ECG’s 2016 Pediatric Subspecialty Physician Compensation Survey includes data from almost 2,000 advanced practice providers (APPs). One of the key findings this year is their expanding role in care delivery, both in terms of their numbers and clinical production. APPs are playing a central role in helping organizations achieve goals around care continuity, access, and affordability, as well as addressing the seemingly constant shortage of pediatric subspecialists. We’ve seen this shift in the way APPs are prioritized in our client work, where we are commonly asked to help design heterogeneous, team-based care models for both inpatient and outpatient pediatric units.
The high level of interest in APPs in the children’s market was also affirmed during our first survey webinar in October, with questions about these providers dominating the Q&A segment. Here we share brief summaries of the issues that were top of mind.
Scope of Practice and Performance Measures
Pediatric organizations are using APPs in a broad range of roles. In some care settings, they handle routine new and follow-up visits, freeing up physicians to focus on higher-acuity patients and specialized procedures. In organizations with multispecialty clinics that serve medically complex children, APPs have become the tissue connecting physicians across specialties, and act as a common touchpoint for the patients and families.
The variation in both their organizational roles and legal scope of practice across states makes measuring APP clinical production difficult (e.g., in terms of WRVUs or patient visits). That said, this year’s survey found WRVUs performed by nurse practitioners (NPs) up nearly 10% over 2015, evidence of the growing number of APPs working and billing autonomously. Among APPs working in the primary care setting, the median annual WRVUs of 3,216 represents nearly two-thirds of the WRVU production generated by a general pediatrician.
Trends in Compensation Plans
The survey shows that the majority of APPs are still paid a straight salary (without incentives), although we may see this change in the future as APPs more frequently work side by side with physicians. In fact, some organizations are now incorporating team-based compensation incentives that reward clinic volume, throughput, outcomes, and patient satisfaction over individual production. With the continued focus on tying reimbursement to value, we believe we will see sustained incremental increases in standardized quality measures going forward. This is particularly important for APPs given that production-based metrics do not begin to tell the full story of the overall impact these providers can have on an organization’s clinical performance.
Consequences of Market Demand
As the organizational demand for APPs grows, the overall market supply is dwindling. The result is twofold—organizations are experiencing difficulty recruiting and retaining experienced APPs, and overall compensation for these in-demand providers is increasing. Our survey shows that compensation for NPs and surgical physician assistants (PAs) rose 3.1% and 2.1%, respectively. This is line with a parallel increase in compensation for physicians, and as APPs’ prominence continues to grow, this will become the new norm.
With the pool of available experienced APPs growing smaller, organizations are hiring more recent graduates. The level of on-boarding required for these new APPs presents a significant challenge for many organizations. The industry is responding with a focus on streamlining on-the-job training to get new APPs to a level where they are more quickly contributing to the care model in a meaningful way. We anticipate that retention bonuses will likely be utilized to ensure a return on this important investment.
It All Boils Down to This
With APPs accounting for a full one-quarter of the providers covered in this year’s survey — the highest percentage we’ve ever seen—there’s no question that they have become a major component of the pediatric provider workforce. Care models are evolving to reflect their growing influence, and proactive organizations are incorporating APPs into team-based models that allow for more patient-friendly and condition-focused care that ultimately reduces costs and improves outcomes, regardless of the care setting.