Trust In Your Doctor Is Not Always A Good Thing When You Are Treating With A Nurse Practitioner In Kingston, New York

A new law in New York proposes to eliminate the requirement that a nurse practitioner be supervised by her “collaborating physician”. In my article about the Nurse Practitioner Modernization Act, I pointed out that there is virtually no supervision or collaboration between nurse practitioners and their collaborating physician in most medical practices. What, you don’t believe me? Today, I’m going to prove my point with actual testimony given by a nurse practitioner in one of my recent cases.

Real Testimony by a Nurse Practitioner: total lack of collaboration with physician

My Question: “What was your policy or procedure in Dr. Jones’s [fictitious name] office, if any, for your collaboration with Dr. Jones?”

Nurse Practitioner’s Answer: “Collaboration with the collaborating physician is at the discretion of the nurse practitioner.”

Stop right there! Do you, Ms. Nurse Practitioner, mean to say that it is solely at your discretion to determine when you collaborate with your physician about patient care? That’s what it sounds like to me. Doesn’t the law in New York (this is a rhetorical point in case you missed the sarcasm) require that nurse practitioners consult with their collaborating physician about patient care? Do you really have the discretion to decide when and how often you consult with your collaborating physician? Are you familiar with New York law as it relates to your responsibilities as a nurse practitioner? (the answer is “no” in case you didn’t pick up on my sarcasm again). Wait, it gets better.

My Question: “Can you describe what your quarterly chart review consisted of?”

Nurse Practitioner’s Answer: “Every quarter I would pull five charts of patients that I had seen during that quarter.”

My Question: “How would you determine what charts to pull for this quarterly chart review?

Nurse Practitioner’s Answer: “When I knew it [quarterly chart review] was coming due a couple of weeks prior to that is when I would start thinking about patients and it’s usually patients I’ve seen in the past couple of weeks.”

Let me get this straight: the nurse practitioner hand-picks five charts of patients who she has seen and gives those charts to her collaborating physician for the physician’s review. If you were the nurse practitioner, wouldn’t you want the doctor to only see the medical charts of patients’ for whom you did your best work? Of course, you would! This is like asking a fifth grader to pick the top five test scores that he received over the last three months–you can bet you’ll only see the best test results.

In essence, the physician is rubber stamping the work done by the nurse practitioner. Is there a real critique of the nurse practitioner’s patient care? Highly doubtful.

Why do physicians rubber stamp the care provided by nurse practitioners?

The secret is in the details. When you see a nurse practitioner, you give your insurance information at the front desk of the medical office, you might pay a co-pay and the medical practice gets paid by your health insurer. What the medical practice doesn’t tell you is that there are very different reimbursement rates by your health insurer depending on whether you are treated by a nurse practitioner or a physician. The medical practice stands to collect a significantly higher fee for its services by submitting a bill that reflects a doctor’s visit, rather than a visit with a nurse practitioner.

In most cases, the medical practice will send a bill to your health insurer reflecting treatment with a physician, even though you were seen by a nurse practitioner. How can the medical group do this? Very simple. By having the physician co-sign the office note for the visit, the medical practice can claim that the physician was involved in the care provided to you, even though the doctor did not see you. With this procedure, the medical practice can collect more money from your insurer.

It’s all about money. With reimbursement rates dropping for Medicaid and Medicare, doctors have to see more patients to keep pace with the Joneses, and the best way of doing that is to have nurse practitioners and physicians assistants taking care of patients. The level of medical care is not the same, but the payment received by the medical practice is.

Why should you care? Instead of receiving treatment from a physician with a medical degree, you are getting treatment from a registered nurse with an advanced nursing degree. That’s fine for the common cold or minor illnesses, but it’s not okay if you have a complicated medical condition.

If you have any questions or concerns please consult a knowledgeable medical malpractice attorney.