2014 MAPRA Conference Advanced Practice Provider (APP) Trends for Hospital and Clinic-based...

2014 MAPRA Conference

Advanced Practice Provider (APP) Trends for Hospital and Clinic-based Practices

Presented by: Josh Schneider

Managing Director

AdvancedPractice.com

Presented to:

© Copyright 2012. AdvancedPractice.com I 877.740.0404 I 2655 Northwinds Pkwy. Alpharetta, GA 30009

Exclusively dedicated to Advanced Practice Providers Locum tenens Contract to hire



The learning objectives for this session are:

• To learn basic information about the recruitment of APP’s

(Advanced Practice Providers), specifically Nurse Practitioners

and Physician Assistants• To learn information about APP practice settings and the

areas that APP’s specialize in• To learn APP nationwide trends related to employment, practice

and growth areas • To review the results of the most recent AdvancedPractice.com

Compensation and Employment Survey and the Jackson

Healthcare Advanced Practice Trends Report

Learning Objectives

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• Over 192,000 NP’s practicing in the US• Estimated 14,000 new NP’s completed their academic programs in 2011-2012• 95% have graduate degrees• 97% maintain National Certification• 18% practice in rural or frontier settings• 88% are prepared in primary care and 76% of all NP’s practice in primary care• 85% see patients covered by Medicare and 84% by Medicaid• 43% of NP’s hold hospital privileges and 15% have long term care privileges• 97.2% of NP’s prescribe medications averaging 20 scripts per day• NP’s hold prescriptive privilege in all 50 states with controlled substances in 49• 2011 mean full-time NP base salary was $ 91,310 with average of $ 98,760• 2012 average annual compensation was $ 99,836• 60% of NP’s see 3-4 patients/hour, 7% see over 5 patients/hour• Average NP is female (96%) and 48 years old and has been in practice for 12.8

years as a family NP (49%)

**AANP, revised 2013 and AP.com 2013 Compensation/Employment Survey

Nurse Practitioners by the Numbers

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Distribution, Mean Years of Practice - NPs

Population Percent of NP’s Years of Practice

Acute Care 6.3 7.7

Adult (pcare focus) 18.9 11.6

Family (pcare focus) 48.9 12.8

Geriatrics (pcare focus) 3.2 11.6

Neonatal 2.1 12.3

Oncology 1.0 7.7

Pediatric (pcare focus) 8.3 12.4

Psych / Mental Health 3.2 9.1

Women’s Health 8.1 15.5

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PA Snapshot

•There are an estimated 93,000 certified PA’s practicing in the US•PA’s can practice in all 50 states•All 50 states have enacted laws that authorize PA prescribing•2 states – FL and KY do not allow PA’s to prescribe controlled

substances•In 2013, the full-time annual salary average was $ 107,268 ($ 51.41/hour average).•Average PA salary increase from 2012 to 2013 was $ 5,103

which was a smaller increase than that of NP’s that increased by $ 5,785

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Growth in Utilization of APPs Nationwide

US New’s report on healthcare jobs in 2014, stated that Nurse Practitioners were the #2 job listing and Physician Assistants were the #8 job listing

In a report released in 2010, The Robert Wood Johnson Foundation found that between 1995 and 2009, the number of NP’s per primary care physician had more than doubled (0.23 to 0.48). As did the number of PA’s per primary care physician (0.12 to 0.28)

This data shows that the combined NP-PA workforce is already three quarters the size of the primary care physician workforce. It is likely to continue as the number of PA’s (93,00) is more than double its size of 10 years ago and the NP profession has grown to over 192,000.

A 2011 National Center for Health Statistics report showed that the percentage of hospital outpatient visits handled by NP’s and PA’s rose from 10% in 2000 to 15% in 2008. The Bureau of Labor Statistics predicts a 23% increase in Nursing jobs and a 41% increase in PA jobs from 2008 to 2018.

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Forces at work propelling demand

* The U.S. healthcare system is undergoing an epic transformation, opening what’s predicted to be a flood of additional medical consumers

* The Baby Boom generation has begun its consumption of greater amounts of medical care

* A shortage of primary care physicians looms

* Chronic diseases are increasing

* The complexity of care proliferates

NP’s and PA’s are positioned to be a critically important player in responding to these converging trends.

