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Do you order hospice?


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https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c09.pdf

 

I hate that it reads NP all over the place but specifically prohibits PAs from doing the face to face or certifying.

 

I order Hospice all the time and my doc just signs them. Whatever the patient needs - we figure it out.

 

It needs to change. So do a lot of other things.

 

Did you get the AAPA email about a survey regarding what AAPA is doing for us and how satisfied we are? I answered it - in a lot of detail.......

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I am in a letter writing mood - catharsis mode.

 

The CEO of NCCPA is on my list as well as AAPA. 

 

I doubt it would help to appeal to CMS or even the AMA because they see us represented by AAPA.

 

Another letter of inquiry would go to AAFP to see if they would let me take the same board exam my doc takes - just to see - I will pay for it. Just let me take it and see what happens.......

 

Anyone you want me to write to as well?

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Guest Paula

AAPA has been trying to fix this for years now.  Several efforts have gone forth and it is imperative that you contact your state senator/representatives to get them to change it.

 

The real questions is:  What is CMS doing to fix this?  they are aware of it.................

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congress_gov_logo3.png

 

 House Bill

 

 

https://www.congress.gov/bill/114th-congress/house-bill/1342/cosponsors?pageSort=lastToFirst

 

191 co-sponsors (435 total reps)

 

 

Sentate Bill

https://www.congress.gov/bill/114th-congress/senate-bill/578/related-bills

 

49 cosponsors (100 total senators)

 

 

 

 

 

 

 

 

CALL AAPA AND YOUR CONGRESSIONAL REPS

 

 

AAPA and all the nursing PAC's have been pushing hard for many years for this to pass

We are close to getting this passed and it would be HUGE

 

 

 

PLEASE PLEASE PLEASE

take the time to call your congressional representative today!!!!!!!!!!!!!

 

http://capwiz.com/aapa/issues/alert/?alertid=64206866  

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Ventana, thank you.  This is good information.

 

I read the summary of this bill.  It says: "Allows payment for home health services to Medicare beneficiaries by: (1) a nurse practitioner, (2) a clinical nurse specialist working in collaboration with a physician in accordance with state law, (3) a certified nurse-midwife, or (4) a physician assistant under a physician's supervision."

 

I already see red flags.  Why does it have to say "a physician assistant under a physician's supervision."  How will supervision be determined?  By requiring a physician co-signature to my orders?  Some government bureaucrat will write rules after the law has passed.  This could still be a problem and not the true fix we need.  Why don't NPs have to have physician supervision? 

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Ventana, thank you.  This is good information.

 

I read the summary of this bill.  It says: "Allows payment for home health services to Medicare beneficiaries by: (1) a nurse practitioner, (2) a clinical nurse specialist working in collaboration with a physician in accordance with state law, (3) a certified nurse-midwife, or (4) a physician assistant under a physician's supervision."

 

I already see red flags.  Why does it have to say "a physician assistant under a physician's supervision."  How will supervision be determined?  By requiring a physician co-signature to my orders?  Some government bureaucrat will write rules after the law has passed.  This could still be a problem and not the true fix we need.  Why don't NPs have to have physician supervision? 

 

 

this is the wording for all reg's for PA's at this time

 

They are stating again that we need to have a supervision agreement with a doc - as this is the standard (at this time) it is merely saying we have to have a doc......   no PA in this county works with out a doc signature.....

 

don't get me going about how useless this is......

 

 

 

This bill would change the current reg's to allow us to order and manage our patients on hospice/VNA

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this is the wording for all reg's for PA's at this time

 

They are stating again that we need to have a supervision agreement with a doc - as this is the standard (at this time) it is merely saying we have to have a doc......   no PA in this county works with out a doc signature.....

 

don't get me going about how useless this is......

 

 

 

This bill would change the current reg's to allow us to order and manage our patients on hospice/VNA

Understanding that this is the wording for all reg's, but why does it have to be. Why does it have to be continually stated "under a physician's supervision"?  It is clear that any PA working in the country has an SP.  There are no states that allow otherwise.  So, why does the statement even need to be there.  It should also then state the NP needs to be "under a physician's supervision if practicing in a state requiring supervision".

 

 

I did also note this in the link above:

" Nurse practitioners cannot certify a terminal illness or the prognosis of 6 months or less, if the illness or disease runs its normal course, or re-certify terminal illness or prognosis. In the event that a beneficiary’s attending physician is a nurse practitioner, the hospice medical director and/or physician designee may certify the terminal illness. Hospice nurse practitioners may conduct face-to-face encounters as described in §20.1(5) as part of the certification process, but are still prohibited by statute from certifying the terminal illness."

 

So, an NP can not certify a terminal illness or prognosis.  So, they really can't certify a patient for hospice then is how I read it.  

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Yeah, this sucks.  There should be NOTHING an NP can do that a PA can't.

 

Exception: wear a nurse's cap.  nurse-cap-medical-white-hat-nurses-hat-3

 

When I started as an NP almost a year and half ago, I tried the nurses cap thing.  It kind of freaked the patients out.  Especially 'cause I'm a dude.  Nurses cap, khakis, stubble.  Not a good look.

 

I agree with your first statement, BTW.  And, I think if you want to wear a nurses cap, you should be able to do that too.  Just don't do it with khakis.  Or stubble.

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Why on earth would UpRegulated post his picture?????  Now we all know what he looks like. 

 

Wasn't me that posted it, Paula.  And I don't know how cop to pa found my latest Linkedin profile pic.  I've since ditched the combat boots and fishnet hose.  No one will know it's me now.

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