These numbers showed a steady increase in payments to NPs and PAs from 2012 (16 percent and 12 percent respectively). In the response to the physician shortage and the ever increasing acknowledgement of NPs and PAs as highly-qualified healthcare practitioners and valuable members of integrated care teams, NPs and PAs are revolutionizing healthcare delivery. NPs and PAs are completing more complicated medical procedures traditionally completed by doctors, including electrocardiograms, pelvic exams, and assisting in heart bypasses, according to Medicare payments.
However, this does not imply that NPs and PAs were not already doing such procedures before 2013. “We weren’t seen before, but we were doing these things,” says Elizabeth Visone, a Connecticut based NP. “(Critics) would say: You can’t do these procedures and you shouldn’t do these procedures. But we were doing them.”
The government has recently begun to crack down on “fraudulent or careless Medicare Billing.” To bill under Medicare, an NP or a PA can bill under his or her own number, with a physician as a co-managed visit, or by the physician if the NP or PA is carrying out the physician’s treatment plan. As advanced practitioners are paid approximately 85 percent of what a physician could bill under Medicare, billing under the physician’s name would lead to a larger payout. With Medicare spending totaling over $500 billion in 2014, the cost savings of having NPs and PAs do more procedures could be significant.
Furthermore, advanced practitioners have had the education and experience to execute such procedures for quite some time, despite public misperceptions. As advanced practitioners are gaining more and more independence and authority, one of the greatest challenges is tackling the beast that is public opinion. “A lot of people misunderstand the roles of PAs and NPs,” says Todd Pickard, director of physician assistant practice at The University of Texas MD Anderson Cancer Center. “With PAs, it sounds like we fetch a prescription pad and get coffee for physicians, and that’s not what we do at all.”
In 2013 almost 900 PAs were paid for heart artery bypasses. Approximately 950 PAs were paid for spinal fusion procedures, both as “first assistants” to doctors. Similarly, more than 1,000 NPs billed for almost 200,000 psychotherapy visits in 2013. In the face of the rising mental healthcare shortage, NPs are meeting a very real need, and “tend to provide mental health care to the underserved, the disabled, and the elderly.”
The healthcare landscape is in a dynamic state of change. The reality of the day is that we have less and less physicians to meet the healthcare needs of our growing and ageing population. Compound that with the millions of newly insured under the Affordable Care Act, and America’s healthcare system could be reaching a breaking point. By accepting NPs and PAs as the highly trained and highly qualified healthcare practitioners they are, and by granting them the authority to do their jobs to their fullest capacity, America will not only avert a full blown healthcare crisis, but also save billions in healthcare spending.