Over the last 20 years, Advanced Practice Providers (APPs)—Nurse Practitioners (NPs) and Physician Assistants (PAs)–have become fully integrated into most aspects of healthcare. This transition happened fluidly in primary care, Emergency Medicine, and across many specialties but Hospital Medicine has long struggled with how to maintain quality while also gaining the cost savings that APPs offer. In our experience, Hospital Medicine programs are also the most likely not to be using APPs at all.
Many programs that do utilize APPs schedule them for nighttime cross cover shifts and possibly for admitting shifts during the day. Highly functioning Hospital Medicine programs have utilized a “team” approach that pairs a physician with an APP to see 25-30 patients per day. The issue with this approach is that a physician alone can see 17-18 patients, so the additional cost of the APP is not covered by the additional patients.
Physicians don’t feel that they can cover a full load of patients while also supervising an APP, and it stands to reason that APPs should have physician supervision when caring for hospitalized inpatients.
When faced with this dilemma at a healthcare system in the Midwest, Core Clinical Partners brought all key stakeholders together to discuss options and landed on a novel approach that has maintained our excellent quality metrics while decreasing cost by 30% over typical rounding models.
APPs round on 15 patients per day while being supervised remotely by a local hospitalist who also works in the system. A full-time remote supervisor works with 4 APPs, helping with management decisions and care plans. If it is determined that a patient needs to be seen at the bedside by a physician, one of the other rounding physicians can assume care.
A diagram of the coverage is below:
This model also allows for better utilization of physicians at smaller system hospitals who don’t have full patient loads. These physicians may have 7-10 patients at their smaller hospital, but now can also supervise 1-2 APPs at the tertiary care hospital.
Decreased Length of Stay (LOS):
This approach has not only enhanced the efficiency of patient care but also contributed to improved clinical outcomes. Over the past two years, the implementation of remote APP utilization has yielded consistently strong metrics, as demonstrated by the steady downward trend in both the ALOS (Average Length of Stay) and GMLOS (Geometric Mean Length of Stay).
Reducing Labor Costs Through APP Utilization and Remote Supervision
By implementing a model that utilizes APPs we successfully reduced labor costs by 30%. Transitioning from a physician who rounds on 18 patients per day to an APP handling 15 patients with remote supervision has resulted in both consistent quality improvements alongside substantial cost savings.
By embracing the strategic integration of APPs and implementing a well-structured remote supervision model, healthcare systems are positioned to not only meet but exceed current healthcare demands, setting new benchmarks for operational efficiency and excellence in patient care. This approach is crucial for healthcare executives looking to improve outcomes and reduce costs while navigating the complexities of modern healthcare environments.