This system-wide initiative for optimizing advanced practice provider (APP) contributions was conducted at the Medical University of South Carolina Health-Charleston. Directors of the APP Best Practice Center designed and conducted a system-wide assessment that included surveys and interviews with APP clinicians and leaders. After review of the report and recommendations by a multilevel team and executive leadership, department leaders were then encouraged to operationalize the final recommendations.

Between 2016 and 2019, as recommendations were implemented, APP productivity as billing providers increased 150% to 321% and APP productivity as performing providers increased 8% to 138%. APP satisfaction improved on 7 measures.

The following are key points to remember about the recommendations from this initiative to optimize high-functioning APP teams:

1. Implement an advanced practice registered nurse and physician assistant billing algorithm for shared visits and independent APP clinics.
2. Review accuracy of performing and billing relative value units monthly with department administrator.
3. Create an advanced practice registered nurse and physician assistant scheduling template with a mix of new and return patients.
4. Identify opportunities for group and survivorship clinics run independently by APPs.
5. Identify opportunities to rotate inpatient/outpatient coverage.
6. Include procedures in APP scope of practice and practice agreements.
7. Educate physicians, registered nurses, administrative staff, and residents on appropriate APP utilization.
8. Annually identify requirements for APPs to qualify for incentive bonus.
9. Redefine job responsibilities of nursing support staff to ensure adequate support for APPs.
10. Assign an administrative assistant to each APP.
11. Review the central scheduling tree.
12. Train frontline schedulers to use a standardized script when scheduling patients with APPs.
13. Train schedulers to match patient diagnosis with the correct physician or APP provider.
14. Provide scheduling support for each patient following APP visits.
15. Standardize 5 days of time off and stipend up to $2,500 for CME annually for each APP.
16. Encouraging each APP and attending physician to collaborate on training for 5 procedures.
17. Encourage residents to collaborate with APP department leaders in creation of resident orientation programs.
18. For APP orientation, implement scheduling and responsibilities at the departmental level and coordinate general orientation with Human Resources.
19. Provide business cards for APPs.
20. List APPs on department website along with physicians.
21. For lead APPs, provide a stipend and dedicated administrative time.
22. Establish regular team meetings to discuss department operations, review monthly relative value unit dashboard, and engage APPs in hiring of physicians, APPs, and other department staff.
23. Conduct APP evaluations annually, with evaluations conducted and completed by the primary supervising/collaborating physicians and department chair/medical director.
24. Provide monetary incentive or compensatory time off in exchange for taking call.
25. Include APPs on department research papers to which they contribute and allocate administrative time for these projects.

Clinical Topics: Cardiovascular Care Team

Keywords: Physician Assistants, Physicians, Nurses, Advanced Practice Nursing, Physician Executives, Health Workforce, Employee Performance Appraisal, Personal Satisfaction, Efficiency, Organizational, Motivation, Leadership

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