Practice Strategies

Improving Productivity with Nonphysician Providers

Adding a nonphysician provider (NP) to your busy practice can lighten your workload, increase patient satisfaction, and boost your bottom line. These medical professionals can be especially helpful in managing the care of patients with chronic conditions and in handling routine forms of care. But, while hiring a nurse practitioner, physician assistant, or other mid-level medical practitioner may seem an attractive alternative to adding another MD, it is essential to consider in advance what role a nonphysician provider would play within the practice and to think about issues such as billing, prescriptions, and the types of care the NP would provide.

Numerous studies comparing the outcomes of patients assigned to a nurse practitioner or a primary care physician have found no significant differences in health status or satisfaction levels. Some research has even suggested that patients seen by an NP are more satisfied with their care because of the additional time and attention they receive from nurse practitioners and physician assistants. The evidence indicates that, within the scope of the responsibilities for which they have been trained, NPs can offer patients nearly the same level of service and often better access than a full medical doctor.

There are, however, built-in limitations to the role that must be taken into account when considering how to integrate an NP into your practice. The degree of autonomy NPs are permitted in practicing medicine varies from state to state. Nurse practitioners and physician assistants are licensed by state boards of medicine, which have different requirements for education and certification. NPs have some authority to prescribe in most states, though certain prescriptions, especially those for potentially addictive pain medication and other controlled substances, may require a co-signature from the supervising physician.

While physician assistants can carry out a wide range of tasks, such as conducting examinations, diagnosing, and ordering and interpreting tests, they are generally licensed to practice medicine only with physician supervision. Nurse practitioners, on the other hand, are permitted to practice and prescribe independently in some states, though not in others. As legislative activity can alter the requirements for NPs, it is important for practice owners to keep up-to-date on changes in the law.

Practices that employ NPs must ensure that mid-level providers do not exceed the limits of the law when administering care. Also, before recruiting an NP, the physicians in your practice should also clarify what responsibilities you feel comfortable delegating to an assistant or nurse practitioner. To minimize confusion about where the NP’s duties begin and end, the boundaries of the clinical role should be thoroughly discussed with candidates for NP positions before they join the practice.

Billing is an issue that should be resolved before a mid-level medical provider joins your practice. Whereas some states allow NPs to bill as primary care providers, others do not. Depending upon the types of services provided and the level of supervision, Medicare generally pays between 85% to 100% of the full physician schedule amount for services performed by NPs. Reimbursements for NPs by private insurers can be more complex. If you discover that one of your payers does not routinely credential NPs and reimburse for their services, you may have to renegotiate your contract with the insurer.

Nonphysician practitioners should not be viewed as replacements for physicians, but as highly trained professionals who offer skills and knowledge that complement those of the doctors on staff. While it may not be feasible to recruit a physician who speaks Spanish or another foreign language prevalent within the community, your practice may be able to hire an NP who has those skills. Recruiting the right nonphysician provider to your clinical team can improve access for patients, expand the range of services offered, and, ultimately, enhance the profitability of your practice.

For more information about our services to the healthcare industry, contact:
Maxine Lawyer, CPA, Partner - Dallas/Fort Worth at 972.448.6905 or
Philip Fox, CPA, Partner - Houston at 713.297.6914.

The articles in this newsletter are general in nature and are not a substitute for accounting, legal, or other professional services. We assume no liability for the reader's reliance on this information. Before implementing any of the ideas contained in this publication, consult a professional advisor to determine whether they apply to your unique circumstances.
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