Essential information for NP and PA students beginning in Family Practice Residency. These are the tips most schools and preceptors fail to mention regarding time management skills and how the business of medicine works.
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Jumping into primary care
1. Jumping into PrimaryJumping into Primary
CareCare
Kimmer Collison-RisKimmer Collison-Ris
MSN, ARNP, WOCNMSN, ARNP, WOCN
2. Taking on a New RoleTaking on a New Role
īŽ Find a mentor matchFind a mentor match
īŽ Understanding the learningUnderstanding the learning
curvecurve
īŽ Know what you knowKnow what you know
īŽ Study-study-studyStudy-study-study
īŽ Simplify your home lifeSimplify your home life
īŽ Build routines into your weekBuild routines into your week
īŽ Build in a day of restBuild in a day of rest
3. Preparing for the visitPreparing for the visit
īŽ Work with your MAWork with your MA
īŽ Know what your RNâs doKnow what your RNâs do
īŽ Delegate when you canDelegate when you can
īŽ Know your patient roomsKnow your patient rooms
īŽ Know your daily scheduleKnow your daily schedule
īŽ Know how long procedures takeKnow how long procedures take
īŽ Know how to billKnow how to bill
īŽ Chart as you goChart as you go
īŽ Plan on 15 min for a visitPlan on 15 min for a visit
īŽ Keep your visit straight forwardKeep your visit straight forward
īŽ Know when to referKnow when to refer
4. Types of Patient visitsTypes of Patient visits
īŽ 1 problem (approx 15 min)1 problem (approx 15 min)
īŽ Assess each system above & downAssess each system above & down
īŽ Know when to include anotherKnow when to include another
systemsystem
īŽ Culture, peak flow, treat as you goCulture, peak flow, treat as you go
īŽ Chart as you goChart as you go
īŽ Account for time spentAccount for time spent
īŽ Plan f/u visit for other issuesPlan f/u visit for other issues
5. ProceduresProcedures
īŽ Plan ahead & schedule apptPlan ahead & schedule appt
īŽ Can only do on same visit if newCan only do on same visit if new
patientpatient
īŽ Canât do w/office visit on sameCanât do w/office visit on same
dayday
īŽ Plan (30-40 min)Plan (30-40 min)
īŽ Know what you can do in officeKnow what you can do in office
īŽ Know when to refer!!!Know when to refer!!!
6. Being preparedBeing prepared
īŽ Know your daily scheduleKnow your daily schedule
īŽ Know your âgo to resourceâKnow your âgo to resourceâ
īŽ Carry a couple reference booksCarry a couple reference books
īŽ Carry paperwork w/youCarry paperwork w/you
īŽ Know recent labs/studies performedKnow recent labs/studies performed
īŽ Do cultures/dips/sats/screensDo cultures/dips/sats/screens
īŽ Plan next f/u visitPlan next f/u visit
īŽ Enlist MA or Nurse assistanceEnlist MA or Nurse assistance
īŽ Know where local resources areKnow where local resources are
7. Mid-Level CareMid-Level Care
īŽ Different than student roleDifferent than student role
īŽ Can feel overwhelmingCan feel overwhelming
īŽ Designed for PEâs, wccâs, episodicDesigned for PEâs, wccâs, episodic
care, chronic care, & urgent carecare, chronic care, & urgent care
īŽ Increases patient access to careIncreases patient access to care
īŽ Frees MDâs for complex careFrees MDâs for complex care
īŽ Temptation to work out of scopeTemptation to work out of scope
īŽ Need to âtag-teamâ with MDNeed to âtag-teamâ with MD
īŽ Know roles/scope of MAâs, Nurses, &Know roles/scope of MAâs, Nurses, &
Office staffOffice staff
8. New ExperienceNew Experience
īŽ Interpreting odd Lab dataInterpreting odd Lab data
īŽ Interpreting odd diagnostic testsInterpreting odd diagnostic tests
īŽ Keeping visits simple/shortKeeping visits simple/short
īŽ Charting in âreal timeâCharting in âreal timeâ
īŽ Constant flow of patientsConstant flow of patients
īŽ Temptation to skip breaksTemptation to skip breaks
īŽ Temptation to âdo it allâTemptation to âdo it allâ
īŽ Temptation to do proceduresTemptation to do procedures
īŽ Temptation to work out of role/scopeTemptation to work out of role/scope
9. Know Practice ExpectationsKnow Practice Expectations
īŽ How many patients dailyHow many patients daily
īŽ Charting expectationsCharting expectations
īŽ Patient follow up expectationsPatient follow up expectations
īŽ Know practice reimbursementKnow practice reimbursement
īŽ Know practice philosophy of careKnow practice philosophy of care
īŽ Know role of practice managerKnow role of practice manager
īŽ Who is your boss?Who is your boss?
