Tenet pushing out PAs and NPs from hospitals

[stellahead]

http://www.modernhealthcare.com/article/20180228/NEWS/180229909

I work at a Tenet hospital, but I am employed by a community surgeon, who is employed by a subsidiary of Tenet. My surgery PA peers who are hospital employed have been told by corporate that they can no longer suture or write post-op notes. And if they write a consult or a progress note, their SP must co-sign their note AND dictate their own note. This is all coming down the pike because of what happened in Detroit (see attached article). The PAs and NPs were told this in a series of negative meetings with management, who when asked why they should even stay, management shrugged. And just to be clear about how they felt about the PAs/NPs, their lunch allowance was revoked in one of these meetings.

Like I stated above, I am not affected because I'm not hospital employed. I can still close, write post-op notes, do consults, etc. Because I'm not considered a "kick-back." What are your thoughts? Any recourse here? This seems farfetched to me -- where is the line between services hospitals provide and a kick-back? Could this signal a national push to get us out of hospitals? And it's not just surgery. Our neuro-intensivist team includes some amazing NPs who are under the same pressure right now.

[lkth487]

I don't know anything about Tenet but there isn't a national push of kicking PAs or NPs out.  At my hospital, they are constantly hiring - and if anything, the pace is accelerating.

[cbrsmurf]

Tenet is huge.

 

From wikipedia:

Since its founding in 1967, Tenet has launched a number of brands and acquired several large health care companies. In 2008 Tenet founded Conifer Health Solutions, which serves more than 700 clients in the healthcare industry, including nearly 300 hospitals. Tenet launched MedPost Urgent Care in May 2014, which is a network of urgent care centers based in the lower United States.^[10] In 2013, Tenet completed its acquisition of Vanguard Health Systems, Inc., an investor-owned hospital company whose operations complemented Tenet's existing business.^[11] The acquisition created the third-largest investor-owned hospital company in the U.S. in terms of revenue and the third-largest in number of hospitals owned.^[12] In June 2015, Tenet acquired United Surgical Partners International (USPI), which made Tenet the largest operator of outpatient surgery centers in the United States.^[13] Shortly after, Tenet moved from No. 229 to No. 170 on the Fortune 500.^[14]

[KPayne]

I actually work at the Tenet corporate office in Dallas- just an admin though and been here a little less than a year. I've been accepted to PA school and begin in the Fall so with that being said, I definitely won't set my sights on working for a Tenet hospital. Lol

[stellahead]

Where are the senior members here? I was really hoping for a more substantial response. Bump.

[mmiller3]

12 hours ago, stellahead said:

Where are the senior members here? I was really hoping for a more substantial response. Bump.

I am not a senior member, but what sort of response are you looking for?

[stellahead]

Ideas on what can be done, especially on how to approach admin. Has anyone seen this type of push before? Any legal recourse? They're basically saying PAs hired by hospitals are in essence providing kick backs to the doctors who are credentialed there. Sounds kind of like a big deal to me. 

[dht88169]

Sounds like a kickback to me.... APCs should either be employed by a physician or have the same direct employer as the physician.  An APC employed by a hospital, cannot perform a service, and subsequently bill it under a physician who is not employed by the hospital.  If an APC performs a service and bills for it, payment is made to the APCs employer.  From what that article suggests, physicians who are not directly employed by the hospital are billing for services which they did not perform but were performed by an APC employed by the hospital.  In other words it appears that the physicians here are billing for services (closures and post op notes) that they received for no cost but at the expense of the hospital.  The solution to this is that the APCs need to have the same employer as the physicians.

[fireguy]

I agree.  It appears that the physicians who are not employing the APP are being paid by the insurance companies for services performed by the APP, who is paid by the hospital.   Look at it this way . Surgeon Joe has a choice of where he wants to do the radical hemicorpectomy procedure.  Hospital A or Hospital B.  Hospital A will provide a surgical assist who will do all the closing and post op follow up, and surgeon Joe can bill for it and collect money.  Hospital B will allow Surgeon Joe to bring his employed by the practice PA in, who will close, and do the post op follow up.  .  Surgeon Joe pays PA Dimaggio his salary.  When surgeon Joe bills for services, he is paid 1000$ by the insurer.  At Hospital B, Surgeon Joe has to pay PA Dimaggio $200 for his time and effort in seeing the patient. At Hospital A, Surgeon Joe can be on the Golf course, and when the bill is paid, he makes $1000, since the hospital is paying the PA salary.  $200 dollars different for same procedure.  If the hospital is picking up the difference (by employing the APP), that can easily be construed as a kickback.  

 

 

[cinntsp]

It's a weird setup for sure.  I have a friend that worked with a hospitalist group at an academic center, but was employed by the hospital, while the physicians were part of a separate group.  I never understood how that was supposed to make sense.

I do some work at a Tenet hospital but am employed by a separate hospitalist group that is contracted by the hospital.  Everything must be co-signed as required by hospital bylaws(not state law) but the docs don't have to write a separate note.