Nurse Practioner Are Seeing Patients Instead Of Doctors

[tmoe]

The previous post was closed.was told to start over,anyway I ask the question about NP as being my primary doctor. Is this going on at all

VA medical center or just in Augusta Ga.Carlie says its been going on but in my seven years as seeing VA doctors this is my first with a

NP.She is doing good so far even givin some pain meds. I think it maybe a good ideal stay on her good side,because they are the one

that does C&P exams mostly. I guess you see the doctor when dying only.I know a lot of MH doctors quit at Charlie-Norwood but looks

like regular doctor also

[jbasser]

Teac, that really doesn't help. It is for Texas. It doesn't say you can choose, only that you will know the name of the provider.

Thanks.

[Teac]

Teac, that really doesn't help. It is for Texas. It doesn't say you can choose, only that you will know the name of the provider.

Thanks.

Oh Come On!

Read the whole paragraph not just the first line:

(3) The name and professional title of the provider in charge of patient care will be provided, in writing. As a partner in the healthcare process, patients have the right to be involved in choosing their provider. They will be educated about their role and responsibilities as a patient. This includes their participation in decision-making and care at the end of life. See attachments A and B for guidelines for managing patient requests to change providers in the Outpatient and Inpatient settings, respectively.

What more proof do you need? Here it is in black and white........

And it doesn't matter that this is listed under the VA in Texas, all VA's have the same patients rights....

Like they say.. you can lead a horse to water but you can't make them drink...

Edited February 13, 2013 by Teac

[jbasser]

Ok That fixes it.

TMOE and everyone lets pack up. Call 2 dudes and a truck and move to San Antonio and set up house. Transfer to the VA , transfer claims to Houston or Waco (NOT) and use this great patient agreement that is in place.

Or we can check our local VA for the same type of document.

Thanks Teac.

J

[carlie]

Teac,

Sorry, but NO it is not there in black and white.

Yes, " patients have the right to be involved in choosing their provider".

But they can only choose from what's available - they can't mandate the credentials

of the provider.

No one has posted ANY disagreement with you that in fact,

ANY PATIENT DOES NOT HAVE TO ACCEPT ANY PROVIDER -

we are allowed to turn down each and every one of them.

The disagreement is that the VAMC DOES NOT HAVE TO PROVIDE

A "DOCTOR" to you. A "DOCTOR" may well have to sign off on the work

of a lower pedigree but they DON't have to provide you with the

medically credentialed personel of your choice in standards -

they go by THEIR choice of standards and it is legal.

Attachments A&B spell it out.

Guidelines for Requests to Change Attending Provider

POLICY MEMORANDUM 11-2009-67 or Treating Specialty in the Inpatient Setting

1. As a partner in the health care process, patients have the right to be involved in choosing their provider. Per the South Texas Veterans Health Care System (STVHCS) Medical Staff Bylaws, Rules and Regulations, Section R.7.5, upon admission to inpatient care at this Medical Center, each patient shall be assigned to the clinical service or section deemed most appropriate for the care and treatment of the condition for which hospitalization is required. These guidelines provide a formal process for addressing patient requests to change attending providers or treating specialties in the inpatient setting of STVHCS.

2. Requests by a patient or their surrogate to discontinue receiving care under a specific resident(s) will be managed by the attending physician or treatment team through direct communication. Psychosocial support services such as Social Work Service, Psychology Service, and the Chaplain Service may be consulted to assist in maintaining the therapeutic relationship through assessment and interventions to address the social, spiritual, and cultural factors that influence patient perceptions and involvement in care. Inability to resolve issues at the level of the attending physician or treating specialty will result in a referral to the Patient Advocate and a formalized approach.

3. When a patient or their surrogate expresses concern about continuing care under the assigned attending provider or requests a change in attending provider, the Patient Advocate will be notified to meet with the patient and/or their surrogate to investigate and/or validate any existing complaint, determine options for resolution of the specific complaint and opportunities to improve future service to patients, and facilitate documentation and review of the request to change the inpatient attending provider(s) or treating specialty.

4. The STVHCS will make every attempt to honor a veteran’s request for a change of provider. Our health care system cannot honor requests for specific providers by name, or requests for providers of specific race, gender (in the inpatient setting), nationality, level of experience or training (resident physician versus staff physician).

5. Upon validation of the patient’s request to change provider(s) or treating specialty, the Request to Change Attending Provider or Treating Specialty form will be completed.

6. The Service Chief of the treating specialty, or their designated representative, will be notified immediately to assist in the transfer of care.

7. It is the responsibility of the Service Chief to notify the attending of record, if s/he is not already aware of the request. The honoring of the request in no way implies improper care. This portion of the process is based solely on the patient’s/surrogate’s right to be involved in choosing their provider. A requested change of provider or service should not be confused with a request for a second opinion.

8. The Chief of Staff must be notified and kept informed of the entire process. If resolution cannot be reached at the level of the Chief of Service, the Chief of Staff will make the final determination.

9. The Medical Center will make every attempt to honor the patient’s request for a change in provider by locating an alternate attending from within the System; however, circumstances may arise where an alternate attending of record cannot be found, in which case Administration will work with the patient/surrogate to find an agreeable solution. It will be the patient’s or surrogate’s responsibility to find alternate care outside the VHA service. At any time during the process, the Ethics Consult Service can be consulted to address specific ethical concerns and or to assist with mediation (see PM 11-06-23 Integrated Ethics Team).

