Multispecialty medical practices with non-physician providers

typically perform better financially than those without physician
assistants and nurse practitioners, an MGMA report finds.
“non-physician providers” continues to accelerate with the advent of
value-based, coordinated care delivery, a Medical Group Management
Association analysis shows.

The use of physician assistants, nurse practitioners and other

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.

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

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

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.”

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

From HealthLeaders Media, by John Commins, April 16, 2014