Practicing for Points: How You Might be Paid as a Nurse Practitioner

Many medical practices determine compensation or bonuses for nurse practitioners using a productivity model. Some practices stick with an RVU-based productivity structure as outlined by Medicare. Others translate billing data into a similar ‘points’ system making bonus or compensation structures easier to understand and administer. Recently, a few ThriveAP readers have reached out to me with frustrations regarding productivity pay in their nurse practitioner role. Naturally, I decided a blog post addressing the issue was in order.

What some nurse practitioners don’t realize is that the medical system itself is built upon a points-based system. These ‘points’ are termed RVUs or Relative Value Units and value is assigned by the Centers for Medicare and Medicaid Services (CMS). Private insurance carriers follow CMS’ lead in reimbursement for medical services. So, if your medical practice accepts insurance, you’re automatically on the roster in the practicing for points game.

Nurse practitioners who are paid a flat hourly or salaried rate without additional compensation or bonuses for meeting productivity goals are essentially sitting on the proverbial bench in this game. They may not realize or be affected by the pressures that come along with this reimbursement system. However, you can bet your employer is monitoring your practice metrics and billing practices. You may never notice but someone is keeping stats even if your compensation structure as a nurse practitioner is straightforward.

If you’re an NP whose compensation is related to productivity, whether your employer tracks RVUs or develops their own terminology for productivity metrics, expect to feel the heat out on the practice court. When your own personal finances are tied directly to the number of patients you see in a day and the amount that you bill, this creates additional stress at work. A slow day could leave your next paycheck lacking. Unattainable goals set by an employer may leave you without the end of the year bonus you expected.

Awareness of the ‘points’ system that exists in the healthcare field is the first step to making sure you aren’t caught off guard by the way your compensation or bonus structure is laid out. The following blog posts will help get you up to speed:

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  1. Nurse Practitioner Productivity Payment Part 1-The RVU
  2. Nurse Practitioner Productivity Payment Part 2-Translating RVUs Into a Paycheck
  3. 4 Ways Productivity Pay Poisons Your Workplace
  4. Top 5 Mistakes NPs Make with their Employment Contracts
  5. How the Way You are Paid Affects Your Job Satisfaction

While I don’t advocate for productivity compensation structures in most circumstances, these models aren’t typically a reason to forego a good job opportunity. But, be aware of how the system works. Make sure the way you will be paid and/or bonused is clearly outlined in your employment agreement and that you understand how the structure works. A clear understanding on the front end will mitigate potential conflict with your employer in the future and make sure you have reasonable expectations as to how much you can expect to earn. 

Are you paid or bonused based on a productivity model? What do you wish you had known before you signed your employment agreement?


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