H&p

[oncogene]

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Can any of you more experienced students comment on the implications of this new legislation? Also, how were H&P handled in the past by pods? If I am reading this correctly we can now perorm the H&P ourselves before a surgical procedure rather than a FP.






APMA Scores Historic CMS H & P Victory

In yet another huge step towards parity with other medical specialties, The Centers for Medicare & Medicaid Services (CMS) on November 27th published regulations granting podiatrists the right to perform histories and physicals (H&P’s) on patients. This monumental achievement was made possible through the exhaustive efforts of the American Podiatric Medical Association (APMA).

Title 42, Chapter IV, Part 482.22(c)(5) of the U.S. Code of Federal Regulations will now require hospital bylaws to ensure that “medical history and physical examination must be completed no more than 30 days before or 24 hours after admission for each patient by a physician (as defined in section 1861(r) of the [Social Security] Act), an oromaxillofacial surgeon, or other qualified individual in accordance with state law and hospital policy.”

Read the Federal Register at:
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/E6-19957.pdf

Source: APMA Daily E-News

 

[jonwill]

Can any of you more experienced students comment on the implications of this new legislation? Also, how were H&P handled in the past by pods? If I am reading this correctly we can now perorm the H&P ourselves before a surgical procedure rather than a FP.






APMA Scores Historic CMS H & P Victory

In yet another huge step towards parity with other medical specialties, The Centers for Medicare & Medicaid Services (CMS) on November 27th published regulations granting podiatrists the right to perform histories and physicals (H&P's) on patients. This monumental achievement was made possible through the exhaustive efforts of the American Podiatric Medical Association (APMA).

Title 42, Chapter IV, Part 482.22(c)(5) of the U.S. Code of Federal Regulations will now require hospital bylaws to ensure that "medical history and physical examination must be completed no more than 30 days before or 24 hours after admission for each patient by a physician (as defined in section 1861(r) of the [Social Security] Act), an oromaxillofacial surgeon, or other qualified individual in accordance with state law and hospital policy."

Read the Federal Register at:
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/E6-19957.pdf

Source: APMA Daily E-News

This is big for three reasons. First, in order to clear someone for surgery, you had to send them to their primary to get it done. It was annoying because it was only good for a set period of time. So, within a short period of time, they had to go from your office to the primary's office, and then to surgery. And if their was a problem, surgery was cancelled.

Second, in order to admit a patient to the hospital, an H&P had to be done. So usually, we had to co-admit or bug another doc in the group to admit.

Thirdly, it means that we can now bill medicare/medicaid for H&P's (I think).

But the catch phrase is "in accordance with state law and hospital policy".

 

[Podman]

This is big for three reasons. First, in order to clear someone for surgery, you had to send them to their primary to get it done. It was annoying because it was only good for a set period of time. So, within a short period of time, they had to go from your office to the primary's office, and then to surgery. And if their was a problem, surgery was cancelled.

Second, in order to admit a patient to the hospital, an H&P had to be done. So usually, we had to co-admit or bug another doc in the group to admit.

Thirdly, it means that we can now bill medicare/medicaid for H&P's (I think).

But the catch phrase is "in accordance with state law and hospital policy".

I agree and I noticed the "catch phrase" as well. I can see some resistance to letting the pod do the H&P, but everything will fall in place in time.

This is certainly a major step forward.

 

[jonwill]

I agree and I noticed the "catch phrase" as well. I can see some resistance to letting the pod do the H&P, but everything will fall in place in time.

This is certainly a major step forward.

Actually, every hospital I have been to this year has allowed pods to admit and do our own H&P's. In other words, any hospital that has a strong pod presence, this is probably already the case. The major hospital system in Iowa put pods on medical staff with admitting privileges last year.

 

[krabmas]

Just as a side note...

It is great that this legislation passed. I was at a few programs that had to delay surgery until the H&P was done. (Florida was one, which has a great scope otherwise).

But if you have a patient that is not ASA 1 or 2 (you can look these levels up on google) it is in the patient's best interest to get an H & P from internal med.

I've seen other surgical specialties refer to Internal med for H & Ps for ASA 2 or higher patients.

ASA 1 - normal healthy patient
2- mild systemic illness (w/out complications)
3- severe systemic illness (w/ complications)
4- severe systemic disease that is a constant threat to life
5- Patient will not survive w/out the operation
6- organ donor - brain dead, harvesting

 

[Dr_Feelgood]

Just as a side note...

It is great that this legislation passed. I was at a few programs that had to delay surgery until the H&P was done. (Florida was one, which has a great scope otherwise).

But if you have a patient that is not ASA 1 or 2 (you can look these levels up on google) it is in the patient's best interest to get an H & P from internal med.

I've seen other surgical specialties refer to Internal med for H & Ps for ASA 2 or higher patients.

