Higher Volume for NPs, PAs Helps Practices

Advanced practitioners once merely played a supporting role in primary care, using their training and skill set to lighten physicians' workloads. However, with medical practices under pressure to increase access for patients and lower costs, many are now giving nurse practitioners (NP) and physician assistants (PA) higher billing.

"One of the trends I'm seeing is the empanelment of advanced practice providers," says Woodcock, who adds that this has a positive impact on continuity of care. "They're getting their own care teams."

Often, she says, empaneled advanced practitioners enable practices to double the size of their patient panel and extend their hours and days.

The Safety Net Medical Home Initiative (SNMHI), a demonstration project from three different nonprofit groups that aims to support high-performing medical homes, defines empanelment as the act of assigning patients to individual primary-care providers and care teams. In essence, the providers accept responsibility for a finite number of patients, instead of the universe of patients seeking care in a practice, allowing the provider and care team to focus more directly on the needs of each patient. Empanelment lays the groundwork for population health management and serves as the key to continuity of care, according to the SNMHI, but it is only an option in states that allow advanced practitioner autonomy.

While some primary-care providers may view the trend as a threat, especially in organizations that use productivity-based compensation models, The Advisory Board Company, a consulting firm based in Washington, D.C., suggests empaneled advanced practitioners can deliver significant benefits.

Data from the firm's 2013 survey revealed a positive correlation between empanelment and advanced practitioner productivity. Of groups that have empaneled primary-care advanced practitioners, 83 percent reported that their advanced practitioners performed above the 50th percentile of productivity, compared to 63 percent of groups that did not.

"Military health clinics have been empaneling NPs for decades with great success," says Cindy Cooke, president of the American Association of Nurse Practitioners, which supports the trend. "Patients in those clinics often seek out an NP as their primary-care manager."

To implement empanelment successfully, administrators must assess the practice supply and demand, monitor their panels to account for staffing changes, and rebalance patient load accordingly, the SNMHI suggests. The practice must also use panel data and registries to proactively contact, educate, and track patients by disease status, risk status, self-management status, community, and family need, it says.

"Empaneling NPs and PAs as part of Patient-Centered Medical Homes has become more of the norm in many geographic areas," says Cookie. "In any setting, partnering with patients in their healthcare journey is a key component to prevention and improved outcomes in chronic disease." 

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.