Do You Need a Nurse Practitioner?

September 30, 2010

With a growing shortage of primary-care physicians, NPs are fast becoming the resource of choice

Are you suffering from over-burdened schedules, annual flu epidemics, working patients asking to be seen after hours, and patients requiring more hands-on education? Taken together, they can add up to longer-than-desired wait times and shorter appointments. If this sounds like your practice, it might be time to consider hiring a nurse practitioner.

Approximately 159,000 nurse practitioners are in practice in the United States today. With practices squeezing costs and a growing shortage of primary-care physicians, NPs are fast becoming the resource of choice for physicians looking to expand their practices and resolve day-to-day patient challenges. But what are they, exactly, and how can they help you?

According to the American Academy of Nurse Practitioners, “Nurse Practitioners are licensed independent practitioners who practice in ambulatory, acute, and long-term care as primary and/or specialty care providers. …In addition to diagnosing and managing acute episodic and chronic illnesses, nurse practitioners emphasize health promotion and disease prevention. Services include, but are not limited to ordering, conducting, supervising, and interpreting diagnostic and laboratory tests, and prescription of pharmacologic agents and non pharmacologic therapies. Teaching and counseling individuals, families, and groups are a major part of nurse practitioner practice.”

Depending on what state you practice in, different regulations govern the level of supervision, collaboration, and oversight required when working with an NP. Check with your state medical board for up-to-date regulations. You can start with this "Chart Overview of Nurse Practitioner Scopes of Practice in the United States."

Patient care

Nurse practitioners focus on health maintenance and prevention, making them invaluable to practices as more payers roll out quality, outcome-based initiatives such as pay-for-performance. Patient recall activities currently managed by nursing or clerical staff can be overseen by an NP to ensure that all activities are completed - such as immunization compliance or spirometry testing.

Utilizing an NP for care management and patient education will likely boost your patient compliance rates and do much to decrease acute care. And clinical training spearheaded by an NP will ensure better and more consistent patient care.

Having a nurse practitioner on staff may also free up more time for you and your practice to reach out into the community and host open-invitation educational sessions, furthering patient education and attracting new patients to your practice.

Lower cost

With the shift toward patient-centered medical homes, increasing numbers of patients with chronic diseases, and greater downward pressure on physician payments, NPs can offer a less expensive alternative to hiring another physician.

For many practices, taking on a high-salary, potential partner-down-the-road simply is not feasible. Nurse practitioner salaries are quite a bit less than starting physician salaries, and they pay for themselves almost immediately by freeing up physician time and taking over certain patient and staff responsibilities. (See "What Should You Pay Your Staff?" for more information on nurse practitioner salary ranges.)

Many payers credential NPs and pay anywhere from 60 percent to 100 percent of physician fee schedules for services rendered. However, not all payers recognize NPs - in those cases, “incident-to” guidelines must be met in order to bill for NP services. In addition, check with the networks in which you participate on how to bill appropriately before submitting your first claim.

Finally, don’t worry about whether or not your patients will accept a nurse practitioner in your practice - if you promote your NP’s strengths and show enthusiasm for your new colleague, your patients will come to trust her care too.

Susanne Madden, MBA, is founder and CEO of The Verden Group, a consulting and business intelligence firm that specializes in practice management, physician education, and healthcare policy. She can be reached at madden@theverdengroup.com or by visiting www.theverdengroup.com.