Medicare reimbursements are down, making it necessary for neurologists to see more patients to maintain their income levels. Add to that the requirements of electronic health records and paperwork of varying sources, and it seems like a cruel joke. You have to work more each year just to keep from falling behind.
Could physician assistants (PAs) or nurse practitioners (NPs) provide a solution to this problem?
The role of the PA or NP in medicine has been fraught with misunderstanding for decades. In fact, there is even controversy over what to call this particular group of health care providers—physician extenders, midlevel providers, limited license providers, or simply clinicians.
But what most neurologists want to know about PAs and NPs is if they can improve their practice’s ability to provide high quality and efficient care.
The answer is: it depends.
The American College of Physicians points out that on average, a NP or PA increases practice revenue by far more than his or her salary. The key to successfully adding one of these providers to your practice is to have a plan in place to integrate them.
Know Your State Laws
The laws governing how PAs and NPs can practice vary from state to state. This affects things like the ability to prescribe medications in general or controlled substances specifically. States also regulate how independently the provider can work from a supervising physician.
The Kaiser Family Foundation maintains lists of these laws by state for both Physician Assistants and Nurse Practitioners. There are legal ramifications when the applicable requirements are not followed, so this is a situation where you should get assistance from someone with legal expertise, if you are at all unsure about these regulations.
Be clear with the candidates you interview about the responsibilities you will expect them to take on. Explain how you expect to work together, if they join your practice. It’s also important to get a sense of their expectations. If you hire someone who has had a high degree of autonomy in the past, but you prefer to be consulted on almost every patient, they may not be satisfied. Conversely, you may want someone comfortable with working independently, which means you need someone who doesn’t need a lot of guidance. Either way, be clear what the boundaries will be around the scope of their practice if they work with you.
Once someone is hired, be sure that all members of your staff understand those roles. It’s also important to send a letter introducing the new provider to your patients. In this letter, make sure your patients understand the difference between your role and the new provider’s role. If appropriate, you can reassure your patients that their care will be seamless and you will continue to oversee it, even if you don’t see them on every visit.
Determine How Their Services will be Billed
Medicare reimburses different amounts based on whether the provider operates under their own name, or “incident to” services under the supervising physician. “Incident to” reimbursements are higher, but come with more conditions on the provider’s practice.
Does it make sense for your practice to get reimbursed at the higher rate by providing more supervision? Or does allowing the PA or NP to work more independently free you up to devote more time to difficult cases and more challenging care?
In the end, adding a NP or PA to your practice can be a good idea, but it might not be for everyone. Try imagining your day with a new practitioner on your team. What roles do you see them filling? How will it change your day? If you can see the benefit, it may be worth the effort to explore the possibility of expanding your practice in this way.