Utilizing NP’s and PA’s inLong Term Care Practice
Marc G. Nevin, MD, CMD, FAAFPLong Term Care Medical Associates
4502 Starkey Road, Suite 9Roanoke, VA 24018
Language Counts“Mid-Level” Providers
“Extenders”
NPP – “Non-Physician Practitioners” or “Non- Physician Providers”
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NP/PA’s
The Differences Between NP’s and PA’s Education
NP – RN ->BSN -> MSN -> FNP/GNP/ANP/APN -> DNP PA – AA/BA/BS -> PA
Licensure NP – combined Boards of Medicine and Nursing – independent license PA – Board of Medicine – practicing under the license of a physician
NP, PA and Physician Practice Models NP and PA work for the physician or practice
In Virginia a Physician may have protocols with 6 NP’s and 6 PA’s
NP has practice and “hires” collaborating physician In Virginia a NP must have a collaborative agreement/protocol with a Physician May have one or several collaborating physicians
Dangerous Generalization:
PA’s are well trained to interview, examine, diagnose and treat medical conditions.
NP’s are well trained to interview, examine, diagnose and treat medical conditions as they take care of patients and their families.
A Rare Combination – RN, PA
Working with NP’s and PA’s What defines your practice is how you define your relationship with the NP’s
and/or PA’s.
The Relationship can be Loose or Highly Structured
Styles of leadership The Boss NP/PA as Junior Colleague NP/PA as Colleague
Protocols, Guidelines, Expectations Protocols
Keep it Simple Keep it Broad Keep it Vague What the NP/PA can do.
Training/Comfort/ Competence Scope of Practice
What the NP/PA cannot do. Physician sets specific limitations
Protocols, Guidelines, Expectations Guidelines
This is where you can be very specific about what you want the NP/PA to do on a daily basis. The nuts and bolts of day to day practice.
Admissions, visit schedule, medical records, dictation, coding, billing, etc. NP/PA to avoid facility issues – staffing, policies, billing, etc.
Expectations
Regulatory Compliance, Standards of Care, Practice Specific Expectations
Continuing Education
Compensation Models Full-Time vs Part-Time
Full-Time Salary & Benefits (Health, Dental, Life, Disability, & Malpractice Insurance; PTO;
dues, fees, licenses; continuing education; 401K) Salary & Benefits & Some share of profits Salary & Benefits & Productivity Bonus Salary & Benefits Productivity & Benefits Productivity & Benefits & Bonus based on success of the practice
Compensation Models Productivity
Share of Revenue Produced – Share of Practice Overhead – Benefits – Employer Payroll Taxes – Employee’s Taxes – Deductions = Paycheck Complex formula, variable paychecks Can be pooled and calculated every 3, 6, 12 months
Simplified System Compensation fee schedule – for each 99300 series code set a fixed $amount to be paid to the NP/PA for
each code submitted. Fee schedule determined by the Medicare/Medicaid Allowable Fees less 15% adjustment, less
estimated overhead costs including all benefits (usually comes to 25-30% of expected revenue) NP/PA can easily track their productivity and pay. Insulated from practice management issues At risk for manipulation of visit codes.
Compensation Models
All compensation models should account for the fact that the practice and/or the collaborating physician should be compensated from the NP/PA revenue for managing the practice, providing support, providing clinical back-up, and for assuming significant risk and responsibility.
Compensation Models On-Call Compensation
Bundled vs Extra Compensation Our Model
Weekdays 5pm-8am $ 60 Weekend Fri 5pm – Mon 8am$250 Monday Holidays $100
On Call Communications Weeknight – email record of all calls to all practice staff Weekend – “Weekend Update” – Template to record all calls by facility and emailed to
all staff All on-call emails are retained in our computers
Oversight and Support Chart Review
Informal Formal
Physician Support NP/PA needs to know that they may work independently as they feel capable, but
the Physician is always available for consultation and support with patients, families and facilities.
ConclusionPhysicians & NP’s & PA’s in Long Term Care Facilities
Great Patient CareGreat Facility SupportGreat Practice ModelGreat Financial PotentialGreat Partnership
Questions and Answers Q&A
Further Questions – Call, Write, or Email Dr Hovland Angel Rivera Dr Nevin
LTCMA - On Call Notes Dates: LGH – 776-4000 (4021, 4022, 4023) CRMH – 981-7000Back-up call - Dr Nevin : cell 520-9851 home XXX-XXXXProvider: NURSING HOMES *CARRINGTON PLACE at BOTETOURT 966-0056Fri – pm Sat - am Sat – pm Sun- amSun- pm *FRIENDSHIP MANOR 265-2100
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