How do you find a PA or NP?

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I've been looking for a PA or NP or maybe even an MD/DO to run my practice doing house calls, but can't find any. I've tried advertising for the past 2 months at schools, in various forums, searching resumes in talent banks, craigslist and can't find anyone that would work for $35 per patient, with a max of 10 patients per day. (I only make $65 per follow up patient from medicare, so I can't pay them too much more, i have no other source of income) They could be part time or full time. What am I doing wrong? How do you find a PA/NP/MD/DO without having to pay extra few hundred dollars to some PA or NP association? Is it really that difficult? How do other companies do what I sure haven't been able to?

Thanks!

Originally Posted by docu

can't find anyone that would work for $35 per patient, with a max of 10 patients per day.

That's probably your problem, although location and practice type/patient panel will turn people on or off, as well. It's not always about the money.

Most midlevels are going to want a guaranteed salary, plus incentive pay based on production beyond a certain level. You are providing no income guarantee, and are capping the number of patients per day rather than incentivizing them to be more productive.

Is this a full-time or part-time gig? At 10pts./day, I'm assuming part-time. You didn't say what sort of hours you expect them to work, either. Most people are going to want a predictable schedule and regular hours. How busy is your practice? If you're fairly sure they're going to be seeing at least a break-even number of patients per day, you might consider offering a guaranteed hourly rate instead of paying them per patient. Sure, you're taking a bit more of a chance in the event the volume isn't there, but if you don't have the volume to justify adding an extender, you shouldn't be adding an extender.

it is more part time than full time. Usually one can get done before 5pm if they start around 9am. If they wanted more patients I'd gladly give it to them.

Originally Posted by docu

it is more part time than full time. Usually one can get done before 5pm if they start around 9am. If they wanted more patients I'd gladly give it to them.

10 patients in a 7-8 hour day is a pretty slow pace. I doubt they'll be able to generate a competitive income with that volume in a pure third-party payer system.

If you're solo, you also need to be thinking about how you'll integrate a midlevel into your practice. You'll definitely want to observe them in action for a while before turning them loose while you're out of the office making house calls. Will they be seeing "your" patients (e.g., for acute/same day issues) or will they build a patient panel of their own? How will your patients feel about seeing a midlevel instead of "their doctor?" Etc...

Make sure you fully understand the scope-of-practice and supervisory statutes in your state. These are usually different for PAs and NPs. Make sure you fully understand the billing, coding, and documentation requirements for midlevels, as well, particularly "incident-to" billing. You can get yourself in serious hot water with Medicare if you do it wrong. The midlevel's status as either an employee or an independent contractor can factor into this.

Useful info from the AAFP: http://www.aafp.org/online/en/home/p...mlpissues.html

thanks for the advice, blue dog. they will be seeing my patients....i probably better ask my biller how the PA/NP can bill....i dont even know if i'll find anyone though...im thinking of closing the practice or giving it away to someone, cuz i hardly make any money to pay my employees let alone myself. i got a couple job offers to go to instead of running this biz. hoping they fall through. someone offered to see my patients in their office but i haven't heard back from them. home calls do not make enough money to pay the bills and there's not even enough money for me to spend on myself, contrary to what i initially thought. i don't do knee injections or other procedures like echos, etc that make the money. im trying to get a hold of someone that will do that, but having a hard time getting in touch with some people i know. hopefully after the holidays people will respond back.

It doesn't sound like you need a midlevel. It sounds like you need a business adviser.

lol bluedog yes i do,. just recently, i talked to a doctor friend and he's going to do diagnostic testing like echos, carotids, etc...on my patients...i'll get a percentage..hopefully that will get me out of the hole i am currently in....how nice ...im so glad..hopefully things will work out...maybe he can get me a PA too if i need one at some point..we'll see how things work out...there is a God...and just in the nick of time...

Originally Posted by docu

lol bluedog yes i do,. just recently, i talked to a doctor friend and he's going to do diagnostic testing like echos, carotids, etc...on my patients...i'll get a percentage.

Be careful. That sort of arrangement could be considered "fee splitting," and/or run afoul of federal Stark regulations. You might want to run it by an attorney first.

http://starklaw.org/

if i were a partner or an employee of this person, then it should be legit right?

i have another question: someone offered me $400 per patient if we refer them patients to get a CNA. That didn't sound legit to me. Just want a second opinion. Someone told me it is legit but i didn't buy it.

Originally Posted by docu

if i were a partner or an employee of this person, then it should be legit right?

Again, I'd talk to an attorney. The penalties for violating Stark are quite harsh.

someone offered me $400 per patient if we refer them patients to get a CNA. That didn't sound legit to me. Just want a second opinion.

Not sure what a CNA is in this context, but paying for referrals is fee splitting, which is both unethical and illegal.

Originally Posted by docu

lol bluedog yes i do,. just recently, i talked to a doctor friend and he's going to do diagnostic testing like echos, carotids, etc...on my patients...i'll get a percentage..hopefully that will get me out of the hole i am currently in....how nice ...im so glad..hopefully things will work out...maybe he can get me a PA too if i need one at some point..we'll see how things work out...there is a God...and just in the nick of time...

I would heed Bluedog's advice. There is a fine line between generating legitimate income and fee splitting or receiving referral fees which are not legal. It's also very easy to start to over utilize these tests to generate income, which not only has legal ramifications but significant ethical concerns.

Some "services" will attempt to get around these issues by bringing the testing to your office (i.e. non-invasive vascular testing, nerve conduction studies, etc) and will allow you to bill for the technical component if you actually assist in the performance, while the company bills for the professional component when they have their expert read the results.

Some do the opposite, and bill for the technical component and allow YOU to bill for the professional component of reading the exams, but you'd better be able to back up your ability to read these exams. However, some of these companies will actually have an expert provide you with a "complimentary" read so when you bill for the professional component you can CYA.

My recommendation is to build a busy practice and work hard and be careful when you start adding ancillary services. Make sure those tests are indicated and necessary and that if you are reading the results, you have the expertise. Otherwise do what's best for the patient and refer him/her to the proper specialist.

Interesting.

In Canada (well, at least in the "have" provinces, like Alberta and Ontario), registered nurses earn $40/hr (not counting their weekends, night shift premiums, or overtime). I haven't known a PA or NP to work for less than $90k per year, and I know of some who pull in ~ $130k to $140k with a 35 hour work week, and 30 minutes allocated per patient (60 minutes for annuals).

It's actually kind of a scam to me ... especially given that many of the PA's have only a bachelor's degree.