How Florence Medicine expands outpatient CV capacity

Florence Medicine, like many organizations during the pandemic, lost physicians due to recruitment competition, burnout, and general physician shortages. But in contrast to other providers, their demand has continued to grow, so Florence Medicine has looked to APPs for support.

First, they hired more APPs—growing their team from 1 to 30 APPs over the span of a few years. They then got to work on standardizing their visit templates to appropriately delineate cardiologist and APP roles while maintaining care quality across sites.

The updated visit template empowers APP staff to take on regular return visits, elevating their role on the care team. This gives cardiologists time to see new patients. Cardiologists still see returning patients every few visits for consistency, which helps demonstrate care team collaboration and instill patient trust. These standardized visit templates allow Florence Medicine to see an additional 50 visits a week, or approximately 200 additional visits a month!

Given their success elevating APPs in existing clinics, Florence Medicine has established APP-led clinics where appropriate. For example, they created a heart failure clinic staffed by APPs and are planning a similar staffing model for a new A-fib clinic. This model provides further structure and support for APP-enabled care.

Florence Medicine hasn’t stop at flexing APPs—they also flex available CV specialists to take general cardiology consults and otherwise increase general cardiologist capacity. This strategy involves empowering CV specialists such as electrophysiologists, invasive doctors, and CV hospitalists who all have the training to effectively take general cardiology consults. For example, EPs take some outpatient cardiology visits while CV hospitalists are empowered to make and relay certain care decisions without looping in a patient’s cardiologist for an unnecessary consult. This has worked well because initially, with limited visits from new patients, referrals for downstream procedures have been relatively low, which gives downstream CV specialists the capacity to support consults.

Beyond elevating and flexing staff to expand capacity, Florence Medicine evaluates whether streamlined infrastructure investments could increase efficiency and broaden capacity. For example, after monitoring projected growth and market trends, leaders made an informed decision to relocate and restructure one of their clinics.

The decision to move locations was in part influenced by the lack of space at the original clinic. It was never an optimal space; the staff just made it work. The new location will include an additional 8 exam rooms and feature a new, dedicated space for the cardiac device team. It will also add space for cardiopulmonary rehab, vascular, and echo to better meet patient needs and coordinate care. Staff anticipate lower utilization across rooms to start, but that is due to continued manpower challenges versus a lack of demand.

Overall, Florence Medicine sees this investment as a worthwhile way to expand capacity through increased efficiency. As leaders continue to expand and elevate their APP staff, having new, dedicated spaces will allow their APPs and available CV specialists to better coordinate care and see more patients.