Health Policy Statement Addresses Roles of Advanced Practice Providers in Team-Based Care
Building teams that include advanced practice providers can help cardiovascular practices meet the challenges of workforce shortages, an aging patient population with growing complexities in care, and a payment system in transition, according to the ACC’s new 2015 ACC Health Policy Statement on Cardiovascular Team-Based Care and the Role of Advanced Practice Providers.
The statement specifically focuses on the role of the advanced practice providers, including advanced practice registered nurses, physician assistants and PharmDs, who are increasingly in a position to extend a team’s capabilities because they have the “requisite education, training and experience to allow them greater autonomy.” The statement outlines the capabilities of these providers, highlights existing barriers and offers recommendations on how to improve cardiovascular team-based care in a way that ensures greater patient and provider satisfaction.
“The team-based approach improves efficiency and quality of care for patients with cardiovascular disease. We hope this policy statement will encourage an open dialogue about barriers to team-based care across practice settings,” said Eileen M. Handberg, PhD, ARNP, FACC, co-chair of the writing panel.
According to Handberg and the other statement authors, the varied post-graduate training experiences of advanced practice providers add a rich diversity of talent and capabilities to the care team. For example, they note that nurse practitioners may be more focused on chronic disease management and patient education, while PharmD roles might be more task-focused around areas like medication adherence, managing complex drug therapies or providing preventative care.
Regardless of the specific job functions, the statement notes that successful and effective cardiovascular team-based care requires “shared goals and clear roles.” The authors note that each team member should have a clear understanding of his/her function and the expectations and accountability that go along with that function – particularly given the increased focus on public reporting and pay-for-performance that is making teams more accountable than in the past. In terms of leadership, the statement points out the ultimate leader of the cardiovascular care team is the patient. “It is the informed patient, in consultation with family, who should ultimately determine the goals of the cardiovascular team-based care,” the report says. “It is up to the health care team to constructively engage the patient.” In addition to the patient, the statement urges a movement away from the historical approach with the cardiologist as the leader to a more flexible approach that “reflects the specific needs of the patient at a particular time and setting.” According to the statement, the leader should be the team member with the greatest knowledge and experience for the task at hand.
The statement recognizes that broad dissemination of this team-based approach to cardiovascular care is not without its challenges. Differences in state regulations regarding the licensure of practitioners, as well as variations in payment policies by private and public payers, can interfere with the team-based approach. In addition, new payment models focusing on value over volume “represent both an opportunity and a challenge for cardiovascular team-based care,” the report states. “The key to success will be to assign the right clinician to the right clinical task and patient at the right time in order to enhance efficiency and avoid indiscriminately replacing more-skilled providers with less-skilled providers.”
Moving forward, the statement urges expansion of inter-professional education to encourage creative interaction by all members of the team; advocacy around sensible payment reforms; and exploration of emerging technologies to extend the capabilities of the cardiovascular team, including telemedicine and virtual teams to help bring care to underserved regions.
“The advancement of team care will require visionary leaders who can see the opportunities of the future,” writes Richard Kovacs, MD, FACC, and Joseph Drozda, Jr., MD, FACC, in an accompanying editorial. “The ACC will need more discussion, reflection, and policy development on the many important and evolving aspects of team-based care … The first ACC HPS on team-based cardiovascular care should stimulate a revolution in the way we think of cardiac care, how we develop and validate team care methods, and how we disseminate knowledge of best practices.”
At the end of the day, “this policy statement supports what many cardiovascular practitioners have known and practiced for years, and it reflects the ACC’s long-standing support for the multidisciplinary team,” said John E. Brush Jr., MD, FACC, co-chair of the panel that developed the report.
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