Practice Notes

Should advanced practitioners have their own panels?



Tiffany Chan

As medical groups hire more Advanced Practitioners (APs) in primary care, organizations looking to maximize their investments are considering assigning APs their own patient panels.


Challenges to AP autonomy

Historically, APs have served as physician extenders, working side-by-side with physicians to share their responsibilities and lighten their workload. However, with a physician shortage on the horizon and margins under pressure, many organizations are seeking new ways to expand access to primary and preventive care at lower cost.

Some state and payer regulations preclude total autonomy for APs, making it difficult for an AP to manage their own panel. Even where regulations do allow it, some medical groups avoid empanelment because they worry that primary care physicians will see their AP colleagues as competitors. This attitude is especially prevalent in organizations that use productivity-based compensation models, where patient volumes are highly sought.

However, our research indicates that empaneling APs can yield major benefits, including increased accountability and elevated engagement.

The Medical Group Strategy Council recently conducted a survey to assess members’ views on this issue.


Majority of groups now empanel APs

Of 20 groups employing APs in the primary care setting, a slight majority allows APs to have their own panels.



Do APs in primary care have their own panels of patients?
n=20
Survey_Results_1


PCPs growing more comfortable with AP practice

Of 20 respondents, only 2 agreed that PCPs in their groups feel threatened by APs. The rest disagreed–including 11 groups that currently empanel APs. These groups may have adjusted their compensation to alleviate any potential threat PCPs would feel.


Evidence of improved productivity for empanelled APs

Not only is empanelment becoming more widespread and less controversial, but preliminary data from our survey also suggest a positive correlation between empanelment and AP productivity. Of groups that empanel primary care APs, 83% reported that their APs perform above the 50th percentile of productivity, compared to 63% of groups that do not empanel their APs.



Reported productivity of empanelled APs
n=19
Survey_Results_2

In addition to the potential improvement in productivity, several medical group leaders reported that empanelment is a powerful lever for recruiting top AP talent.


Balanced approach to assigning AP panels

There is also room for diversity in scope of practice. While many APs thrive as independent providers, others may prefer or be better suited to supporting a physician in managing his or her panel. For example, we spoke with one medical group that assigns panels to a majority, but not all, of its APs. Medical group leadership should match individuals to roles that suit their skill sets.

It is also important to note that even empanelled APs benefit from regular collaboration with physicians and the ability to refer more challenging patients to a physician's care. Practice arrangement should facilitate this teamwork.

Learn More

The Medical Group Strategy Council recently completed extensive research on how to organize, educate, compensate, and manage APs within a medical group. Register for our national meeting to learn more.

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