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(Editor's note: This is the second of a two-part series that describes how two agencies use nurse practitioners in their program. Last month, we looked at services provided by the two programs, and this month, we evaluate reimbursement for nurse practitioner services as well as how to hire nurse practitioners.)
The challenges faced by home health managers when hiring nurse practitioners are many of the same challenges faced when hiring home health nurses. While it takes time and effort to find the right person, a nurse practitioner can add an extra level of service within your agency, according to experts interviewed by Hospital Home Health.
Physicians surveyed prior to the start-up of a palliative care consulting service offered by her home health agency indicated that while they wanted someone with a high level of assessment skills, they preferred not to work with a physician, says Kim Kranz, RN, MS, vice president of operations at Home Nursing Agency in Altoona, PA. The palliative care consultant works with physicians, hospital staff, and families to suggest symptom control methods, identify goals for the patient's future care, and help families make difficult decisions regarding their family member.
Although palliative care is common in a hospice setting, Kranz wanted a nurse practitioner who was not a hospice employee. "Not all of the patients seen by our consulting service are ready for hospice, so I did not want patients and their families thinking that we were suggesting hospice, she says.
Because the palliative care consultant is talking with patients and family members about sensitive, emotional issues, it is important that the person is compassionate, as well as knowledgeable, and able to talk to people in difficult situations, says Kranz. "The nurse practitioner also needs to be able to communicate with the physician at a different level as well, she adds.
Just as the shortage of experienced home health nurses makes it difficult to add staff, there also is a shortage of nurse practitioners, says Joan Marren, RN, MEd, CEO of the Visiting Nurse Service of New York. "I believe that there are a lot of nurse practitioners who would like to work with home health agencies, but we have not had a lot of openings for them, so they probably don't consider it a career option.
For Marren's service that has a nurse practitioner visit the patient in the hospital before discharge and at home before the first physician visit if needed, the requirements included community health experience and experience as a nurse practitioner. Just as she would not hire a new graduate to make home health visits without prior nursing experience, Marren wants nurse practitioners who are accustomed to working independently.
You also need to develop the job description to appeal to nurse practitioners, says Marren. "Nurse practitioners are interested in jobs with a wide scope of responsibilities for which they can make use of their nurse practitioner skills, she says. "They are interested in a collaborative practice and salary and benefits do play a part in their decisions.
Nurse practitioners can be reimbursed under Medicare Part B, points out Marren. "As long as their activities are substitutes for physician services, you are reimbursed, she says. For example, visits to the patient to conduct medical assessment, manage a health condition, or provide intervention are all legitimate, she adds. "A telephone consultation or a conversation with a home health nurse to discuss a patient are not billable, she says.
Because the reimbursement falls under Medicare Part B guidelines, your billing department must have the correct forms to file and everyone needs to understand the documentation requirements, says Marren. "There are different requirements for nurse practitioner documentation and home health nurse documentation, so there is education involved, she adds.
While some activities or some costs may not be fully reimbursed, the nurse practitioner does offer other benefits to a home health agency, says Marren. "Our re-hospitalization rates have dropped since we implemented our nurse practitioner house calls program, and physicians have been very happy with the service, she says. "The physician satisfaction and the improved outcomes have resulted in more referrals to the agency.
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