Optimizing Advanced Practice Provider Roles Through Standard Patient Contact Hours: Improving Patient Access and Workforce Sustainability.
TL;DR
Improvements in patient access, APP productivity, and financial performance, along with APP engagement, were observed by establishing clear job standards, addressing barriers that impeded patient care, and redistributing workflows.
Abstract
Objective
To assess changes in patient access, productivity, financial performance, and workforce outcomes before and after the implementation of standardized clinic workweek expectations for advanced practice providers (APPs), inclusive of physician assistants and nurse practitioners, in ambulatory specialty care. The initiative established 36 patient-facing hours per week for a full-time APP and included redesigning workflows and care team responsibilities.
Methods
A multidisciplinary team approach was used to optimize clinical operations and support APP sustainability. Interventions included assessing workload and identifying barriers. The use of protocols, pathways, and reallocating nonclinical tasks allowed a focus on patient-facing efforts. Alignment of template scheduling and standard unavailable times helped to launch a dashboard that monitored percent compliance with clinical workweek expectations. An APP job architecture using an ambulatory playbook and expected hours template was developed. Workflows were enhanced by looking at total care team growth needs. Key opportunities include reducing electronic burden and developing new pathways for complex triage and medical record review. Access, productivity, financial, and workforce outcomes were evaluated descriptively from fiscal year 2023 through fiscal year 2025 as part of a quality improvement initiative.
Findings
Between fiscal year 2023 and fiscal year 2024, among 2,018,479 patient encounters and across 17 medical and surgical specialties, patient experience scores for "ability to get an appointment" improved from 68.5% to 70%, rising from the 63rd to the 69th percentile. Overall patient visits increased 6.2%; APPs accounted for 77% of visit growth. New patient visits increased 4.5% with a 16.8% increase in APP new visits. APP work Relative Value Unit (wRVU) increased 20%, a 24% increase in total payments. APP engagement scores increased from the 47th to the 56th percentile.
Conclusion
Improvements in patient access, APP productivity, and financial performance, along with APP engagement, were observed by establishing clear job standards, addressing barriers that impeded patient care, and redistributing workflows. Continued evaluation is needed to determine the sustainability of these changes and further opportunities for specialty care teams.