Why I Became a Physician Assistant

Published first on CompHealth: November 21, 2013

Meet Lisa Shock

‘Tis the season for many things — giving thanks, prepping for the holiday rush, and physician assistant (PA) admissions. Once again, applications are flooding in for a coveted seat in the PA class. As I perform one of my favorite faculty duties, I often reflect on my own journey toward becoming a PA.

When I was growing up (I’m showing my age here), it seemed like the only things to do in medicine were to become a physician or a nurse. I went off to college as a proverbial pre-med student and became interested in research as a neuroscience major at Colgate University. I was the first in my family to receive a college education, and I had no role models or college funding. I often say I am from New York, but not the pretty part. I worked 20-30 hours a week, first in the admissions office and then in the lab, for my entire college career. I had a bumpy start, but recovered quite nicely. It was the growth and learning from that bumpy start that allowed me to take a road less traveled.

I moved to North Carolina immediately after college and worked at UNC Chapel Hill in the department of biochemistry. I took some time to do extra coursework and get work experience as I pursued a career in medicine. Then I heard about the PA profession and realized I was living in the backyard of its birthplace at Duke University.

I went to the Duke PA office armed with my life’s work in a manila folder and asked what the prerequisites were for admission. I spent the next two years garnering practical clinical experience as a certified nursing assistant in an outpatient family practice/urgent care setting, and worked directly with a physician and two other Duke PAs prior to my admission to the Duke program in 1997.

I have never looked back. Being a PA has allowed me to do everything I have ever wanted to do in medicine. I owned a practice with another PA and a physician, I delivered primary care in rural North Carolina for more than 12 years, I ran and managed a skilled nursing home service, I precepted students, and I have two faculty appointments.

At this point in my career, I am most interested in having a bigger impact at the health system level, and my administrative experience has allowed me to sit at the table of an accountable care organization and advocate for an expanded role for PAs in the new value-based healthcare model.

I continue to practice clinically for many reasons, the most important being that I love patients. I practice inpatient as well as outpatient medicine, and am one of the few PAs in the nation with active clinical care in both settings as well as business and administrative experience.

I am incredibly grateful that my twisted road has afforded me so many wonderful and meaningful experiences. If you are a PA, I hope my road less traveled will inspire you to continually push the limits of your career and expand into new roles and responsibilities. If you don’t know much about what PAs can do, I hope my atypical career path will educate you as to what is possible when PAs are given an opportunity to grow. I give thanks for these opportunities daily and wish you and yours a blessed Thanksgiving.

Click here for more articles from Lisa Shock, including:

About the Author: Lisa P. Shock+, MHS, PA-C, is a seasoned PA who has practiced in primary care and geriatrics since her days at the Duke PA program in the late ‘90s. She is an Associate Clinical Professor at the Duke University PA Program and enjoys part time clinical practice.  In addition, she is the president and CEO of Utilization Solutions in Healthcare, a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve the use of PAs in the healthcare system.  Contact her with questions at lisa@pushpa.biz.

Mythbusting the incident-to rules for PAs and NPs

First published on Comphealth.com

Female on computer

MYTH = All insurers and payors follow incident-to rules.
MYTH = PAs and NPs cannot get paid 100% reimbursement for seeing a Medicare patient.
MYTH = PAs and NPs cannot see new Medicare patients.
MYTH = PAs and NPs must have the physician on site at all times to see any Medicare patient.
MYTH = Incident-to billing applies to all sites of service including hospital settings.

Since the creation of incident-to billing for non-physician providers (Physician Assistants – PAs, Nurse Practitioners – NPs) by the Centers for Medicare and Medicaid Services (CMS), there has been significant confusion regarding proper billing and reimbursement for claims. I have often referred to the concept of incident-to billing as the most misunderstood and misattributed billing issue for PAs and NPs, hence the multiple MYTHS applied to this concept above.

Within the Medicare reimbursement system, PAs and NPs are reimbursed at an 85% rate when billing under their own provider number. Incident-to was developed as a mechanism to allow physician/midlevel teams to capture 100% reimbursement if specific clinical and documentation conditions are met.

Following the 3 S system will ensure your success in following the rules.

[Read more…]

Happy Holidays from Utilization Solutions in Healthcare!

