Non-surgical specialties, including rheumatology, are more profitable when they use a non-physician provider (NPP) and other support personnel, according to new data from the Medical Group Management Association (MGMA).
The finding isn’t necessarily new, because past reviews have reported that the use of NPPs can demonstrably improve a practice’s financial bottom line.1 But the latest data are a reminder for rheumatologists of the day-to-day value they can reap by bringing on key support staff, says MGMA Senior Fellow of Industry Affairs David Gans.
“You can invest in technology, you can invest in physical capital, and you can invest in human capital,” Mr. Gans says. “NPPs are a human capital investment [who] … [can] address a substantial amount of the care responsibilities for a [patient]. And they have much lower compensation levels [than physicians do].”
The data from the 2017 MGMA DataDive Cost and Revenue Survey, which compares ratios of NPPs with full-time equivalent (FTE) physicians, are undeniable.2 For physician-owned practices with a ratio of 0.21–0.40 NPPs to one FTE physician, total medical revenue after operating costs was $548,688. For practices with 0.41 or more NPPs to one FTE physician, total revenue was $751,133. In hospital-owned practices, the trend was similar. For practices with 0.20 or fewer NPPs per physician, total medical revenue after operating costs was $220,147. For hospital-owned groups with 0.21–0.40 NPPs per FTE physician, revenue jumped to $234,444; and for groups with 0.41 or more NPPs per FTE physician, revenue climbed to $338,790.
Beneath the numbers, the basic return on investment is that the more work an NPP can handle for a rheumatologist, the more new patients the rheumatologist can see. More patients, of course, means more revenue.
“This [increase] is true whether you’re a physician-owned practice or part of a hospital system,” Mr. Gans says.
If the trend is economically obvious, why aren’t more groups using NPPs? Or more NPPs?
Practice Limitations
One constraint for practices is physical space. A solo practitioner doesn’t add a provider so that the two of them can split one exam room. Bringing on more staff means adding space, and more space means greater expense for the practice.
Often, “private-practice doctors are so concerned about practice overhead they constrain the physical facility,” Mr. Gans says. “In private practice, the doors are thinner, the rugs are thinner, and the exam rooms are smaller. I’ve had excellent care in both [private and public] facilities because of the quality of providers, but you can see the difference in facilities.”
Another issue to consider before adding an NPP is having enough patients to justify the added personnel. Take the situation of Richard Lai, MD, a rheumatologist who joined the Great Falls (Mont.) Clinic, a physician-owned practice, in 2015.
“[The clinic] had a rheumatology practice in the past,” Dr. Lai says. “Unfortunately, the provider left. … I’m just [coming] on to reestablish the rheumatology practice, so [the clinic wasn’t] able to get a mid-level [provider] or an NPP for me right away, because the patient load [didn’t justify the addition].”
Bringing on NPPs
Two years after joining the clinic, Dr. Lai is now ready to add an NPP. The multi-specialty practice he works with is the largest referral center in a roughly 100–300 mile radius, and his census is growing quickly, because other regional rheumatologists are either not accepting many new patients or the wait times for existing patients are long.
“[Now] is actually a pretty good time [to add an NPP], because I’m seeing quite a number of patients already, and some of them are pretty stable,” he says. “And these [patients] can be delegated to the NPP. The [NPP] can do follow-ups, labs, treatments.”
One area in particular Dr. Lai sees a use for NPPs is in helping manage such diseases as myofascial pain syndrome (MPS) or fibromyalgia. Dr. Lai has even had preliminary discussions with his clinic’s pain management specialist to run a fibromyalgia center staffed by NPPs.
“I have quite a [few] fibromyalgia patients on board,” Dr. Lai says. “So I would like to start with an NPP who is trained in fibromyalgia … and I [can then] absorb more patients.”
Dr. Lai believes NPPs could also work with other stable patients diagnosed with inflammatory arthropathies, such as rheumatoid arthritis, gout, pseudogout and psoriatic arthritis, as well as connective tissue diseases, such as Sjögren’s syndrome.
Another area in which NPPs can be a benefit is in an infusion center. Dr. Lai’s multi-specialty clinical has a center already set up for hematology and oncology, and he has used it often. He would like to operate his own outpatient center, under the co-management of an experienced NPP.
“I know physicians need to be on board, at least within the same medical facility, in case something happens,” he says. “But … there aren’t a lot of issues with infusions.”
Experience is key. Rheumatology is a specialty that suffers from a shortage of trained professionals, and the same can be said of its support staff.
“Rheumatology is a booming field, and I don’t think many NPPs are experienced in handling complicated rheumatologic cases,” Dr. Lai says.
“[The NPP you hire] can’t be just [any] nurse practitioner or physician assistant,” adds Mr. Gans. “It has to be the right one. It has to be someone with degrees of experience in your specialty with skills that complement the physician’s. A non-physician provider who has worked in primary care may not be good for a surgical practice or a nonsurgical specialty, [such as] rheumatology.”
Richard Quinn is a freelance writer in New Jersey.
References
- Medical Group Management Association. Report: NPP Utilization in the Future of US Healthcare. 2014 March.
- Medical Group Management Association. News release: Analysis of U.S. medical groups finds adoption of non-physician providers and support staff among factors driving more profitable and productive groups. 2017 Jul 19.
