using a nurse for pump refills/adjustments?

[Welcome123]

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I have recently started a locums position with an interventional pain practice. The first day the practice nurse had a visit in my name for a pump refill and adjustment. I declined managing this patient as I am not familiar with pumps. Since that time there have been multiple office visits under my name for pump refills and adjustments. I have a dozen office visits/procedure notes for this in my name. I have not signed off on any of the notes as I have never seen these patients nor have even been asked to manage them and therefore I do not feel it is appropriate to sign for them.

I have emailed my recruiter and the response I have gotten is that there is no issue with any insurance coverage and any billing questions should be taken up with the practice.

I am reluctant to do this for obvious reasons.

How would you guys handle this?

 

[lobelsteve]

I've whittled my practice down to 2 pump patients. One MSO4, one baclofen.

I believe it is an MD only task to refill/reprogram a pump. I've seen it done by RN, LPN, MA, PA, NP.

Looking at the rarity of a complication from refill, the risk is always low. But looking at who refilled the pump and missed, the likelihood that it was a non-MD was sky high. And the doc is the deep pockets. If I am going to kill someone, it is going to be me and not my LPN.


SML

 

[Ducttape]

in terms of financials, prior to about a year ago, it was not an MD only procedure - anyone could fill, but supposed to be supervised.

Now, in order to get paid for a pump refill, it is an MD direct supervision procedure.

 

[drf]

We use one trained nurse for refills. All drugs and changes are signed of by an attending. Bill non physician visit.

 

[SSdoc33]

I have recently started a locums position with an interventional pain practice. The first day the practice nurse had a visit in my name for a pump refill and adjustment. I declined managing this patient as I am not familiar with pumps. Since that time there have been multiple office visits under my name for pump refills and adjustments. I have a dozen office visits/procedure notes for this in my name. I have not signed off on any of the notes as I have never seen these patients nor have even been asked to manage them and therefore I do not feel it is appropriate to sign for them.

I have emailed my recruiter and the response I have gotten is that there is no issue with any insurance coverage and any billing questions should be taken up with the practice.

I am reluctant to do this for obvious reasons.

How would you guys handle this?

stand your ground. talk to management. if this was part of your assumed duties when you started, then you better learn what you are doing and how to do it. however if it was not clearly stated, i dont think it is a routine part of an interventional spine. i know i wouldnt feel comfortable refilling, reprogramming, and managing the pumps. plus, i really wouldnt WANT to. if anything goes wrong (and when it does with baclofen pumps, the results can be pretty scary)you are on the hook because you are aware that your name is attached, despite the fact that you didnt sign off on it. you have to at least address this with management to have some sort of leverage if there is a complication.

 

[101N]

BINGO.

1am and your phone rings. Dr. so and so this is the ER calling, one of your pump patients is here and seems to be in withdrawl: what would you like to do?

You are sitting on a powder keg of risk.

 

[Jcm800]

my NP fills my pumps. she is quite good at it. I can fill them, and rarely do.

 

[Jitter Bug]

Don't retroactively sign any of that stuff. Especially if you don't know the patients or the RN. The recruiter doesn't give a crap about you. Talk to the office manager or medical director.

 

[Welcome123]

Don't retroactively sign any of that stuff. Especially if you don't know the patients or the RN. The recruiter doesn't give a crap about you. Talk to the office manager or medical director.

Thanks for the response.

Talking to the medical director is not an option as I made it clear that this was not something I do on the first day and when I declined the director ( a physician without a license, gave the order on what adjustment should be made).


I am not sure how to handle this except to not sign any of the notes.

Any other advice?

 

[Ducttape]

find a new locum tenum position... not to be facetious...

 

[101N]

find a new locum tenum position... Not to be facetious...

1+

 

[Jitter Bug]

If he doesn't have a license how can he give a an order to adjust a pump? So what this really means is the practice nurse works without supervision and the director assumes no-one will check closely enough at the paperwork out to see that his MD is not active. Do you have MD colleagues? What is their role in this practice?

 

[Welcome123]

find a new locum tenum position... not to be facetious...

1+

If he doesn't have a license how can he give a an order to adjust a pump? So what this really means is the practice nurse works without supervision and the director assumes no-one will check closely enough at the paperwork out to see that his MD is not active. Do you have MD colleagues? What is their role in this practice?

He can give an order to the nurse since he owns the practice and is the employer (whether she honors it or not is her choice-she shouldn't as he is unlicensed ). It was not my order but it looks like the visit/procedure will be billed under my name despite my lack of input. There is another licensed provider that I have not met.

Ducttape,101N- Thanks! I am no longer at this position.

I am unclear if there is an obligation to report this or to whom I would report this to.

I appreciate the responses!

 

[SSdoc33]

He can give an order to the nurse since he owns the practice and is the employer (whether she honors it or not is her choice-she shouldn't as he is unlicensed ). It was not my order but it looks like the visit/procedure will be billed under my name despite my lack of input. There is another licensed provider that I have not met.

Ducttape,101N- Thanks! I am no longer at this position.

I am unclear if there is an obligation to report this or to whom I would report this to.

I appreciate the responses!

I don't get a shut out? What's a guy gotta do to get some sdn love?

 

[101N]

I don't get a shut out? What's a guy gotta do to get some sdn love?

SSdoc33: U DA Man! (That is of course if you are a man.)

 

[Welcome123]

I don't get a shut out? What's a guy gotta do to get some sdn love?

Much appreciation SSdoc33!!

 

[SSdoc33]

Thanks. But I still feel cheated

 

[Welcome123]

Thanks. But I still feel cheated

Don't feel cheated.

I thought your post was well thought out and in fact was quite similar to the course of action I took (initially declining management and then requesting risk management advice from the recruiter as the practices management was not an option).

It was definitely better than the advice I got from the recruiter.

I am glad I am moving on.

I am just not sure if i can leave this information with the recruiter or if I need to notify medicare or the state board.

 

[101N]

Thanks. But I still feel cheated

http://www.youtube.com/watch?v=1G30gIjZWKk

 

[facets]

Aw, what's wrong? SDF would not be what it is without your input.

 

[Mister Mxyzptlk]

I have always had pump refills done by my RNs. I do some, they do some.. If you're doing locums you need to get all of the duties spelled out before you take an assignment. Someone dropped the ball here and it wasn't fair to the other parties involved.

 

[Welcome123]

I have always had pump refills done by my RNs. I do some, they do some.. If you're doing locums you need to get all of the duties spelled out before you take an assignment. Someone dropped the ball here and it wasn't fair to the other parties involved.

Thanks for the response.

There was no dropped ball. I made it clear on my first day, that this wasn't something I was familiar with and didn't give any orders on any patient ever, nor did I see any of these patients. The nurse presented one patient to me and I declined management. Following that, I believe there have been approximately ten office visits in my name that I discovered after the fact.

 

[Ducttape]

im thinking that the other thing you might have thought of doing, in retrospect, was to tell the nurse to contact the medtronic rep to see about referring the patient to a different pain clinic that was comfortable with managing pumps.

also, im curious. pumps are not a requirement for pain fellowship, but i am surprised that you did a fellowship and did not have any experience with pumps.

is that the experience of other recent grads? i finished 2 years ago and i had more than enough experience with pumps - enough to know that i dont want to have anything to do with them....