To a joyful present
And a well-remembered past….
Best wishes for Happy Holidays and a magnificent New Year!

Medical Hazards at Work

Is your throat sore? Is your nose running? Do you have a fever? If you have any of these symptoms, chances are that you got them by sitting at your desk. Although it might look sterile, in fact, your desk harbors more germs and bacteria on it than a kitchen table or even a toilet. That shouldn’t be surprising when you think that at least 50% of Americans eat lunch and snack at their desks and one-third of workers go to work when they’re sick. When combined with the fact that we touch our faces 16 times every hour, it might be a miracle that we aren’t sick all of the time. The remedies to the spread of illness in the workplace are simple enough: wash your hands and your space, unchain yourself from your desk for lunch, and take a day off when you’re not feeling well.

Created by: www.LearnStuff.com

Medical Hazard At Work

How Entrepreneurial Nurses Can Help With the Chronically Ill

Chronically ill patients can benefit from having full-time nursing for care at home or in a hospital. Many people who are chronically ill need regular administering of medications. Nurses can administer medications and keep doctors updated of patients’ progress. Many insurances and Medicare will cover nurses for home healthcare. For this reason, the practice is becoming more popular. Let’s take a look at how the chronically ill, such as those with cancer, can benefit from having nurses help.

Importance of Nursing of Chronically Ill Patients

Many studies have shown that patients in good spirits will heal faster than those who mentally are bogged down with worry and fear. For some people, this means leaving a hospital setting to heal in the comfort and privacy of their own homes to be happier. Equipment can be delivered to the homes of the chronically ill, and nurses can be brought in to monitor the patients. Traveling or entrepreneurial nurses are commonly hired to care for the chronically ill. Here are some benefits of nursing of chronically ill patients:

Consistency

Home care nursing allows caregivers and families to form relationships. With long-term relationships between nurses and patients, more focused care can be provided. Patients do not need to re-adapt to a new nurse every day. The same nurse or nurses will visit periodically.

Inform of Financial Assistance Available

Nurses can inform patients of the resources available from public aid and private aid for cancer treatments. The U.S. Department of Veterans Affairs (VA), Medicare and Medicaid all offer help to people who need a nurse to help at home. Most patients have to pay up front for hospice services and later; they can be reimbursed for the services. Many cancer patients are eligible for Medicare if they are disabled and under the age of 65.

Help Patients Cope

Patients can cope with their cancer diagnosis with the help of nurses. They are trained to answer end-of-life questions. Nurses make recommendations to patients about how to improve their quality of life and improve their outlook. Though they are not therapists, they have helped many people with chronic illnesses and can make recommendations.

Consider Hiring Nurses for Chronically Ill Patients   

Hiring nurses can help educate patients and administer medications on a consistent basis. Investing in home hospice and nurses can change the way patients recover. Contact the National Association for Home Care and Hospice (NAHC) for recommendations of nurses who care for the chronically ill.
Find a healthcare provider like a RN whether you may be dealing with your breast cancer chemotherapy or struggling through your mesothelioma treatment. Get on the road to mentally and emotionally fighting your disease and find a trusted professional who cares and can help. Stay in the fight and ever give up hope.

 

Melanie Bowen’s Bio:

I joined the Mesothelioma Cancer Alliance in 2011 as an awareness advocate for natural health and cancer cure initiatives. You will often find me highlighting the great benefits of alternative nutritional, emotional, and physical treatments on those diagnosed with cancer or other serious illness. I also assist in social media outreach in my efforts to spread awareness.

 

PAs and NPs in Primary Care – One Part of the Care Delivery Solution

Lisa P. Shock, MHS, PA-C

Physician Assistants (PAs) and Nurse Practitioners (NPs) are skilled medical professionals who play an integral part in health care delivery.  The health care system is facing a shortage of primary care clinicians. Current definitions of primary care include family medicine, internal medicine, pediatrics and obstetrics/gynecology.  Currently, there is a shortage of primary care physicians and the American Academy of Family Physicians predicts that, if current trends continue, the shortage of primary care physicians will reach 40,000 within 10 years. This is critical when looking at health reform and examining the concept of increasing numbers of patients seeking access to medical care under a reformed system.  Increasing utilization of PAs and NPs is part of the solution.  Studies suggest that the addition of a PA or NP to a medical practice may offer enhanced patient satisfaction, improved physician work-life balance, improved revenues and greater access to care for patients.

