Nurse practitioner's business practice and legal guide /
Carolyn Buppert.
- 2nd edition
- Sudbury, Mass. : Jones and Bartlett, c2004.
- x, 496 p. : ill. ; 26 cm.
Includes bibliographical references and index.
Table of Contents
Preface.............................................. ix Chapter 1 What Is a Nurse Practitioner?................... 1 Definition of Nurse Practitioner ................. 1 A Nurse Practitioner, by Any Other Name............ 2 Services Provided by NPs ...................... 3 Preparation and License Requirements............ 5 Initials .................................... 6 Areas of Practice............................. 6 Legal History of NPs.......................... 6 Demographics .............................. 7 NPs in Primary Care.......................... 7 NP versus PA: What's the Difference?.............. 11 NP versus Physician: What's the Difference?........ 13 NP versus RN: What's the Difference?............. 15 NP versus CNS: What's the Difference?............ 16 Where Do Nurse Practitioners Practice?............ 18 Appendix 1-A: State-by-State Definitions of Nurse Practitioner .......................... 19 Appendix 1-B: State-by-State Titles for Nurse Practitioners ......................... 36
Chapter 2 Legal Scope of Nurse Practitioner Practice......... 39 Professional Association Definition of Scope of Practice................................ 39 Statutory versus Regulatory Scope of NP Practice..... 40 Physician Challenges to NPs' Scope of Practice...... 41 Need for Clarity of Scope of Practice.............. 41 NP Scope of Practice Compared with RN Scope of Practice................................ 42 NP and MD Scope of Practice Compared........... 46 Mandated Physician Involvement with NP Practice... 47 Appendix 2-A: State Laws Defining NPs' Scope of Practice, State by State....................... 50 Appendix 2-B: State-by-State Requirement of Physician Collaboration, If Any ................ 76
Chapter 3 State Regulation of Nurse Practitioner Practice..... 104 How Laws about NP Practice Evolve.............. 104 What Is Regulated? ........................... 105 Appendix 3-A: Agency That Regulates Nurse Practitioners, State by State................... 107 Appendix 3-B: Nurse Practitioner Qualifications Required by Law, State by State................ 110 Chapter 4 Federal Regulation of the Nurse Practitioner Profession ............................... 125 Medicare .................................. 125 Medicaid .................................. 129 Nursing Homes ............................. 129 In-Office and Hospital Laboratories under CLIA...... 130 Self-Referral by Health Care Providers, under the Stark Acts ................................ 130 Prescription of Controlled Substances under the DEA. 131 Reporting to the National Practitioner Data Bank..... 132 Patient Confidentiality ........................ 132 Discrimination in Hiring and Firing............... 132 People with Disabilities under the ADA............ 132 Appendix 4-A: Documentation Guidelines for Evaluation and Management Services ........... 134 Chapter 5 Prescribing ................................ 170 Controlled Substances ........................ 170 Guidelines for Prescribing Legally................ 174 Appendix 5-A: State-by-State Law on Prescriptive Authority ................................. 176
Chapter 6 Hospital Privileges........................... 208 Are Hospital Privileges an Issue for NPs?........... 208 Do PCPs Need Hospital Privileges?............... 209 What If Health Plans Require PCPs To Have Admitting Privileges? ........................ 210 Do NPs Need Hospital Privileges for Advancement of the Profession? .......................... 210 Do Individual NPs Need Hospital Privileges?........ 211 Who Has Hospital Privileges? ................... 212 Does Federal Law Support Full Hospital Privileges for NPs? ................................. 213 What Does It Mean To Have Hospital Privileges?..... 214 Levels of Privilege............................ 214 The Application Process ....................... 214 Expense ................................... 215 Denial of Privileges........................... 215 Expect Change .............................. 216
Chapter 7 Negligence and Malpractice.................... 217 What Can Happen to an NP Who Is Sued?.......... 218 Life Cycle of a Lawsuit......................... 219 What Is Malpractice?.......................... 219 Elements of Malpractice ....................... 220 Examples of Lawsuits against NPs................ 221 The National Practitioner Data Bank.............. 226 Working with Practice Guidelines................ 227 How To Prevent Lawsuits...................... 228 What To Do If Sued........................... 228 Communication ............................. 228 Liability of Collaborating Physicians.............. 229 Malpractice Insurance ........................ 231
