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re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187
Posted on 4/9/16 at 9:35 am to cwil177
Posted on 4/9/16 at 9:35 am to cwil177
In the real world, physician oversight of mid levels generally consist of the mid level electronically signing the docs name on the chart, per his request.
0
Posted on 4/9/16 at 9:39 am to LATigerdoc
For doc in a box type places there is no reason why a NP is less than sufficient. An NP can write me a prescription for strep, etc. If its serious they refer you to an MD. The system works very well in nearly every other state.
Things like this can safely reduce the cost of health care without compromising the quality of service.
Things like this can safely reduce the cost of health care without compromising the quality of service.
Posted on 4/9/16 at 9:42 am to pleading the fifth
quote:
But what's funny is, studies have shown that NP's order more imaging, more follow up studies, and more referrals to subspecialist than do Family practitioners, thus eliminating the savings gained through decreased reimbursement.
Reimbursement could be affected here with the shotgun approach, but what about salary obligations of the system? What is the savings of a system paying four on staff; two MDs, two NPs, as opposed to one MD and three "autonomous" NPs. Why have two physicians on staff when you can have 1?
It's all a bottom line driven business and if there is a way or angle to provide the same care (on paper) while saving money, you bet laws will be changed to do so.
I just don't like the opening door by these changes. Sure it may save money, but at what expense? You are trusting the public to decide what level of care they need (MD v. NP) and some may not get that correct.
This post was edited on 4/9/16 at 9:45 am
Posted on 4/9/16 at 9:43 am to MSMHater
quote:
Those mid levels evaluate and determine care plans just as the docs do. They run the clinics, not the docs. They make the care decisions in 75% of cases. Yet you feel them incapable of managing primary care? The brightest mid levels are plenty capable of being a better provider than most physicians. I"ve seen it on many ovcasions and have hired and fired both
I don't know who you are or what you do but I'd be willing to bet you are fricking circus clown. If you are going to make some obnoxious claim like that then you better start backing it up with facts. So let's see them. Show me where NPs are diagnosing and developing treatment plans for cancer patients ON THEIR OWN.
NOT managing a plan already put in place by an MD.
Posted on 4/9/16 at 9:44 am to WalkingTurtles
quote:
guess by eliminating doctors in some practices, it reduces overhead and reduces the amount insurance/out of pocket pay out as well. I think this bill could really make care more affordable especially for smaller clinics.
HA
No. Same charge. Insurance may pay a little less, pt has same copay. Now my cash patients pay less to see my NP's than for me. However, I still review ever single note they produce and am available for any questions they have. So, essentially the only thing the patient misses is my actual physical presence. Which they do get if sick enough...at no extra charge. What I've seen is that the NP's are doing visits we didn't have time to do and didn't charge for. We'd just do it or call it in. It's a farce to say they are increasing access to care. And the ones solo? I have to fix their shite all the time when the patient gets bad enough to come pay for a real doc. Are there shitty doctors? Hell yes. Are they some good NP's? Yes. But we can't take the worst of one profession and compare them to the elite in another to make a decision. NP's need supervision plain and simple. Anybody promoting autonomous NP practice should really take the time and see the difference in training.
NP school is literally like an intro to medicine type college level training. It's not shite compared to medschool...and then we have a minimum of three years residency.
Posted on 4/9/16 at 9:44 am to LATigerdoc
quote:
I'm a specialist. There's no NPs in my field or if any, it's exceedingly rare so
You really should get out of LA. occasionally.
Posted on 4/9/16 at 9:46 am to Crimson
quote:
For comparison, I have linked the Family NP curriculum at Vanderbilt. LINK. It's an 18 month curriculum.
Here is the next 2 year program you must enroll in after the 18 month MSN program you linked. Vandy DNP. A lot of schools only have a DNP program for APRN programs (NP, CRNA, etc.). To become a APRN through OLOL or LSU, you must enroll in a 3 year DNP program that requires critical care experience. They don't even offer a MSN program, it is only on the site because of those previously enrolled and finishing it up part-time.
I'm not a nurse. At $80 a visit, we call our pediatrician and say that pink eye is going around the daycare and our son has it now. Please call in a script. If you don't, I guess it will go untreated. Also, we see the NP at the clinic now more than our regular doc because she has been practicing longer and seen more. I have a sibling that runs residencies for pediatrics and she gets any more complicated call because she trains most new pediatricians around south LA.
Posted on 4/9/16 at 9:46 am to WaWaWeeWa
I'm the guy docs like the OP hate.
Their administrator. And I've forgotten more about our Healthcare system then you will ever know. Go away.
Mid levels create care plans without true supervision every day at MD Anderson. Your ignorance of the dynamic doesn't make it noto true.
Are PA's too inferior as well?
Their administrator. And I've forgotten more about our Healthcare system then you will ever know. Go away.
Mid levels create care plans without true supervision every day at MD Anderson. Your ignorance of the dynamic doesn't make it noto true.
Are PA's too inferior as well?
This post was edited on 4/9/16 at 9:52 am
Posted on 4/9/16 at 9:50 am to WylieTiger
quote:
It's all a bottom line driven business and if there is a way or angle to provide the same care (on paper) while saving money, you bet laws will be changed to do so.
Bottom line? I produce more and see more pt's than both my NP's combined. All while reviewing every single pt note they produce and being available to see pt's they are not comfortable with. THIS is how is should work. I have never ever had to ask an NP for a solution to a medical problem. However, they ask me hundreds of questions a day. Talk to my two NP's and the other I'm training. They'll tell you how stupid it is to have solo NP's and I'll guarantee you they'll never be tempted to venture out on their own. They were never meant to. It's bullshite to create some half arse school for medical assistants then a few years later try and create an alternative path to med school.
