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Questions for PA's in Ohio!! (pulmonary outpatient/inpatient position in a practice currently with only NP's)


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I hope I can find some assistance with this!

Background story-I did a clinical rotation with an NP I knew in a pulmonary practice in Ohio. This practice (and area in general) is very NP dominant and has never employed a PA before. The NP I know reached out due to a potential opening due to situation with one of their new hires and wanted me to gather information for her and the other NP at the office to present to one of the partners in the practice in hopes of convincing them to hire a PA (me 🙂). This position would be a mixture of outpatient and inpatient rounds a few days a week at a hospital. They also occasionally do rounds at an LTAC. The physicians and one of the NPs in the practice also do rounds in ICU (the other NP is not acute care certified so she is unable to).

My question--In Ohio, I know I would be able to see and bill for all of my own patients in an outpatient setting, but I was wondering if this is the case inpatient (including ICU and LTAC) as well. I am currently a PA in hospital medicine in Pennsylvania (nocturnist position) and know that my daytime PA colleagues have to have all of their patients seen and addended by the physicians (they essentially act as scribes). I know Pennsylvania requires 100% co-signature, but for Ohio's co-signature requirement, their statement: "Required review of selected patient record entries made by and medical orders issued by the PA" is vague to me and doesn't really answer my question of whether or not they would have to see every patient that I would round on in the hospital.

This seems to be the biggest barrier to them hiring a PA and I wanted to be able to provide this information so they could consider hiring me and taking the chance on switching up their normal thoughts of only hiring nurse practitioners because it's what they know and are comfortable with. I was also hoping to offer rounding in the ICU as well given I have some ICU training and since one of their NP's cannot currently do that as some more persuasion. Would all the patients I see in the unit also need to be seen by the physicians? 

 

Sorry for the loaded question, just hoping for some input from currently practicing Ohio physician assistants since my google search isn't helping! 

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The barrier might be hospital bylaws. I work in Ohio (but not inpatient medicine so take this for what it’s worth) but I think over the years I have heard that the hospital bylaws dictate how often a patient has to be seen by the admitting physician (and the fact that PAs don’t have admitting privileges).  

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I have worked in inpatient medicine in Ohio (though not in the last year). 

Physicians did not have to see our patients or cosign our orders before they are executed. We did have our charts and orders countersigned (easy step with Epic, etc), but that happened offsite and/or off-hours.

This is the practice for both the PAs and NPs in our group (and, as far as I know, in other practices as well). It especially made sense for us since the physician was often called for overnight changes and this way he knew what we had been up to.

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23 hours ago, physassistww said:

Thanks everyone for the input, I gave them the info! They have their meeting on Monday to discuss the future of their current NP who they are having issues with, so hopefully I will hear if my "hire a PA instead pitch" works! 🙂  I will keep you all updated.

Keep us updated on this one.  I would be shocked if they brought on a PA over just going after another NP, but who knows.

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BTW, the supervisory agreement (which might have been renamed by now) need only be kept in your file at your practice; no need to file it with the state in Ohio. I believe they just need to indicate that you are now working for whomever the physician(s) are at the new practice.

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I've done EM in Ohio, not IP.  The docs did not see all of out patients, in fact didn't see most of them.  They did put a "I was available for consultation note" in the chart - that was at the the request of the EM staffing co so they could bill at the 100% incident to rate.  From reviewing IP notes on folks I'd seen that were admitted (the hospitalist doc was the official accepting provider) even if the hospitalist PA's or NP's actually accepted the admission, the docs did not sign all the notes.

One thing you will have to consider is that PA's in Ohio can't order the meds for procedural sedation/RSI, so that will require the doc's presence for intubations, etc.

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