Building a Team-Based Gastroenterology Practice With Advanced Practice Providers

The use of advanced practice providers (APPs), such as nurse practitioners and physician assistants, has grown substantially in gastroenterology practices in the United States. The first formal training programs appeared in the mid-1960s; however, incorporation of APPs into gastroenterology practices occurred sporadically until the early 1990s, when several large practices began utilizing APPs in both outpatient and inpatient environments. Over the next 20 years, APPs became increasingly more common. In hospital settings, they provide continuity of care, especially for practices that rotate physicians into hospital services on a periodic basis. Efficient use of APPs frees physicians to focus on new patients, procedures, and complex chronic care management. APPs who have independent, appropriately managed schedules can generate revenue that covers salary and benefits. Billing and coding for APPs can be complex, but once regulatory issues are understood, these aspects become straightforward and can be easily applied to gastroenterology practices. There is an ongoing need for more formal training and onboarding resources, which could be met by national gastroenterology and hepatology societies. This article reviews the various ways in which APPs can be incorporated into gastroenterology and hepatology care.