**2012-2013 Jackson Healthcare Advanced Practice Trends Report

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Results of the AdvancedPractice.com2012-2013 Compensation and Employment Survey

At a GlanceOver 1,000 respondents•73% Nurse Practitioners•22% Physician Assistants •5% Other APP’s

•83% are female, 17% are male•83% full-time, 17% part-time (Part-time

increased over 2011)•65% have been in practice for 9 years or

less

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Results of the AdvancedPractice.com2012-2013 Compensation and Employment Survey (continued)

Employment Status• 70% are Employees (91% salaried, 9% hourly)• 14% are Locum Tenens or Independent Contractors exclusively• 4% are solo practice, owner or partner• 2% are PRN• 1% are Retired• 9% Other 20

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Results of the AdvancedPractice.com2012-2013 Compensation and Employment Survey(continued)

Practice Settings•51% are employed at a practice/clinic or office-

based setting (up 4 percentage points from 2011)• 20% are employed in hospitals• 8% in Government (VA, IHS, Military, Corrections)• 3% in Outpatient Surgery or Urgent Care Center• 3% in Nursing Home, Assisted Living, Long Term

Care facility• 2% in Mental Health facility• 2% in Academic settings• 1% in Home Health• 10% Other

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Who Owns the Facility in which they work?• 41% - A hospital or health system• 26% - A Doctor or Group of Doctors• 25% - A Company or Corporation• 4% - A Nurse Practitioner or Group of NP’s• 4% - Don’t Know

Where Did They Find Their Current Position?• 36% - Referral , word of mouth• 34% - Internet• 10% - Professional Association• 13% - Staffing or Recruiting Agency• 7% - Other

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Do they anticipate remaining in this type of practice in the next 6 months?

83% - Yes17% - No

Top 4 Reasons to leave current practice setting in the next 6 months:

#1 – Lifestyle Choice, seeking less time working and more time in private life#2 – Seeking more challenging work / patient variety#3 - Seeking more leadership opportunities#4 – Money / Compensation package• Money dropped from #1 in 2011 to #4 in this year’s survey

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Nurse Practitioner Job Satisfaction with current practice• 28% Very Satisfied• 46% Satisfied• 23% Dissatisfied• 3% Very Dissatisfied

Top 5 Reasons for Nurse Practitioner Job Satisfaction:#1 – Patient Care / Type of Work Performed#2 – Work Environment / Setting / Relationship with Colleagues#3 – Compensation and Benefits#4 – Autonomy#5 – Variety / Challenging Cases / Ability to Grow

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PA Job Satisfaction with current practice• 33% Very Satisfied (slightly more than NP’s)• 38% Satisfied (8 percentage points below NP’s)• 20% Dissatisfied• 9% Very Dissatisfied (6 percentage points higher than NP’s)

Top 3 Reasons for PA Job Satisfaction:#1 – Work Environment / Setting / Relationship with Colleagues#2 – Patient Care / Type of Work Performed#3 – Compensation and Benefits

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Results of the Jackson Healthcare Advanced Practice Trends 2013-2013

The Top 5 Drivers of NP / PA Dissatisfaction

#1 – Supervisor / Management – 27%#2 – Don’t Feel Valued – 22%#3 – Salary – 19%#4 – Support Staff – 13%#5 – Physician Attitude

The Top 3 Qualities that NP’s and PA’s seek in a work Assignment

#1 – Work / Life Balance – 59%#2 – Pay – 57%#3 – Control over schedule – 34%• Other factors include friendliness, location, independence, training and working in a team environment

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Specialties in Highest Demand

A study by Moran and Hooker documents the movement of PA’s from primary care to surgical and medical subspecialties from 1997 – 2006. The PA workforce doubled during this time. However, the IM subspecialty PA workforce increased 262% and the surgical subspecialty PA workforce increased 186%.

