Strategically Employing APPs in Ambulatory Care

Strategically Employing Apps Web

In order to meet the increasing and shifting demand for care of an aging population, healthcare organizations have been exploring ways to mitigate a gap in physician supply and demand. The threat of a physician shortage is not new and may increase as the pandemic causes some physicians to retire prematurely to avoid burnout or financial insolvency.

One approach that healthcare organizations have taken to help fill voids in patient care while alleviating physician burdens has been to employ advanced practice providers (APPs). Employment of APPs has been adopted as a strategic means to add to organizations’ provider base at quicker recruitment rates and lower compensation costs than the employment of physicians. But too often the financial results are subpar or worse: incremental production and revenue achieved by the APP is below expectations and does not offset the costs.

With a goal of increasing access at lower costs, what causes the financial imbalance resulting from APP employment?

While healthcare organizations hire APPs to expand access and lower costs, the organizational structure and commitment to these roles may be deficient, resulting in a loose patchwork of stagnant apprenticeships for the APP, eliciting less-than-optimal financial results.

Strategic Approaches and Keys to Success

Consistency in Structure and Accountability

Healthcare organizations that employ APPs have enjoyed the most success when they adopt an enterprise-wide philosophy for APP employment and utilization. Standardized job descriptions and productivity performance expectations by specialty have reduced variability in the utilization of APPs. A provider governance committee (composed of physicians and APPs), in formal collaboration with human resources, ensures consistency across the enterprise. Provider governance also plays a role in setting the parameters for the number of APP FTEs per supervising physician so that the clinical needs of the program are balanced with market demand and in establishing a consistent organizational compensation philosophy for its physicians.

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