C25

Physicians

Standing out by providing physicians with uncommon support

An important key to the success of our Foundation of Care starts on the front lines, at the point of care. Our collaborative practice model is designed to provide Attending Physicians and Medical Directors with comprehensive support for patients in long-term care settings.

We provide PHS Physicians and Nurse Practitioners (NP) who have a passion for geriatric care. While the PHS NP and Physician follow individual state regulations for scope of practice and chart review, direct supervision of the Nurse Practitioner is not required.
As a result, teaming with a PHS NP to manage the day-to-day rigor of patient care provides several important advantages for the physician and facility Medical Director:

  • Frees the physician to attend to other areas of need
  • Improves the efficiency of services that physicians can provide to patients
  • Decreases the number of calls to the physician and his/her office
  • Helps the care center meet state and federal regulatory guidelines

Attending Physicians and facility Medical Directors can confidently rely on the PHS
Nurse Practitioner to:

  1. Make regular rounds at the long-term care center
  2. Provide call coverage for long-term care and SNF patients
  3. Assess patients, review medications, orders, and laboratory tests
  4. Perform annual history and physical assessments
  5. Review and respond to abnormal laboratory values
  6. Review and respond to pharmacy and consultant recommendations such as psychiatric, dietary, speech therapy, and physical therapy
  7. Attend to acute and chronic problems presented on a daily basis
  8. Conduct critical visits:
    • Post-hospitalization
    • Patients experiencing acute illness such as infections, respiratory problems, urinary tract, and wound management
    • Patients whose chronic condition changes
    • Patients with unkown mental status changes

While ultimately, the effectiveness of our Foundation of Care is measured by patient satisfaction and outcomes, it starts with those who deliver it at the point of care. That's why every day we strive to make a positive difference in the lives of the patient, as well as the physician.

To learn more about the specific role and capabilities of the PHS nurse practitioner, leave your information at the Contact Us link.


Physicians FAQ


How many visits does the NP have to make for PHS?
There are no quotas for the PHS Provider and no pre-determined reason for seeing patients. All patients are seen based on medical necessity.

How can we both see the patients under Medicare?
NPs will be doing medically necessary acute and episodic care visits. Physicians have oversight and make chronic disease management visits (recertification), and initial comprehensive H&P visits.

Can you only see the patient once or twice per month under Medicare?
There is no "cap" on the number of times per month a patient may be seen by the Provider. However, all visits must be medically necessary and patient driven. Follow-up visits are done according to national AMDA standards for appropriate re-evaluation of geriatric residents in LTC.

Will I be making less money if a NP is also seeing my patients?
Typically the NP is seeing patients for the problems and concerns that are currently being faxed or called to the office or to the physician. Phone and fax responses are non-billable. Under the PHS model, the patient is seen and assessed promptly rather than treated based on a faxed report, saving the physician time and preventing delay in evaluation and treatment of the patient.

What visits can the NP make?
Acute or episodic care visits; annual H&P; discharge; alternating chronic disease management visits (if allowed by  the state and preferred by physician); first visit on a new patient (prior to the initial comprehensive H&P visit by the physician).

Do I have to supervise the NP while he/she is seeing patients?
No. The model of care is a collaborative practice model. The NP and physician follow individual state regulations for scope of practice and chart review, but direct supervision is not required.

Will my malpractice premiums go up?
PHS provides the professional liability coverage for all of our NPs. The NP is not carried on the physician's medical malpractice policy. Any specific questions about your individual med-mal policy should be directed to your carrier. Liability of a particular attending physician may, in fact, be reduced significantly by having a NP on site to see patients at the time of need rather than encountering a possible delay in direct Provider care.

Is the NP an employee of mine or the Nursing home?
Neither. The NP is an employee of PHS.

What documents can the NP sign in the Nursing Home?
Verbal orders, pharmacy recommendations, letters that families need or request, some social services forms, depending on the state and discharge forms

What forms is the NP unable to sign?
Initial 30-day H&P; Forms to apply for State aid or Medicaid; Hospice or Home Health orders

Does the NP take after hours call?
Yes. The NP typically takes the after-hour and weekend calls related to the nursing home patients. However, the physician and NP may make other arrangements for call.

How will I know what the NP has done each day?
The NP and Physician establish a communication process for their practice. This may be a daily phone call or other mechanism of communication. The extent and manner of communication is mutually agreed upon. The NP provides a visit note to the facility for the chart.

Do I have to sign each note the NP writes?
No, but some states require the review of a percentage of charts for QA purposes. 

Can the NP perform dietary and pharmacy reviews on my patients?
Yes. The NP will review consultant pharmacy and dietary recommendations and order interventions accordingly.  This practice will insure compliance with Gradual Dose Reductions and weight management as required by Federal regulations.

I already have an NP in my practice. Won't this program compete with my NP making visits?
Physicians who already employ NPs frequently re-assign that NP to their private office practice and have the PHS NP focus on their LTC patients. In this manner, the office is a more productive practice and there are fewer interruptions in the office practice because the PHS NP is on site caring for the nursing home patients.

What other functions can the NP perform on behalf of the attending?
The NP can serve as a bridge of communication between you and your patient and their families since they are onsite and more available during the day when families often visit.  

 

A NP can address code status, preventive interventions, surgical and other workups with patients and families.  NPs can save you time and increase patient and family satisfaction on your behalf. 

 

With the shortage of registered nurses in the nursing home setting, the NP provides skilled oversight of nursing issues when necessary.

 

The NP may perform procedures on site that other nursing personnel may not be able to perform such as venipuncture, suturing, catherization, replacing G-tubes, impacted cerumen removal, PAC flushes.

 

NPs are an excellent resource for attending Care Plan conferences on your behalf, meeting patients and their families and discussing issues with the interdisciplinary team. This saves you time and increases patient and caregiver satisfaction.

 

Most importantly, the NP can reduce unnecessary hospitalizations by being onsite and addressing acute clinical issues promptly. This can save the facility from providing non-emergency transportation to the hospital, reduce unnecessary laboratory and radiological testing and costs to the patient, family and facility and increase patient and caregiver satisfaction.