*Major types of NP’s: 1. Family Nurse Practitioner – 31% of total practicing 2. Adult Nurse Practitioners – 18% of total practicing 3. Pediatric Nurse Practitioners – 18% of total practicing 4. Other NP Specialties – Women’s Health, Psychiatric/Mental Health,

Occ. Med, Geriatric, Correctional Health – 33% of total practicing

*Most in demand in our practice at AP.com: 1. Psychiatric / Mental Health with Family Psych certification 2. Cardiovascular / Cardiothoracic Surgery PA 3. Primary Care NP – FNP, ANP, etc. 4. Occupational Medicine NP 5. Orthopedic Surgery PA 6. Correctional Medicine PA or NP

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Key Questions APPs Want Answered in a Job Interview

•What is the patient population in the practice? Adult, Geriatric, Pediatric?•What is the specialty of the practice? Primary Care, Psych, Surgery, Emerg Med?•Is the practice focused on a particular patient base? Disabled, Women, Fertility?•What is the APP’s role in the practice? First assist, clinic work, psych evals?•What is the work schedule? Weekdays, weekends, on-call?•Are there other APP’s in the practice? What is their role?•Is there a supervising / collaborating physician in place? How broad or

limiting is the collaborative agreement?•How much responsibility and autonomy will I be given?•How many patients will the APP be expected to see per day?•Does the practice use EMR? Will there be training on the EMR system?•Why is the position open? Is it a replacement or an expansion?•Will the APP need to be credentialed / privileged by the hospital?•What is the salary and benefit package – include paid CME and license cost ? •Will there be an employment contract?•What are the growth opportunities in this role?



PA/NP Reimbursement

•Medical / Surgical Services delivered by PA’s and NP’s are covered by Medicare, Medicaid and nearly all private payers.

•Medicare pays for medical and surgical services provided by PA’s and NP’s at 85% of the physician fee schedule. This applies to ALL practice settings

including hospitals, nursing homes, clinics, first assist in surgery for PA’s, etc.•“Incident To” billing is a Medicare provision that allows for services provided by a PA or an NP in a physician’s office to be billed under the NPI of the physician with reimbursement at 100%. This billing requires the claim to be billed with the “Q6” modifier.•Shared Visit Billing is a Medicare provision that allows for services provided in the hospital by both the APP and the physician to be billed under the NPI of the

physician with reimbursement at 100%.•APP’s must apply first for their own NPI number and then enroll in Medicare via the PECOS system. Many private insurance payers are now reimbursing for APP services direct and not through “Incident to” or “Shared Visit” billing.•Overall, APP’s can provide 80-85% of the services that a physician can

provide at 1/3 to 1/2 the cost.

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Helpful Links

•American Academy of Physician Assistants (AAPA) – www.aapa.org

*American Academy of Nurse Practitioners (AANP) – www.aanp.org

*Champion Nursing – www.championnursing.org

*Advanced Practice.com 2012-2013 Compensation and Employment Survey – www.advancedpractice.com

*Jackson Healthcare Advanced Practice Trends 2012-2013 – An attitude and outlook report on Nurse Practitioners and Physician Assistants – www.advancedpractice.com

*Advance for NP’s & PA’s – www.advanceweb.com/NPPA

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http://www.aapa.org/

http://www.aanp.org/

http://www.championnursing.org/

http://www.advancedpractice.com/

http://www.advancedpractice.com/

http://www.advanceweb.com/NPPA



AdvancedPractice.com

A distinctive difference:The only national, full-service Locum Tenens agency dedicated exclusively to Advanced Practice ProfessionalsNiche, full-service job board

Employer postings at no charge Audience-specific positions

Strategic marketing partnerships designed to extend market reach – making for more cost-effective recruiting than our clients can do on their own

Our Value to our ClientsWe:• Are Industry experts• Have the highest quality providers• Have client-specific service delivered in concierge style• Offer automated service delivery• Are “high touch” with our clients and providers

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Questions?

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Thank you!

Josh SchneiderManaging DirectorAdvancedPractice.comjschneider@advancedpractice.com678.690.8204 Direct404.964-7321 Cell404.751.5215 Fax 20

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mailto:[email protected]

2014 MAPRA Conference Advanced Practice Provider (APP) Trends for Hospital and Clinic-based...

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