Advanced practitioners bring much to the table. They can enhance the quality of care, improve patient access, and help boost revenue. But they are not a magic bullet. NPs and PAs only deliver value if you can justify their salary and, perhaps more importantly, if your physicians are committed to making them part of the team. "[Advanced practitioners] make a lot of sense," says Max Reiboldt, CEO of healthcare advisory firm Coker Group. "They are less costly than hiring another physician, and yet able to generate more revenue for the practice, and provide a better patient experience. But it must be based on need."
Before you hire a NP or PA, he says, consider the business case for doing so. Factors include how busy you are, your goals for future growth, and patient wait times. "If your ability to grow your patient base is limited because you don't have enough providers, or your patients cannot get in to see you for several weeks for non-urgent appointments, that's a real problem and the solution may be to hire [an advanced practitioner]," says Reiboldt, noting patients these days aren't willing to wait. "You have to look at supply and demand."
If patient access is the issue, look at whether your practice may be able to improve patient flow through creative scheduling alone, says Charlene Mooney, a consulting executive with Halley Consulting Group "It used to be that every patient was given a 15-minute time slot, but [these days] you have to cater the schedule to the patients you have," she says, noting a new patient may require 30 minutes, while a simple check-up may need only 10. "By tailoring your scheduling to the patients and their needs, you can help take the most advantage of the time you have."
Your practice may also be able to increase patient volume by using your staff more efficiently, says Mooney. "Take a look at the reception process or the process used to take patients to the back and make sure everyone is working efficiently and to the highest level of their ability," she says. "A lot of times you can take some of the administrative tasks off the clinical people to free them up."
Square footage is yet another concern. You can't very well add providers if you don't have space for them to work, says Mooney, noting many practices are converting closets that once held paper records into mini-exam rooms with great success. "I've seen practices hire [an advanced practitioner] and they don't have anywhere to put them so everyone is falling all over each other," she says.
Apart from solving patient access problems, says Reiboldt, PAs and NPs might be a fit for your practice if you feel you aren't spending enough time on patient education, wish to expand your hours, are losing new business to walk-in urgent care clinics, or simply can't afford to recruit a full-time physician. Given a physician's higher salary, says Reiboldt, the average primary-care physician would need to collect $400,000 to $500,000 annually to offset salary, benefits, and overhead, while an advanced practitioner need only generate $250,000 to $300,000 in revenue to positively impact net income. "It doesn't take much of a financial analysis to see that [an NP or PA] starts to make sense," he says.
If you do decide to recruit an NP or PA, you must onboard effectively. "You should treat bringing [one of these professionals] into your practice the same way you would bring in another partner," says Lloyd Van Winkle, a family physician in Castroville, Texas, and board member of the American Academy of Family Physicians. "You need to spend a lot of time in preparation — hiring someone who is a fit for your staff and your patient population, which improves your chance of success down the road."
To that end, he says, include all key staff members, especially those who will work directly with the new hire, in the interview process and solicit their feedback during the initial trial period. Your employment contract should include an opt-out clause with a 30-day and 90-day review, allowing both sides to bail if it's not working out.
A designated mentor who can show your new hire the ropes, answer any questions, and make him feel welcome can also help smooth the transition, says Van Winkle. Likewise, all new recruits should be given a copy of your practice mission and standards so that everyone knows what to expect from each other.
It goes without saying that advanced practitioners should be included in medical staff meetings, but Mooney suggests taking it one step further. "If you can get them involved in a committee at the hospital where your doctors are affiliated, it helps make them feel even more a part of the medical community, which is another important way to introduce [them] to [their] peers," she says. "You want them to feel at home and welcomed with open arms."
As for patients, the process of introducing an advanced practitioner is more delicate. Integration works best when the doctor to which the NP or PA reports introduces her personally, highlighting her experience, training, and areas of expertise. "Especially with[advanced practitioners], some patients may feel they aren't as knowledgeable as the doctor, so you need to explain to them why you brought them on and that they are part of your team," says Mooney. "It is important to present this person as a partner in delivering their care, rather than making the patient feel that you are dumping them onto someone new and abandoning them." Exceptions should be made, however, for patients who feel strongly that they'd prefer to see only the doctor.
To demonstrate your practice takes seriously the teamwork approach, it also makes sense to have providers reference a note or comment that another provider made in a prior encounter. While in the exam room, for example, the NP or PA might note that the doctor was pleased with their latest test results or blood work, and vice versa. Such comments help assure your patients that the providers in your office regularly consult each other.
Advanced practitioners can deliver significant value, but the decision to recruit must be driven by economics and a commitment to team-based care. Before pulling the trigger, practices should take the pulse of patient access, consider growth objectives, and perform a cost-benefit analysis to ensure their investment will produce a return.
Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached at [email protected].
This article originally appeared in the May 2015 issue of Physicians Practice.