As health care delivery is transformed, the implementation of the Patient Centered Medical Home (PCMH) as a vehicle for patient care is rapidly expanding.  Primary care delivery in both internal medicine and family practice is shifting toward this system of population management of chronic disease.  Recent studies from the American College of Physicians and the American College of Family Physicians state that PAs should be recognized as primary care providers in the PCMH model.  Accrediting bodies such as (NCQA) and the Utilization Review Accreditation Commission (URAC) support the PCMH as a proven model for delivering high quality, cost-effective patient care and encourage the inclusion of Physician Assistants within the delivery model.

Nationally, the American Academy of Physician Assistants (AAPA) supports the fundamental premise that standards used to define PCHM and care delivery models are not limited to physicians. Approximately 30,000 PAs practice in primary care of the nearly 80,000 PAs nationwide. Many PAs will practice in health care PCMHs; lead patient care teams and will participate in and be an integral component of quality performance reporting.

Robin P. Newhouse, PhD, RN, NEA-BC, and her co-authors compared advanced practice registered nurse (APRN) processes and outcomes to those of physician providers in a recent article in Nursing Economics. Sixty-nine studies published between 1990 and 2008 were analyzed and 28 outcome metrics were summarized and examined for nurses practicing in APRN roles.  Newhouse and her co-authors describe patient outcomes for each of three groups: nurse practitioners, certified nurse-midwives and clinical nurse specialists. Outcomes for NPs examined metrics including:  glucose control, lipid control, patient satisfaction, functional status, and mortality. Study results indicated that APRNs provide safe, effective, quality care and play a significant role in promoting health and health care.

Utilization of PAs and NPs in the PCMH model may exist in several ways.  In some settings, PAs may be focused on acute care or on management of chronic conditions, while in other communities, PAs/NPs may maintain their own panels of patients alongside physicians, and in rural communities, PAs may practice alone with a physician located off site.  Optimal utilization supports the patient to choose a PA/NP as a primary care provider, ensuring and increasing access to care while the physician maintains oversight of the PA scope of practice.  This utilization model allows for continuity of care, fosters patient/provider relationships, and underscores chronic disease management efforts for challenging care conditions including diabetes and asthma.  Ultimately, the role of the PA/NP within the PCMH will depend on the clinical setting, patient population, clinical competency and experience, and the professional relationship between the PA/NP and the physician(s).

Implementing a strategy to incorporate PAs and NPs into existing primary care practice models will offer measurable, demonstrated improvement in quality metrics and management of chronic disease populations.

 

About the author:

Lisa P. Shock, MHS, PA-C, is a seasoned PA who has practiced in primary care and geriatrics since her days at the Duke PA program in the late 90s. She enjoys part time clinical primary care practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs in the health care system.  Contact her with questions at lisa@pushpa.biz

 

References:

http://www.thedoctorweighsin.com/nurse-practitioners-and-physician-assistahnts-a-solution-for-the-primary-care-dilemma/

http://www.forbes.com/sites/jacquelynsmith/2012/06/08/the-best-and-worst-masters-degrees-for-jobs-2/

https://www.nursingeconomics.net/cgi-bin/WebObjects/NECJournal.woa/1/wa/viewSection?s_id=1073744466&ss_id=536874019&tName=posttest3001021

 

Does the Electronic Health Record Get in the Way of Patient Care?

Guest Blog – COMP Health – APRIL 2012

Lisa P. Shock, MHS, PA-C

President/CEO Utilization Solutions in Healthcare, Inc.

CompHealth Consultant

As I was thinking about this month’s blog, I came across several articles discussing the relationship of technology to patient care.  There are many opinions discussing the impact of technology, and specifically the electronic health record (EHR) on patient relationships.  It begs the question, can we be efficient clinicians and also connect with a patient even though we are facing a computer with an electronic record demanding data input?

