Maximizing the Value of Advanced Practice Providers

While it can take weeks or even months to land a new appointment with an affiliated primary care provider, or medical or surgical specialty physician practice, chances are an advanced practice provider (APP) — advanced practice registered nurse (APRN) or physician assistant (PA) — will be able to see a patient much more quickly.

As such, APPs have been a tremendous value-add to healthcare organizations, especially during the pandemic and helping to combat current workforce issues. They play a pivotal role in enabling organizations to not only survive but thrive in this environment:

• Reassigning or eliminating administrative tasks from APPs and physicians increase access and revenue; an additional 1.1 million patient visits could have been added over the last year with an additional $76.9 million in revenue as identified from 787 ambulatory clinics.
• Having a mix of physicians and APPs can modify an organization's cost structure and improve margins by appropriately leveraging skills to meet patient need.
• Because of the physician shortage, APPs often are the primary care providers providing preventive care to patients in rural and underserved communities.
• National data indicates that APRN and PA jobs are expected to grow 40% and 28% respectively over the next decade to fill the physician shortage, therefore organizations need to provide a comprehensive transition to practice to fully assimilate these APPs successfully into the organization.

Recent Vizient Clinical Team Insights — an annual assessment from 34 provider hospitals and nearly 800 clinics — not only addresses the current state of the clinical workforce but provides guidance for healthcare organizations on how to recruit and retain quality APPs while reimagining the healthcare delivery model.

"There's not enough physicians to fill the healthcare system's patient demand, so they have to change their models of care delivery," said Christen Hunt, associate vice president of clinical team insights at Vizient. "Adding APPs to the mix is the projected cost-effective solution, hence the job outlook. However, an APP's success is contingent on making them part of a cohesive clinical team."

Recruitment and onboarding

An important first step to building a cohesive clinical team is to recruit APPs into the organization utilizing the clinical team they will be working with. This allows the organization to hire for fit. The Clinical Team Insights showed that 41% of organizations utilize human resources rather than a provider recruitment team as the primary recruiter of APPs, while only 19% of organizations recruit physicians using HR.

"We really want to see physicians and APPs recruited through a recruitment team that includes both physicians and APPs," Hunt said. "This involves everyone from the beginning to ensure collaborative decision-making about candidates and to promote good working team relationships by setting clear expectations."

Hunt adds that as APPs are hired, organizations need to dedicate more resources to onboarding and helping them transition to practice, which many health systems cut during the pandemic. Expectations for these newly minted providers are high: 94% of APPs in ambulatory clinics have their own schedule and see both new and established patients. New graduates are expected to be at full productivity within six months in 90% of acute care settings and 60% of ambulatory clinics.

"For these new-to-practice providers to be truly successful, systems need to help them transition from student to provider," she said. "Formal postgraduate programs such as Vizient's Physician and Advanced Practice Provider Onboarding Program is one way to help new-to-practice providers practice at the top of their license, and have the confidence to treat a full range of patient types while meeting practice productivity expectations."

Practicing top of license

Many states lifted practice restrictions during the pandemic, implementing the emergency release of restrictions allowing APPs to function to their fullest potential — resulting in a sharp decline in APP turnover. Emergency pandemic provisions have expired or were repealed and now burnout continues to grow with recent data showing turnover trending back up.

"This is a big dissatisfaction for many APPs," Hunt said. "Coming out of that crisis mode, healthcare systems fell back into old routines and the collegiality of physicians, APPs and other clinical staff really pulling together has been bumped to the back burner."

She emphasizes that it's also essential for organizations to minimize APP non-top-of-license activities such as care management, form completion and prior authorizations.

"Leaders can reduce administrative tasks and support employee well-being by focusing on workflow efficiencies, centralized resources, clinical team practice structure and scope of practice," Hunt said.

Compensation methodology also can impact APPs being leveraged to top of scope of practice. Clinical Team Insights revealed that nearly two-thirds (62%) of acute care organizations do not standardize APP compensation methodology across their healthcare systems.

"Many times, we see physicians and APPs in competition for new patients when tied to incentives instead of working together to improve access. That's not the right thing for the patients," Hunt explains as this encourages some physicians to dominate new appointments which can lead to prolonged wait times for a patient to be seen. "The ratio of physicians to APPs is now almost one-to-one and will continue to increase. Systems really need to create more of a team environment that includes similar compensation methodologies to incentivize physicians and APPs to work together. This will not only help organizations recruit top talent but minimize lateral transfers and attrition by reducing burnout and improving the team culture."

Collaborative leadership structures

Leadership and governance structures for APPs have evolved significantly in recent years and continued movement forward is crucial in supporting this growing workforce. Clinical Team Insights identified that 64% of health systems have an identified APP leader with oversight of APPs.

"It's really important to have a leadership structure for APPs in which they are evaluated and coached by those with their same education and training," she said adding its equally critical to integrate them into governance communities and creating an APP council is one way to help. "As such a huge workforce body, they need to have their voice, expertise and viewpoints front and center contributing to the organization."

Healthcare is undeniably a changing culture that is no longer solely led by the physician care model, but now inclusive of APPs and the entire clinical team.

"It's about your physician, APP, nurse, front office staff — they all are essential to delivering care," Hunt said. "So having a thorough, thoughtful way to integrate the entire care team into the organization and equally value each's contribution will increase engagement leading to reduced healthcare system costs and improved patient outcomes."