However, while APPs present a huge opportunity to solve these problems—and do so in a fairly cost-effective manner—they aren't always used at top-of-license, leaving considerable untapped potential on the table.
Our research uncovered three main ways to triage patients between APPs and physicians. Two of these approaches are driven by the medical group, while the third is based on consumer preferences. Below we detail each of these models and considerations for choosing one for your own practice.
1. Type of care provided
One way to structure your APP model is to divide responsibility between APPs and physicians according to type of care provided. In primary care, for instance, physicians would see all new patients, while some existing patients are shifted to APPs for care management. In specialty care, physicians maintain their role as diagnosticians by primarily seeing new consults, while APPs provide follow-up care.
Some groups fear that this model may cause physicians to feel like they are "losing" their patients to APPs. To address these concerns, ensure that APPs have access to well-developed training and receive regular physician supervision. Alternatively, consider compensating physicians for the portion of the panels that APPs manage. This model is ideal for groups with more experienced APPs looking to build their own panels or groups looking to build up physician panels, since this model helps free up physicians' schedules to see new patients.
2. Patient acuity level
Another approach is to triage between APPs and physicians based on patient acuity level. In primary care, this means that APPs see patients with a single condition or multiple well-managed conditions; physicians see those with more complex comorbidities. In specialty care, patients are triaged according to the severity of their condition. For example, a neurology APP would see a patient with headaches, whereas a physician would see the patient with seizures.
However, this model is not without challenges. Physicians may fear that their panels will overflow with complex patients, making diagnosis and care management more difficult and increasing visit lengths. Given that physicians undergo extensive training and receive exposure to a breadth of conditions, they are better equipped to handle higher-acuity patients. This model also benefits groups with newer APPs who will benefit from seeing a range of conditions independently.
3. Patient choice
Some medical groups are giving patients more control over which provider type they see. Under this third model, patients choose whether to see a physician—who often has a longer appointment wait time—or to see an APP more quickly. This approach allows patients to make tradeoffs between their preferences regarding access and loyalty to a specific provider. It might come as surprising to some to learn that patients will often choose opt for convenience and see an APP.
This approach helps decrease overall wait times and increase patient satisfaction. In addition, by offering patients additional choices and accessibility options, groups differentiate themselves from competition and are better positioned to win patient loyalty at a time when patients increasingly value expedient care.
That said, this model removes some autonomy from both the physician and APP and may heighten physicians' concerns over losing their patients or APPs' level of independence. To ease these concerns, focus your attention on how APPs help reduce the burden on physicians to meet consumer demands, while still giving both an opportunity to see a range of patients.
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Although appropriate for both primary and specialty care, groups should implement this more-advanced model after physicians have welcomed and integrated APPs into the care team. Groups should also consider using more experienced APPs with this approach, given their level of autonomy under this model.