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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
Naghma

[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
>your PED?
>
>Do different rules apply to different settings?
>
>What should the upper age limit be?
>
>Thanks,
>
>Geoff Capraro
>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
>fast track.
>
>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
>settings.
>
>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:
>    http://www.aapa.org/
>    http://www.sempa.org./
>
>Rich
>
>--
>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
>The URL for the PED-EM-L Web Page is:
>  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html