NPP Demand Rising Under Value-Based Care Models

Multispecialty medical practices with non-physician providers typically perform better financially than those without physician assistants and nurse practitioners, an MGMA report finds.

The use of physician assistants, nurse practitioners and other "non-physician providers" continues to accelerate with the advent of value-based, coordinated care delivery, a Medical Group Management Association analysis shows.

The report examined growth in the use of non-physician providers at multispecialty practices and found that the number of full-time-equivalent NPPs per FTE physician has increased by 11% since 2008. Correspondingly, the analysis determined that medical practices with NPPs typically perform better financially, perhaps because the NPPs boost patient capacity and improve access to providers.

"While it's encouraging to see that practices who invest in employing non-physician providers benefit financially from such arrangements, medical groups are driven by the desire to serve patients and improve their satisfaction with their experience," MGMA President/CEO Susan L. Turney, MD, said in remarks accompanying the report.

"Being successful in a value-based environment will require practices to innovate and staff their organizations thoughtfully to ensure patients have access to their providers and are satisfied with their experience," she continued.

Nurse Practitioners Love Their Jobs, For Now

The MGMA analysis is consistent with the rise in demand for NPs and PAs seen at healthcare recruiters Merritt Hawkins & Associates. Travis Singleton, senior vice president at the Irving, TX-based firm, says search requests for these non-physician providers "grew by 300% year-over-year from 2012 to 2013, which is insane."

Singleton says the appeal of non-physician providers is obvious, starting with the fact that compensation for NPs and APs is about one-third that of physicians, "and maybe even a little bit less."

Tallying the Cost Advantages
But that's just for starters. "Where you are starting to see the real cost advantage is in the fully functioning co-management type of world," Singleton says.

"There is this spectrum of duplication where the physician and the nurse practitioners are doing too many of the same things. On the other end of the spectrum you are maybe allowing the nurse practitioner to do too many things and you have a problem with continuity of care. If you find that middle range ratio in your medical group – most people will tell you it's about two NPs to one primary care physician—then the cost efficiencies are incredible."

NY Abolishes Written Practice Agreement for NPs

In a well-coordinated practice, Singleton says, the non-physician providers are seeing "the coughs and sniffles and things an MD probably shouldn't be handling on the front line anyway. So, you are able to see two and three times the production you would see out of one MD and you are getting better care because this allows the NPs to spend more time with the patients who fall under their scope of care while allowing the MD more time with more chronic or complex patient."

One of the biggest, but often overlooked drivers in the use of non-physician providers, Singleton says, is that payers are now recognizing and reimbursing for the services they provide. "That is the difference. It is going to follow the money," he says. "If the third-party payers continue the trend of recognizing more and more expanded duties by NPs and PAs you are going to see people use more of them."

Tight Demand, 'Spotty Supply'
With demand for non-physician providers expected to remain strong, Singleton says the supply will remain tight and "spotty" in different parts of the country and within urban and rural settings. "Unlike the MD population, we are able to affect NPs and PAs much more quickly," he says. "Even though you are only seeing an increase in schools of 2% to 5%, we have seen a really healthy increase over the last decade."

How Teamwork Can Save Primary Care

Unfortunately for proponents of primary care, a growing number of non-physician providers are following physicians into more urban areas and into subspecialties because that's where the money is. "It's a much easier quality of life and it pays a lot better," Singleton says. "Where we need them most is in general primary care."

"For NPs specifically, 88% are focusing on primary care. But only 18% of those are in rural areas, and rural areas are where we need them the most."