LKPAC Posted May 24, 2016 Share Posted May 24, 2016 Do you order hospice, or must it be done by your physician? Is there a Medicare rule on this? Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted May 24, 2016 Administrator Share Posted May 24, 2016 No, yes, and yes. Link to comment Share on other sites More sharing options...
LKPAC Posted May 24, 2016 Author Share Posted May 24, 2016 What is AAPA doing to fix this? I get pissed every time I can't take care of my patients because of some rule that doesn't allow PAs! Link to comment Share on other sites More sharing options...
Reality Check 2 Posted May 24, 2016 Share Posted May 24, 2016 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....... Link to comment Share on other sites More sharing options...
LKPAC Posted May 24, 2016 Author Share Posted May 24, 2016 Yeah, this sucks. There should be NOTHING an NP can do that a PA can't. Exception: wear a nurse's cap. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted May 24, 2016 Share Posted May 24, 2016 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? Link to comment Share on other sites More sharing options...
Guest Paula Posted May 25, 2016 Share Posted May 25, 2016 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................. Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 25, 2016 Moderator Share Posted May 25, 2016 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 Link to comment Share on other sites More sharing options...
LKPAC Posted May 25, 2016 Author Share Posted May 25, 2016 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? Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 25, 2016 Moderator Share Posted May 25, 2016 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 Link to comment Share on other sites More sharing options...
DizzyJ Posted May 25, 2016 Share Posted May 25, 2016 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. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted May 25, 2016 Share Posted May 25, 2016 It should really read: PAs can certify under current and most recent regulations at the state level. Wouldn't that be more appropriate? Link to comment Share on other sites More sharing options...
UpRegulated Posted May 25, 2016 Share Posted May 25, 2016 Yeah, this sucks. There should be NOTHING an NP can do that a PA can't. Exception: wear a nurse's cap. 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. Link to comment Share on other sites More sharing options...
cop to pa Posted May 26, 2016 Share Posted May 26, 2016 Link to comment Share on other sites More sharing options...
LKPAC Posted May 26, 2016 Author Share Posted May 26, 2016 1427285008-90102000.jpg ROTFLMAO ! Link to comment Share on other sites More sharing options...
Guest Paula Posted May 30, 2016 Share Posted May 30, 2016 Why on earth would UpRegulated post his picture????? Now we all know what he looks like. Link to comment Share on other sites More sharing options...
UpRegulated Posted June 2, 2016 Share Posted June 2, 2016 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. Link to comment Share on other sites More sharing options...
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