Integrating NPPs for a Patient-Centric Practice

The world of patient care today consists of one provider surrounded by a patient panel, but soon, that will shift to a "building a team around a population of one - the patient."

That's according to Ted Johnson, group vice president for Hospital Corporation of America’s (HCA) Physician Services Group. HCA operates 170 hospitals in the U.S. as well as more than 800 affiliated practices, overseeing a total of more than 3,700 providers.

That breadth of care is made possible through the integration of non-physician providers (NPPs), which the organization has seen grow from a workforce of 250 three years ago to its current level of 850.

"NPPs are our fastest growing area of employment," Johnson said at his session on integrating NPPs into healthcare environments at this year's Medical Group Management Association (MGMA) Annual Conference in Nashville, Tenn. , on Wednesday (Oct. 13). "Clearly, the literature is not new that there is a clear and present threat in the reducing number of [physicians] available with an aging population requiring healthcare."

Add to that government regulations encouraging team-based care and changing consumer behaviors toward immediate access, the need for additional staffing at medical practice and health systems is growing.  NPPs have and can continue to fill those needs, Johnson said.

"[Rather than] having a panel [of patients] and a provider, we are building teams of providers around the patient and providing the patient with solutions for their care," he said. "…It is no more provider-centric, but instead, a team of people who can deal with the portfolio of issues," patients have, ranging from a simple refill request to more complex visits.

While ideal in theory, creating this shift also has to make business sense. Johnson notes that while his firm is committed to "NPPs performing at the top of their license as independently as possible," he also has to justify hiring someone. That justification takes shape if he can calculate that the cost of hiring an NPP will result in twice their salary in added revenue.

"Below that, we have to ask what is needed: Is the need there or is it a 'lifestyle enhancement' for a physician? … I don't want it to be the case where we add an NPP to a physician who is in the 35^th percentile of productivity and remains there after the hire. We need to get to a higher threshold [of productivity]," Johnson said.

That also includes structuring compensation correctly for NPPs, he added. While it may be easier to tie productivity to compensation in primary care, the same can't be seen for surgical and other specialties. So it's very important that practices find a way to measure what NPPs do, how that ties to physician productivity, "and create incentives to give them the desire to make the physician more productive," Johnson advised.

And while integrating an NPP into practice is a balance of addressing access and capacity, it is also an issue of acceptance - especially when licensing and responsibilities for these various roles differ by state, from complete autonomy to heavy physician oversight.

"It really varies market to market," Johnson said. "But there are opportunities for us to education patients about what these providers bring tour practice and their care."