Payments to NPs, PAs outpace physicians

The industry increasingly is calling upon nonphysician practitioners (NPP) such as physician assistants (PA) and nurse practitioners (NP) to help expand healthcare access and optimize physician efficiency. And according to Medicare billing records, NPPs have certainly stepped up to the plate.

In particular, 15 percent more NPs and 11 percent more PAs received Medicare payments in 2013 than 2012 for all types of care, USA Today reported. Meanwhile, 5 percent fewer physicians received payments from the program. Overall, Medicare payments in 2013 totaled $1.5 billion for roughly 65,000 NPs and $1 billion for close to 50,000 PAs, representing payment increases of 16 percent and 12 percent, respectively, while physicians saw total payments drop 7.6 percent.

What's more, the data show healthcare organizations are heeding advice to utilize NPPs to the top of their licenses. In 2013, PAs billed not just for office visits, but also tissue biopsies, X-rays, and as "first assistants" to doctors in heart artery bypasses and spinal fusion procedures. The same year, NPs took on high-severity emergency department visits, pelvic exams and mental healthcare for the elderly, according to the Centers for Medicare & Medicaid Services (CMS).

Although the prevalence of NPPs has grown in the wake of the Affordable Care Act, some practitioners point out that the ensuing scope-of-practice debates are unwarranted. "We weren't seen before, but we were doing these things," Elizabeth Visone, an NP in Connecticut, told the newspaper. "[Critics] would say: You can't do these procedures and you shouldn't do these procedures. But we were doing them."

Healthcare organizations should note, however, that CMS officials are on high alert for cases of careless or fraudulent billing connected to NPPs. CMS encourages all health providers to bill under their own national provider identifier.

To learn more:
- read the article from USA Today