Greater Use of Nonphysician Providers Seen in Office Settings

Employing nonphysician providers (NPPs) by physician practices has grown in the past 15 years, according to the Medical Group Management Association (MGMA).

An analysis by MGMA, titled “Nonphysician Provider Utilization in the Future of US Healthcare,” states that practices are hiring more NPPs in an attempt to try to extend the reach of physicians, enhance revenues, and increase patient satisfaction while introducing a new way to deliver care in a value-based environment.

“Being successful in a value-based environment will require practices to innovate and staff their organizations thoughtfully to ensure patients have access to their providers and are satisfied with their experience,” said Susan L. Turney, MD, MS, FACP, FACMPE, MGMA president and chief executive officer.

According to the MGMA analysis, medical practices that employ NPPs typically perform better financially. This may be a result of increasing a practice’s capacity to serve patients and enhancing access to providers.

“This staffing model is implemented more frequently because it allows NPPs to work at the top of their licensure and ensures physicians more time to devote to complex cases,” says Laura Palmer, an MGMA senior industry analyst. “Staffing a practice in this way can improve access options for patients.”

The study says that unlike nurses, NPPs can bill insurers direction for their services; they are also reimbursed at the physician rate. Federal and private health plans set their own rules for NPP billing. Under Medicare, NPPs can bill “incident to” a physician’s care, using the physician’s National Provider Identifier (NPI).

NPPs must perform these services under a physician’s direct supervision or while the physician is present in the same office suite to immediately assist. Moreover, “incident to” services must be furnished in the physician’s office or clinic as an integral part of a Medicare patient’s normal course of treatment.

According to The Advisory Board, a global research, technology, and consulting firm, NPPs have to follow stringent requirements in the office setting as compared to the hospital setting, per guidelines from the Centers for Medicare & Medicaid Services (CMS).

According to CMS, a physician is required to supervise the services provided by the NPP in the office setting. This differs from CMS’ requirements in the hospital outpatient setting—in that setting a physician does not need to be physically present in the same office suite, just that he or she is "immediately available.

These requirements have slightly changed, especially in the delivery of cancer care, according to The Advisory Board.

The Advisory Board said that a number of recommendations were made by the Hospital Outpatient Payment (HOP) Panel to CMS to adjust physician supervision requirements for specific services, including many cancer-related services. This committee recommended that several services can safely be provided with general supervision, instead of direct supervision.

Although CMS declined to adopt all of the Panel’s recommendations, it did announce a reduction in the minimum required level of supervision for a number of services, including injection/infusion, intravenous, and central venous access services.

Who Provides Supervision for Outpatient Chemotherapy? (n=49)

Total

Percentage

Medical oncologists

20

41

Medical oncologists and physicians who are not medical or radiation oncologists

5

10

Medical oncologists and radiation oncologists

1

2

Medical oncologists and NPPs

13

27

Medical oncologists, NPPs, and physicians who are not medical or radiation oncologists

6

12

NPPs

3

6

Radiation oncologists

1

2