Module 3.

Topical outline and readings

Readings
Topical Outline
Fitzgerald Fitzgeral
Chapter(s): Buppert d NP Fast Facts
On-Line Chapter( Certificat Chapter(s
Video s) ion Exam )
Program and
and spiral Practice
bound book Prep
book

Module 3 1. Practice ownership On-line Chapters Chapter

2. CPT coding/ICD-10 codes video 11, 16 19
3. Culturally competent Chapter 21
practice Spiral book
No readings

Assignment for Module 3:

After completing all the readings and on-line videos list above, use this
form to answer the following questions and upload this document with
your responses to the Module 3 assignment link.

Module Assignments do not have a page minimum or maximum. Please

cite sources as appropriate.

****Upload as a Word document****

Also, complete the On-Line quiz as noted above (Chapter 21).

Module 3 Assignment upload is due by 2.6.17* midnight

Fitzgerald Quiz (Chapter 21) for this Module are due by midnight 2.6.17*.

Module 3

Module 3 Assignment Questions:

1) A - If you were going to start your own practice: Identify the practice setting
and/or target
Population for your practice site.

Rural area - where access to healthcare is already limited

o Target Population: Pediatrics, Adults, Geriatrics
o Family Practice is a prime area for NPs to practice due to the limited
number of providers and reports of upcoming physician shortages,
especially in primary care.
o Without changes in the states medical education system, Georgia will
rank last in the United States in physicians per capita by 2020.
 https://www.aamc.org/download/100598/data/

B - List advantages of practice ownership in your identified setting.

More significant and closer relationship to patients
Lower cost of living than urban setting
Higher pay and potential for student loan reimbursement
Higher level of autonomy in practice
More input on practice decisions such as visit length, practice management,
referrals, etc.
Get to see a wide variety of patients throughout the lifespan, including
geriatrics and pediatrics
Provide a continuum of care over the patients lifetime
Providing full access to patients - with the benefit of both nursing and
medicine

C- List barriers that you may encounter when you are the owner of the practice.
Getting on commercial insurance provider panels
Getting and keeping a collaborating physician
Limited access to specialists and hospitals
Patients who want to see an MD not an NP
Getting privileges at hospitals
Lack of legal authority to admit patients to nursing homes, to order home
care, or to direct hospice services
Dealing with increased chronic health problems with limited access to care

D - How will you recruit patients to your practice?

Word of mouth
Letters
Flyers
Health Fairs
Local churches
Newspaper
Signage
Websites and Social Media
o May not be as useful as other methods in this type of community

E - Why is a detailed business plan necessary for your success?

A business plan serves multiple purposes for the owner of a future
independent NP practice. First, it helps a potential future practice owner
decide whether a practice will be profitable. It can also help lenders decide
whether to participate. A business plan is also used to orient employees,
suppliers, and other people with whom the business will deal. A strong
business plan points out to the practice owner potential adversities and weak
areas, giving an opportunity to respond before there is a business failure.
2) Describe a patient you saw in the clinic recently and identify CPT code and ICD
10 coding with
required supportive documentation.

A 72 year old, white female presented to clinic with complaints of right

middle toe injury. She reports jamming her toe on a piece of furniture, while
doing some housework and moving. This occurred last night. She states it
was very painful, and bruised immediately. She is here today to make sure its
not broken.
Upon examination, her right middle toe is reddened and bruised. The
surrounding toes appear normal and without injury. No bruising to the mid-
foot or plantar surface of the right foot. She has limited range of motion in
the right middle toe due to pain. It is tender to palpation of the PIP and DIP
joints. Non-tender over the metatarsals. Ecchymosis and mild erythema
noted on the right middle toe. The right middle toe is not warm to the touch
and the skin is intact.
X-Ray of the right foot Complete
o CPT code: 73630
o X-rays shows no evidence of a fracture
Treatment: Buddy taped the right middle toe to the right second toe for
support. Patient advised to rest and elevate her right foot, and use ice and
NSAIDs as needed for pain relief. Follow-up if symptoms worsen or do not
resolve.
ICD-10 Code: M79.674
99213

3) Review and respond to one of the 4 situations on Buppert pages 479-480.

