How to Optimize Care Delivery in 2021? Look to Advanced Practice Providers

A new data report by the Medical Group Management Association (MGMA), Optimizing Advanced Practice Providers in Healthcare, shows the increased need for advanced practice providers (APPs) in care delivery and practice performance amid the COVID-19 pandemic. With a looming physician shortage and the impacts of expanded telehealth, new technology, value-based care models and the ongoing effects of the pandemic, APPs continue to play an increasingly vital role.

According to a November 3 MGMA Stat poll, more than half (55%) of the 796 respondents plan to add new APPs to their practice in 2021. Among healthcare leaders looking to add APPs next year, more than two-thirds (68%) are considering adding nurse practitioners (NPs), and more than half (58%) say they anticipate adding physician assistants (PAs).

“As medical practices continue to feel the effects and implications of the [COVID-19] pandemic overthe next 18-24 months, a smart solution to help decrease physician burden and burnout is to lean on and elevate the roles of APPs,” said Halee Fischer-Wright, MD, MMM, FAAP, FACMPE, president and CEO of MGMA. “With APPs overseeing patients with lower-acuity issues, physicians are able to spend more time on patients with complex needs. Sharing the responsibilities will allow for better care outcomes. Doing so is also crucial as practices support returning patient volumes while striving to maximize profitability and efficiency.”

Highlights from the report include:

• Need for APPs is increasing:
  - Medical practices across the country are increasing their use of APPs. Data from the 2020 MGMA DataDive Cost and Revenue dataset found that the APP-to-physician ratio has increased from 0.42:1 in 2012 to 0.60:1 in 2019. The U.S. Bureau of Labor Statistics estimates overall employment for NPs will grow at a rate of 45%, much faster than the average for all occupations, and that the PA field will grow at a rate of 31%.
• APP compensation on the rise:
  - According to 2020 MGMADataDive Provider Compensation data, APP compensation rose 2.13% from 2018 to 2019.
  - Median NP compensation reached $111,238 in 2019, and PAs earned a median salary of $112,260 in 2019, a 6.8% increase from 2015.
  - Surgical PAs earn the most with a median compensation of $129,183.
• APPs will play critical role with the shift to value-based care.
  - A team-based approach is proven to boost quality and efficiency and lower costs, and APP utilization is a key component in those staffing models.
  - Value-based care programs by CMS and commercial payers will be heavily influenced by APPs both today and well into the future with the continued end goal of cost reduction while maintaining and improving upon the care provided.
• Knowing when it makes sense to hire an APP:
  - MGMA data show that practices that utilize APPs continually perform better financially than practices that do not.
  - Using an estimation of average cash net revenue or work RVUs (wRVUs) can help you determine a break-even point for adding an APP.
  - An ROI analysis can help compare the increased revenue from adding surgeries and/or billing surgical assist fees as compared to the APP expense.