How to use NPs and PAs in allergy practice

| | September 18, 2023

How to use NPs and PAs in allergy practice

Whether you’re looking to grow your practice, improve patient access or keep up the continuum of care when an allergist in your practice retires, working with Nurse Practitioners (NPs) and Physician Assistants (PAs) is something to consider. Likewise, if you’re an employee of a hospital or health system, working with NPs and PAs may already be part of your day-to-day operations. This article looks at new ways to utilize NPs and PAs in allergy practice, plus answers questions on compensation for supervision and how to properly bill for NP/PA services.

Almost a quarter of the physicians in the U.S. are currently 65 and older, and the Association of American Medical Colleges (AAMC) projects a shortage of 21,000 to 77,100 specialty physicians by the year 2034. When done thoughtfully, incorporating Advanced Practice Clinicians (APCs) into your allergy practice is a useful way to provide quality health care services to your patients. Let’s look at some key considerations below.

How to utilize NPs and PAs in allergy practice.
It’s important to find the right role for APCs in your practice. For example, many allergists prefer to see new patients themselves. However, the role NPs and PAs play in allergy practice has evolved over the past several years, with these providers taking on expanded functions in some practices. The College’s Practice Management Committee shared the following list of services APCs provide in their practices:

  • Follow-up visits (immunotherapy, medication, etc.).
  • Shot room coverage.
  • Acute visits (including urgent, day-of appointments and short-notice testing.)
    Consider blocking slots in an APC’s schedule for same-day appointments to ensure patient access for urgent visits – especially during busier times like peak pollen season.
  • Cover remote offices when no allergist is present.
    Some practices are staffing offices solely with APCs. Allergists can conduct virtual consults as needed or work with the APC on a scheduled but limited basis. Supervision is remote, with case discussion, chart review, etc. (Note: remote supervision is allowed by Medicare through December of 2024).
  • Oral challenges and/or drug desensitization.
    “We use NPs for a food allergy-specific clinic that includes patient evals, testing, oral challenges, early food introduction and oral immunotherapy,” said Melinda Rathkopf, MD, MBA, FACAAI, chair of the Practice Management Committee.
  • Saturday and extended hours coverage.
  • Call coverage.
  • Clinical research.
  • Community outreach and education.

Should you be compensated for supervising NPs and PAs?
During the College’s recent meeting of the Employed Allergist Focus Group, the question of compensating allergists for supervising NPs and PAs was discussed. Some allergists said they receive a stipend for APC oversight, while others don’t. The American Association of Provider Compensation Professionals discusses this issue and compensation methods for APC supervision in their article Compensating Physicians for APC Supervision.

How to bill for NPs and PAs
The College’s article Billing for Advanced Practice Providers outlines billing options for APCs, including “incident to” billing vs. billing directly under the APC using their own National Provider Identifier (NPI).

For more details on how NPs and PAs can add value to allergy practices, view our free 15-minute educational module Integrating NPs/PAs. The interactive module:

  • Explains how to successfully integrate an NP or PA into your practice.
  • Discusses state and federal regulations, as well as licensing requirements.
  • Reviews scope of practice and prescriptive authority.
  • Explains how to get reimbursed for their work.
  • Helps you determine whether to add a physician or an NP/ PA to your practice.

There is a lot to consider when looking to increase patient access and grow your practice. Working with APCs may be a way to reach your goals.