The Proper Way of Using NPPs

Karen Mosteller, CPA, CHBC, has a passion for helping businesses — in particular, medical practices — run better. A business consulting, technology and bookkeeping partner with Fort Myers, Fla.-based Markham Norton Mosteller Wright & Company, P.A., Mosteller has been helping medical practices grow their business and improve profits for 20 years.

One of the methods for improving profits is the hiring of non-physician practitioners (NPPs). Physicians, she says, have always seen the value in hiring NPPs, and that’s especially true today with across-the-board cost constraints.

“[Hiring an NPP] is a reduced direct cost,” Mosteller says. “If they find the right person and right fit, it’s going to add a substantial amount of revenue to the practice.”

The key, however, is thorough planning.

Beyond the numbers

The National Society of Certified Healthcare Business Consultants indicates that the median annual income of an NPP is less than 50% of a non-owner primary care physician. And since NPPs productivity is more than 50% of physicians, an opportunity exists to substantially improve a medical practice’s bottom line.

However, Mosteller suggests that, as much as hiring an NPP is a numbers game, there are other elements that are even more important.

“It’s more important to have the right person and the right culture and the right fit for the NPP,” Mosteller says. “If it’s [a medical practice’s] first go at it, I would caution people not to only look at the numbers but to look at the culture of the organization. Are they going to treat that person as a true provider and not just a glorified nurse?”

Jim Moniz, chief executive officer of Northeast Wealth Management, echoes those thoughts. He says that, ultimately, the most important element when hiring an NPP is maintaining the patient experience.

“We want the patient to feel that even though they’re seeing the physician’s assistant, the doctor is aware of what’s going on,” Moniz explains. “There should be a feeling that [the practice is] enhancing care, not passing it off.”

Working well, and not so well

Mosteller says the medical practices that use NPPs well are the ones where the physicians identify them as a peer who can help. And that needs to be communicated to the staff, to the patient and to the community.

“There could be roadblocks if [the NPP] is not marketed well and promoted well by the physician,” Mosteller says. “The physician and the administrator have to be the ones who start that push, and then it will trickle down to everybody else. That’s a good team approach.”

Conversely, she says, the NPP concept does not work well when a practitioner says he or she is overworked and needs to hire an assistant. But when the NPP is hired, the physician micromanages them, insisting on signing off on everything they do.

“If you’re not utilizing this person, and giving them the latitude to do what they can do, and what you train them to do, then it’s not a win-win situation,” she says. “Because you’ve taken on this overhead, and you haven’t relieved yourself of the time that you were hoping to relieve yourself of.”

Planning and evaluating

Too often medical practices make the mistake of thinking that they can simply bring in a nurse practitioner and that will enable the physician to see more patients, according to Moniz. That’s true, he says, but it’s the overall patient experience that needs to be considered.

“Find out what the doctor is really good at, and find out what they’re really bad at, and get support to take over those bad things, so the doctors can be as profitable as possible,” Moniz says. “If you’re adding staff, make sure that the people being added are supportive all the way down the line. And have a fundamental focus on how to get the whole practice to focus on client experience, client expectation and client deliverables. You do that, and the practice is going to grow.”

As to the numbers, Mosteller says that practices must consider the direct as well as the indirect costs. By bringing in an NPP, will you need more space? Is rent going to increase? What additional equipment and supplies might be needed?

“There are all these intangibles that the practice needs to analyze and plan for,” she says.

And evaluate. Mosteller recommends that, depending on how a medical practice tracks its financials, a sub-division or department be set up to capture not only the cost, but also the billing side. In other words, what are the revenues being generated by that new hire?

“Then you can assess whether that person is as productive as you thought they would be, or what you need to do to market them and get them more productive.”