Chapter 8 Risk Management ........................... 233 Risk of Making a Clinical Error................... 233 Risk of Being Sued for Malpractice When There Was No Clinical Error ....................... 237 Risk of Public Perception That the Individual NP Is a Poor-Quality Provider.................... 237 Risk of Breaching Patient Confidentiality........... 237 Risk of Violating a Patient's Right to Informed Consent ................................. 238 Risk of Negligent Nondisclosure ................. 243 Risk of Poor Quality Ratings.................... 245 Risk of Disciplinary Action ..................... 245 Risk of Medicare Fraud........................ 247 Business Risk Management..................... 248 Dealing with High-Risk Patients ................. 249
Chapter 9 Reimbursement for Nurse Practitioner Services..... 252 Payers .................................... 252 Medicare .................................. 252 Medicaid .................................. 256 Indemnity Insurers ........................... 257 Managed-Care Organizations ................... 257 Direct Contracts for Health Services.............. 262 Billing Third-Party Payers ...................... 262 Billing Self-Paying Patients ..................... 268 Conclusion ................................. 269 Appendix 9-A: Credentialing Information .......... 270
Chapter 10 The Employed Nurse Practitioner ............... 273 What Rights Does an Employed NP Have?.......... 273 Does an NP Need a Contract?................... 274 Three Difficult Clauses ........................ 275 How To Negotiate a Reasonable Agreement......... 281 Interviewing ................................ 287 Responsibilities of an NP Employee............... 288 Employer's Evaluation of the NP's Performance...... 288 Malpractice Insurance ........................ 289 Collaborative Practice Agreements ............... 289 Appendix 10-A: Sample Nurse Practitioner Consultation Practice Agreement............... 290 Appendix 10-B: Sample Employment Agreement..... 295
Chapter 11 Practice Ownership: Legal and Business Considerations for the Nurse Practitioner Owner.. 306 Advantages of Practice Ownership................ 306 What Is Stopping NPs? ........................ 307 Decisions before Starting a Practice............... 308 Business Planning............................ 324 Doing Business.............................. 330 Appendix 11-A: A Checklist for Setting Up a Practice.. 345 Appendix 11-B: Independent Contractor Agreement.. 360 Appendix 11-C: Sample Business Plan............. 365 Appendix 11-D: Professional Services Agreement .... 382
Chapter 12 Lawmaking and Health Policy.................. 389 The Legal Process............................ 389 The Judicial System........................... 390 Health Policy ............................... 391 Laws and Rules That Affect NPs.................. 391 Untitled-5 7/23/03, 3:36 PM6 Table of Contents vii Changing Laws .............................. 391 Understanding the Big Picture................... 392 The Process of Changing the Law................ 398 Conclusion ................................. 406
Chapter 13 Promoting the Profession to the Public........... 407 Public Relations Steps......................... 408 Setting the Goal ............................. 408 Developing the Plan .......................... 408 Developing the Budget ........................ 409 Working the Plan ............................ 409 The Substance of the Message................... 410 Supporting Data ............................. 411 Collecting Impressive Facts..................... 413 Present Barriers to Fact Collection................ 414 Not-So-Impressive Facts about NPs............... 414 Dealing with the Downside..................... 415 Appendix 13-A: A Simple PR Plan for a State NP Organization .............................. 418 Appendix 13-B: Some Talking Points for NPs........ 421 Appendix 13-C: Sample Fact Sheets on NPs......... 424
Chapter 14 Standards of Care for Nurse Practitioner Practice... 428 Definitions of Standard of Care.................. 428 Who Is Monitoring Standard of Care?............. 428 How Should NPs Keep Current on Standard of Care?.. 442 Credentialing ............................... 442
Chapter 15 Measuring Nurse Practitioner Performance........ 444 Measuring Quality ........................... 444 Multiple Measures, Multiple Measurers............ 445 Productivity ................................ 446 Housekeeping Performance Measures............. 447 NCQA Measures of Clinical Performance........... 447 Other Measures ............................. 449 Formal Research............................. 450 Patient Ratings .............................. 450 Peer Review ................................ 451 Utilization ................................. 451 How To Get an "A" on Performance Report Cards.... 451 Ensuring Compliance ......................... 452 Appendix 15-A: NPs' Self Evaluation.............. 455 Untitled-5 7/23/03, 3:36 PM7 viii NURSE PRACTITIONER'S BUSINESS PRACTICE AND LEGAL GUIDE Appendix 15-B: HEDIS-Based Health Maintenance Flowchart for Ages 18 and Over................ 456
Chapter 16 Strategies for Advancing the Profession........... 458 Opportunities in a Changing Field................ 458 Opponents of a See-a-Nurse-First System.......... 459 What Are the Challenges for NPs Attempting To Advance the Profession? ..................... 460 Strategies To Implement Collectively.............. 461 Ten Strategies............................... 461
0763733415 (hbk.) 9780763733414
Nursing--Practice--United States. Nurse practitioners--Legal status, laws, etc.--United States.