īŽ Know practice medical director roleKnow practice medical director role
īŽ Know when to interrupt someoneKnow when to interrupt someone
īŽ Know practice expectation of staffKnow practice expectation of staff
10. General Family PracticeGeneral Family Practice
īŽ Philosophy of carePhilosophy of care
īŽ Make up of Pediatrics/Adults/GeriatricsMake up of Pediatrics/Adults/Geriatrics
īŽ Charting Requirements for reimbursementCharting Requirements for reimbursement
īŽ Coding Requirements for reimbursementCoding Requirements for reimbursement
īŽ ââLeaky Boatâ to a practiceLeaky Boatâ to a practice
īŦ High % of HMO, Medicade, Medicare, chronic woundHigh % of HMO, Medicade, Medicare, chronic wound
carecare
īŽ Money MakersMoney Makers
īŦ Labs, proceduresLabs, procedures
īŦ CosmeticCosmetic
īŽ % of Practice Patients% of Practice Patients
īŦ MedicadeMedicade
īŦ MedicareMedicare
īŦ HMOâsHMOâs
īŦ Private PayPrivate Pay
īŦ InsurersInsurers
11. Surgical PracticeSurgical Practice
īŽ Know pt mixKnow pt mix
īŽ Know insurers/reimbursement foKnow insurers/reimbursement fo
īŦ ConsultationsConsultations
īŦ ProceduresProcedures
īŽ Your role frees up SurgeonsYour role frees up Surgeons
īŽ Surgical assist is reimbursableSurgical assist is reimbursable
īŽ Cosmetic procedures make $Cosmetic procedures make $
īŽ Know your scope of practiceKnow your scope of practice
īŽ Know practice philosophyKnow practice philosophy
īŽ Know expected work & on call hoursKnow expected work & on call hours
12. Specialty PracticeSpecialty Practice
īŽ Know patient mixKnow patient mix
īŽ Know philosophy of careKnow philosophy of care
īŽ Know your expected roleKnow your expected role
īŽ Know how you benefit practiceKnow how you benefit practice
īŽ How do you bring in moneyHow do you bring in money
īŽ Know reimbursement differencesKnow reimbursement differences
īŽ ConsultationConsultation
īŽ Stream-lined care, specializedStream-lined care, specialized
īŽ Usually affords more timeUsually affords more time
īŽ Know money-pitsKnow money-pits
īŽ Know money makersKnow money makers
13. Becoming a Smart ProviderBecoming a Smart Provider
īŽ Fill out your own paperworkFill out your own paperwork
īŽ Know your numbersKnow your numbers
īŽ Know Coding/billing/reimbursement processKnow Coding/billing/reimbursement process
īŽ Consider becoming a P.S.Consider becoming a P.S.
