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How often do you hear someone say, "That person does not need to be in the ED."? What if there were a system where the ED came to them?
Brad N., M.D. - January 31, 2017 9:50 AM
Interesting evolution to pre-hospital care. I'm curious about the economics of this service. Are patient's billed not only for the EMS call, but also billed for the NP services? What is the reimbursement rate, on average? Is the program financially self-sustaining or does it require funding from the county/city (which then is passed on to tax payers)? Thank you for your insight.
Jennifer F. - March 15, 2017 12:24 PM
Sorry for the delay...The overarching goal of the Advanced Practitioner Response Unit is to pursue patient-centered care by ensuring client safety, timely linkage to medical and social services, and providing for a positive experience of care. Upstream dispositioning by experienced NPs has helped a select group of patients save on both the direct and indirect costs of acute care, and this approach has served to highlight and improve systemwide inefficiencies. LAFD also sees the benefits of using Advanced Practitioners to free-up other 911-responders, so these other ambulances in turn can quickly attend the next time-critical emergency in the community. LAFD is currently not billing for this service, and like many mobile integrated healthcare programs around the country, is working on ways to ensure sustainability and improve patient navigation in close collaboration with each client's respective payer. CMS has suggested in the past that mobile integrated healthcare will be re-imbursed using value-based strategies, however these remain to be defined.
William L. - July 1, 2020 9:18 AM
I'm a nurse practitioner certified in both emergency and family practice with over 10 years emergency experience. I recently moved from a group where I had a great deal of autonomy and could choose when to utilize my attending for cases/decisions that I was not comfortable with to a group where I'm expected to report every case and am micromanaged to distraction. I feel like I'm losing my decision making skills for lack of being allowed to make a decision. I feel I have gone from a collaborative relationship with my attending to a subordinate relationship. My question is twofold:
1) Is there any good research and/or articles about the best way to utilize NP/PAs in the emergency department?
2) Is there any good way to let my attending know that I know enough to know what I don't know and will gladly ask their advice in that case. Otherwise, they're just making more work for both of us and destroying my efficacy and job satisfaction in the process?