Pain practice setup with PA's, NP's, and scribes

[thecentral09]

Hey guys, so I am in the process of setting up a hospital based pain practice and have a question regarding your setup and "midlevel" providers versus scribes to increase your throughput. My question is how have you integrated PA's and NP's into your system, and at what length do you become involved in also seeing their patients for the purposes of billing. Realistically, it would be an ideal situation where you could increase your throughout with their help, but also be involved in recording the physical exam and assessment/recommendations for the purposes of billing at a higher level and remaining more directly involved with patient care.
A follow up question, in a hospital setting where you are being reimbursed on a wRVU basis, what amount of additional interaction and documentation must you do to also sign the NP or PA's note as the primary provider so that wRVU is reflected onto the physician.

---

Members don't see this ad.

 

[BobBarker]

You won't get any of their RVUs. You are better off going the scribe route and doing as much as possible yourself in the hospital employed setting.

 

[Ducttape]

That's wrong.

First most practices will provide a % for supervising the APP. Ask for 5-10% of the midlevels wRVU. Small amount but adds up.

Second, the mid level can be utilized to see follow ups while you perform procedures, thereby improving your wRVUs. They can also initialize auth process for procedures.

Third, you can arrange to see all new patients with the midlevel, who then does the majority of your documentation, which can improve efficiency, leaving you time to see other patients while still having new eval visit billed under you. Similar to a teaching attending model with residents/fellows.

Fourth, the midlevel can also do some of the important time consuming stuff like referrals, PT reqs, review UDSs... some scripts...

Scribes are great. They improve your efficiency. But if you are the physician for the practice, midlevels can help a lot.


Sent from my iPhone using SDN mobile

 

[cowboydoc]

This is highly dependent on your hospital system. Agree with Duct if your system allows it. I've been looking to create some more efficient processes. I wanted a PA, but our system won't allow PAs to do much of anything for my ortho partners in terms of VERY limited scope of practice. Therefore, the scribe idea sounds like a great solution. Price is only about $25k/year. You'd have to do the aforementioned labs, rx's, f/u visits, but can train staff to streamline this as much as possible and you get credit for all wRVUs.

 

[BobBarker]

I have a NP at my hospital practice. She gets her own RVU's for her encounters which are all my follow ups. I see all new patients. I discuss every patient and rx every medicine.

 

[lobelsteve]

I have a NP at my hospital practice. She gets her own RVU's for her encounters which are all my follow ups. I see all new patients. I discuss every patient and rx every medicine.

If she sees the patient and you write the Rx, and something goes wrong....overdose, diversion, etc....how much heat is there? This is why I never considered a midlevel.

 

[drusso]

If she sees the patient and you write the Rx, and something goes wrong....overdose, diversion, etc....how much heat is there? This is why I never considered a midlevel.

Mid-levels, scribes, MA's, MSW's, PT's are all essential members of the patient care team..

 

[BobBarker]

It's my decision and my follow up patient so I would welcome any heat on me. Same as if she was an intern.

 

[SSdoc33]

a mid-level really cant make the decision about who gets a shot, where, when, how often, and who doesnt. thats the art of medicine that is the sole jurisidiction of the interventionalis. not the referring surgeon, not the PCP, and certainly not the NP or PA who has zero formal training in our subspecialty. there are so many little nuances about what we do -- IMHO it is incredibly difficult to teach within a year or 2. there are better ways to spend 100k/year, and if you have that many medication refills, your practice is, lets say, questionable.

 

[Ducttape]

in this area, there is one NP that has been working in the field with the same doctor since 2001. another one has been working in pain since 2003, and teaches the fellows at the U. I can identify 3 others that have been working in pain medicine since 2011, including my own.

no offense, but it is presumptuous to think that someone, even a trained monkey, cant identify that someone who has had an ESI in the past for radicular back pain "with clinically meaningful benefit and no untoward side effects" who might be a candidate for another one...

as far as initial injection - that's why you see the patient with the NP on the first visit. or see the patient in office before any injection scheduled.

 

[thecentral09]

Thank you all for your replies. As I am becoming established, I want to ensure that my wRVU reflects the amount of involvement I have in caring for my patients. I am concerned in a wRVU model that not seeing follow ups (i.e. having a midlevel see them all) does miss/waste a significant opportunity at collecting significant amount of additional compensation via wRVU. I will also be in a model where clinic and procedure areas are separate and will not have the ability to do both simultaneously.