Forging New Bonds with NPs and PAs

From a practice management perspective, the case for incorporating nonphysician providers (NPPs) into your staffing model is clear. Nurse practitioners, physician assistants, and other advanced practitioners improve patient access, lower costs, and enhance revenue by enabling doctors to work to the fullest extent of their licensure. Unfortunately, such wisdom is often lost on patients.

Some still insist on being seen solely by their physician. Others may consent to being treated by an NP or PA, but ultimately lack confidence in the quality of care they receive. Such scenarios are best remedied with an education campaign that emphasizes team-based care, says family physician Reid Blackwelder, president of the American Academy of Family Physicians. "When we look at providing care, the goal is to make sure every member of the team is functioning at the top of their training and to work as a team," he says. "That's the best way to improve access and outcomes and that should be part of your message to patients."

The use of "shared information" is also an effective way to demonstrate that your providers work together, says Rosemarie Nelson, a principal with MGMA Health Care Consulting Group. "One technique is for the provider to reference a note/comment that the other provider had made in the previous encounter; something such as, 'I see that Dr. Smith was pleased with your cholesterol values at your last visit,' or, 'My nurse practitioner, Vince, told me that you're finding it difficult to get in 30 minutes of exercise each day,' or, 'My PA, Joan, was impressed at how well your surgical recovery went and how quickly you returned to normal activities.'" Comments like these instill confidence that your providers consult each other, which can help put reluctant patients at ease.

According to Nelson, practices that experience the most success at getting patients to accept new NPPs have physicians that personally introduce their nonphysician team member(s). "Either literally in person, explaining that they work as a team and will be sharing the patient's care, or as introduction to subsequent visits and/or services," she says. A surgical specialist, for example, might explain to patients that his nonphysician provider will be checking on them prior to surgery and will also round on them post-op. Or, he may explain that patients will alternate visits between the physician and the NPP, with each collaborating and sharing patient information.

Promote your people

You should promote your NPPs in your office and on your website, as well. Try posting a board in your waiting room with pictures of everyone on staff - including providers, administrators, and clerical staff, suggests Jack Valancy, a medical practice consultant in Cleveland Heights, Ohio. The same approach can be applied in a more interactive format on your website, which has the added benefit of allowing both current patients and prospective patients to click on headshots of your staff for a complete bio, including training, experience, clinical interests, and expertise, says Valancy.

For his part, Blackwelder says his office website includes clickable links on all provider titles such as "nurse practitioners," and "doctors of pharmacy," which define their scope of care. "We're entering an era in which that kind of transparency is not only appropriate, but expected," says Blackwelder.

Know the differences

Your front-desk staff, including your receptionist and scheduler, should also be well versed on the role your NPPs play, since these nonclinical staff members are the first point of contact with patients. "They should be comfortable explaining NPPs' roles," says Valancy, including the difference between an NP and PA, if your practice employs both. Indeed, there is much confusion over the various and often overlapping roles that NPs and PAs perform, which vary by practice and by state licensing. Both types of practitioners provide routine patient care, preventive care, and health education.

NPs, however, are registered nurses with advanced education and clinical training who are licensed to practice independently in 18 states and Washington, D.C., and with varying degrees of physician oversight in other states. They have prescriptive authority in all states, and receive nursing accreditation and graduate education (master's or doctoral degree), along with national board certification in neonatal, pediatric, family, women's health, adult, geriatric, psychiatric, or acute care medicine. They provide a range of healthcare services including the diagnosis and management of common and complex medical conditions.

PAs, on the other hand, are licensed to practice and write prescriptions in every specialty and setting, working in teams with physicians and other healthcare providers. Their scope of practice is defined by delegation decisions made by the supervising physician, consistent with the PA's education, experience, facility policy, and state laws. PAs complete three-year, accredited, graduate-level programs, pass a national certifying exam, and recertify as medical generalists every 10 years.

Don't get pushy

Every practice must decide for itself how assertive it wants its staff to be in promoting its NPPs, especially for patients who insist on seeing a doctor. Practices should also take the time to get to the bottom of their patients' concerns. After all, that's what being patient-centered is all about. "The patient is most important," says Blackwelder. "I see PAs and doctors making assumptions all the time, but it's important to ask about [patients'] concerns so you can directly address them."

Remember, too, that when it comes to educating your patients about NPPs, a soft sell can be more effective, says Lori Foley, principal with healthcare consulting firm Pershing Yoakley & Associates in Atlanta. "It's helpful to have the physician personally introduce [his] NPPs to patients, and talk about their bedside manner and that [they're] well-trained, for example, but don't oversell it," she suggests. "It becomes uncomfortable for the patient. Simply frame it in the context of how the NPP fits in with your practice and the benefits they can bring, but don't push it upon the patients."

Perhaps the most effective way to bring patients on board, says Foley, is to offer them a choice when they call to schedule appointments. "The best form of marketing is to indicate that there would be a delay to see the physician, but that your NP or PA has availability today and can see the patient at their convenience," she says. "Stress that availability and flexibility, which is always attractive to patients."

Patients can benefit greatly from the use of nonphysician providers, but they may not be clear on exactly how. As you roll NPPs into your staffing model, be sure you also embark on an education campaign that highlights team-based care, utilizes shared information, and promotes better access.

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.

This article originally appeared in the November/December 2014 issue of Physicians Practice.