A landmark decision in my workplace - Page 3

Sorry studentdr, I missed your post until now. No offense taken from your post.
AFAIK, the factor is simply calendar years. That is how it as explained to us and I have not heard anyone raise your question. I think patient complexity will only figure in in-so-far as the RVU calculations for productivity/bonuses. Higher RUVs will mean more bonus dollars. For the most part we all see the same gamut of complexity in the family practice clinic anyway, but if the physician are indeed seeing more complex patients the RVU to productivy bonus ratio ought to make up for it.

(I have fewer 99214s because I choose to have a half a day of no appointments/walk-ins for "acute only" stuff. It's fast, easy peasy and lucrative. I can see as many as 16 by lunch, but they are all 99213s. :shrug: That pays better than seeing ten 99214s, but the main point is that our patients have such a hard time getting in because we are all so busy and booked out for several weeks, and it is a nice thing to offer them. I also do shared medical appointments and generate quite a lot of revenue with those, which bill out about as much as a 213.
The main incentive here is to see as many patients as possible, and code and bill correctly. That is how any of us, physician or NP, is going to improve our bonuses. Obviously there is also an incentive to do more lucrative procedures in the clinic as well. The bonus potential could almost double the salary. I'll never get there, but my office mate might. He saw 37 patients by 4:30 today! I saw 21. He bills most of them as 214s and mine were about 1/2 and 1/2 214s and 213s. I did have a 212 that was just a recheck on something, but I also had a 215, so it's still pretty even steven, lol.
I agree that if someone wants to do primary care, as I do, it would be an unexpected choice to opt for the larger amount of sacrifice and debt to do the same thing for the same money. However, there will still be some people who will do it. Just like I got a DNP and incurred more dept and made additional sacrifices to obtain it, and I don't make any more money than the master's prepared NP in my office, lol. In any event, right now there are more physicians in family practice within the company than NPs, but I understand that trend has been shifting for a long time and will soon be the other way around. There simply aren't enough physicians who want to do family practice here, so the company mission is to recruit and retain NPs. The letter we got says that they aim to be the "employer of choice in the region" for Nurse Practitioners and they want to "set the gold standard" for NP-physician equality and egalitarian leadership within the company. (They are restructuring the board of directors to have an equal ratio of physician and non physician members).
It has been a week, and of course all of the NPs are thrilled (my husband has thought of 1000 ways to spend my raise, lol, and lots of people are planning vacations and home improvements!) and I have not heard of any discontent. The PAs in the surgical services have been offered s different kind of bonus compensation that I guess they are pleased with. Their situation is different, as is that of the midwives, because of the global billing issue. They were not totally ignored, but just have a different set up, although they are being considered employees and not "full providers" (companies language, not mine). To be a "full provider," one must be an independent provider, which by state law the NPs are. The poor CNS was totally ignored. I heard they didn't really want her to stay anyway, and I suspect that was mostly personal. Rumor has it they are going to replace her with a dietician.
The interesting thing to keep in mind is that this was voted on and passed by the physicians. They want more NPs. they are pleased with our patient outcomes, our collegial working relationships and with the revenue we bring into the company. They want NPs beating down the door to work here. The physicians didn't lose anything. They are hoping by recruiting NPs, they will increase revenue and there will be more money for everyone, not to mention better access for our patients.

I'm pretty excited about it!

We found out on Friday that our corporate pay schedule is being completely revamped and NPs and MDs/DOs in any given specialty will be paid the same, weighted according to experience, not educational path. MSN/DNP prepared NPs will earn the same as MDs/DOs with the same amount of time in practice. Post graduate residency does count toward years of experience, as do fellowships. My "residency" was part and parcel of my graduate program, i.e. pre-graduation, and would not count. They way it was explained to me is that the corporation sees no effective difference between the physician in his/her first year of practice after a 3 year family practice residency and the NP with 3 years experience.
Salary varies widely according to specialty. I am in family practice and we are at the bottom of the salary tiers, but I am about to get a 28K a year raise, effective July 1st. Some of the specialties do not have NPs, so it doesn't apply-surgery for instance.

Bonuses will be paid on productivity and billing/collections, and be completely unrelated to level or type of education. They also threw out the patient satisfaction component. All that matters now is how much revenue one generates for the (for-profit) company. This is a very large corporation spanning two states, with 9,000 employees. It was approved by the board of directors that is almost entirely (11 physicians and 1 NP) made of up physicians- and it will be interesting to see how many of our competitors follow suit in the next few years. If this is the future, one would have to be absolutely crazy to go to medical school and then enter a low paying specialty like family practice/pediatrics, etc.

I think NPs might also have to be crazy to stay in backward states that do not allow for NP independence. I will be earning twice what my Duke classmates who stayed in NC earn, and have complete autonomy while I think the North Carolina NP practice act still calls for "supervision."

I suspect the dominos will start falling soon. States that restrict practice and income will not have any providers at all, and with health care reform coming to fruition around the corner, no one can afford to be in that position.



Unfortunately, the organization sees PAs differently and they are not included in the restructuring. There is one CNS (in diabetes) and she was not included either and I heard she resigned in protest at the end of the day Friday. Both of the states that this organization has offices in have independent provider status for NPs. I assume PAs and the CNS were left out because they cannot be independent providers. This is a real shame, and I hope it will be rectified very soon.

A a 99213 pays the same regardless how its coded. The diagnoses and the order are important in auditing. The diagnosis along with the time and the level of critical thinking are what determine the level of the E/M. The other portions are to back up the level.