More Practices Hiring Non-physician Providers

By Jennifer Larson, contributor

April 21, 2014 - More medical practices are incorporating nurse practitioners, physician assistants and other non-physician providers to extend their ability to deliver more care to more patients, according to a new analysis from the Medical Group Management Association (MGMA).

The increase can be seen over the last 15 years, but at a much faster pace in recent years. Specifically, the number of full-time-equivalent, or FTE, non-physician provider (NPP) per FTE physician increased from .27 to .30 in multispecialty practices since 2008. That represents an 11 percent increase.

“NPPs are assuming a pivotal place in the future of healthcare,” the authors wrote in the report, NPP Utilization in the Future of U.S. Healthcare. They noted that the roles for NPPs will expand further as the population ages, the primary care physician shortage continues and the Affordable Care Act brings more patients into the system.

Kenneth Miller: The demand for non-physician providers will increase.
Kenneth Miller, PhD, RN, CFNP, expects medical practices to add more nurse practitioners to their staffing plans as the demand for primary care increases.

Their findings are not surprising to Kenneth Miller, PhD, RN, CFNP, president of the American Association of Nurse Practitioners (AANP). As the demand for primary care continues to increase, he expects the demand for non-physician providers like nurse practitioners will also continue to increase--and more practices will find ways to embrace models that include them.

And there will be plenty of work to go around.

“No single discipline is going to be able to handle all those people,” Miller said.

>Financial benefits

Why the increase? One major reason relates to the bottom line.

“The reason is clear: Practices with NPPs typically perform better financially, generating higher physician income,” wrote the MGMA analysts.

Another MGMA report on high performing medical groups in 2010 found that 61 percent of “better-performing practices” used non-physician providers. The 2013 edition of the report saw this number grow to almost 68 percent.

Those practices have a higher patient capacity, which translates into more revenue. However, that’s not the only benefit.

“NPPs allow practices to care for more patients and free physicians to perform work that only physicians can do. Because NPPs spend more time with patients than physicians for routine visits, they can increase the depth of the provider–patient relationship and enhance patient satisfaction,” the authors wrote.

Travis Singleton: Merritt Hawkins has seen increase in requests for NPPs.
Travis Singleton reports that Merritt Hawkins, an AMN Healthcare company, has seen a substantial increase in search requests for non-physician providers.

The increased demand is showing up in search requests for non-physician providers, noted Travis Singleton, senior vice president of Merritt Hawkins, an AMN Healthcare company specializing in recruiting permanent physicians and non-physician providers. The year-over-year growth in search requests is around 160 percent, which is “huge,” he said.

“We don’t [usually] see that,” he said. “A big year may be 10 or 20 percent.”

Singleton credits the realization among physicians that employing non-physician providers and allowing them to practice at the top of their license makes sense for everyone. It allows doctors to see more complex cases, for example, while the nurse practitioners and physician assistants take on cases appropriate to their training and abilities.

“It’s that kind of reformed thinking that’s made it explode,” he said.

Community health centers embrace NPPs

Gary Wiltz reports that community health centers have embraced NPPs.
Gary Wiltz, MD, reports that community health centers are more likely to use models of care that incorporate non-physician providers.

As CEO of Teche Action Clinic in Franklin, La., internist Gary Wiltz, MD, is one of many community health center physicians who have embraced a model of care that incorporates both non-physician providers and physicians. His clinic system currently employs 10 nurse practitioners throughout eight sites.

In fact, a 2012 report from the National Association of Community Health Centers (NACHC) found that community health centers are already more likely to use non-physician clinicians than other type of primary care practices.

The model makes a great deal of sense for community health centers, Wiltz said. He has found that nurse practitioners are very well-suited to providing a large percentage of the type of primary care typically provided in the clinics. They’re educated and trained to work to address avoidable illnesses, which is what many of the patients need. In rural areas, this approach is especially helpful because it expands access to more people.

“I’m a big believer in what they can contribute to the whole effort that we’re making,” said Wiltz, the chairman of the NACHC board of directors.

One of the biggest challenges going forward will be creating that true team atmosphere that already exists in many community health centers, Singleton said. Health systems that plan to hire more non-physician providers should have a plan that goes beyond just handling reimbursement and patient access--it should also include how to help providers from all levels work together efficiently and effectively.

Practices will also need to consider the situation in their state as they move forward with hiring decisions.  For instance, nurse practitioners can diagnose and treat patients in 17 states without physician supervision, but physician assistants are always under the supervision of physicians.

Although the laws governing the supervision of nurse practitioners vary, the trend toward using more non-physician providers like nurse practitioners is likely to continue.

“I don’t think we’re anywhere near done with it,” Singleton said.


Related articles and reports:
NPP Utilization in the Future of U.S. Healthcare - MGMA report
Performance and Practices of Successful Medical Groups - MGMA report
The Limits on Nurse Practitioner Practice: Current and Future Trends

© 2014. AMN Healthcare, Inc. All Rights Reserved.