PAs and NPs: How they boost practice earnings (Medical Economics Special Section)


Nonphysician providers can add significantly to the bottom line. They an also handle patient education, and may even allow you to take a vacation.

Like most physicians, internist Jeffrey M. Kagan is a busy man. In addition to taking care of patients in the Newington, Conn., office he shares with partner Turgut Yetil, Kagan is the Hartford medical director for the Vitas hospice program, takes care of residents at several nursing homes, and is on the board of his local synagogue. In order to see that patients' needs are met, Kagan turns over some of the practice's patient care to nurse practitioner Stacie Zibel.

Besides visiting nursing home patients, Zibel helps at the hospital-sometimes with rounds, but usually she expedites discharge by writing scripts, home instructions, and discharge summaries. In Kagan's office, she has her own patient panel and sometimes sees Kagan's or Yetil's patients, as well. She also returns phone calls, makes referrals to specialists, fields calls and faxes from the nursing homes, counsels patients (she's a Certified Diabetes Educator), and coordinates follow-up care.

"Stacie works on my day off and on my partner's day off," says Kagan. "And having her here increases patient satisfaction because she can accommodate same-day appointments and she's often able to spend more time with patients than I can. She frees me up for more complicated cases and lets me get home earlier."

In a previous article, we explained how to decide whether to hire a midlevel or another physician (see "NPs and PAs: A seller's market," Jan. 5, 2007; also available at If you've opted to go with a nonphysician provider, read on for tips from Dunn and others on how to hire the best person for your practice and then quickly get him or her up to speed.

Which midlevel is best for your practice?

In deciding whether you should opt for a PA or an NP, begin by finding out what your third-party payers' reimbursement policies are toward these nonphysician providers. Most insurers-including Medicare and Medicaid-pay for both, but some may be more inclined to pay for services provided by one profession than the other. You need to consider that when making your choice.

Next, check your state laws. NPs' and PAs' ability to prescribe varies from state to state.

All NPs and PAs who prescribe controlled substances must register with the DEA, and some need a state controlled-substances license. Be on the lookout for changes in state law, however, because statutes regulating midlevels' scope of practice can change, enabling the nonphysician provider to do more for you and your patients. For example, they might be granted expanded prescribing authority, or the right to order physical therapy, pronounce people dead, sign death certificates, or provide services for homebound and hospice patients.

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