Welcome to 2022 and the 12th year of The Adelman Advantage. You are reading the 133rd edition of this monthly publication! This month, I am excited for you to meet Ultra Health Providers, a Tennessee-based organization that provides on-site medical services to the aging population at no cost to the facility.
There is an urgency to respond to the longstanding deficiencies in health human resources in the long-term care (LTC) home sector, which have been laid bare by the coronavirus disease COVID-19 pandemic. Nurse practitioners (NPs) represent an efficient solution to human resource challenges. NPs have an important role as physician extenders and in optimizing resident care and supporting long-term care staff. Our firm is proud to call UHP a strategic partner and client and read on to learn more about how UHP may be a solution for staffing and for other needs in your community.
Meet Adam England, CEO of UHP
Adam, tell us about Ultra Health Providers (UHP) and what you offer to providers and patients?
England: UHP provides on-site medical practice, providing services to the aging population at no cost to the facility. Our mission is simple—to improve the health and well-being of our aging population. We serve:
Skilled Nursing Facilities;
Long-Term Care Facilities;
Assisted Living Facilities; and
At-Home Transitional Care.
UHP’s full-time nurse practitioners give specialized patient care resulting in faster response time, better face-to-face interactions between the patient and physician, and improved patient-centered care outcomes. Our provider clients have experienced quality ratings increase from 2 stars to 5 stars along with reduced risk, RTHs and improved metrics.
How do the federal regulations intersect with UHP Nurse Practitioners?
England: There are several federal regulations that speak to Nurse Practitioners or Non-physician practitioners (NPPs). Most notably, F714 governs the physician delegation of tasks in the skilled facility and describes the tasks that can be delegated to a nurse practitioner. Most states provide for “collaboration where the NPP works with one or more physicians to deliver health care services within the scope of the NPP’s expertise. NPP’s may perform physician tasks including performing examinations, evaluations, required visits and writing orders.
If the physician delegates the task of performing visits to the NPP, the NPP must meet certain requirements for:
§483.30(a), F710, physician supervision
§483.30(b), F711, physician visits
§483.30(c), F712, physician frequency and timeliness of visits.
UHP NP’s provide quality measure management, acute or episodic care visits, gradual dose reductions/medication management and transitional care management. As a result, patients benefit from reduced unplanned patient hospitalizations; fast response to pharmacy recommendations, improved patient and family communication; improved staff satisfaction and reduced pharmacy costs.
Importantly, an NP allows physicians, medical directors and staff to attend to other areas of patient needs. Along with a skilled provider, the NP can assess acute patient changes, review medications and laboratory tests, respond to results and attend family care conferences. Additionally, phone calls and faxes to the office decrease.
What are some of the Frequently Asked Questions about UHP?
What guidelines does the Nurse Practitioner (NP) follow?
Each NP is directed by clinical practice guidelines as outlined by AMDA, The Society for Post Acute and Long Term Care Medicine.
What type of visits can the NP make?
Acute or episodic care visit, Annual H&P, Facility discharge, alternating chronic disease management visits and first visit on a new patient (prior to the initial comprehensive H&P visit by the physician)
How many visits are required for UHP for the NP?
There are no quotas for the Ultra Health provider and no pre-determined reason for seeing patients. All patients are seen based on medical necessity.
What documents can the NP sign in the nursing home?
Verbal orders, pharmacy recommendations, letters that families need or request, some social services forms, depending on the state and discharge forms
Are there documents that the NP is unable to sign?
Initial 30-day H&P; Application for State aid or Medicaid; Hospice or Home Health
Is the NP an employee of the physician or the care facility?
Neither. The NP is an employee of Ultra Health Providers.
Do I have to supervise the NP while he/she sees patients?
No. The model of care is based upon a collaborative practice model.
How will I know what the NP has done each day?
The NP and Physician establish a communication process for their practice. This may be a daily phone call or another mechanism of communication. The extent and manner of communication are mutually agreed upon. The NP provides a visit note to the facility for the chart.
In our experiences as defense counsel and risk solutions experts in long-term care, NPs have played a key role in supporting staff, improving quality outcomes, reducing and mitigating risk and creating greater continuity of care.
Learn more about United Health Partners and reach out to Adelman Law and Claims Management for more information on facility best practices with nurse practitioners from a litigation and risk mitigation perspective.
