have their own practices, but under MD supervision/collaboration, what is the protocol for acquiring an MD to supervise. How open are MDs to doing so for an NP practice. What do MDs usually charge an NP as a fee to collaborate with them.

In these states that require NP/MD collaboration, in general do NPs also revieve hospital priveleges?......What is meant by the term "hospital priveleges"?

Thanks in advance for answering an ignorant persons questions!

 

[fab4fan]

???

LPNs don't collaborate with MDs. They assist in following orders the physician writes for patients. They may communicate with physicians and give input on behalf of patient care, but collaborate may be stretching it.

As an LPN, you don't get "hospital privileges." You're hired by a hospital as an employee. I don't know if you're thinking that as an office LPN you might "pre-round" on a doctor's patients for him to give him a head's up on what's going on with his patients, but those situations are rare, if they still exist at all, and I've never heard of it being referred to as "hospital privileges." You aren't really privileged to do anything. Your license and scope of practice is pretty limited, and the facility would have limitations on what it would allow you to do, unlike what an MD might allow you to do in his office under his own license.

What states still allow this?

 

[jrdn1284]

I was told Arizona gave NPs full hospital priveleges. I wasnt sure what that referred to. I know there are a handful of states that allow complete independent NP practices completely independent from MDs with full prescriptive authorities (ie... AZ, IA, NH, MT, ID, OR, WA, NM, DC, WY, Maine). The nurse practitioners pearson report is where I have obtained this up to date information on the subject. http://www.webnp.net/downloads/pearson_report09/ajnp_pearson09.pdf

My understanding is that in all other states NPs can have a practice, however an MD must supervise it (can be offsite). What does that mean, supervise? And what is the feelings of MDs supervising NP practices?

 

[fab4fan]

An NP is totally different from an LPN. One is a registered nurse with a minimum of a master's degree and credentials practice as a mid-level provider; the other is a licensed practical nurse who has completed about one year of nurse's training and has a license to practice a limited scope of nursing under the supervision of a registered nurse or physician. An NP can in some states practice independently; an LPN can never practice independently.

Perhaps you confused the two terms in your first post.

 

[jrdn1284]

You are correct, I didnt intend to write LPN in the first post. My questions concern an NP. Can you help me with these questions cocerning an NP?

 

[fab4fan]

You should probably ask doctors how they feel about supervising NPs. It looks like you've already researched the states that require some supervision v states that allow indep. practice.

The one hospital where I worked allowed NPs to come in to write admitting orders in the ED provided they were countersigned within a certain timeframe by the attending. That was a cardiology group. That hospital did give NPs "privileges" but again, there were limitations. They weren't fully independent practitioners.

 

[core0]

I was told Arizona gave NPs full hospital priveleges. I wasnt sure what that referred to. I know there are a handful of states that allow complete independent NP practices completely independent from MDs with full prescriptive authorities (ie... AZ, IA, NH, MT, ID, OR, WA, NM, DC, WY, Maine). The nurse practitioners pearson report is where I have obtained this up to date information on the subject. http://www.webnp.net/downloads/pearson_report09/ajnp_pearson09.pdf

My understanding is that in all other states NPs can have a practice, however an MD must supervise it (can be offsite). What does that mean, supervise? And what is the feelings of MDs supervising NP practices?

Except in very isolated areas its unlikely that NPs have full staff rights. Medicare requires that all medicare patients be assigned a physician. Critical access hospitals can waive the need for a physician to personally see the patient but they must be available. In addition Medicare requires that NPs have a physician collaborator to bill even if the state does not.

I have the priveleges to admit, discharge, order medications and test etc but its under the auspices of my sponsoring physician just like the NPs I work with.

Here is an article from Advance that discusses it:
http://nurse-practitioners.advanceweb.com/editorial/content/editorial.aspx?CC=36854

An here is an article by Carolyn Bupert on billing for inpatient services:
http://www.medscape.com/viewarticle/705683

Since its unlikely that you will have full staff privileges you will generally be an employee of a physician group or the hospital.

For outpatient services there are PA or NP owned practices. This requires finding a collaborating physician. In some states for NPs the NP can directly hire the physician. In most states the physician must be hired by the company that owns the clinic (which can be owned by the NP). PAs can own 99% of the company by Medicare rules. Either way there must be sufficient guarantees of independence for the physician to prevent interference in medical practice.

David Carpenter, PA-C

 

[jrdn1284]

Thanks a million for the good info and resources concerning my NP questions.

I have not had any MD/NP experience up to this point, so I am unaware of the situation.

In general, what are MDs feelings about being employed, even if part time, at a NP owned company. Is this common? What are MDs general feelings toward outpatient NPs and practices.

You said on your previous post,

"Either way there must be sufficient guarantees of independence for the physician to prevent interference in medical practice"

I understand this statement, but could you ellaborate on this statement with any experience or knowledge you have.

Thank you sincerely