|This is the first of a two-part series on using advanced practitioners in physician networks. The second article covers advanced practitioner compensation, including the development of productivity and quality metrics.|
The first decision to make when adding advanced practitioners to your network is deciding which type – Nurse Practitioner vs. Physician Assistant – is best for your situation. Provided below are details regarding NPs and PAs and how they differ:
Nurse Practitioners (NPs)
According to the American Association of Nurse Practitioners, “all NPs must complete a master’s or doctoral degree program, and have advanced clinical training beyond their initial professional registered nurse preparation. Didactic and clinical courses prepare nurses with specialized knowledge and clinical competency to practice in primary care, acute care and long-term health care settings.”
- Nurse practitioners can prescribe in all 50 states but can prescribe controlled substances in only 47.
- Nurse practitioners are allowed access to patients without a collaborating physician in 19 states and the District of Columbia, according to the American Association of Nurse Practitioners. Many of those are largely rural and in the western half of the U.S. Remaining states require collaboration or supervision.
- Nurse practitioners can prescribe medication, diagnose patients, prescribe other treatments, and make referrals to physicians.
- Nurse practitioners frequently provide services related to patient evaluation and management.
Physician Assistants (PAs)
The American Academy of Physician Assistants defines a PA as, “a medical professional who is nationally certified and state-licensed to practice medicine. All PAs are graduates of an accredited PA educational program. PAs are licensed to practice and authorized to prescribe medication in all 50 states, the District of Columbia and all U.S. territories with the exception of Puerto Rico. They practice medicine in all settings and specialties.”
- Physician assistants are generally supervised by a physician. Most state PA practice laws allow supervising physicians, as leaders of the medical team, to determine how best to utilize PAs in a practice.
- Physician assistants tend to perform more procedures, including surgical procedures, such as putting in chest tubes, starting central lines, reducing dislocated bones, and making and removing casts.
|Nurse Practitioners||Physician Assistants||Physicians|
|Degree(s) awarded||Master’s Degree or Doctor of Nursing Practice (DNP)||Physician Assistant Certified (PA-C), usually also a Master’s Degree||Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.)|
|Number practicing in U.S.||155,000||83,600||691,000|
|Percent in primary care||70-80%||31%||30%|
|Number of education programs in U.S.||257 DNP programs||170||141|
|Base salary (2010)||$89,845||$89,726||$173,175|
Seven Best Practices for Adding Advanced Practitioners to Physician Networks
Here are Healthcare Strategy Group’s seven “Best Practice” steps for adding advanced practitioners to your network to build a high-performing healthcare team:
STEP 1: Be familiar with state laws and requirements regarding NPs and PAs.
STEP 2: Decide what you want the provider to do. This step will also help in determining selection of NP vs PA.
STEP 3: Determine the experience, skill sets, and specialized training required and provide clear expectations (i.e., ONP, Oncology NP).
STEP 4: Obtain physician buy-in to the physician-led team approach. Physician(s) must be willing to treat the NP/PA as an equally important part of the team.
STEP 5: Determine how the NP/PA can be and will be credentialed with commercial insurers and Medicare/Medicaid.
STEP 6: Decide how the NP/PA will be used. Will the advanced practitioner provide separately billable services or is the focus on allowing the team physicians to see more patients and increase collections?
Step 7: Understand how utilization affects production results and compensation for all the providers on the care team (i.e., midwife delivering babies, but wRVUs accruing to physician).
A major step to achieving physician buy-in is explaining plans for increased efficiency, heightened scheduling capacity, and improved quality. Management may also need to reward/compensate physicians for NP/PA oversight and mentoring. Normally, we recommend a physician bonus of $10,000 to $20,000 per year per NP/PA. This often offsets any wRVU bonuses a physician might lose due to a NP/PA picking up patient volume that normally would have gone to the physician. Modeling the impact on physician compensation is a critical step to garnering physician support.