HealthAugust 03, 2020

Best practices for hiring advanced practice providers

By: Bana Jobe

Advanced practice providers can help practices grow revenue, but you have to hire the right people and work to keep them on payroll.

As medical practices brace for a projected shortage of up to 122,000 physicians by 2032, there's renewed interest in engaging advanced practice providers (APPs) such as nurse practitioners and physician assistants to help narrow the gaps.

If you've been wondering whether these providers are right for your clinic, there's a number you need to know: $500,000.

That's the average net return on investment that APPs contribute to medical practices each year, according to a recent lecture by Laura Kirk, PA-C, senior physician assistant supervisor at the University of California, San Francisco. Much of that value derives from APPs' ability to manage most patients and serve overflow while freeing physicians up for more complex cases and billable care.

Now available for CME credit on AudioDigest, Kirk's lecture "Advanced Practice Providers: Onboarding, Partnership, and Retention" reviews the scope of APPs as well as best practices for hiring, billing and team engagement for these emerging roles in healthcare.

What are advanced practice providers?

APPs include providers who have the full scope of practice to diagnose, order testing, treat and prescribe. Generally, this includes nurse practitioners (NPs) and physician assistants (PAs) but not ancillary providers such as technicians.

While both PAs and NPs can have similar responsibilities and salaries, their training differs. For example, NPs are registered nurses who receive master's- or doctorate-level education, making them ideal for family or pediatric practices. PAs have a medical training background, including surgical learning, which can make them valuable for the OR or other care areas.

All APPs serve as an extension of the clinical team, providing routine care as well as services for surveillance, inpatient procedures and postoperative visits. Their scope can also include triaging referrals, conducting virtual visits and answering patient questions. Often, they also participate in clinical research and teaching at academic centers.

Because they can bill independently under their own NPI, APPs can help providers manage patient volume as a second set of clinical hands in the office.

To listen to the full lecture and earn CME credit, visit AudioDigest.


Onboarding advanced practice providers

Turnover for APPs can cost as much as $300,000, so it's important to lay the onboarding groundwork to keep them on payroll. To do so, Kirk recommends a five-step approach:

  1. Orientation: Train APPs in your specific practice standards and EMR workflow. Also take the time to introduce them to the culture and team members.
  2. Observation: Have APPs observe providers in the clinic so they can understand practice-specific patterns and standards.
  3. Shared Care: Have APPs gradually support physicians by first giving them shared tasks such as initial intake, documentation notes or simple procedures.
  4. Collaborative Care: Allow APPs to be increasingly independent but have physicians available as backup.
  5. Autonomy: APPs see patients independently and are a fully productive component of clinical staff.

Engaging APPs in your practice

Because APPs are an extension of the practice, they should feel included in team culture and workflows- and that starts with introductions. Introduce them to the staff and community with your endorsement so that they're seen as a critical piece of the team from the get-go.

You might consider writing a script for the scheduling and reception teams so they can explain what a PA and NP are, elaborate on their training and provide context for the areas of medicine they support. This script should also include communication with the referring network so they know their patients are in good hands. Giving APPs a bio page on your practice website can help, too.

Beyond that, team meetings are a natural opportunity to engage APPs, as these meetings allow practice managers to share big-picture visions and goals while enabling everyone to engage in dialogue around current and future practice needs.

Because APPs still need to meet CME requirements to maintain their licenses and certifications, it's also important to give them paid time off and development funds so they can attend conferences and maintain memberships in professional associations. Give them a platform to share their learnings with the wider team by encouraging lunch-and-learns or grand rounds.

Happy patients, happy staff and a happy bottom line

Beyond the operational benefits of APPs, perhaps the most appealing reason to hire one is patient satisfaction: More than 9 in 10 patients feel APPs provide high-quality care and are trusted clinicians. Many people appreciate that APPs can explain complex concepts and make it easier to get on the appointment schedule, Kirk adds. Increasingly, patients care more about the care they receive than the credentials of the provider.

These trends indicate that there's immense value in bringing an APP on to your team, but you do have to put in the work to hire the right people, pair the right roles with the right responsibilities and retain employees for the long term. Do that and you might see that $500,000 sooner than you think.

Bana Jobe
Lippincott® Medicine
Lippincott is a leading international medical publisher of professional health information for practitioners, faculty, residents, students, and healthcare institutions with a full suite of essential medical products, from books and journals to digital solutions.
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