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Collaborating MD: What are fair collaborating physician fees for nurse practitioner collaborations?

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Q.I was contacted by a company that runs a chain of clinics, and one is about to open in my region. A nurse practitioner provides the care at the center and they’re looking for a physician to form a collaborative agreement with the NP to meet state requirements. The recruiter estimated that the work would only require about four hours of my time every month. I’d only need to go to the clinic on a monthly basis to meet with the NP and review a few patient charts. What is the going rate for collaborating physician fees?

 A.As background for readers who haven’t supervised a nurse practitioner before, let me describe why you got this call in the first place.

Collaborating physician meaning

The specific duties that NPs are allowed to carry out vary from state to state, though generally include assessing, diagnosing, and treating patients as well as prescribing medications. In many states, NPs can practice on their own. Most states (38 states as of 2019), however, require NPs to have a collaborating agreement with a physician.

The written agreement between a physician and NP lays out several points:

  • The NP’s scope of practice under the collaboration,
  • When and how the physician will be consulted,
  • Practice protocols,
  • The process for documentation review by the physician.

Some states have a somewhat standard agreement in which the physician and NP have only a few details to decide on and fill in. They may require that the physician meet with the NP at a certain frequency or that the physician review a certain percentage of patient charts. Other states offer more leeway in details of the collaboration.

Regardless of the state’s exact requirements for supervising physicians, collaborating with an NP involves time, effort, knowledge, medical decision-making, and risk. It is work for which the physician should be compensated.

Collaborating physician fees

[box]Note that, in the question asked above, the NP works at an organization that the physician isn’t otherwise involved in. If a physician and NP are part of the same practice or organization, collaborating may be a routine job responsibility. The MD wouldn’t necessarily be paid extra for this.[/box]

Compensation for collaborating physicians varies greatly. What constitutes a fair fee depends on many factors, such as:

  • The NP’s type of practice,
  • The volume of patients seen by the NP,
  • The requirements of the physician,
  • The NP’s need for consultation,
  • and others.

The compensation model can take on several forms. Common ones are:

  • A flat fee (usually monthly),
  • An hourly rate,
  • A fee per chart reviewed.

If you have any say in the matter, I recommend a flat fee. The reasons for this are similar to the reasons I recommend a flat fee for medical writing and for any physician consulting work. Essentially, you should avoid trading your time for money.

It’s hard to say in advance how much time your collaboration will take you every week or month. This can vary depending on the hours worked by the NP, how autonomously they work, how many patients they see, how complicated those patients are.

Your agreement may require you to be available for consultation during the NP’s clinic hours. Or even 24 hours per day, 7 days per week. Even if you don’t get called often, that’s a big commitment.

Moreover, you take on liability as a supervising physician. And your medical license is ultimately on the line. These factors need to be considered when determining your fee.

Unfortunately, there isn’t a “going rate” for collaborations. You must consider the details of the agreement, understand what’s required of you, and negotiate a fair compensation.

Determining the cost for collaborating physician services

I’m aware of a large national healthcare payor with a home visit program that is currently offering $400 per month to physicians supervising a part-time NP. The NPs assess patients, but don’t treat or write prescriptions. Chart review requirements are minimal. For this low-risk work requiring only about an hour of the physician’s time per month, $400 is reasonable.

For full-time NPs who are making treatment decisions and writing scripts or performing procedures, closer to $2000 per month would be in the ballpark of a reasonable fee.

But each collaborative agreement is different.

Ask questions to make sure you fully understand the NP’s practice and what will be required of you as the supervising physician.

  • What type of work will the NP be doing?
  • What training and experience does the NP have?
  • What procedures are performed at the clinic?
  • What are the state’s and organization’s requirements for chart review and clinic visits?

You also need to determine what out-of-pocket costs will be associated with the collaboration from your end. Find out if the NP’s organization covers:

  • Malpractice insurance
  • State collaborative practice fees
  • Other expenses such as cost of travel for clinical visits

Use this information to determine what compensation is fair. Don’t undervalue yourself.

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