Often, there are 4 central themes to consider:

1 – Maximize the patient encounter – Does the EHR and all of the data it requires minimize our ability to connect with patients?  When we are addressing sensitive personal issues – can we effectively listen?  In my own experiences, I am careful to do the following during the encounter – despite my laptop being present:

1 – Greet the patient/introduce learners/acknowledge if you are running late

2 – Maintain eye contact

3 – Do NOT type if a patient is crying or emotionally labile

4 – Sit down when taking the history

5 – Leave the laptop, wash your hands and do the exam – focus on the patient the entire time

6 – Resume the last details with the laptop if needed – (prescriptions, orders, etc) and conclude the visit with a clear expectation of when you will see them again in follow up.  –

2 – Maximize reimbursement – It can be great to have coding resources at your fingertips as part of your EHR, but is it templating dangerous?  In a world of cutting and pasting, it can be really easy to document a comprehensive physical exam.  The challenge is to ensure that your documentation genuinely matches the work you did as well as the medical necessity for that work.  Alternatively, creating electronic shortcuts for common patient care modalities – such as smoking cessation or counseling on diet and exercise – may allow you to capture additional revenue for work done and properly documented during a patient visit.

3  – Improve patient care – In this era of meaningful use, EHRs are enhancing our ability to care for populations of patients.  For example, you can use the EHR as a tool to gather all of your diabetic patients, and then drill down – and measure their disease control by running a report on all diabetics with a hemoglobin A1C greater than the goal of 7.  As health information exchanges become more prevalent and evolve, we will also have the ability to exchange information on a given diabetic patient, both in the primary care office as well as the hospital.

Cost control may be an additional benefit of improved provider communication.  A recent study showed physicians who had access to a health information exchange (HIE) ordered fewer lab tests for patients with prior test results after the HIE was formed than they did previously, according to a new study published in the Archives of Internal Medicine.

4 –Patients are People too – One of my first clinical preceptors taught me very wisely that patients have basic physical needs as well as an emotional agenda of sorts for their health care visit.  If you as a clinician do not satisfy their agenda, while only paying attention to yours, therein will arise conflict.  Within a busy clinical day, we need to not only see our patients, but also complete their health record and address billing and coding to ensure reimbursement, not including completing many other nonreimbursible tasks.  Keeping in mind these basic elements of human communication, we can all then focus on care of the patient rather than the care of the chart.

 

About the author:

Lisa P. Shock, MHS, PA-C, is a seasoned PA who has practiced in primary care and geriatrics since her days at the Duke PA program in the late 90s. She enjoys part time clinical primary care practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs in the health care system.  Contact her with questions at lisa@pushpa.biz

 

References:

How can I spend less time in a Patient Encounter?  http://tinyurl.com/cog5d9r

http://www.kaiserhealthnews.org/Stories/2012/March/26/doctors-smart-phones-ipads-distracting.aspx

http://archinte.ama-assn.org/cgi/content/extract/172/6/517-a

 

 

 

Physician Assistant Workforce – Will the Supply Meet the Demand?

Guest Blog – COMP Health – FEBRUARY 2012

Lisa P. Shock, MHS, PA-C

President/CEO Utilization Solutions in Healthcare, Inc.

CompHealth Consultant

Times are changing.  It is refreshing and exciting to see college students now declare that they want to be a PA in the future.  This is certainly different from just 15 years ago when I was on my journey toward a PA career as a student in the Duke PA program.  This year, 17,000 PA applicants are estimated to be competing for 5,550 seats nationwide.  There is a significant proliferation of PA programs all across the country, and NC is no exception going from 4 programs to 8 within the next year.

Most PA leaders will agree that much more data is needed on PA contributions to the health care workforce, as research is small but growing.  If you recall our CompHealth webinar last year on meeting the challenges of health care reform.

Dr. Therus Kolff and I discussed some of the changes that have occurred in the health care workforce resulting in increased utilization of PAs and NPs on clinical teams.

In the 1960’s studies began to indicate we would not have enough primary care physicians, particularly in rural areas.  As primary care demands grew, so did the demand for primary care PAs and NPs.   As physician specialties were “stressed” by a flat supply but increasing demand, opportunities grew for mid level providers not only in primary care, but across more specialties as well.

Cooper et al (see reference 1) projected  “provider shortages” in the range of 150,000 to 200,000 by 2020.  The AAMC (American Association of Medical Colleges) predicts only a shortfall of “91,500” by 2020. NP & PA programs have not been able to ramp up and fully supplement the decreasing physician supply (in this case provider supply) even when you add in the increasing numbers of PAs & NPs.

