Practice Notes

Want to maximize your APP workforce? Deploy them autonomously.

by Hamza Hasan and Eliza Campbell

Advanced practice providers (APPs) are a valuable resource to help medical groups expand access, better manage patients, and deliver cost-effective care. Many groups have realized this potential: ambulatory physician offices saw a 27% increase in APPs between 2013 and 2016. And demand for APPs continues to accelerate; there were more recruiting searches for nurse practitioners and physician assistants this past year than ever before.

While most groups are using APPs in large numbers, they are losing out on sizable productivity and profit potential because they often use APPs in physician-support roles. For example, many groups give APPs overflow patients from the physician's panel, rather than proactively scheduling patients to see the APP. Others use APPs in support staff roles more similar to nurses or medical assistants.

Even though laws around APP scope of practice vary by state, most groups can find a more autonomous role for APPs while adhering to local regulations—and these more autonomous roles are key to maximizing the value of APPs.  

Autonomous APP roles within a care team

However, "autonomous" doesn't mean complete independence. Instead, to get the most from their APPs, groups can intentionally deploy them in autonomous roles within a broader physician-APP care team. This means that APPs work together with a physician to co-manage a panel, and APPs see patients independently during the office visit.

Deploying APPs in this way can help groups advance their access, population health, and new business goals. For instance, Reliant Medical Group's—a multispecialty group based in Massachusetts—shift to this model was crucial for its continued success under value-based care.

A closer look at Reliant's care team model

Reliant found that trying to simultaneously manage large panels, accommodate patient access, and meet other population health demands was unsustainable for a single primary care physician (PCP). Spending up to 70 hours per week on these tasks, PCPs were burned out and unable to make thoughtful, value-based care decisions. Compounded by PCP-recruiting challenges in its market, Reliant quickly realized it had to restructure how it delivered care.

The group decided to move to a team-based approach with a PCP-APP pair at the helm. A full-time PCP and full-time APP work together to manage a 3,250-patient panel, with additional support from a team of two nurses, two medical assistants, and two administrative assistants.

Patients can see either the physician or APP at each visit, depending on provider availability and patient complexity. By working together, the team has more bandwidth to get patients in quicker and better manage them, share tasks to reduce burnout, and focus more attention on cost and utilization management.

About half of Reliant's providers work together in a physician-APP care team. Since implementing this model, the group's physicians and APPs have expressed overwhelmingly positive feedback, and patient experience scores have also improved. As Dr. Thad Schilling, Reliant's Chief of Primary Care and Clinical Care Transformation, told us, "We've had patients say: 'I had a great first visit with [the APP]. I can't wait to meet my new doctor.' When the initial visit is with someone other than the physician but you get such a positive [reaction] from the patient, you know you're doing something right."

 

Learn more: Register for the 2018-2019 National Meeting Series

Join us at our upcoming National Meeting to stay up to date on our latest research and learn more strategies for securing greater value from APPs. Registration is now live for employed medical groups and independent medical groups.

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Sept. 11 webconference: How to get the most value from your APPs

Ethan Brosowsky, Senior Director

While most medical groups are deploying Advanced Practice Providers (APPs) in large numbers, the vast majority are doing so in one-off pilots that limit the ROI of the APP workforce.

Join me on Tuesday, September 11 at 1 pm ET, where I'll present the latest research on the four components of a scalable, high-value APP model.

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