īŽ Carry your own Malpractice InsuranceCarry your own Malpractice Insurance
īŽ Get an accountant (file quarterly)Get an accountant (file quarterly)
īŽ Know your tax write-offsKnow your tax write-offs
īŽ Get quickbooks and record receipts dailyGet quickbooks and record receipts daily
īŽ Employee, Consultant, Sub-ContractorEmployee, Consultant, Sub-Contractor
(Locums)(Locums)
īŽ Signing up w/insurersSigning up w/insurers
īŦ Medicare (know probs & pitfalls)Medicare (know probs & pitfalls)
īŦ Regence, Premera, UniformRegence, Premera, Uniform
īŦ HMOâs expectationsHMOâs expectations
īŦ MedicadeMedicade
14. Charting the basicsCharting the basics
īŽ Write out chief complaint cc:Write out chief complaint cc:
īŽ State new or âpt is new to meâState new or âpt is new to meâ
īŽ Write out timing, duration, location, severity, worseningWrite out timing, duration, location, severity, worsening
sxsx
īŽ Include pertinent (+) and (-)Include pertinent (+) and (-)
īŽ ROS (at least 2)ROS (at least 2)
īŽ Exam (1 system up, 1 system down, others asExam (1 system up, 1 system down, others as
indicated)indicated)
īŽ Assessment: Dx &/or diff. dxAssessment: Dx &/or diff. dx
īŽ Determine stability, acute, chronic, worseningDetermine stability, acute, chronic, worsening
īŽ Plan of care: address all pointsPlan of care: address all points
īŽ If referring use âconsultationâIf referring use âconsultationâ
īŽ Describe when f/u will occurDescribe when f/u will occur
īŽ Include labs reviewed/discussed/MD specialistsInclude labs reviewed/discussed/MD specialists
conferred withconferred with
īŽ Include rx meds orderedInclude rx meds ordered
15. MedicalMedical
Coding/ReimbursementCoding/Reimbursement
Remember that carrying out care is differentRemember that carrying out care is different
than what you learned in schoolthan what you learned in school
Need to know the basics to include in chartingNeed to know the basics to include in charting
to meet coding criteriato meet coding criteria
Always include amt of time spentAlways include amt of time spent
assessing/counseling if poss to help visitassessing/counseling if poss to help visit
codecode
Know difference between new, estab,Know difference between new, estab,
consultation, well visit, and timed visitconsultation, well visit, and timed visit
Write out detail diagnosis codes or addWrite out detail diagnosis codes or add
descriptorsdescriptors
If poss use more than 1 dx to help justify yourIf poss use more than 1 dx to help justify your
codecode
16. Coding/ReimbursementCoding/Reimbursement
īŽ You need to know as much as medical coderYou need to know as much as medical coder
(your totally responsible)(your totally responsible)
īŽ Know procedures need body identification andKnow procedures need body identification and
code and have return time requirementscode and have return time requirements
īŽ Know office visits (OV) and proceduresKnow office visits (OV) and procedures
generally canât be billed on same day unlessgenerally canât be billed on same day unless
new and require code â25ânew and require code â25â
īŽ Know code modifiersKnow code modifiers
īŽ Reimbursement classes from medical billersReimbursement classes from medical billers
vary per practice settingvary per practice setting
īŽ Canât bill for visit same day as other specialistCanât bill for visit same day as other specialist
visit for Medicare pts as is consideredvisit for Medicare pts as is considered
âduplication of servicesââduplication of servicesâ
īŽ Medicade coding is differentMedicade coding is different
17. How to get paid/reimbursedHow to get paid/reimbursed
īŽ Know Credentialing ProcessKnow Credentialing Process
īŽ Know Cash reimbursement rulesKnow Cash reimbursement rules
īŽ Canât charge non-insured less thanCanât charge non-insured less than
reimbursed for by insurers or consideredreimbursed for by insurers or considered
fraudfraud
īŽ Canât pay someoneâs co pay or licensure canCanât pay someoneâs co pay or licensure can
be revokedbe revoked
īŽ Know HMO rules before signing upKnow HMO rules before signing up
īŽ Know how your practice is paidKnow how your practice is paid
īŽ Canât âforgiveâ debt unless funding is set upCanât âforgiveâ debt unless funding is set up
īŽ If private practice, find reliable subcontractedIf private practice, find reliable subcontracted
medical biller and call their referencesmedical biller and call their references
īŽ Match charting to coding on fee slipMatch charting to coding on fee slip
18. Organizing your timeOrganizing your time
īŽ First: look at daily scheduleFirst: look at daily schedule