At the community level there remains a Physician and PA and NP shortage.  How will educational programs meet the demand?  More programs are taking advantage of federal training grants to assist program expansion but clinical training and preceptor sites remain a challenge to recruit even at established, existing programs.

You can help by encouraging and supporting clinical providers to precept students.  Ensuring quality health care education for learners is critical to the success of this overall system expansion.  All of us currently in established clinical roles gained training and experience from our teachers and clinical preceptors.

Are you doing your part to help the greater system?  What do you think about the proliferation of programs nationwide?

 

Reference:

Cooper, Richard A. New Directions for Nurse Practitioners and Physician Assistants in the Era of Physician Shortages. Academic Medicine, Vol. 82, No. 9 / September 2007.

 

Check out my recent tweets related to this subject:

:http://www.physicianspractice.com/blog/content/article/1462168/2020425,

Lisa P. Shock, MHS, PA-C, CompHealth consultant, is a seasoned PA who has worked with clients to expand care teams in both large and small hospital settings. She enjoys part time clinical primary care practice, is a preceptor for both PA and NP students, and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs and NPs in the health care system. Contact her at lisa@pushpa.biz

 

 

Physician Assistants (PAs) and their Impact on the Patient Centered Medical Home ( PCMH)

Lisa P. Shock, MHS, PA-C

As health care delivery continues to transform, the implementation of the Patient Centered Medical Home (PCMH) as a vehicle for patient care is rapidly expanding.  Physician Assistants (PAs) are becoming increasingly recognized as important players on the patient care team.  Recent studies from the American College of Physicians and the American College of Family Physicians state that PAs should be recognized as primary care providers in the PCMH model.  Accrediting bodies such as (NCQA) and the Utilization Review Accreditation Commission (URAC) support the PCMH as a proven model for delivering high quality, cost-effective patient care and encourage the inclusion of Physician Assistants.

Nationally, the American Academy of Physician Assistants (AAPA) supports the fundamental premise that standards used to define PCHM and care delivery models are not limited to physicians. Approximately 30,000 PAs practice in primary care of the nearly 80,000 PAs nationwide. Many PAs will practice in health care PCMHs; lead patient care teams and will participate in and be an integral component of quality performance reporting.

Utilization of PAs in the PCMH model may exist in several ways.  In some settings, PAs may be focused on acute care or on management of chronic conditions, while in other communities, PAs may maintain their own panels of patients alongside physicians, and in rural communities, PAs may practice alone with a physician located off site.  Optimal utilization supports the patient to choose a PA as a primary care provider, ensuring and increasing access to care while the physician maintains oversight of the PA scope of practice.  This utilization model allows for continuity of care, fosters patient/provider relationships, and underscores chronic disease management efforts for challenging care conditions including diabetes and asthma.  Ultimately, the role of the PA within the PCMH will depend on the clinical setting, patient population, clinical competency and experience, and the professional relationship between the PA and the physician(s).

Using broad legislative language to describe the primary providers of health care encourages flexibility and innovation as practices shift toward developing systems of care that focus on value and quality rather than volumes of patients.   Population management of chronic diseases will meet the needs of patients and community through models like PCMH and utilization of PAs will be an essential part of the successful solution.

 

About the author:

Lisa P. Shock, MHS, PA-C, is a seasoned PA who has practiced in primary care and geriatrics since her days at the Duke PA program in the late 90s. She enjoys part time clinical primary care practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs in the health care system.  Contact her with questions at lisa@pushpa.biz

References:

American College of Physicians. Internists and Physician Assistants: Team-Based Primary Care. Philadelphia: American College of Physicians; 2009: Policy Monograph. (Available from American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.)

American Academy of Family Physicians and American Academy of Physician Assistants. (2011). Family Physicians and Physician Assistants: Team-Based Family Medicine. Joint Policy Monograph.

www.aapa.org/uploadedFiles/…/The…/PI_PAs_PCMH_Final.pdf

 

 

 

Do you employ a PA or NP? — Practice Management Pearls

Lisa P. Shock, MHS, PA-C

In this time of health reform, a crucial starting point for enabling overburdened primary care providers (PCPs) to move toward enhanced primary care delivery is to leverage nurse practitioners (NPs) and physician assistants (PAs) to bolster PCP productivity and patient access.

