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Nurse-led visits in primary care

  • 1.  Nurse-led visits in primary care

    Posted 08-15-2022 17:32

    Hello,

    Is anyone conducting Nurse-led visits in primary care clinics? If so what types of visits are the RNs doing and are you billing for these visits?

     

    Thank you!

    Lee Ann

     

    Lee Ann Hinsky DNP, MSN, RN

    PPG Vice President of Patient Care

     

     

    3602 New Vision Drive

    Fort Wayne, IN | 46845

    260.266.5453, Cell - 260. 241.2706

     leeann.hinsky@parkview.com

    Proverbs 3:5&6

     



  • 2.  RE: Nurse-led visits in primary care

    Posted 08-16-2022 08:53

    Hi!  I am looking into this as well and would love information too! 

    Mariam Shahbazi MSN MBA RN

    Director of Nursing

    Primary Care, Urgent Care and Occupational Health
    University of Kansas Health System



    ------------------------------
    Mariam Shahbazi
    University of Kansas Health System
    Overland Park KS
    ------------------------------



  • 3.  RE: Nurse-led visits in primary care

    Posted 08-16-2022 11:02

    Yes, I am doing annual wellness visits and we are billing for them.

     

    Tammy Tucker RN,BSN

    MRHC Case Manager

    435-719-5535

     






  • 4.  RE: Nurse-led visits in primary care

    Posted 08-16-2022 12:47
    We do what we call "nurse visits"..vaccines, patient education, BP checks, etc





  • 5.  RE: Nurse-led visits in primary care

    Posted 08-17-2022 07:57
    We initiated RN led Wellness visits approx 12 years ago. While the patients who completed them were complimentary of the education they received, we struggled to acheive completion rates above 30%. We have since moved away from that workflow, instead opting for a combined visit with the office team completing the  required screening questions with the patient, then inviting the provider in to complete the visit. Many times there is a adjacent E&M problem(s) focused visit. Both are billable by the provider, with no nursing visit charges. The patients have accepted this much more readily in our market. We have a small treatment room staffed by LPNs that completes BP readings, routine injections, EKGs, etc. We do not routinely charge nurse visit charges, but do apply the injection fees when indicated.

    ------------------------------
    Toni Wendling MSN, RN
    Administrative Director of Primary Care
    Stormont Vail Health
    Topeka KS
    785-354-0558
    twendlin@stormontvail.org
    ------------------------------



  • 6.  RE: Nurse-led visits in primary care

    Posted 08-17-2022 10:50
      |   view attached
    Hello- 
    There are many ways of doing nurse led visits. There are independent nurse visits, and shared visits, called co-visits that are led by nurses but combine with provider for medical decision making and treatment. Here is an article I co-wrote a few years ago that explain how we did this in a community health clinic. Goal, increase access, increase top of scope work, decrease burden of double books for primary care providers. Patients loved them b/c they go in quickly for mostly minor acute chief complaints and had great nurse education and history taking. So important to clarify nurse documentation and provider documentation to meet criteria for billable visits. Malia

    ------------------------------
    Malia Davis
    VP/CNO Ambulatory Services
    Intermountain Healthcare
    Denver CO
    (303)425-8136
    ------------------------------



  • 7.  RE: Nurse-led visits in primary care

    Posted 08-17-2022 11:36
    Malia,

    That was incredibly helpful! Great work!
     
    Our organization is in the infancy of developing RN support in our ambulatory clinics and we are looking to expand services into RN Nurse Visits. Any and all information is greatly appreciated.

    ------------------------------
    Dotty Parker
    Director Nursing- Ambulatory Clinical Quality
    Montage Medical Group
    Monterey CA
    (831)265-3989
    ------------------------------

    Original Message


  • 8.  RE: Nurse-led visits in primary care

    Posted 08-19-2022 08:26
    Thank you for sharing that article describing your project, Malia. Great demonstration of a successful integration of the RN in a primary care setting!
    Has the clinic been able to follow through with the plans for spreading the model as outlined?

    ------------------------------
    Leslie McDowell ANP-BC, DNP, RN
    QI Specialist / Curriculum Developer
    Northwest AHEC / Wake Forest University School of Medicine
    Winston Salem NC
    (336)972-7852
    ANP-BC, DNP, RN
    ------------------------------

    Original Message


  • 9.  RE: Nurse-led visits in primary care

    Posted 09-21-2022 11:55
    Hello-
    Have you explored the option of virtual nurse visits and what the workflow would look like for the nurse and the patient?

    ------------------------------
    Kathy Miller MSN
    Manager Regional Clinical Services
    OSF Medical Group
    Peoria, IL
    (309)645-8891
    Kathy
    ------------------------------

    Original Message


  • 10.  RE: Nurse-led visits in primary care

    Posted 09-22-2022 01:59
    RN visits can be used to assist the doctor/provider in managing their patient panel. For example, follow-up on hypertension, hba1c, patient education, and prevention of health complications. This is done in collaboration with the primary care provider. It is usually not billable.


    Sent from the all new AOL app for iOS



    Original Message


  • 11.  RE: Nurse-led visits in primary care

    Posted 09-22-2022 06:09

    Good morning,

    In the VA, nurses do face-to-face and virtual nursing visits.  Nurses provide education on the technology of setting up the virtual visits and can provide test calls if indicated.  There is also a tech center that troubleshoots the technology with the Veteran to ensure they have access to the virtual platform.  The virtual nursing visits, called VVC in the VA, were instrumental during the Covid-19 pandemic to ensure Veteran's maintained access to their Primary Care team.

