Last week we began looking at APPs (advanced practice providers) as valuable members of a patient’s healthcare team, especially in today’s current shift from fee-for-service healthcare, to value-based healthcare. I quoted MEDI Leadership’s Kathy Gibala, and I think it’s worth mentioning again as we continue to take a look at how to educate patients on, and encourage them towards, the benefits of having an APP on their healthcare team. Gibala writes in her MEDI Leadership newsletter, “Over the past several years a lot has been written and done around team-based care. A few of the reasons for this increased focus include: the changing healthcare industry landscape; the shift to value-based care; Quadruple Aim goals (raising population health, improving patient experience, reducing waste/cost, and enhancing care team well-being); the rise of the empowered consumer along with increased expectations regarding access, efficiency and high reliability; provider burnout; and the looming physician shortage.” (1)
APPs in Healthcare Today
The world has now witnessed first-hand how incredibly versatile and valuable the role of an APP truly is. The American Association for Physician Leadership looks ahead to the future of the healthcare industry while gleaning from the past in their article, “The Key Role of Advanced Practice Providers in Today’s New Normal.” Authors write, “In response to COVID-19, 78.6 percent of organizations redeployed or planned to redeploy APPs into other specialties because of clinical staffing shortages in critical departments. Given APPs’ extensive training, specialty skill sets, and ability to adapt to different settings, these strategies often include redeploying APPs to provide support for COVID-19 surge-related activities in the intensive care unit, testing sites, and employee health clinics, highlighting the versatile role this workforce plays in meeting patient needs and organizational goals. As the industry plans for what lies ahead, physician leaders will be called upon to extract the lessons learned regarding care team optimization to help improve patient access, experience, and safety. Additionally, they will be expected to continue to maintain a flexible workforce to prepare for potential surges, mitigate certain financial risks, and increase revenue.” (2) The healthcare industry is left in the wake of the pandemic, and there’s no doubt about it – the optimization of APPs proves to be a valuable solution to softening some of the blows. Chances are high, as healthcare professionals, you are already aware of this reality; however, the difficulty lies in educating your patients on the potential benefits of APPs and encouraging them towards accepting APPs as part of their healthcare team.
Awkward Tension
You’ve probably had the awkward (and potentially even frustrating) encounter when, for whatever reason, much to his/her dismay, a patient unexpectedly learns he/she will be meeting with an APP for an appointment rather than his/her physician. I can only imagine some of the stories you have to share. Perhaps you’ve even been the patient on the receiving end of that surprise. It’s not news that patients don’t like surprises. Yet, it’s also inevitable within a healthcare facility that things just happen sometimes. Physicians get behind in seeing patients, caught up in paperwork, or are attending to personal or family matters (gasp!). Many healthcare facilities have caught on to the benefit of APPs within their practice. Advanced practice providers help alleviate the high demand on physicians, and add another helpful, knowledgeable, experienced individual to the team table. The challenge is how to educate patients on those benefits so as to preventatively alleviate any awkward tension and even encourage patients to seek out APPs as part of their healthcare team.
Optimizing the Value of APPs
Jeff Morris, MD, MBA, FACS, FRCS(C), provides some great insight on the matter in his article for Huron, “Optimizing the Value of Advanced Practice Providers.” He writes, “The simple secret to optimizing the value of your APPs is to focus on how you integrate and promote them as part of your team.” (3) He then lists several suggestions on how to integrate APPs in a way that helps both the healthcare facility staff, as well as patients make a smooth transition to integrating them as part of team-based healthcare. Here they are in summary:
- Words Matter:
Be intentional and selective with your words when describing APPs to staff and patients. Avoid terms such as “mid-level provider,” “physician extender,” and “non-physician provider.” These terms inflict a negative connotation and imply that the type of care they deliver is inferior to that of a physician. - Terminology Might Need Explanation:
Morris sums it up nicely, “Don’t assume that all patients are familiar with terms such as APP, CRNA, Nurse Practitioner, PA, etc. If patients do not understand these words and roles, the intensity of their anxiety will be greater. We recommend using words that are easily understandable and that are reassuring to patients about the APPs’ training and competency.” (3) - Managing the Team:
Introducing patients to their APP ahead of time can help create trust. Use this introduction as an opportunity to educate the patient on what the APP brings to the table. For example, “Sarah has been a Physician Assistant on my team for 4 years now, and she is awesome. The patients love her, and they tell me she is better at doing throat swabs than I am!” Morris explains, “When other team members (such as the Medical Assistant or receptionist) also endorse the APP, it positively reinforces the patient’s perception of the APP as a trusted and competent clinical provider and a valued member of the team.” (3) - Promoting the Team:
In order for patients to understand the benefits of team-based healthcare, the medical professionals involved need to do just that: be a team. This means communicating well, consistently meeting to ensure everyone is on the same page, reiterating the benefits of the team and each individual member to the patient, and utilizing more subtle opportunities to support the team philosophy such as the website and front office staff. - Don’t Surprise Patients:
Reluctance from patients to meet with APPs is going to be more likely when they’re blindsided. This can cause the patient to feel anxious or abandoned. Patients desire (and deserve) to have some ownership in their personal healthcare team. Communicating with them ahead of time and/or arranging an opportunity for them to meet the APP can help alleviate tension when things inevitably do arise. Morris provides an example dialogue, “John, my wonderful Physician Assistant, whom you met on your first visit will see you to check your wound and take your sutures out when you come in. He will let me know how you are doing and then I will see you the following week at your next visit.” (3) - Invest in Your Advanced Practice Providers:
Intentionally ensure the APP is a good fit for the entire healthcare facility and the patient population during the hiring process. Provide APPs with incentive programs linked to quality of care and patient experience. Offer continuing education and developmental opportunities both professionally and personally.
A Worthwhile Investment
At the heart of the matter is the goal of creating and cultivating culture. Intentionally set a culture within your healthcare facility that says we value team-based care which leads to optimal and cost-efficient health outcomes for the patients. How can this philosophy be communicated to patients at each point within your healthcare facility – from the website to the front office staff, to patients’ interactions with their physicians, etc. To conclude, I’ll leave you with one more quote from Morris’ article in which he hits the nail on the head, “If you see APPs merely as a “pressure-release valve” for your workload overflow, that is how they will be perceived by your patients and by others in the practice. If you truly believe in them as valuable and valued members of your healthcare team, they will be appreciated and respected by both patients and staff alike. This will greatly enhance the quality, the consistency, and the patient’s perception of the care they receive–a very worthwhile investment.”
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Thank you!
Jerry
Jerry L. Stone
Co-Founder/COO
MedicalGPS, LLC
Resources:
- https://medi-leadership.org/
team-based-care-worthwhile- journey - https://www.physicianleaders.
org/news/the-key-role-of- advanced-practice-providers- in-todays-new-normal
- https://www.huronlearninglab.
com/resources/articles-and- industry-updates/insights/ august-2016/optimizing-the- value-of-advanced-practice- provider