[NPInfo] Clinical doctorate

[DMyersFNP at aol.com]

First, KUDOS Jeff for so eloquently re-stating what many of us clinicians  
have known and understood for years.  I am coming off a "bad week" at the  
office clinically.  I found an AV malformation in the frontal lobe of a  gentleman 
that complained only of a headache and blurred vision in his right  eye.  He 
will be undergoing radiation therapy because it is  inoperable.  I also 
discovered kidney cancer on another gentleman  complaining of abdominal pain.  As a 
result of my complete abdominal exam  in the office I posited a "theory" that 
led to the need for an abdominal CT  scan.  At first we found a "gallbladder 
full of stones" that ended up being  a dilated cystic duct from a previous 
cholecystectomy; a protruding lumbar disk  and a "shadow" over his left kidney.  He 
now is scheduled for a  nephrectomy.  I on the other hand am trying to think 
of a ICD 9 code that  would cover Martha Rogers or any of the other fine 
ladies of nursing theory that  would enable me to get paid for my work.  You see, 
these gentlemen are HIV  positive and need Ryan White funding to cover their 
medical costs and my  assessments.  One has Medicaid but I only get reimbursed 
less than 80% of  the usual and customary services because I am an NP without 
benefit of an MD to  utilize the "incident to" clause.  Yes I am bitter right 
now because I have  cared for these gentlemen for over 3 years.  I am the sole 
provider for an  nurse founded, nurse managed Title 3 Ryan White AIDS clinic.  
I have a  collaborating MD by law for prescribing practices but not for 
"incident to"  privileges.  I want a clinical doctorate that emphasizes what I need 
to  know to diagnose and treat and how to increase my reimbursement and keep 
my  clinic physically responsible and solvent.  I want a board of nursing in 
IN  and KY that can get me full practice privileges and parity in reimbursement 
for  equal work.  Jeff, keep on keepin on!
 
Denny Myers MSN
 
AAHIVM Specialist
Matthew 25 AIDS Services INC
Henderson KY
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