Many practices are hiring nurse practitioners and physician assistants, collectively referred to as nonphysician providers (NPPs). But most aren't quite sure how to optimize the skills and value of these clinicians, which will be increasingly needed with the coverage expansion under the Affordable Care Act. Integrated well, NPPs can help your practice increase patient access, boost physician productivity, and generate new revenue. Here are some tips to get started:
1. Think strategically about the NPP's highest and best use
About half of the practices we work with treat their NPP as if she were a high-level nurse. They insist on signing every chart note (which most states don't require), or require her to see patients in collaboration with the physician, instead of independently. These practices are missing big opportunities to maximize revenue and streamline operations.
Optimizing an NPP's skills and value starts with an assessment of your practice's most common scheduling, access, and productivity "pain points." For example: Does it take more than 48 hours to schedule new patient appointments? Are physician appointment slots limited for complex patients with diseases like diabetes, who could benefit from more follow-up care?
Collaborate with your NPP to decide on the visit types, conditions, and patients that are most appropriate for her schedule — then check your state's scope-of-practice rules to verify that the NPP can legally deliver these services in your practice.
2. Develop patient scheduling protocols and scripts for staff
Using clearly written protocols, staff can capably fill the NPP's schedule with appropriate patients — opening valuable physician slots for complex cases.
Develop a written script that helps staff explain the benefit of seeing the NPP. For example:
"Dr. Brown doesn't have an appointment for four weeks but I can schedule you with Glenn Ross the day after tomorrow. Glenn is a specialty-trained physician assistant and can evaluate your condition and order tests and medicines."
Review the protocols and the script with scheduling, reception, and check-in staff. Just as you do for each physician, establish parameters for the number of patients per provider, and the time allotment for various visit types. A typical, productive NPP can handle 12 to15 patients per day, and usually isn't double-booked.
3. Try a "specialty clinic" approach
Smart practices fill otherwise dark exam rooms with NPP-led "specialty clinics" when physicians aren't in the office. According to Teri Romano, MSN, MBA, CPC, a consultant with KarenZupko & Associates, Inc., "Specialty clinics for back pain, sports injuries, diabetes management, or wound care speed patient access, optimize the NPP's productivity, and maximize the use of the exam rooms that so often go unused ..." The NPP can bill for these services under her own name and number, and the practice typically receives 85 percent of the physician allowable; although that will vary by commercial payers and Medicare. "That's 85 percent of something when the exam rooms were previously generating nothing," Romano says.
Start by blocking an afternoon each week for your new specialty clinic. When patients call for an appointment and are told there will be a long wait to see the physician, offer them the option of seeing the NPP instead. Staff should follow a script that describes the NPPs training and skills, explaining that using the specialty clinic will speed the patient's access to care, and that there is always the option of seeing the physician if the NPP thinks it is necessary.