The Business of Health Care and How NPs Should be Involved

Abstract

Ok, I admit it: I'm an Internet junkie. I love reading all those reports from clinical conferences I don't attend, article summaries from journals for which I don't have normal access, and the latest medical news sorted and analyzed for me. So I read with interest an article by Robert C Scroggins, JD, CPA, CHBC, “Why More Doctors Should Use NPs and PAs and Why They Don't.” (www.medscape.com/viewarticle/705120?src=mp&spon=24&uac=34165MZ), in Medscape Business of Medicine. Granted, the author was a business attorney, so he used terms like “physician extender” throughout, and his comments made me suspect he knew very little about nurse practitioners (NPs), physician assistants (PAs), and their roles. I had to remember he wrote the article to advise physicians, but I found it fascinating to listen to his analysis of reasons to hire NPs and PAs: •Potential changes in health care being discussed now are going to bring more patients into the system and physicians can't take care of them all. They should enlist other providers to help them.•Competition may require physicians to use more “physician extenders.” Retail clinics, boutique practices, etc, are taking physician patients. Different providers can help see more patients and see them sooner in the practice.•In a time of declining reimbursement, physician extenders can help boost revenue. Scroggins estimates an NP or PA can generate more than $30,000 profit for a practice. Some of these conclusions seem a little naïve. We are already taking care of patients, and we are the competition in many cases. Whether or not the author was knowledgeable from a professional point of view, he was very partial to NPs and PAs from a business point of view. He listed 4 reasons physicians give for not wanting to use NPs or PAs and then quickly debunked them: •PAs and NPs don't fit with the culture of my practice. (Of course the culture will be different if there is no NP or PA, so hire one and change the culture.)•I don't have the space to add another person. (Seek new facilities if you want to make money!)•I'm reluctant to invest in the additional overhead. What if I hire this person and then my volume declines or my income drops? (Business is risky. Have a good business plan.)•I don't know how I'll divide the current workload; this will change my whole workflow of the office, and it may become chaos. (Actually, NPs and PAs can handle patients all by themselves. Just choose the patients you want them to see.) What this business attorney didn't know is that NPs are good for business. His arguments for using NPs would be stronger if he said NPs provide excellent care, patients like them, NPs actually like patients and it shows, NPs generate practice loyalty from patients, NPs generally keep good patient records and this helps ensure reimbursement, their risk for litigation is low, and their malpractice liability insurance costs are low. NPs need to master the business of health care to sell the NP role. Nobody else is going to do it for us.