ASA 1 - normal healthy patient
2- mild systemic illness (w/out complications)
3- severe systemic illness (w/ complications)
4- severe systemic disease that is a constant threat to life
5- Patient will not survive w/out the operation
6- organ donor - brain dead, harvesting

I hate to split hairs but I've always understood that ASA 5 the patient is not expected to survive w/ or w/o the surgery.

 

[Dr. Gangrene]

Hey, Dr. feelgood. I hate to be a truth/fact pointer outer but haven't you perfected the art of splitting hairs? I dub thee Sir hair splitter perfecterer. (p.s. Love you're posts, and like the variety you bring).

 

[Dr_Feelgood]

Hey, Dr. feelgood. I hate to be a truth/fact pointer outer but haven't you perfected the art of splitting hairs? I dub thee Sir hair splitter perfecterer. (p.s. Love you're posts, and like the variety you bring).

I hate to splint hairs but a smile not the laugh would have been appropriate like this 😀 and then the laugh at the end like this .

I don't know why I have been so anal lately; it used to be Sam's job but I guess I'm the new Sam and whiskers.

 

[JEWmongous]

Doc Feelgood, Jonwill, and anyone else who knows:
I'm curious about what happened last year when pods were put on the medical staff and given admission privilages in Iowa. Was there resistance from the MD's or DO's...or specifically, orthopedic surgeons? Was it a smooth transition? (I don't know the status of pods at the hospitals beforehand). Did this affect the entire state or just a hospital system in Des Moines? Last question, how often is podiatric surgery done in a hospital? I mean, most pods do minor procedures (ingrown toenails, etc) in their office and more involved (bunion, hammertoe, etc) in a surgical suite. Is this correct? Are the complex fractures or procedures done in the hospital so the patient can receive pain medication and such? Is it also for use of the OR and access to anesthesiologists? Sorry for the dumb questions! Take care.

 

[jonwill]

Doc Feelgood, Jonwill, and anyone else who knows:
I'm curious about what happened last year when pods were put on the medical staff and given admission privilages in Iowa. Was there resistance from the MD's or DO's...or specifically, orthopedic surgeons? Was it a smooth transition? (I don't know the status of pods at the hospitals beforehand). Did this affect the entire state or just a hospital system in Des Moines? Last question, how often is podiatric surgery done in a hospital? I mean, most pods do minor procedures (ingrown toenails, etc) in their office and more involved (bunion, hammertoe, etc) in a surgical suite. Is this correct? Are the complex fractures or procedures done in the hospital so the patient can receive pain medication and such? Is it also for use of the OR and access to anesthesiologists? Sorry for the dumb questions! Take care.

As far as I know, everything went smooth. The DO program from DMU was very supportive and the dean spoke out about it. The MD's, mainly the ortho guys, were very supportive as well because it meant less work for them. Prior to this, every time a pod in an ortho group wanted to admit a patient, they had to call one of their ortho partners! I'm sure there was some resistance behind closed doors (their always is). But all in all, it was very smooth. This affects any hospital in the state that is part of the network and it is the largest network in the state. In smaller towns, this has really never been a problem because the smaller hospitals just want business.

Where we do surgery depends on where we have privileges. Usually, if you don't have privileges in a hospital and you want to start doing surgery there, you apply for them. The more complex procedures, especially trauma (ankle, calc, pilon), are generally always done in the hospital OR because it usually comes into the ER. And they often have to be admitted for pain control. Many times, elective procedures are done in surgery centers but can be done in the hospital as well.

 

[Dr_Feelgood]

As far as I know, everything went smooth. The DO program from DMU was very supportive and the dean spoke out about it. The MD's, mainly the ortho guys, were very supportive as well because it meant less work for them. Prior to this, every time a pod in an ortho group wanted to admit a patient, they had to call one of their ortho partners! I'm sure there was some resistance behind closed doors (their always is). But all in all, it was very smooth. This affects any hospital in the state that is part of the network and it is the largest network in the state. In smaller towns, this has really never been a problem because the smaller hospitals just want business.

Where we do surgery depends on where we have privileges. Usually, if you don't have privileges in a hospital and you want to start doing surgery there, you apply for them. The more complex procedures, especially trauma (ankle, calc, pilon), are generally always done in the hospital OR because it usually comes into the ER. And they often have to be admitted for pain control. Many times, elective procedures are done in surgery centers but can be done in the hospital as well.

Well stated but being mr.factchecker guy, I do remember 1 orthopod that had issue but I think it was more personal (against a local) than professional.

 

[JEWmongous]

Cool thanks for the info! That's good to hear it was a smooth transition.

 

[krabmas]

I hate to split hairs but I've always understood that ASA 5 the patient is not expected to survive w/ or w/o the surgery.

I also heard that about ASA 5.

I copied that list directly from the ASA website.

 

[Dr_Feelgood]

I also heard that about ASA 5.

I copied that list directly from the ASA website.

Huh, well I guess that is it then is it is the ASA point system.