[NPInfo] supervision vs collaboration in MI

[Diana Galler]

When I worked in MS in the mid-90's, the BON always used the term "collaborative physician" wheras the Meidcal Board always used the term "supervising phsyician" when it came to NPs. Although the definitions of the two words are quite different, the BON's standard answer to me when I questioned the difference in the wording was that "it was just semantics"-- that the meaning was the same .
  Dena Galler

"suernfnp at iwon.com" <suernfnp at iwon.com> wrote:
  
Imagine my surprise when I renewed my NP license online at the Michigan government website. Something new since I last renewed 2 years ago; there is now a requirement to enter the SUPERVISING physician's license number, first and last name. I received no snail or e-mail about this new requirement. And what happened to our supposed "collaborative" relationship with a physician? I guess it's true, in MI we've slipped from collaboration into supervision without any protest.

Sue D in MI




--- On Mon 01/07, Shelby Havens < shelbyhavens at hotmail.com > wrote:
From: Shelby Havens [mailto: shelbyhavens at hotmail.com]
To: npinfo at nurse.net
Date: Mon, 7 Jan 2008 20:30:50 -0500
Subject: [NPInfo] Re: Incident To Billing - For Shelby


Dear Carla:

Thanks for the information. Oregon and Florida are on TWO DIFFERENT PLANETS. In Florida, nurse practitioners work under the general supervision of a physician. Most of the nurse practitioners I know work for the University of Florida, the Health Department, the Veterans Administration, or other government agencies. I'm in psychiatry, and in Florida, if you want to take care of the mentally ill, most of the patients are either in jail or prison, because these are these are the default treatment facilities in this state. I was the Director of Mental Health at a county jail in the past. I am now the psychiatric provider for a 60-bed long-term inpatient unit for schizophrenics and other seriously mentally ill inmates in a maximum security prison. Some of my patients are on Death Row. My salary is paid by the State of Florida. There is no third party billing. None of my patients have insurance. We do not participate in the Medicaid program. We do not bill 
Medicare. This is my world, and welcome to it!

There is only ONE private psychiatric practice in my town that employees nurse practitioners. I am familiar with how the place works, because I interviewed for a job there. All of the ARNP's billing is done "incidental to" and is billed under the psychiatrist's name. The gentleman told me this, from his own mouth. I have no idea what hours he works and whether he is present when the nurse practitioners are seeing patients in his office. The ARNP's are paid 40% of the collected monies. The psychiatrist takes 60%. He is not negotiable about changing ANYTHING about the billing or salary arrangement. 

Blue Cross and Blue Shield of Florida is by FAR the largest insurer in this state. They do NOT permit nurse practitioners to be network providers. PERIOD. There is apparently nothing that any lobbyist, attorney, nurse practitioner group, or anybody can do about this situation. They wrote me a letter and said they do not 
contract with ARNP's. The state insurance commissioner's office told me that they have no jurisdiction over this issue. 

I have a Blue Cross Blue Shield of Florida provider number, but I am an out of network provider. I am also insured by the Blues, and I always choose network providers when I need healthcare, because it costs me less. Paula asked why I don't see an ARNP as my primary care provider. The reason I don't is because there aren't any ARNP network providers! 

If anyone can give us some advice about how we can dig ourselves out of this Hellish situation in Florida, please do! We don't have many nurse practitioners opening private practices around here, because there is a stranglehold on both autonomous practice and the reimbursement system. This is why list members like Jeff and myself are so strident in our comments. Carolyn Buppert might be helpful to nurse practitioners in other states, but in my opinion, she hasn't done much to help us in 
Florida. We are in the Dark Ages of advanced practice nursing, with no visible light at the end of the tunnel. It is a tremendously oppressive situation. Nurse practitioners in most other states apparently do NOT understand what it is like for us down here. 

There are apparently almost 10,000 nurse practitioners in Florida, and NOBODY can seem to do anything to advance our profession. I am a highly effective person - I own a nice home, pay my bills on time, and keep the oil changed in my car. I haven't been able to accomplish ANYTHING that would increase my autonomy and enable me to get reimbursed for my services. I have been an ARNP practicing in Florida since 1992. There doesn't seem to be anyone who is politically savvy enough to help Florida's nurse practitioners. If I could have an autonomous psychiatric private practice and get reimbursed for my services, I certainly would NOT be earning my bread and butter by taking care of Death Row inmates. 

Thanks 
for listening to my rant and for letting me ventilate. Fellow listmates, PLEASE don't tell me that getting a DNP degree is the panacea for this situation. Please save your keystrokes - I can't bear hearing to hear the rhetoric again! 


Best Regards,

Shelby Havens, ARNP

~Love is an act of endless forgiveness.~ -- Peter Ustinov No trees were harmed in the sending of this message and a very large number of electrons were asked their permission to be terribly inconvenienced. And a party was thrown for them afterwards for being really cool about it. 
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