Attachment A (page 1 of 2)

POLICY MEMORANDUM 11-2009-67 REQUEST TO CHANGE ATTENDING PROVIDER(S) OR TREATING SPECIALTY

Please Print

Patient’s Name: ___________________________________________________________ Social Security #: __________________________________________________________ Current Provider(s)/Team: __________________________________________________ Reason for Request: ________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Patient or Patient Surrogate Signature: __________________________ Date: ________

Patient or Patient Surrogate has been visited by the Patient Advocate:  Yes  No Patient Advocate Name: _____________________________________________________ Patient Advocate Signature: _____________________________ Date: _______________

_______________________________________________ ____________________

Reviewed by (Chief of Service/Representative) Date PLAN OF ACTION: ________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

Attachment A (page 2 of 2)

POLICY MEMORANDUM 11-2009-67

Information on Assignment and Change in Assignment of Primary Care Providers at the South Texas Veterans Health Care System

1. At the South Texas Veterans Health Care System (STVHCS) patients are assigned to a primary care provider (PCP). Primary Care (PC) is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Primary care provides long-term patient-provider relationships, coordinates care across a spectrum of health services, educates, and offers disease prevention programs. It is the policy of the Veterans Health Administration (VHA Directive 2006-031) that the full scope of PC is provided to all eligible veterans seeking on-going health care. Exceptions may be made for some veterans requesting limited care, such as subspecialty care for service-connected conditions, or for those scheduled only for compensation and pension exams.

2. Each veteran receiving PC must be assigned a single PCP. Those who spend a significant part of the year living in two regions of the country and who have complex needs requiring close supervision may have PCP’s assigned at more than one VHA medical facility. The PCP functions as part of an interdisciplinary PC team, which includes, at minimum, a medical doctor or nurse practitioner or physician’s assistant, as well as nurses and administrative support personnel.

3. Primary care programs place a premium on sustaining the personal relationships between patients and their providers. This therapeutic alliance improves the likelihood that patients will participate in preventive health screenings, take active and educated roles in decisions affecting their health, and ultimately become more independent in managing their own health. Psychosocial support services such as Social Work Service, Psychology Service, and the Chaplain Service may be consulted to assist in maintaining the therapeutic relationship through assessment and interventions to address the social, spiritual, and cultural factors that influence patient perceptions and involvement in care.

4. As a partner in the health care process, patients have the right to be involved in choosing their provider. The STVHCS will make every attempt to honor a veteran’s request for a PCP of a specific gender (male or female). Otherwise, the selection of a new PCP is based on a PCP rotation system. Our health care system cannot honor requests for specific providers by name, or requests for providers of specific race, or nationality.

5. Patients may request a new PCP by completing a “Request to Change Primary Care Provider” form. The honoring of the request in no way implies improper care. This portion of the process is based solely on the patient’s/surrogate’s right to be involved in choosing their provider. If a request for a new PCP is not approved the clinic director or chief medical officer will notify the patient in writing or by telephone with a reason for disapproval.

6. Inability to resolve an issue at the level of the clinic leadership will be referred to the STVHCS Primary Care/Managed Care Product Line (PC/MC PL) Leadership. If an issue cannot be resolved at that level then there will be a referral to the Patient Advocate. At any time during the process, the Ethics Consult Service can be consulted to address specific ethical concerns and/or to assist with mediation (see PM 11-06-23 Integrated Ethics Team).

Vicki Hannigan, M.D. Medical Director PC/MC PL Roger Roehl, MHA Administrative Director PC/MC PL

Attachment B (page 1 of 2)

7

REQUEST TO CHANGE PRIMARY CARE PROVIDER

Please Print

The selection of a new primary care provider will be based on a rotating team selection process and not on patient preference for a particular provider. Exceptions will be made for patients requesting a provider of a particular gender due to personal concerns.

Patient’s Name: ___________________________________________________________ Social Security #: __________________________________________________________ Current Team/Provider: ____________________________________________________ Reason for Request: ________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Patient or Patient Surrogate Signature: __________________________ Date: ________

________________________________________________ _____________

Reviewed by (Clinic Director or Chief Medical Officer) Date New Team/Provider: ________________________________________________________ Scheduler Signature: _______________________________________ Date: ____________

SCHEDULING DEPARTMENT WILL NOTIFY PATIENTS BY MAIL OF NAME OF NEW PRIMARY CARE PROVIDER AND RESCHEDULED APPOINTMENT DATE AND TIME

Attachment B (page 2 of 2)

8

[Teac]

Carlie,

I guess we are going to have to agree to disagree...Because I think common sense dictates that everyone who request a doctor will be assigned a doctor.

No one at the VA is going to force anyone to accept a PA. NP or any doctor for that mater .. and if you make a complaint or request a change they will change the provider....

to be sure:

I never stated that you had the option to request a specific doctor, only that you can request a doctor .. and that the VA will not force any provider on any veteran.

I also stated you can request a doctor by Gender... I know because I have and will again if I am saddled with a female primary care doctor....(the directive states a request by gender in an inpatient setting cannot be honored).

I also never said you have the right to request a resident vs. an attending....( that is a doctor who is more experienced than another).

I also said if your not happy with the doctor that they provide, you can request another doctor, and that request will be honored ( I Have and the VA did)

Notice the directive does not even address NP or PA's.. I suspect that is because they are not doctors and by their training they were never intended free rein to treat patients.

We can discuss this until we are blue in the face... Your not going to sway me and ,I am not going to sway you.

I will continue to accept treatment from only doctors, and I guess you will accept treatment from anyone......that's your right....

I actually think your reading something into the directive that isn't there.

[Teac]

Ok That fixes it.

TMOE and everyone lets pack up. Call 2 dudes and a truck and move to San Antonio and set up house. Transfer to the VA , transfer claims to Houston or Waco (NOT) and use this great patient agreement that is in place.

Or we can check our local VA for the same type of document.

Thanks Teac.

J

Being sarcastic doesn't help much either........