Some States Are Moving to View APPs Like Physicians. What Does This Mean for Urgent Care?

Utah state legislators just voted to expand physician assistants’ ability to practice without physician supervision. North Dakota did the same 2 years ago. While that’s clearly a nod to advanced practice providers’ essential role in administering healthcare, as well as a concession to the downturn in physicians choosing to practice primary care, there are concerns among some in the urgent care community that the trend toward recognizing care provided PAs and nurse practitioners on the same level as that provided by a physician is really driven by economics. As Alan Ayers, MBA, MAcc, president of strategic initiatives for Experity and senior editor, practice management for JUCM points out, if a facility can employ multiple APPs for the same price as a single physician, that physician can spend more time supervising and developing APPs instead of treating patients directly, thereby stoking the number of patients seen by APPs and boosting revenue. Even when there is a 15% cut in reimbursement for using APPs, given that an APP typically costs 50% less, even seeing four or five patients per hour, APPs are more cost effective than a physician. One of the driving factors in a shift to APPs has been the case rate reimbursement structure, as insurers pay a weighted flat fee for a patient visit rather than reimbursement based on acuity of the case or the level of the clinician providing the care. Under a fee-for-service structure, on the other hand, a physician would be paid more for a single 45-minute procedure than an APP would rack up for seeing multiple sore throat patients over the same amount of time. The possible consequence of these two movements converging, Ayers reasons, is that the general acuity level of care provided in the urgent care center could start to drop—the long-term effects of which could be disastrous for the industry. The question to consider is, does it make sense to broaden the authority of APPs in the spirit of increasing patient visits at a lower cost, or to focus on ensuring that all urgent care providers receive fair compensation for the services they provide?