Neurosurgical Clinic setting

[Jas girl]

I am a NP working in a Neurosurgical practice (Louisiana), graduated 1 year ago (with 13 previous years as RN). I would like to know...in other parts of the country, what are the daily requirements of patients seen in an office/clinic setting. Because I work in a surgical practice (one of three NPs with one neurosurgeon), I see new patients, follow- ups, and postoperative patients. When productivity is evaluated by management/MD, I find that it is difficult to determine a "true" value since about 40% of our patients are post-op (free visits due to covered under post-op global/no credit for NP). Our management is very concerned with the economy, healthcare reform, etc...and has recently informed the NPs that they want us to double the amount of patients seen in one day. Management has cited the reasoning after reviewing "national average" of patients seen in a neurosurgical practice. Does anyone know where to obtain this data? I would like to do my own research. Please tell me your thoughts.

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[core0]

I am a NP working in a Neurosurgical practice (Louisiana), graduated 1 year ago (with 13 previous years as RN). I would like to know...in other parts of the country, what are the daily requirements of patients seen in an office/clinic setting. Because I work in a surgical practice (one of three NPs with one neurosurgeon), I see new patients, follow- ups, and postoperative patients. When productivity is evaluated by management/MD, I find that it is difficult to determine a "true" value since about 40% of our patients are post-op (free visits due to covered under post-op global/no credit for NP). Our management is very concerned with the economy, healthcare reform, etc...and has recently informed the NPs that they want us to double the amount of patients seen in one day. Management has cited the reasoning after reviewing "national average" of patients seen in a neurosurgical practice. Does anyone know where to obtain this data? I would like to do my own research. Please tell me your thoughts.

I would ask them to show you where they got the information. If they are willing to say you are below average they should be willing to show it. Its most likely MGMA data. The problem with MGMA data is that they don't have a lot of data from surgical specialty practices.

The best data is probably from AAPA. You can find it here.
http://www.aapa.org/images/stories/Specialty_Practice/Neurosurgery08C.pdf

The mean is 74 per week and the median is 65 per week. As far as not getting credit for follow up, its not a free visit, its paid for in the global fee. Since someone has to do it, it can be done either by the NP or the surgeon. If the surgeon is doing something that is more productive such as surgery instead, you should get credit for the portion of the global fee that equals the follow up visit (or alternatively a portion of the surgical fee that the surgeon is doing instead). The AAPA has a nice study which shows roughly one third of the practice income that a ortho PA produces comes from downstream revenue (ie increased physician productivity doing something that pays better).

On the other hand I would tend to agree that a neurosurgery practice with three NPs and one surgeon is probably overstaffed. Most surgical practices are one to one at best with some ortho and spine services that do a lot of non-operative work going up to 2 PAs to 1 surgeon. Without knowing what you are doing its hard to say.

David Carpenter, PA-C

 

[Jas girl]

I would ask them to show you where they got the information. If they are willing to say you are below average they should be willing to show it. Its most likely MGMA data. The problem with MGMA data is that they don't have a lot of data from surgical specialty practices.

The best data is probably from AAPA. You can find it here.
http://www.aapa.org/images/stories/Specialty_Practice/Neurosurgery08C.pdf

The mean is 74 per week and the median is 65 per week. As far as not getting credit for follow up, its not a free visit, its paid for in the global fee. Since someone has to do it, it can be done either by the NP or the surgeon. If the surgeon is doing something that is more productive such as surgery instead, you should get credit for the portion of the global fee that equals the follow up visit (or alternatively a portion of the surgical fee that the surgeon is doing instead). The AAPA has a nice study which shows roughly one third of the practice income that a ortho PA produces comes from downstream revenue (ie increased physician productivity doing something that pays better).

On the other hand I would tend to agree that a neurosurgery practice with three NPs and one surgeon is probably overstaffed. Most surgical practices are one to one at best with some ortho and spine services that do a lot of non-operative work going up to 2 PAs to 1 surgeon. Without knowing what you are doing its hard to say.

David Carpenter, PA-C

Thanks for your response. I will definitely check out the site you mentioned. You made some great points.

TCB, NP