Physician Business Ideas - A Presciption for Higher Reimbursement: Do More Procedures

Prelude: Among practicing physicians, it is widely known that one is paid more for procedures than cognitive activities. It is also known that referring common procedures, such as skin, biopsies, to specialists cost the system more and costs patients more in terms of convenience and delay. With these facts in mind, I asked John L. Pfenninger, MD, a family physician who is president and director of the National Procedures Institute to tell the story of his organization. John passionately believes that his compatriots in their offices can do more procedures and do them well and safely with more convenience for patients and with less cost to the system. Here is John’s story, which appears in my book Innovation-Driven Health Care (Jones and Bartlett, 2007.

The Story of the National Procedures Institue (NPI)

By John Pfenninger, MD

The story of the National Procedures Institute (NPI) is quite simple. I was born and raised on a farm, so I was used to, and enjoyed, working with my hands. Surgical specialties interested me, but the time needed to finish a residency program and the life style afterwards were not very enticing. Subsequently, I chose family practice, so I could” do everything like the old country doctors.”

Family Practice Residencies Deficient in Teaching Office Surgical Skills

It didn’t take long to see that family practice residency programs were quite deficient in teaching office surgical skills. Initially, physicians that were in private practice as “GPs” became residency directors. They tended to do many more of the surgical procedures. They delivered babies, performed appendectomies, set fractures, and so forth. As time went on, however, experienced faculty became few and far between. Salaried physicians had a tendency to do less and less with their hands. Hospital credentialing processes and liability concerns from insurers further limited interests in procedures.

Learning to Do the Simple Things

Still, there were many of us who wanted to learn how to treat hemorrhoids, inject veins, do vasectomies, put in IUDs, apply casts, do dermatological surgery, perform the procedures needed for emergency and hospital care, and more. However, there was no formalized training available to learn these procedures! Although state and national academies offered a small smattering of selections once or twice a year, there just weren’t enough quality education being offered in the procedural skills area.

Doing Office Procedures Makes Sense

Doing procedures makes so much sense. Many things can be performed in the office as opposed to the hospital. Surgeons are trained to do everything in the operating room but this markedly increases costs. Sebaceous cysts, lipomas, hemorrhoids, and many other conditions can be treated in an office setting. Patients appreciate this. So do insurers, because costs can be kept to a minimum.

Other Advantages

Other advantages of doing procedures include a reduction in the delay of diagnosis. If a skin lesion looks atypical and the clinician in comfortable doing a skin biopsy, it is biopsied on the spot. The alternative is referring the patient away. This may take 6 to 8 weeks before another evaluation. In the case of melanoma, this puts the patient as increased risk.

Physicians who do procedures have a tendency to know about the disease process. Describing what a rose smells like or what an orange tastes like is difficult. How does one explain the color red to a blind person? Similarly, it is difficult to explain various disease processes.

However, if the clinician becomes involved with seeing, feeling, and exploring the innuendoes of the disease process, the diagnostic acumen becomes more accurate. Doing procedures can also break up the monotony of day-to-day practice.
In addition, reimbursements are greater for surgeries and procedures, versus nonsurgical areas. Numerous studies are available showing that that those who perform procedures have a significantly higher income. For most family physicians, they chose the specialty, not to be case managers and paper pushers, but rather, to provide comprehensive care. Doing procedures makes this more likely.

NPI Born in 1989

Thus, in 1989, NPI was born with purpose of teaching procedural and surgical skills for primary care clinicians. It has grown from teaching two courses the first year to over a hundred in 2006. Over 15,000 clinicians have been trained with the National Procedures Institute. After 17 years of teaching procedural skills, NPI remains the leader for educational opportunities in the field of teaching primary care physicians to perform appropriate procedures in their offices.
Along with the text, Pfenninger and Fowler’s Procedures for Primary Care , a 2000 page textbook, NPI seminars have changed he physicians deliver medical care in the United States. NPI can be accessed at www.npinstitute .com.