Make them pass USMLE I, II, III and complete a residency and we'll talk.
Posted on 4/9/16 at 9:53 am to MSMHater
quote:
I'm the guy docs like the OP hate. Their administrator. And I've forgotten more about our Healthcare system then you will ever know. Go away.
I'm the doc guys like you hate. I'm the one running his own shite extremely successfully and at a far lower overhead than any of your bloated clinics, giving superior care, and keeping all the candy for myself.
I'm the one in this area cutting you guys off at the legs. Of course, some docs need a boss. Want better production? Get better docs and pay them accordingly. Quit trying to make money off their work. Make it on all the ancillaries and referrals...assuming you are with a hospital system.
Posted on 4/9/16 at 9:53 am to lsunurse
Rectal temps? When I started out in NICU in '86, those were no longer done and no longer recommended except in extreme cases. Perforation risk.
Posted on 4/9/16 at 9:55 am to LATigerdoc
lol frick off with your protectionist bullshite. The ama and other doc associations are holding healthcare back. You don't need 12 years of school/residency to manage common chronic disease states or run a rapid strep/flu test.
Posted on 4/9/16 at 9:55 am to MSMHater
quote:
I'm the guy docs like the OP hate.
quote:
Their administrator.
The good ones don't need you. I'm indifferent towards admins. Never had one, never will. Wasted salaries in an already bloated system. Take the admins out and people keep being seen, treated, and living. Take the docs out? Awwwwwwww shite.
Posted on 4/9/16 at 9:56 am to MSMHater
You have a wife that's a midlevel provider (and have called her a 'hepatologist' ). You're clearly biased and, like most administrators, don't know anything about actual medicine.
Let NPs try passing all of the tests we take or the residencies we complete as part the standardization of our training. Here's the truth: none of the them would pass step 1 because their education is ridiculously subpar.
NPs overconsult, overtest, etc. This is a basic fact anyone exposed to healthcare knows.
). You're clearly biased and, like most administrators, don't know anything about actual medicine. Let NPs try passing all of the tests we take or the residencies we complete as part the standardization of our training. Here's the truth: none of the them would pass step 1 because their education is ridiculously subpar.
NPs overconsult, overtest, etc. This is a basic fact anyone exposed to healthcare knows.
This post was edited on 4/9/16 at 9:57 am
Posted on 4/9/16 at 9:57 am to SM6
quote:
For doc in a box type places there is no reason why a NP is less than sufficient. An NP can write me a prescription for strep, etc. If its serious they refer you to an MD. The system works very well in nearly every other state.
And if they misdiagnose you and don't realize that you need an MD, then what?
quote:
Things like this can safely reduce the cost of health care without compromising the quality of service.
We've already proven in this thread that this legislation will likely not affect pricing, and there is even the argument that costs will rise as the number of unnecessary tests goes up, along with readmits and extra work that will be necessary when diagnoses get missed.
I agree that we need more access to primary care in our state. I have no problem going to an NP myself for minor issues, but I think assuming that the quality of health care is the same between an NP and physician is incredibly naive.
Posted on 4/9/16 at 9:59 am to SmackoverHawg
quote:
The good ones don't need you. I'm indifferent towards admins. Never had one, never will. Wasted salaries in an already bloated system. Take the admins out and people keep being seen, treated, and living. Take the docs out? Awwwwwwww shite.
I think administrators are one of the biggest problems in healthcare. It's a shame most docs can't or won't run their own gig.
Posted on 4/9/16 at 9:59 am to Tiguar
quote:
lol frick off with your protectionist bullshite. The ama and other doc associations are holding healthcare back. You don't need 12 years of school/residency to manage common chronic disease states or run a rapid strep/flu test.
Manage chronic disease states? Yes, you do.
Strep swab? No you don't. The problem is you guys don't even know a fraction of the knowledge or decision making that goes into each decision....and neither do the NP's. They follow us and do what we would do or they think we would. They have no clue about the physiology, biochemistry, anatomy, and pharmacology. The just think "cough-zpack". They have no clue why. Or why sometimes I'll use Levaquin or doxycycline or Bactrim.
NP training is what it is.
Posted on 4/9/16 at 10:00 am to MSMHater
Ha what a surprise. Administrators have done more to royally F the healthcare system than docs could ever do.
Shall we get into the brilliance of value-based purchasing, linking reimbursements to patients satisfaction scores (which is completely idiotic and only something bureaucrats could possible dream up), and Press-Ganey? I cannot wait to hear your thoughts on these.
Shall we get into the brilliance of value-based purchasing, linking reimbursements to patients satisfaction scores (which is completely idiotic and only something bureaucrats could possible dream up), and Press-Ganey? I cannot wait to hear your thoughts on these.
Posted on 4/9/16 at 10:01 am to Parallax
quote:
You have a wife that's a midlevel provider (and have called her a 'hepatologist' ). You're clearly biased and, like most administrators, don't know anything about actual medicine.
And boom goes the dynamite.
Posted on 4/9/16 at 10:01 am to MSMHater
quote:
'm the guy docs like the OP hate. Their administrator. And I've forgotten more about our Healthcare system then you will ever know. Go away.
Ohhhh you sound like a big bad boy
More like an armchair quarterback
Go back to making your power point for the next staff meeting, but before you do please confirm this for me... If you were diagnosed with stage 3 lymphoma today, you would go see the NP right?
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