     

    Thank you,

    Amy Fulwood, MSN, RN, AMB-BC, VHA-CM

    Assistant Chief Nurse

    The Villages VA Outpatient Clinic

    8900 SE 165th Mulberry Lane

    The Villages, FL  32162

    Office:  352-674-5000  EXT. 305072

    Cell:  352-284-5687

     

    Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives. ~ William A. Foster

     

     




    Original Message


  • 12.  RE: Nurse-led visits in primary care

    Posted 10-13-2022 11:57
    Thank you for posting your paper. It was very insightful and the provider/RN schedule posted was helpful to envision the clinic's day.

    ------------------------------
    Eunice Lee RN
    AltaMed Health
    Anaheim CA
    ------------------------------

    Original Message


  • 13.  RE: Nurse-led visits in primary care

    Posted 08-17-2022 11:47
    Hi

    My organization has nurse-led visits in primary care. These include immunizations, injections, point of care testing, walk-in triage, blood pressure checks and medication titration (RN), diabetic monofilament foot exams (RN), simple wound care, EKGs for medication clearance, BMI checks for children and adults, and basic infusions for hydration. There is no copay at this time for our members.

    ------------------------------
    Vernita Goodlett BSN RN PHN
    Director Of Ambulatory Clinical Practice
    Kaiser Permanente
    Bakersfield CA
    (951)691-3176
    ------------------------------



  • 14.  RE: Nurse-led visits in primary care

    Posted 09-02-2022 10:06
    Vernita,

    I would love to hear more about the diabetic monofilament foot exams as far as process and documentation.

    ------------------------------
    Dotty Parker
    Director Nursing- Ambulatory Clinical Quality
    Montage Medical Group
    Monterey CA
    (831)265-3989
    ------------------------------

    Original Message


  • 15.  RE: Nurse-led visits in primary care

    Posted 08-18-2022 11:06
    We do nurse led visits here! Mostly consisting of Wound Care, Medication Reconciliation, Injections, ABI's, EKGs, etc. We have two open nurse schedules with time slots for 40 minute visits. One schedule is just wound care and the other is mostly wound care and LAIs.

    ------------------------------
    Rory Gravelle
    Central City Concern
    Portland OR
    (971)361-7820
    ------------------------------



  • 16.  RE: Nurse-led visits in primary care

    Posted 08-19-2022 08:47
    It looks like some of the tasks included in the visits described by Vernita and Rory would require standing orders. Any insights to share about that process? (i.e., Agreement among physicians/APPs, annual revisions, process for interpretation of point of care labs/EKGs?)
    Or maybe these are shared visits with the provider as described in Malia's article....?

    ------------------------------
    Leslie McDowell ANP-BC, DNP, RN
    QI Specialist / Curriculum Developer
    Northwest AHEC / Wake Forest University School of Medicine
    Winston Salem NC
    (336)972-7852
    ANP-BC, DNP, RN
    ------------------------------

    Original Message


  • 17.  RE: Nurse-led visits in primary care

    Posted 09-02-2022 14:49
    Hello,
    We're doing RN nurse-led visits.  We do AWVs, stand-alone and co-visits, as well as HTN protocol, education nurse visits, and wound care.  We do bill for these visits.


    Thanks
    Cynthia

    ------------------------------
    Cynthia Griffin, MS, RN, BSN, CPHQ, CCM
    Chief of Nursing Services for Community Care
    The Medical Group of Christiana Care
    Newark, DE
    302-623-0152
    ------------------------------



  • 18.  RE: Nurse-led visits in primary care

    Posted 09-02-2022 15:10
    Hi Cynthia,
    I'm curious--for AWVs, do you have a provider see the patient during the visit in addition to the nurse?  I'm being told we cannot bill for the AWV if the visit is nurse-only.
    Thanks so much,
    Carla

    ------------------------------
    Carla Lally BSN RN MPH
    GFHC
    Willimantic CT
    ------------------------------

    Original Message


  • 19.  RE: Nurse-led visits in primary care

    Posted 09-22-2022 08:14
    Cynthia,
    Are the nurses performing AWVs dropping chronic care codes in these visits? Do you bill under the AWV code as well as an 99211?
    thank you for any insight you can provide!
    Melissa

    ------------------------------
    Melissa Taylor, BSN, RN, AMB-BC, NE-BC
    Director of Ambulatory Nursing-Primary Care
    Elliot Health System
    Manchester, NH 03103
    Mtaylor@elliot-hs.org
    ------------------------------

    Original Message


  • 20.  RE: Nurse-led visits in primary care

    Posted 09-06-2022 17:21
    Yes, here's a link to our billing criteria



    ------------------------------
    Deborah Scannell RN
    Cambridge Health Alliance
    Somerville MA
    (617)780-9735
    ------------------------------



  • 21.  RE: Nurse-led visits in primary care

    Posted 09-23-2022 09:04
    Hi everyone, 

    We currently have nurse visits for wound care, immunizations, STI treatments, etc. We are hoping to expand to include things such as PrEP and checkins for chronic management. I would be very happy to hear more about strategies for implementation both success and failures!

    ------------------------------
    Christopher Mangels ACRN, MSN, OCN, RN
    Nursing Professional Development Manager and Infection Preventionist
    Fenway Health
    Hyde Park MA
    (443)690-2805
    ------------------------------



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