Supervision Reimbursement

September 1, 2006

I am a family physician currently negotiating a long-term contract at the end of my first year with this practice. I am supervising two physician assistants directly and assisting with the supervision of two nurse practitioners. What is a customary and fair amount to expect in return for two to three hours per week spent supervising, answering clinical questions, reviewing charts, handling patient complaints, and covering some inpatient admits for nonphysician providers?

Question: I am a family physician currently negotiating a long-term contract at the end of my first year with this practice. I am supervising two physician assistants directly and assisting with the supervision of two nurse practitioners. What is a customary and fair amount to expect in return for two to three hours per week spent supervising, answering clinical questions, reviewing charts, handling patient complaints, and covering some inpatient admits for nonphysician providers?

Answer: There really is no "industry standard" for supervision reimbursement; this is more a matter of finding something you all can agree on than following a standard.

I can share some possible compensation designs that you could propose.

There are many groups that simply assign all of the revenue -- and the expenses -- to the supervising physician. You don't say whether the PAs and NPs in your practice bill incident-to only under your physician ID, bill on their own, or also work "for" the other physicians in the group in which you are just the one lucky enough to supervise.

You could consider an hourly rate. If it takes you 30 minutes a day to perform supervisory duties and your time is worth $150 an hour (a typical physician income), then start calculating this number based on the days a week and weeks a year you spend supervising. On the other hand, most physicians find that "supervision" means a few minutes here and there, so it's hard to track the time you spend on these tasks each day. Still, you could use your estimate of 2.5 hours a week and ask for $375 a week or so regardless of actual hours worked. That way, no one has to keep track, and you can assume you'll do a bit more some weeks and bit less other weeks.

If all physicians in the group share overhead and revenue from the nonphysician providers evenly, you could suggest that, as the supervisor, you take a slightly higher percentage than the others. This is simple negotiation. I'd start by asking for 15 percent more and see where it goes. The others can always offer to rotate the supervision if they are interested in picking up extra cash, too.

I like the model of taking a percentage of what the PAs and NPs bill, since this encourages you to teach them to be efficient and productive. If they make more, so do you.