Start by including the
description of the situation you chose as noted in Buppert and then include your
response.
Situation 2
You get a letter from a pharmaceutical company inviting you to participate in
a round table discussion hosted by the company. There will be 15 attendees,
all NPs who provide womens health care. The topic will be treatment of
hypercholesterolemia in the older woman. The company has a prescription
product for reducing cholesterol. The letter offers you $500 plus a gourmet
dinner. The writer wants to send you a consulting contract.

o The first question to consider is whether this is a gift form of payment

from a pharmaceutical company as a kickback OR payment at fair
market value for personal services rendered? In order to make that
determination, the NP must decided if they are going to be expected
to:
Prescribe the companys Rx out of pure obligation
 o Some other things to consider are whether you are truly providing
$500 worth of consultative services?
Did you have travel, lodging, or meal expenses associated with
the consulting that may make this reimbursement more logical?
o Do you have the experts necessary to consult on this drug?
What are your qualifications for being considered to consult?
Do you provide womens health care or treat
hypercholesterolemia in your practice?
o If you prescribe this drug in practice, will it unnecessarily cost your
patients or patients insurer more than a generic product?
o Will this drug work any better than a comparable generic product?
If not, why should it be used? And from an ethical standpoint,
why would you prescribe it in your practice this goes back to
the feeling of obligation.
o Does this comply with the current PhRMA code standards of bona fide
consulting?
Is there an educational component to the meal or speaker, as
required by current PhRMA code?

o Acoording to http://phrma-
docs.phrma.org/sites/default/files/pdf/phrma_marketing_code_2008-
1.pdf

Consulting arrangements with healthcare professionals allow companies to obtain

information or advice from medical experts on such topics as the marketplace,
products, therapeutic areas and the needs of patients. Companies use this advice to
inform their efforts to ensure that the medicines they produce and market are
meeting the needs of patients. Decisions regarding the selection or retention of
healthcare professionals, as consultants should be made based on defined criteria
such as general medical expertise and reputation, or knowledge and experience
regarding a particular therapeutic area. Companies should continue to ensure that
consultant arrangements are neither inducements nor rewards for prescribing or
recommending a particular medicine or course of treatment.

It is appropriate for consultants who provide advisory services to be offered

reasonable compensation for those services and reimbursement for reason- able
travel, lodging, and meal expenses incurred as part of providing those services. Any
compensation or reimbursement made in conjunction with a consulting
arrangement should be reasonable and based on fair market value.

Token consulting or advisory arrangements should not be used to justify

compensating healthcare professionals for their time or their travel, lodging, and
other out-of-pocket expenses. The following factors support the existence of a bona
fide consulting arrangement (not all factors may be relevant to any particular
arrangement):
 A written contract specifies the nature of the consulting services to be
provided and the basis for payment of those services;

A legitimate need for the consulting services has been identified in advance
of requesting the services and entering into arrangements with the
prospective consultants;

The criteria for selecting consultant are directly related to the identified
purpose and the persons responsible for selecting the consultants have the
expertise necessary to evaluate whether the particular health- care
professionals meet those criteria;

The number of health care professionals retained is not greater than the
number reasonably necessary to achieve the identified purpose;

The retaining company maintains records concerning and makes

appropriate use of the services provided by consultants;

The venues and circumstances of any meetings with consultants are

conducive to the consulting services and activities related to the services are
the primary focus of the meeting; specifically, resorts are not appropriate
venues.

While modest meals or receptions may be appropriate during company- sponsored

meetings with healthcare professional commercial consultants, companies should
not provide recreational or entertainment events in conjunction with these
meetings.

It is not appropriate to pay honoraria or travel or lodging expenses to non-faculty

and non-consultant healthcare professional attendees at company-sponsored
meetings, including attendees who participate in interactive sessions.

Resources:

Buppert, C. (2015). Nurse practitioners business practice and legal guide (5th ed.).
Bethesda, MD: Jones &Bartlett Learning.