10/26/2017. Incorporating NPs into an EP Practice. Karla Rusk, MS, CCRN, ANP-BC, ACNP-BC Lead Nurse Practitioner, Electrophysiology. Disclosures.

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1 Incorporating NPs into an EP Practice Karla Rusk, MS, CCRN, ANP-BC, ACNP-BC Lead Nurse Practitioner, Electrophysiology Disclosures None 2 1

2 Health care has become complicated. More patients.. sicker patients More regulations, More documentation.emr Billing, coding, ICD9 ICD 10. Reduced reimbursement 3 Cardiovascular Team Based Care Advocated by the American College of Cardiology Patients benefit from the mix of professional disciplines, different education and training paths. Role for Advanced Practice Providers (APP) Shared Goals and Clear Roles Examples CHF, Device, Anticoagulation clinics Brush JE, Handberg EM, Biga C, et al ACC Health Policy Statement on Cardiovascular Team-Based Care and the Role of Advanced Practice Providers. JACC 2015;65:

3 Advanced Practice Provider Nurse Practitioner Clinical Nurse Specialist Physician Assistant All require Master s level education, National certification, State licensure. PA practice under physician supervision NP, CNS practice in a collaborative relationship with physician, some states NPs have full practice authority. 5 Patient Outcomes More than 25 years of study.. APP patient outcomes are comparable with physicians Mundinger MO, Kane RL, Lenz ER, et al. Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians A Randomized Trial. JAMA.2000;283(1): Hoffman LA, Tasota FJ, Zullo TG et al. Outcomes of Care Managed By An Acute Care Nurse Practitioner/Attending Physician Team in a Subacute Medical Intensive Care Unit. American Journal of Critical Care. 2005; 14 (2) : Dellinger RP, Kleinpell RM, Wesley EE et al. Nurse Practitioner and Physician Assistants in the Intensive Care Unit: AN Evidence Based Review. Critical Care Medicine. 2008; 36 (10): Newhouse,R, Stanik-Hutt, J, White, K, et al. Advanced Practice Nurse Outcomes : A Systematic Review. Nursing Economics; Pitman 29.5 (Sep/Oct 2011): David D, Britting L and Dalton J. Cardiac Acute Care Nurse Practitioner and 30 Day Readmission. Journal of Cardiovascular Nursing. 2015; 30 (3): Scherzer R, Dennis P, Swan B et al. A Comparison of Usage and Outcomes Between Nurse Practitioners and Resident-Staffed Medical ICUs. Critical Care Medicine: 2017;45(2):e132-e137. Strzelczyk T, Kaplan R, Medler M & Knight B. Outcomes Associated with Electrical Cardioversion for Atrial Fibrillation When Performed by an Advanced Practice Provider. JACC

4 Liability NPs have lower rates of malpractice claims and lower costs per claim. Malpractice rates remain low, Only 1.9% of NPs named as primary defendant in a malpractice case AANP National Nurse Practitioner Sample Survey 7 OSU EP Team Based Care 8 4

5 EP World EP Lab/IPR Inpatient Service Device Services Clinic EP Consults 9 SHARED GOALS Provide the highest quality care. Timely access to EP care Keep the lab moving, avoid delays and cancelations. Keep the attending physicians in Lab. Reduce LOS and readmissions Keep Referring Base Happy 10 5

6 EP Lab/Invasive Prep and Recovery Every patient required to have H&P prior to procedure. NPs do pre-procedure H&P, evaluate if appropriate to proceed, different procedure. Manage patients post procedure, enter orders, manage problems, discharge planning, family issues. If overnight, enter medication orders, etc. NP coverage 06:00 19:00 > 3000 H&Ps Hospital EP Service NP managed service. (Operational) Admissions, daily rounds, documentation,ongoing clinical management, monitoring, intervention. Contact with consulting teams. Contact with bed placement, transfer center. Independent and shared billing Discharges. >1400 in 2016 Coverage 06:00-19:

7 Outpatient Clinic Combined MD/NP clinics. shared billing EP NP Clinic >1100 visits 2016 independent billing NPs - same support as physicians (RN, MA, scheduling support) 13 Device Services NP clinical director Policy/procedures Manage patient, programming issues Interpret remote reports Manage safety alerts. St Jude medical advisory pts 55 dependent, generator changes within 30 days. 14 7

8 EP Consults Managed by EP Fellow (Operational) Team: EP attending, EP fellow, Cardiology fellow and Nurse coordinator Current NP role - Follow up consults, independent billing. NP can bill for new consult or attending can bill no shared visit billing. 15 I GOT YOUR 6! Trust is essential APP has to know the physician partner has their back. Won t throw them under the bus if when they make a decision. The Physician has to be confident in the APP s judgment. They can t micro manage every aspect of care. Comes with time and honesty 16 8

9 Is an NP or APP right for your practice? Cost effectiveness will depend on how the APP is utilized. Be aware of your state s scope of practice. Criteria : EP experience? Cardiology experience? Orientation/Training can be a long process. Where do you need the support? 17 Keys to a successful team Every member should function at the top of his/her scope of practice. Never send a man to do a boy s job. Commitment Mutual respect Honesty Everyone s contribution is important. Sense of humor 18 9

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