Enhancing the effectiveness of provider teams to care for patients is a constant challenge in any health care setting. Due to the shortage of physicians, advanced practice providers (APPs) – namely advanced practice registered nurses (APRNs) and physician assistants (PAs) – are in high demand.
Health care organizations are shaping their teams to ensure that all providers are practicing to the full breadth of their education and training to provide quality care in a variety of primary and specialty settings. When utilized at the top of their license, i.e. to the full extent of their state-specific scopes of practice and hospital-specific staff bylaws instead of handling tasks that could be effectively completed by someone else, APPs can fill an important gap in care delivery systems.
As chief financial officers look at their labor spend, the question becomes, are APPs fulfilling their purpose and making a positive contribution to the bottom line? The answer depends on many variables.
“The reality in most hospitals is that integrating APPs poses a number of organizational challenges ranging from a need to define roles and responsibilities to establishing support and utilization protocols,” said Jane McCarthy, MS, RN, CPHQ, senior director, nursing leadership at Vizient. “Vizient identified these challenges in 2013 and created the Center for Advancing Provider Practices (CAP2) to assist members as they work to realize the benefits APPs offer.”
The CAP2 program is an interactive solution that packages organizational assessments, benchmarking reports, references and toolkits, educational webinars and networking opportunities into a multifaceted Web-based resource that can deliver deep insights into the efficiency of an organization’s APPs.
To get started, an organization assesses how it utilizes its APPs – how many it has, where they are practicing and what they are doing. The assessments and benchmarking reports aren’t intended to determine if current utilization is right or wrong; rather, it provides insightful data for consideration on how to potentially maximize effectiveness.
Gathering insights through benchmarking
The assessment and comparative benchmarking reports identify variation both within the organization itself and against similar organizations. Perhaps a system has multiple hospitals and the assessment reveals that one hospital is approving a number of privileges for APPs, yet two other hospitals aren’t approving any of them. This can provide the leadership team with valuable insights related to variation in practice within the system that can trigger a review of the state practice acts and medical staff bylaws to promote standardization across the system.
Insights harvested from benchmarking reports could also lead to readjustment of APP utilization in both acute and ambulatory settings. For example, an academic medical center might compare the areas where their APRNs treat against where counterparts at similar hospitals treat to identify additional patient care opportunities.
“Once an organization assesses the areas where their APPs deliver patient care, it’s also helpful to determine which core and specialty privileges are approved by the governing body,” McCarthy said. “This helps to ensure the APPs’ time and expertise are maximized in the appropriate areas of treatment.”
Demonstrating APP value to the organization
Assessments and benchmarking reports also give leadership a clear picture of how productive APPs are in their organizations. As labor budgets grow tighter and finance is looking to trim expenses, they might see the organization employs a number of APPs but don’t really have a good grasp of their role and their overall contribution to the bottom line.
“CAP2 is a highly effective way to educate the C-suite about the critical role APPs play in strengthening the organization’s ability to improve patient outcomes,” McCarthy said. “That’s been somewhat of a challenge because as you try to tease out specific indicators to demonstrate those contributions, it’s sometimes difficult to specifically attribute indicators to APPs. When fully optimized with identifiable clinical and financial outcomes, APPs can and do demonstrate their substantial value to an organization.”
This was no more apparent than in the case of a health system comprised of three hospitals and more than 300 clinics in the southeastern United States. Challenged to meet the demand for direct care providers, the system began adding APRNs and PAs by as much as 10 percent per year. Today, the system employs more than 900 APPs. To accommodate this influx of personnel, the system engaged CAP2 to assess its leadership structure, identify resources to help APPs demonstrate outcomes of care, and determine how to assimilate incoming APPs into existing teams and departments.
The greatest impact was felt by conducting organizational assessments and comparative benchmarking to optimize the APP level of production. By ensuring their APPs were working at the top of their license, the APPs proved adept at handling a litany of patient care procedures and treatment applications, instead of being limited to scribe work.
Additionally, the system’s surgeons can now spend more of their time and energy performing procedures, which improves operational efficiency.
Currently, the CAP2 database includes data from more than 350 health care organizations including greater than 800 ambulatory clinics across 31 states, overall representing more than 30,000 APRNs and PAs in 50 clinical specialties.
“Armed with the knowledge and tools needed to optimize APPs, organizations can improve clinical outcomes, reduce variation in practice and decrease costs,” she added.
For more information on how the Vizient CAP2 solution can help you optimize utilization of your organization’s APPs, click here.