The training at his center follows an arc of observational learning in which APPs first spend time with physicians to understand the nuances of otolaryngology. Then, the training moves to a “shared” model in which APPs begin to gather and synthesize information and implement documentation. Finally, training moves to a “collaborative” approach, in which APPs act more independently but still work in conjunction with physicians.
Explore This IssueDecember 2015
Having APPs in a practice can essentially push everyone to the top of their game, he said. “I think we all know the buzz words ‘top of the license,’” he said. “We need advanced practice providers to work at the top of their license, nurses working at top of their license, (and that) can drive otolaryngologists to work at the top of their license, too.”
Panelists acknowledged that adding APPs to a practice requires some finesse in handling the social dynamics. “Some of our physicians work well with advanced practice providers; others don’t,” Dr. Stringer said. “They’re just all different.”
In 2010, there were no independent clinics run by APPs in Dr. Stringer’s department. Now, seven to 12 general otolaryngology APP clinics exist, opening up 70 to 120 patient appointment slots per week, said April Hunt, MSN, NP-C, the lead APP at the University of Mississippi Medical Center. This means higher patient volumes, fast appointment times, and freed-up appointment slots for physicians, she said.
APPs in the department recently started to take emergency and inpatient calls and provide four hours of coverage daily. The department is also working on establishing an APP residency in otolaryngology. “To do this, we really have to have strong support from everyone involved,” Hunt said. “Introducing your APP when you walk into a room—introducing them as providers and part of the care team to the patients—is so important. It builds trust and gives them confidence.”
Marie Gilbert, PA-C, the medical liaison between the American Academy of Physician Assistants and the AAO-HNS, emphasized the importance of understanding “incident to” billing, in which APPs provide certain follow-up care. For care to be considered “incident to,” the patient must have been originally seen by the physician when the plan of care was made. The APP handles the re-check of that problem, while a physician is physically present in the office suite. In that scenario, the re-check visit can be billed under the provider number of the physician who is present and is paid at 100% of the physician’s fee schedule. Any other scenario is not considered “incident to.”