Optimal Use of Advanced Practice Providers at an Academic Medical Center: A First-Year Retrospective Review

Area of Science:

• Healthcare Administration
• Clinical Operations
• Quality Improvement

Background:

• Advanced practice providers (APPs), including physician assistants/associates (PAs) and nurse practitioners (NPs), are crucial for team-based care in academic medical centers (AMCs).
• Optimizing APP care delivery models to maximize top-of-license practice is vital for enhancing ambulatory capacity and financial performance.

Purpose of the Study:

• To assess the impact of restructuring APP care models to encourage independent practice sessions.
• To evaluate the downstream effects on productivity, patient satisfaction, and physician performance within an AMC setting.

Main Methods:

• A quality improvement study involving a one-year retrospective review of internal data (July 2021-June 2022).
• An APP oversight committee was formed to optimize ambulatory care, realign APP funds flow, and establish performance standards.
• Certified registered nurse anesthetists (CRNAs) were excluded from the analysis.

Main Results:

• APP productivity saw significant year-over-year increases: 53% in work relative value units (wRVUs), 84% in payments, and 79% in charges.
• Completed APP visits increased by 45%, with 92% being return patient visits.
• No adverse impact on patient satisfaction, physician wRVUs, or programmatic expansion was observed.
• 78% of PAs and NPs reported working at the top-of-license most or all of the time.

Conclusions:

• Enhancing APP utilization through top-of-license initiatives can successfully boost productivity and revenue.
• These improvements can be achieved without compromising physician wRVUs or overall performance.
• Hospitals and health systems have an opportunity to optimize their APP workforce for better care delivery and efficiency.