Ways to Pump Up Your Bottom Line (Despite Healthcare Reform)

Leigh Page


October 25, 2012

In This Article

1. Hire Midlevel Providers

With more covered patients seeking doctors and the threat of declining reimbursements in the long term, doctors are under pressure to see more patients. Hiring midlevel providers, mainly nurse practitioners and physician assistants, is a good way to increase efficiency.

"If you have not hired midlevels yet, it's time to start," says John Croce, managing partner of Fairfield Consultants in Fairfield, Connecticut. When they are under direct supervision by a physician, midlevels command the same Medicare reimbursement as physicians. And because midlevels are paid less than physicians, they can spend more time with patients. They can deal with less complex cases and give patients unhurried, personal attention, he says.

But Laurie Morgan warns that you have to have enough work for midlevels when you bring them on board. If there are not enough new patients to occupy new midlevels, they will leave the physicians with less work to do, she says.

Bringing a new midlevel into the practice should be coordinated with a marketing campaign that bumps up the number of patients in the practice, she says. "If you bring in a nurse practitioner who has an interest in diabetes, have her provide an open house on diabetes," Morgan says. The practice could also attract more patients by offering Saturday or evening hours, she says.

Physicians who bring on midlevels should also understand malpractice coverage. Often, physicians can put a midlevel on their own policy, but this is not automatic and has to be arranged with your insurer. You can also buy separate coverage for midlevels, which usually costs one quarter to one third of a physician's premium.

Even when midlevels have separate coverage, supervising physicians may still be held liable for their actions. These physicians may be implicated for inadequate supervision, improper delegation of authority, vicarious liability, and informed consent. "You don't want the physician assistant operating in an office without any MDs around," John Croce advises. "Something could go wrong, and your malpractice coverage would be at risk."

Croce says it's important to prepare patients before they see your midlevels. Some patients may initially object to seeing a midlevel rather than a physician, but if it means they can be seen right away, they are usually not opposed, he says.