Organizations across the country have struggled with the idea of compensating physicians to work with advanced practice providers (advanced practice registered nurses and physician assistants). The topic is complex, regulated, and often times political. Nevertheless, implementing a best practice process for this issue will be critical to creating a cohesive compensation plan. This article will outline this complex topic and how organizations should manage it under their contracts and compensation does.
Understanding Compensation for Collaboration
One of the most problematic issues regarding this topic is one of terminology. For example, is the compensation for actual oversight? Is it for training? Is it for situations in which the advanced practice provider will slow the physician down? Or, is the compensation merely for team-based goals? To ensure that all parties are operating at the top of their license? These are questions that every organization needs to understand to effectively communicate and plan around this topic.
The reason these distinctions are critical is that ultimately the answers will impact how a compensation plan is developed. For example, if the issue is purely about training then the organization and compensation plan might include short-term stipends for the training. Or, if the purpose is to create mutually beneficial goals, the compensation plan might contemplate more team oriented metrics for bonuses. The bottom line is that every organization needs to know the strategy and goals of the collaboration
Paying Physicians for Ongoing Oversight
One of the most common areas of high-risk relates to payments for oversight in perpetuity. What is this? This is a payment plan in which the organization does not take into account the education, training, or skill set of the advanced practice provider over a period of time in relation to a financial amount paid to a physician for oversight. In short, whether the advanced practice provider has a significant skill set or is brand-new, the organization will pay X amount per year to the physician for oversight. This is a mistake for a few reasons.
First, by regulation, compensation paid to a physician must be fair market value for the services that are personally performed by physician. If one physician is training a brand-new person and another physician is merely signing off on charts at a distant location for an experienced nurse practitioner, clearly the work is different. Because the work is different, a fair market value rate is unlikely to be a rate that is consistent between those two examples. Second, from a commercial reasonableness standpoint this type of process fails to take into account changes in state scope of practice regulations. For example, in Florida a nurse practitioner may have to operate at the same location as the collaborating physician and have 50% of their charts reviewed whereas in Colorado the nurse practitioner has a fully independent license.
Creating an Organizational Approach
While future articles will discuss in depth analysis of the various types of compensation models in these areas, it is important that all organizations focus on beginning the conversation. For example, all organizations should begin to discuss the differences between advanced practice providers whether it be a nurse practitioner or physician assistant. In addition, advanced practice providers are trained much differently in various academic programs and their skill set would be different in various specialties. By beginning these conversations with your organization you will be able to properly implement a compensation plan that takes into account the nuances of physicians and advanced practice providers working together to create a new model of care for patients
