re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187

And there's a huge difference here.

This bill would take the doctor out of the loop completely and have no MD involved.

That's different than your brothers situation

quote:

---

Not sure how they would think they have more training.

You need a Master's to be a PA.

You need a Master's or a PhD to be an NP. The AACN even recommends that the PhD become a requirement.

---

Their core training is very different. A nursing degree and masters is based on a nursing curriculum. A PA's training is a condensed version of medical training with far fewer/shorter rotations and no residencies.

The first 1.5-2 years of med school and PA school aren't that drastically different. Gross anatomy, pathophysiology, etc... PA and MD students at UTMB actually share cadavers. But testing and training after that point are far more intensive and comprehensive for a MD. USMLE's, rotations, residency, fellowship, etc...

Ok PA school is harder to get into and the Pa students say their coursework is superior to nps. Some of the np stuff is done online. And the DNP is somewhat a new thing and the calling themselves doctor party is very shady

Ok I'm not sure how many ways you can measure it / judge it. Maybe more was not the most appropriate term. PAs would argue their education is more rigorous

We do 2 years.
They do 1.

Plus it's harder troll

quote:

---

Plus it's harder troll

---

I'm a troll now?

Ok, "doc".

quote:

---

Maybe if you saw some patients instead of dicking around on the internet all day, you could hang on to some of your patients

---

No need. He's probably got 2 NP's running clinic.


its a joke doc. relax.

This

quote:

---

Story: went to the ER one night in College. Had no insurance. NP checked my ear gave me a shot and got me a script. A real doctor came in and looked at my ear and left, and I got a bill for $900 from the hospital, paid and all good. Then a $900 bill came from the doctor, frick that. I never paid it, that worthless SOB. So you won't get any sympathy from me. A NP can deal with a ton of minor stuff without the overwhelming cost of the MDs.

---

While you may feel this is relevant, I feel you misunderstand the situation a bit. Let me try to explain a little more about the system in place. It's convoluted, and it's not as straightforward as I think it should be.

1) you went to the ER. The ER can bill you just for showing up. They provide the money for the facilities and the ancillary staff (lab tech, phlebotomist, nurses, the janitors that come and clean, bills, etx). They're allowed to bill for the use of these services as well as any products/supplies used by the patient.
2) the providers (varies by state) are typically contracted by a private physician group. They usually can't be/aren't employed directly by hospital. Often, this includes MDs. In this setting, probably no ER is going to allow patients to walk in and out the door without a physician seeing them (caveat- urgent cares/freestanding clinics inside an ER may be able to do it a little more easily, but in my ER, the MD sees every patient who walks in and out the door. And that excludes the residents who have an independent license and can practice medicine in the state of Louisiana without supervision. The staff doctors even come behind us, and for a lot of good reasons). Often, NPs are part of that same group. By paying the hospital, you don't necessarily pay the physician or NP. Your not paying a bill and then not being sent multiple attempts to collect isn't necessarily something that was "right." You likely not only didn't pay the physician group. But you likely didn't pay the NP's employer as well.
Now, when you talk about the cost and think it's outrageous, I'll agree. Wholeheartedly. But ER care is very, very expensive. You can see a physician 24/7 and have immediate access to life-saving measures within, typically, under 3 hours. Labs are available at all hours of the night within, for the most part, an hour. And when labs come from the ER, they take precedent over whatever was happening ahead of time if it wasn't deemed emergent. As you can imagine, it cost a fair amount of money to keep these sorts of people within X minutes of the hospital, thus the inflated cost of the care.

I truly despise the way it works in terms of patients getting multiple bills for the same service. The alternative would be either:
1) ER's directly paying the physicians/NPs/PAs as they do nurses
2) 3rd party billing contracted through the same group who bills you $1800 instead of $900 twice (assuming this doesn't drive up any more cost of paying the 3rd party biller)


And lastly, the NP may have seen you on their own accord and been paid by the hospital. And you may be in a state where they're allowed to do that in an ER without the physician's oversight. But even in that case, the physician was asked by the NP to go in the room. For that alone, the guy/gal has to bill for their time. Again, $900 is a ton for that sort of time, but the problem you're describing having gone to the ER for was kind of the equivalent of renting a tractor-mounted jackhammer to break up a 1x1 square foot of concrete. Sure, it did a great job at getting you in, correctly diagnosed, and out the door appropriately, but the cheaper alternative would've been just as good.


I guess I fail to see where you interpret that costs could have been saved. Is it that you believe the $900 bill wouldn't have been sent if the physician merely reviewed the chart instead of walked in the room or wasn't involved in the care at all? And if so, why would the NP not have submitted the same bill because of his/her group's independent billing structure?



This is very unfortunately way more complex than, "hey. This is an ER. If your cold is a cold, it's $200, but if you go to that clinic tomorrow AM it's $45"