īŽ Review abn labs, pass normals to MA to call ptReview abn labs, pass normals to MA to call pt
īŽ Have MA room pt as arrivesHave MA room pt as arrives
īŽ Donât double bookDonât double book
īŽ Keep visits to around 15 minKeep visits to around 15 min
īŽ Clean as you go in roomClean as you go in room
īŽ Clarify needs to MAClarify needs to MA
īŽ Ask for teaching help from RNAsk for teaching help from RN
īŽ Send pt for necessary tests, sched f/uSend pt for necessary tests, sched f/u
afterwardsafterwards
īŽ In pt visit: Pick 1 or 2 probs onlyIn pt visit: Pick 1 or 2 probs only
īŽ Carry resource books w/youCarry resource books w/you
īŽ Keep interruptions to minimumKeep interruptions to minimum
īŽ Get your lunch, leave the facility-re energiesGet your lunch, leave the facility-re energies
īŽ Get help if need second opinionGet help if need second opinion
19. Keeping an office visit on trackKeeping an office visit on track
īŽ After âhelloâ _____________After âhelloâ _____________
īŽ What can I do for you today? (cc) have themWhat can I do for you today? (cc) have them
pick top 2pick top 2
īŽ Let them they can set up addâl appt for otherLet them they can set up addâl appt for other
issuesissues
īŽ Explain you want to ask specific questionsExplain you want to ask specific questions
īŽ Chart as you go your observations and whatChart as you go your observations and what
they saythey say
īŽ Assess system up and down of cc:Assess system up and down of cc:
īŽ If you find other things may need sep. apptIf you find other things may need sep. appt
īŽ Exam & ask clarifying questionsExam & ask clarifying questions
īŽ Explain observations as you goExplain observations as you go
īŽ Discuss poss tx/tests as you goDiscuss poss tx/tests as you go
īŽ Teach & Type-stating when to call/seek careTeach & Type-stating when to call/seek care
īŽ State visit finished end w/giving rx/apptState visit finished end w/giving rx/appt
20. Plan for Patient EncountersPlan for Patient Encounters
īŽ Know visit: components, worrisome findings,Know visit: components, worrisome findings,
gen tx/meds, tests to order, pt education, f/ugen tx/meds, tests to order, pt education, f/u
īŽ Practice visit types:Practice visit types:
īŦ New born examNew born exam
īŦ Jaundice/poor feeding NB examJaundice/poor feeding NB exam
īŦ Well childWell child
īŦ Well adultWell adult
īŦ Sick childSick child
īŦ Sick adultSick adult
īŦ Initial, f/u, & emergency OB visitInitial, f/u, & emergency OB visit
īŦ Postpartum f/u visitPostpartum f/u visit
īŦ Chronically ill adultChronically ill adult
īŦ Urgent care type visitsUrgent care type visits
īŦ Emergency type visitsEmergency type visits
21. Balancing Work/Home LifeBalancing Work/Home Life
īŽ Your family is your lifeYour family is your life
īŽ Donât sacrifice your spouse/S.O.Donât sacrifice your spouse/S.O.
īŽ Donât sacrifice your kids-set time asideDonât sacrifice your kids-set time aside
īŽ Learn to say ânoâLearn to say ânoâ
īŽ Incorporate daily/weekly routinesIncorporate daily/weekly routines
īŽ Know you canât âdo it allâKnow you canât âdo it allâ
īŽ Make time to studyMake time to study
īŽ Make time to exerciseMake time to exercise
īŽ Plan out meals aheadPlan out meals ahead
īŽ Keep work out of family timeKeep work out of family time
īŽ Donât talk to patients at homeDonât talk to patients at home
īŽ Date your spouse/S.O.Date your spouse/S.O.
īŽ Plan out vacation/away timePlan out vacation/away time
22. Building your C.V.Building your C.V.
-Work history-Work history
-Specialty focus-Specialty focus
-Professional Membership/Affiliations-Professional Membership/Affiliations
-Professional Lectures given-Professional Lectures given
-Professional Publications written-Professional Publications written
-Continuing Education-Continuing Education
-Professional Education-Professional Education
-Preferred Provider w/list of insurers-Preferred Provider w/list of insurers
-Community Involvement-Community Involvement
23. NetworkingNetworking
īŽ Look beyond your instructor/schoolLook beyond your instructor/school
īŽ Visit your colleagues/classmatesVisit your colleagues/classmates
īŽ Join a professional organizationJoin a professional organization
īŽ Lecture at a universityLecture at a university
īŽ Lecture within the communityLecture within the community
īŽ Host/participate in health eventsHost/participate in health events
īŽ Write a local health newsletterWrite a local health newsletter
īŽ Participate in conferencesParticipate in conferences
īŽ Participate in a studyParticipate in a study
īŽ Specialize in a field of interestSpecialize in a field of interest
īŽ Join a study group/peer review groupJoin a study group/peer review group