Onboarding and Working with APPs

According to Dr. Zanation, this type of APP strategy has four major benefits. First, “the expectation for the provider and the patient is well delineated by the standardized workflows within thatspecific subject area. For example, in the survivorship clinic, each patient knows they will have alternating visits with the physician and the APP. They also understand they’re likely to be scoped as well as have speech and swallow evaluations, as well as yearly TSH [thyroid-stimulating hormone test] and health labs.”

“Second, these clinics free up patient access on the physician’s schedule for urgent disease-specific problems. Third, each one of these clinics aligns very well with our ancillary care services, which also drives additional utilization and revenue. In the vestibular disorders clinic, we have a complete setup for vestibular testing, including rotary chair testing as well as CNS [central nervous system] and vertebrobasilar testing. By increasing needed patient access, we can drive appropriate utilization of our ancillary investments,” Dr. Zanation said. “Fourth and finally, there is an educational and expertise component to seeing the same types of patients over and over again. For APPs, this drives confidence in clinic procedures as well as understanding of complex diagnostic testing and clinical needs.”

Expanding Demand

Dr. Schmalbach explained that there are many different models for APPs. “The otolaryngologist and department/practice should aim to identify the greatest need and manner in which an APP can best augment patient care.”

As more and more is being asked of physicians, the role of otolaryngology– head and neck surgery APPs will increase, Dr. Schmalbach said. “A well-trained APP allows better communication with patients, timely discharge/decrease in length of stay, and increased access to patient care. APPs will also be invaluable in rural regions and other areas where there is limited patient access to otolaryngology physicians.”

Looking ahead, Dr. Zanation expects APPs will significantly impact disease-specific intake and long-term follow-up for ENT patients. “Disease-specific pathway strategies will be important for both maintaining appropriate access for patients as well as physicians’ schedules,” he said.

Healthcare access, especially in rural settings, continues to deteriorate as the breadth of ENT practice continues to expand. Many academic centers in North Carolina will not “see balance patients, and there are fewer endocrinology and sleep/neurology practices in North Carolina than ever before. So, we have a huge patient need in these areas that has developed faster than we are creating otolaryngologists,” Dr. Zanation said. APP-based specialty clinics enable a much faster start-up at a lower cost to provide care. These clinics also create synergy with medical and surgical practices and enhance the utilization of ancillary departments. Dr. Zanation said, “It’s a win for the patients, a win for the referring practices, and a win for us as owners and operators of private practice businesses.”