Review finds APRNs may outperform physicians | National Nursing News

Review finds APRNs may outperform physicians | National Nursing News

AANP Conference

http://www.lvrj.com/news/sebelius-addresses-5-600-124408819.html

Awesome conference! The lecture where I presented our clinic model received a standing ovation; there are many NPs who are just getting the state authority to practice independently. As you can see from the link above, the federal government is very enthusiastic about NPs. Thanks for your patience while I was gone, and thanks to Lisa for taking over so I could go.

WORKLOAD!

I am so happy to report that the clinic is doing great! I am busier than ever though and trying figure out ways to get out of here on time for dinner.

You may not know this but many of the tasks I provide are not covered by your insurance. Phone calls and emails along with many other duties are considered non-covered benefits. Many providers have chosen to have a yearly non-covered benefits fee of between $100 to $300 per patient, and others have chosen to charge fees for certain services; for now, I fall into the latter category and will post fees for extra work on my website in the next few months.

If any of the next 3 items are completed during an office visit, the fee will be waived, otherwise the fee is $30.

• Referral letters and insurance pre-authorization for specialists visits
• Letters for school, work, jury duty, etc.
• Form completion, including medication pre-authorization, FMLA / short-term disability, DOT physical, sports physical, etc.

I will offer the following services on a fee-for-service basis:

• Virtual visits -- if any email request will take longer than 10 minutes or require a treatment plan / prescription, you will be sent a virtual visit form ($30)
• Phone consult -- this is if you want to speak to me on the phone for medical advice that normally would be discussed at a proper visit ($30 per 15 minutes)
• After-hours phone calls (anytime other than 9am to 5pm on Monday to Friday) -- calling after hours for medical advice and treatment, and keeping you out of Urgent Care or the ER ($40)

So why, you might ask, am I doing this? I know it is hard to believe but there are patients who consistently use the "free" services and don't come in for a visit, and that is not in my business plan. I do always reserve the right to waive the charge, but I just want the policy out there if I need to use it. Would love feedback from all of you! -- Kristina

Call to Action

Many of you already know that I belong to a non-profit organization called Ideal Medical Practices, IMP for short (http://www.idealhealthnetwork.org/). The IMP clinic model is designed to enhance provider-patient relationships, increase face-to-face time with providers and patients, reduce the workload in primary care, and instill patients with a sense of responsibility for their health and their health care dollars. An excerpt from the website is below:

The goal of an Ideal Medical Practice is Ideal care for patients in balanced, ethical and sustainable practices.

Ideal health care rests on a foundation of effective primary care.

1. Effective primary care is based on excellence in access, relationship over time, comprehensive services, and care coordination.
2. Ideal care is defined through patient experience.
   • “I can get care when and how I need it”
   • “I have a PCP who knows me as a person”
   • “My PCP takes care of the bulk of my health care needs”
   • “My PCP coordinates any and all care I need”
3. Balanced, ethical and sustainable practices are defined through Primary Care Provider/PCP experience.
• “I am free to do what is best for my patient”
• “I have the funding and autonomy I need”
• “I have the time I need”
• “I know my patients and can communicate with them effectively”
• “I have the tools, and technology I need”

Briefly, I want to address the above statement because some of the goals are being met, but all the goals are attainable and necessary for our health care system to survive and thrive. I will use Village Family Clinic as the example; I think we do a pretty good job with items #1 and #2, mostly because those are the items over which the provider and patient have control. #3 is where the health care system has control and causes providers the most trouble.

• "I am free to do what is best for my patient" -- Many patients are dealing with high deductible insurances (or no insurance) and cannot always financially afford the best evaluation or treatment. And anyone who has ever waited for a referral to a specialist or pre-authorization for tests or medication knows that the provider does not make the final decision with respect to care.
• "I have the funding and autonomy I need" -- Third party payers (ie -- insurance companies) are the "elephant" in the exam room, due to some of the issues from the last statement, taking away autonomy by creating barriers to increase provider workload and increase patient expense, thus discouraging both from the proper care. I understand that most systems need checks and balances to control quality and cost, but I do 6-8 hours of uncompensated work per week because of these barriers. As far as funding, let's just say there is a reason that doctors are choosing specialties over primary care by a 50 to 1 margin.
• "I have the time I need" -- With the IMP model, I have enough time with patients because I decreased my clinic expenses, so I can generate less revenue and still keep the doors open. Our medical system financially rewards the providers that see the most patients, and not the providers that give the best quality care.
• "I know my patients and can communicate with them effectively" -- This one is no problem, right? Have I mentioned that I LOVE EMAIL! But the privacy police will be after me to comply in the next few years -- the only solution will be a securepatient portal that either you, I or all of us will have to pay for.
• "I have the tools and technology I need" -- Finally most clinics are embracing technology, and that has created competitive prices for electronic health records/systems. This has also created programs that are completely different and cannot "talk" to each other and work together. It is inexcusable that we cannot communicate securely with specialists and hospitals when we can do it with the pharmacies through e-prescribing. I still get almost all patient information from outside the clinic by fax -- talk about not secure; if you are one number off, then your neighbor gets the test results.

Well, there are no perfect solutions, but it is a fact that health care systems with strong primary care as a base have healthier patient populations (Davis, Commonwealth Fund 2007, Wasson, JACM 2006, Moore, JACM 2006). In October 2011, I am going to Washington DC with IMP as the nurse practitioner liaison. We will be advocating for improvements in primary care, and the "hook" is "Primary Care can thrive on $1 a day."

What does that mean for us? If your health care provider (me) was paid $365 per year for each patient (which is about as much as everyone pays per month for insurance), I could make a living with a patient panel of 600 people. I currently have 1200 patients to do the same thing. Obviously this is way oversimplified because some patients need more or less care, but the concept is the same: 80-90% of health care could be done for 1/12 of the price. Hmmmm -- I see that as pleasing to both sides of the aisle in DC.

If any of you have stories about our health care system that I can share with the congressional members in October, please email them to me in the form of a letter. I will take them with me and you will be heard. Thanks!

Kristina

KG and VFC published online!

Here is a link to an article about Village Family Clinic and the technology used to accomplish successful patient care.

http://amazingcharts.com/why-us/hear-what-users-say/kristina-garrido-case-study/

SECOND YEAR ANNIVERSARY!

It is our 2nd anniversary with many positive changes for the next year. Now that we are open 6 days a week (with the addition of Lisa Garcia, ARNP) there will be plenty of convenient appointments for everyone. Also, I am on the board of Ideal Medical Practices, a non-profit dedicated to saving primary care by encouraging and educating small practices about their business and latest technology. I hope to help other doctors and nurse practitioners to practice medicine without getting on the "hamster wheel."

I appreciate your continued patronage and support -- I could not have done it without you! -- KG