PAs and NPs are able to perform about 80% of a primary care physician’s work while collecting about 70% as much in revenue, despite reduced billing amounts (for instance, from Medicare).   Capturing maximum reimbursement is a challenge for any medical practice, but there are some special nuances you must be aware of when working with PAs and NPs so that you capture all of the proverbial “money on the table.”

Here are the 5 Keys to Successful Reimbursement when employing PAs and NPs:

1 – Medicare

Does your practice REALLY understand “Incident to” Services?

Have you met the criteria to bill and collect at 100% or are you better off billing under the PA or NP’s own provider number?

Is your documentation and coding sufficient to survive an audit of incident-to billing?  Having sound processes and policies as well as an in-depth understanding of the rules is important to compliance and reimbursement success.

2 – Medicaid

State budgets are tapped.

Some states want to limit PA/NP reimbursement even in Federally Qualified Health Centers (FQHCs) where the original Federal guideline recommends full reimbursement.

Not every state credentials PAs and NPs.  This results in a wide variation on reimbursement rates. It is critical to understand not only the current Medicaid policies in your state, but also keep abreast of any political changes that may be on the horizon, as those changes or mandates could affect reimbursement for your practice.

3 – Third Party Payors

New contracts often mandate individual credentialing of PAs and NPs.  Reimbursement rates vary by state, but in NC, new BCBS and Aetna policies are mirroring Medicare Incident To rules – with a flat reduction in reimbursement at 85% and no provision for incident to “capture” of funds.

Third party payors such as Blue Cross Blue Shield (BCBS) are leading the charge to reward primary care practices for quality care and offer higher reimbursement rates with Patient Centered Medical Home (PCMH) designations and/or participation in Blue Quality Recognition programs.  Careful review and timely negotiation of contracts is especially important, as these new programs are unveiled.  Many practices are seeing double-digit reimbursement increases as a result of participation in third party payor quality programs, and PA/NP services are also included.

4 – Uninsured/Under insured

Clinics and hospitals are going to have to consider alternate payment models for cash paying patients.  Balancing overhead costs and efficiency is important for any practice, but if you are in a location with a higher population of uninsured/under-insured patients, a thorough examination of collections is necessary.  PAs and NPs do well in these underserved practice environments and the cost to expand the care team with a PA or NP is often cost effective.

5 – Perpetuation of myths and bad information

This may be the most important one of all.  Practice Managers, consultants and office administrators frequently have little to no understanding of the supervision requirements or the clinical capabilities (and therefore “bill-ability”) of PAs and NPs.  If this is the case, delivered services as well as collectible revenues are under available and underestimated.   Ensuring a complete understanding of the state statutes and the medical board requirements is a must.  The ability of the physician to delegate clinical duties to the PA/NP, thereby defining the scope of practice, is critical to developing efficient, quality care delivery systems as well as maximizing reimbursement.

The typical PA brings in revenue of $231,000 with an average salary of $84,000, according to The MGMA Physician Compensation and Production Survey: 2008 Report Based on 2007 Data.  After covering the cost of his or her own salary, benefits, and incremental overhead a typical PA or NP can boost your bottom line by an estimated $30,000 or more.   Developing a clear understanding of the above policies will ensure that your practice realizes a positive return on its PA/NP staffing investment.

 

About the author:

Lisa P. Shock, MHS, PA-C, is a seasoned PA who has practiced in primary care and geriatrics since her days at the Duke PA program in the late 90s. She enjoys part time clinical primary care practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PA and NPs in the health care system.  Contact her with questions at lisa@pushpa.biz

 

References:

http://www.mgma.com/store/Surveys-and-Benchmarking/Physician-Compensation-and-Production-Survey-2008-Report-Based-on-2007-Data-Print-Edition/

AAPAhttp://www.aapa.org/your_pa_practice/reimbursement.aspx

AANPhttp://www.aanp.org/NR/rdonlyres/67BE3A60-6E44-42DF-9008-DF7C1F0955F7/0/2010FAQsWhatIsAnNP.pdf