Presentation on theme: "Deb Bakerjian PhD, RN, FNP Thomas Caprio MD Charles Crecelius MD, PhD"— Presentation transcript:
1 The Nuts and Bolts of NP/physician Collaborative Agreements in Long Term Care Deb Bakerjian PhD, RN, FNPThomas Caprio MDCharles Crecelius MD, PhDKaryn Leible RN, MD, CMDMary Pat Rapp PhD, RN, FAANPBarbara Resnick PhD, RN, FAANP, FAAN
2 Purpose of this Session This session is designed to help interested nurse practitioners and physicians design a collaborative practice agreement. The essential components of an agreement will be reviewed followed by small group sessions where the attendees will evaluate the strengths and weaknesses of a variety of agreements.
3 DisclosuresThe authors have no disclosures related to this presentation.
4 Learning ObjectivesIdentify the essential components of a nurse practitioner/physician collaborative practice agreement.Recognize the strengths and weaknesses of 4-6 different collaborative agreements.Develop the basic components of a collaborative practice agreement for a personal practice.
5 BackgroundA MDA & GAPNA formed Ad Hoc workgroup to explore collaborationResulted in white paper published in both JA MDA & Geriatric NursingSeveral areas of agreement in the areas of collaborationFeedback indicated many NPs & physicians are unsure of how to develop collaborative agreements
6 What is Collaboration?The regulatory definition of ‘‘collaboration’’ is defined at 42 CFR (c): Collaboration is a process in which a NP works with one or more physicians to deliver health care services within the scope of the practitioner’s expertise, with medical direction and appropriate supervision as provided for in jointly developed guidelines or other mechanisms as provided by the law of the State in which the services are performed.
7 What is Collaboration? contin In the absence of State law governing collaboration:Collaboration is a process in which NP has relationship with one or more physicians to deliver health care services.Such collaboration is evidenced by documenting NPs’ scope of practice and indicating relationships with physicians to deal with issues outside their scope of practice.NPs must document this collaborative process with physicians.
8 What is Collaboration? contin Collaboration The regulatory definition of ‘‘collaboration’’ is defined at 42 CFR (c): The collaborating physician does not need to be present with the NP when the services are furnished or to make an independent evaluation of each patient who is seen by the NP.’’
9 Collaboration in Practice Continuing professional relations that fosters best patient outcomes through optimal use of individual skillsDynamic process dependent upon skills & competencies of NP & physicianCollaboration is an iterative process involving:Trust, excellent communicationMutual goals & common direction in practiceCollaboration requires each party sharing responsibility for care
10 Why Collaborate Expands the overall expertise of the practice Collaboration between NPs & physicians shown to improve resident outcomes
11 State RegulationsNP scope of practice is regulated at the state level and varies widelyPearson report is excellent source providing data about state regulations and variationsNPs & physicians must know their state regulations prior to constructing a collaborative agreementFederal regulation may be more restrictive than states in some cases
12 Collaboration Best Practices Ideal attributes of NP/physician collaboration include collegiality, respect, & patient-centered careNPs & physicians skills are unique to their trainingSkills often overlapComplex, high-acuity patient care requires distinct skills of bothDelegated tasks/skills must be mutually understood & agreed uponStrong collaborative practices shares common goals & key principlesClinical competencyConsistent care delivery processessound problem-solving & decision-making skills
13 Collaborative Agreements Collaborative agreement is a contract between NP & physicianBased on mutual agreement and understanding of unique skillsCan be either procedurally or process basedShould not be too specific – this is a key area where practices may face problems
14 Processes Should be broad based Should be realistic and relevant to specific practiceBased on scope of practice allowed in state and within the education, training & experience of NPMutually agreed upon
15 Procedures Procedures outline steps to accomplish a specific task Procedures should be applicable to everyone within a practice (not just the NP)Procedures are best conceived as a guideline and not specific steps or rigid rulesPreamble to procedures should indicate they are guidelines unless otherwise specified
16 The Road to Collaborative Agreements Assemble the factsMembers of the teamCredentials of the teamExperience of the teamPractice descriptionNumber & types of patientsSettings/location of patientsSupport services availablePayer sources
17 The Road continuedDetermine the skills, competencies of the NP & physician based on the practice needsDetermine the responsibilities of the physician & NPExpectation of patient visitsExpectation of documentationOn call, vacation coverageDiscuss/describe communication processWhat about emergencies
18 The Road continued Standardized care processes Resources Documentation EHRPaperSemi-structured formsBilling processesResponsibility of cliniciansCommunicating work completed to billers
19 The Road continued Confidentiality & non-disclosure Non-compete clause HIPAA complianceNon-disclosure of proprietary dataNon-compete clauseSpecific non-compete languageLength of time of non-complete
20 The Road continued Provision of resources Payment Office space Exam rooms (if also seeing office patients)Telephone, computer, beeperPaymentHourlyAnnual salaryFee for servicesBenefits, vacations, continuing education
21 The Road continued Audits Know state requirements Audits should be reciprocalEx: 10% of both NP & physician charts will be audited to determine degree that protocols are followedEx: Each quarter 20 NP& 20 physician charts will be randomly pulled to review as a team. Each quarter may focus on a different care process or disease process
23 Typical Collaborative Agreement Sections General Information (parties)Names, degrees, licensesCompetenciesPractice descriptionSettings & conditions of care covered by agreementNursing home, office, hospital, patient homeRoutine, urgent, emergencyDocumentation, medical recordsClinical practice standards, guidelines
25 Collaborative Agreement Limitations on authorityReview of care (if required)Chart reviewSignatures neededTiming of review/signaturesMutual auditsDuration of agreement
26 Types of Collaboration NP employed by physicianNP & physician both employed by group or NH (staff model)NP contracted (self-employed) or employed by NP PracticeNP employed by NHNP employed by payer (Evercare)NP in specialty collaborative practice & consulting
27 GROUP WORK- 30 min Break in to 6 small groups Each group has a vignette and facilitatorDiscuss the issues related to the scenarioBe prepared to report out to the rest of the group on your recommendations or questions
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