Trauma patients up to the 14th B'Day
All other patients up to 21st b'day
Cystic Fibrosis and congenital hearts on a case by case basis
[log in to unmask] writes:
>Dear List Subscribers:
>Our pediatric emergency department is situated in a large teaching
>hospital, and sees a significant number of children aged 18-21. For
>institutional reasons, we are seeing a great deal more recently.
>Our group is just curious to know- what upper age limit applies for
>Do different rules apply to different settings?
>What should the upper age limit be?
>PEM Fellow Boston Medical Center
>------------------ Reply Separator --------------------
>Originally From: Richard B Ismach <[log in to unmask]>
>Subject: Re: NP's in ED
>Date: 09/08/2001 03:00pm
>Kate, et al -
>As I told you off-line, we use both Nurse Practitioners and
>Physician Assistants in our adult ED fast track. We use NPs and PAs
>interchangeably, but in a few ways PAs are better:
> * In Georgia, PAs can prescribe independently, but NPs cannot
> (not a problem in most states).
> * PAs usually have better procedural training (e.g., wound
> repair) at graduation. After a few years of practice, the
> difference vanishes.
> * PAs are trained to practice fairly independently, but to work
> with and under a physician's direction. Some NPs expect to
> practice completely independently, without any interference
> from a physician. In an ED setting, a physician will certainly
> be named in any lawsuit involving a non-physician provider.
> Thus, EPs are sometimes more comfortable working with PAs than
> with NPs.
>Despite these issues, we are happy with a mix of PAs and NPs in our
>Billing is as Zach outlined: both NPs and PAs can bill (at 85% of
>the physician's fee) for E&M or procedural services. However, many
>private insurers, at least in Georgia, are now refusing to pay for
>PA or NP services in the ED. It is well established that customers
>(patients) are better satisfied and costs are lower with
>non-physician providers. Thus, this seems to be just a ploy to
>avoid paying some claims. Still, this may be a major issue in some
>The alternative is for the physician to bill for services of the PA
>or NP. I am less familiar with this - all the departments I've
>worked in had the non-physician provider bill directly, using their
>own number. This requires the physician to see each patient, a
>potential problem for everyone's efficiency.
>Some PA resources on the web:
>Richard B Ismach, MD, MPH
>Assistant Professor of Emergency Medicine
>Emory University School of Medicine
>Office: (404) 712-9656
>Pager: (404) 686-5500 -> 11037
>For more information, send mail to [log in to unmask] with the
>message: info PED-EM-L
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