Can NPs work as RN's?

Trauma Columnist · Dec 17, 2006

mvanz999 - you are correct $35 is pretty good money for an APN in IL. However, our state is home to the AMA which keeps our salaries artificially low.

tiredfeetED · Dec 17, 2006

Thanks Trauma just got back from graduation ceremonies time to party!::balloons:
I know that our instructor was saying that when she went to go on an interview for a position at a MD medical group they offered her $35.00 an hour. She makes $45-50 dollars an hour per diem as an RN. She laughed and walked out I think for the schooling and responsibility that NP's have they should make anywere from $65-85 an hour. Just my thoughts.

It is true of central cali, there are many APN working as staff RN. Wages are increasing daily as it is not unheard of to make 40/hr with bennies as a staff RN which is more the norm. My classmates from the Bay area make 60-65/8h 1.5 after 8h as staff RN (perdiem). The pt ratio laws and state prisons are driving up the wages ($96,000/yr with state bennies). For me, Midlevel provider is what i want to do.

Advanced Practice Columnist / Guide · Dec 17, 2006

It is true of central cali, there are many APN working as staff RN. Wages are increasing daily as it is not unheard of to make 40/hr with bennies as a staff RN which is more the norm. My classmates from the Bay area make 60-65/8h 1.5 after 8h as staff RN (perdiem). The pt ratio laws and state prisons are driving up the wages ($96,000/yr with state bennies). For me, Midlevel provider is what i want to do.

If the hospitals are willing to pay the RN's that much, can you give me a figure of how much they pay their hospital-based NP's?

tiredfeetED · Dec 18, 2006

I havent seen the hospitals use NPs in my area. The ER docs use midlevels. State prison pays NPs about 1k more/monthly than staff RNs.

core0 · Dec 18, 2006

If the hospitals are willing to pay the RN's that much, can you give me a figure of how much they pay their hospital-based NP's?

The reason that you don't see many hospitals employing NP's is economics. The RN salary is simply supply/demand. Not many nurses/lots of demand = high salaries. This is compounded when there are laws (California) or regulation (hospital rankings) that demand certain nurse staffing ratios.

The NP situation is somewhat different. It is very difficult for a hospital to charge for NP services. There are rare cases where it may make financial sense to hire an NP for certain services. Also it may be helpful for a hospital to hire an NP to retain certain physician services. Here though there is not as much competition and there is no income to offset the salary. Also remember that many NP's are salaried as opposed to staff nurse which are hourly (a source of additional income). I have actually seen cases where if you took an hourly rate for the NP they are below the pay for a staff nurse.

David Carpenter, PA-C

mvanz9999, RN · Dec 18, 2006

mvanz999 - you are correct $35 is pretty good money for an APN in IL. However, our state is home to the AMA which keeps our salaries artificially low.

Well, that sux! I have no desire to live in CA though.

Hm....

Why do they keep the NP salaries artificially low? So there's no competition for the doctors?

core0 · Dec 18, 2006

Well, that sux! I have no desire to live in CA though.
Hm....
Why do they keep the NP salaries artificially low? So there's no competition for the doctors?

More likely more money for the doctors. Most NP's work for medical practice. I have not seen any absolute statistics, but I would guess less than 10% of NP's own their own clinics. Most of these are rural health clinics that have limited income (although the Advance salary profile shows that NP's that own their own clinics make the most). So if you are working as an employee, their is a strong incentive to keep salaries down. Look at it this way, there is no increased income from paying an NP more, only increased cost.

David Carpenter, PA-C

Trauma Columnist · Dec 18, 2006

The whole thing boils down to how much money can an NP bring to their practice or facility. I work for a private practice and I bill at 85% of the MD rate (can't change that - that's CMS regs). So...I have to see higher volume than MD's in order to bring in revenue.

Dialysis patients are to be seen four times per month per CMS (Medicare). So...the MD sees the pt once per month and then I see them the other 3 times and that way our practice can bill the max allowable charges.

