Best way to incorporate mid level providers into existing physician workflow and utilizing them to best capture all ICU billing opportunities

Blending mid level providers into an established workflow and best way to capture billing opportunities

One of my big goals has been the addition of a mid level 24 hour a day additional provider to the ICU team at my hospital. We have come a long way in that we have secured the FTEs to hire into the position. We have a reporting structure and have decided to hire a lead mid level provider. We have made steps in posting the positions. I am currently working on the educational piece to help bring these new mid level provider to the knowledge point we feel they will need to be at to truly function at the top of their license. I expect this process to take the better part of a year of training. To help I am in the process of creating more standardied guidelines and protocols.

The piece that I have a diffixult time conceptualizing is the integration of this new work force into the existing work flow of the  high functioning physician lead structure. It will, absolutely, be a culture change and I want to create a structure that will ensure success.

my current ideas revolve around changing the current structure of rounds and responsibilities so that the two groups grow together into a “new” system that is built around the core things we do well. I use “new” in quotations because we have residents physicians and the model is similar to how we incorporate them but I want the mid levels to also have unique responsibilities that are theirs alone.

i am hoping that some of you have ideas or have gone through the incorporation of mudlevels into a high functioning practice and how you made it successful or what pitfalls you wished you were able to bypass.

the second portion of my question is how to incorporate the mid levels into current physician billing to catch missed billing opportunities.


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Participant comments on Best way to incorporate mid level providers into existing physician workflow and utilizing them to best capture all ICU billing opportunities

  1. One of the key aspects to the success of such a program will be recognition of the capabilities of the midlevel provider. Despite the fact that some of these individuals are exceptionally skilled, I have seen them treated poorly by some physicians and even nurses because they are not a doctor. Establishing clearly to everyone on the team the value that the mid level brings be important to delineate responsibilities in expectations for performance and behavior.

    One model that I have seen be successful is to incorporate the mid level in to the clinical care team with full participation in rounds just like an additional resident. Specific patient types and acuity levels can be defined for what type of patient is cared for by the mid level and what type is cared for by the resident. Once the residents realize the skill an expertise of the mid level as well as the fact that this mid level enabled them to spend more time in the operating room, the resident will understand the value of these providers. From the billing standpoint, developing specific tasks that the mid level can perform an Bill for enable is a collection of a considerable amount of revenue that can help offset the cost. For example, line insertions when performed by the resident may not typically be a billable event unless there is direct attending physician supervision. Insertion by a mid level however is and this can’t eliminate much of the drudgey of ICU care for residents who are already per physician in these procedures.

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