Basic Training Collaborative Practice in Long Term Care Setting Jo Ann Fisher, MSN, FNP-C
Basic Training Objectives • Define the scope of practice of the • NP/PA • Describe the components of a collaborative agreement • Describe the NP/PA/Physician duties and responsibilities in a collaborative practice • Discuss the clinical privileges and protocols for the nurse practitioner. • Describe reimbursement practices
Basic Training Definition comes from the Board of Nursing and the Board of Medicine Practice is determined by education, level of experience and state board regulations Both NPs / PAs must provide their regulatory boards with required agreements Define the scope of practice
Basic Training Collaborative Agreement Nurse Practitioners Protocols: initial, with any change and every 2 years with re-licensure Includes: requiring authority, parties to the protocol, nature of practice, description of duties and management areas (conditions, treatments, and drug therapies. Duties of MD/DO and requirements for physician intervention
Basic Training • Collaborative Agreement • Physician Assistants • Supervision Data Form sent to the Board • of Medicine with original list of • supervising physician(s) and location(s) • of practice. • Lists can be sent if a physician or • location is added or deleted • No other description of practice needed .
Basic Training Who is Responsible? • MD/DO provides clinical as well as • practice oversight and education for the • NP & PA as needed. Orders need to be • co-signed for PAs. • NP/PA is responsible for advising the • physician of complex or unstable • clinical cases, for Schedule 2 drug orders and for advanced directives • Both NPs and PAs can practice in LTC and • ALF facilities (credentialing is done when • requested)
Basic Training Payment Issues • NPs/PAs both can obtain Medicare, • Medicaid, UPIN and NPI numbers • Most insurers pay non-physicians • Billing can be done by the practice or • independently • NP/PA can bill for all except the initial • H & P, which must be done by MD/DO
Basic Training Summary • The nurse practitioner and physician • assistant offer a high level of care for • the LTC patient. • Communication between the NP/PA • and physician is key to a safe and very • beneficial collaborative relationship