I use this as an example only - its the bottom line!

mvanz9999, RN · Dec 18, 2006

The whole thing boils down to how much money can an NP bring to their practice or facility. I work for a private practice and I bill at 85% of the MD rate (can't change that - that's CMS regs). So...I have to see higher volume than MD's in order to bring in revenue.
Dialysis patients are to be seen four times per month per CMS (Medicare). So...the MD sees the pt once per month and then I see them the other 3 times and that way our practice can bill the max allowable charges.
I use this as an example only - its the bottom line!

So do you have a link to another post where you describe what you actually spend your day doing?

Advanced Practice Columnist / Guide · Dec 18, 2006

The reason that you don't see many hospitals employing NP's is economics. The RN salary is simply supply/demand. Not many nurses/lots of demand = high salaries. This is compounded when there are laws (California) or regulation (hospital rankings) that demand certain nurse staffing ratios.
The NP situation is somewhat different. It is very difficult for a hospital to charge for NP services. There are rare cases where it may make financial sense to hire an NP for certain services. Also it may be helpful for a hospital to hire an NP to retain certain physician services. Here though there is not as much competition and there is no income to offset the salary. Also remember that many NP's are salaried as opposed to staff nurse which are hourly (a source of additional income). I have actually seen cases where if you took an hourly rate for the NP they are below the pay for a staff nurse.
David Carpenter, PA-C

There's some truth to your remark for hospitalist NP's who only do H&P's and progress notes. But even those NP's can bring revenue to a hospital. I belong to a group of critical care NP's hired under our Department of Surgery's Trauma and Critical Care Services. We manage patients in the cardiothoracic surgery ICU and perform invasive procedures in addition to H&P's, consults, and daily ICU notes. We charge for each A-line, central line, chest tube, Swan-Ganz we put in. Our H&P's and progress notes are way more detailed than senior ICU staff. We have gotten kudos from our coders because they can get the highest revenue codes for our documentation and this translates to higher profits despite the fact that we can only claim 85% of the fee. I think it's all a matter of spreading the word to physicians about what we can do. Our collaborating physician has been such a great advocate for NP's. She even helped us with strengthening our case for a raise and yes, she is a female surgeon and the most awesome one I've met!

mvanz9999, RN · Dec 18, 2006

Um....can I have your job? :lol2:

core0 · Dec 18, 2006

There's some truth to your remark for hospitalist NP's who only do H&P's and progress notes. But even those NP's can bring revenue to a hospital. I belong to a group of critical care NP's hired under our Department of Surgery's Trauma and Critical Care Services. We manage patients in the cardiothoracic surgery ICU and perform invasive procedures in addition to H&P's, consults, and daily ICU notes. We charge for each A-line, central line, chest tube, Swan-Ganz we put in. Our H&P's and progress notes are way more detailed than senior ICU staff. We have gotten kudos from our coders because they can get the highest revenue codes for our documentation and this translates to higher profits despite the fact that we can only claim 85% of the fee. I think it's all a matter of spreading the word to physicians about what we can do. Our collaborating physician has been such a great advocate for NP's. She even helped us with strengthening our case for a raise and yes, she is a female surgeon and the most awesome one I've met!

I don't understand how you can charge for seeing the patients. If I understand the Physicians are hospital employees (or more likely employed by a physician group that has a contract with the hospital) then they have already been payed to see the patient when they did the surgery. Depending on the surgery there is a 30 or 90 day global period that is covered by the surgical fee. If you did not do surgery and are continuing to follow them (not uncommon with trauma services) then only one person from the service can charge. If they are part of the same service then you can us Co-billing with medicare to increase your charges. You can over course charge for any procedures that you do. If you are in the same service and you and the physician are charging for services this is double billing (if I understand the relationships).

Also on the subject of billing. The 85% rule only applies to Medicare patients. If they are not medicare (medicaid has its own rules) then you bill at whatever rate you have negotiated with the insurance company. If you do not have a contract with the insurance company it is the usual and customary rate. This also applies to medicare HMO's and PPO's. There are very few people with straight medicare or medicare primary after medicare part D came out. We collect the physician rate for PA services in my practice for new patients and consults that are not medicare (unless there is specific PA/NP language in the contract.

David Carpenter, PA-C