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Our Take

Deploying APPs Autonomously

20 Minute Read

While organizations are employing advanced practice providers (APPs) in growing numbers, many rely on physician-driven pilots that result in APPs practicing below top-of-license and turning over. To realize their full potential, organizations must deploy all APPs as autonomous providers.

To achieve this, organizations should align many aspects of APP deployment, training, compensation, and leadership more closely to that of physicians.


The conventional wisdom

The APP workforce is growing rapidly. According to data from the Bureau of Labor Statistics, APPs are projected to be one of the fastest growing health care roles across the next ten years, outpacing the average growth rate across health care occupations—even physicians.

Despite this increase in hiring, most organizations fail to deploy APPs to their full potential. Physicians often dictate deployment models and determine their working relationship with the APPs on their care team. This physician-driven approach means that, while some practices or specialties may use APPs autonomously, more often than not APPs work below top-of-license, seeing overflow patients and being used in “extender” roles.

Overall, this approach causes two problems:

Missed profit and productivity: According to one Advisory Board member, medical groups lose about $50 for every primary care visit that’s conducted by a physician that could’ve gone to an APP. Put differently, across the year, that’s almost 1,500 lost wRVUs for every primary care physician who doesn’t work with an APP.

Increased turnover: At the same time, APP turnover is on the rise. Working below top-of-license is disengaging, which explains why almost 10% of APPs change jobs annually. And this turnover is costly. According to Advisory Board research, the cost to replace an APP is about $115,000 in primary care.

Up to this point, fragmented, physician-driven APP deployment has limited the ROI of these care team members.

Autonomy[ aw-ton-uh-mee ]noun

While autonomous APPs may co-manage a panel with a physician, they see and treat patients independently during the visit—acting as a provider in their own right.

Provider[ pro-vid-er ]noun

We use the term “provider” to refer to both physicians and APPs who diagnose and treat patients, serving as a patient’s primary caregiver.


Our take

Organizations must deploy APPs autonomously to fully capitalize on their value. APPs can perform many of the same tasks as physicians usually at less than half the salary1—making them an indispensable care team member for delivering high-value, cost-effective care. While they may co-manage a panel with a physician, APPs should see and treat patients independently, acting as a provider in their own right.

Regardless of state regulations, market dynamics, or specialty, all APPs can— and should—work autonomously. Not only does this increase productivity and top-of-license practice, but autonomous roles are also more engaging for APPs, thereby reducing turnover costs. How much autonomy organizations grant their APPs is directly linked to ROI. To lock in this autonomy, leaders should shift to a centralized strategy for APP hiring, deployment, and oversight, as opposed to the current physician-driven approach.

Terminology considerations

We use the more comprehensive term “APPs” throughout our work, but focused our research primarily on nurse practitioners (NPs) and physician assistants (PAs). However, many of the approaches discussed in the following pages can be applied across all types of APPs.

Regulatory considerations

Laws governing APP scope-of-practice and supervision requirements vary across the country. Though we do not comment on these regulatory considerations in our research, organizations should be able to implement the following best practices regardless of their state’s regulatory landscape.


Four components of an autonomous APP model

In order to maximize the ROI of their APPs, leaders must deploy them more like they do their physicians. In the following pages, we introduce a four-part model that promotes APP autonomy and discuss how APPs should be approached the same as—and different from—physicians.

  • Component

    Standardized roles that advance strategic goals

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  • Component

    Centralized onboarding and clinical training

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  • Component

    Performance-based compensation

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  • Component

    Involvement in group governance

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Parting thoughts

Organizations should consistently leverage APPs as autonomous providers, aligning their deployment, training, compensation, and leadership more closely to that of physicians. Each organization is likely at a different point with each of these four components, depending on their investment in APPs to date.

Your next step is to determine where to begin implementing this model.

In our experience, there isn’t a single order of operations that works best. While it often makes sense to start with standardizing deployment, some organizations begin by revamping training or hiring an APP leader to spearhead this work. Fill out the brief diagnostic on page 15 of the PDF to help you determine where to begin. We recommend focusing your efforts in the areas with 1-2 checked boxes.

For additional support on your APP strategy, please reach out to your membership advisor.

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