Issue link: https://beckershealthcare.uberflip.com/i/981659
13 Executive Briefing APPs can help manage this demand and take some of the workload off physicians to create a more positive healthcare experience for both patients and providers. 3. A booming APP workforce. While the U.S. physician workforce shrinks, the APP workforce continues to exhibit tremendous growth. The number of nurse practitioners licensed to practice in the U.S. skyrocketed from 120,000 in 2007 to more than 248,000 in March 2017, representing a record-high total, according to data from the AANP. By the end of 2016, there were 115,547 certified PAs practicing in the U.S., up from approximately 108,000 in 2015, according to a report from the National Commission on Certification of Physician Assistants. The abundance of APPs will prove useful for hospitals that hire these clinicians and give them more responsibilities to support physicians. 4. A growing and aging patient population. The AAMC expects the U.S. population to grow 12 percent by 2030, with the number of Americans 65 and older growing 55 percent during the same period. This demographic shift will drive greater need for preventive and geriatric care that a physician workforce alone cannot accommodate. APPs, credentialed and capable of meeting most patients' preventive and chronic care needs, have a crucial role to play in meeting the demands of an aging population amid the intensifying physician shortage. Hospitals must adapt as the roles of APPs change APPs help hospitals and health systems address the physician shortage head on — whatever that deficit looks like for a specific health system or individual market. At the same time, updating bylaws and internal policies and ensuring continued regulatory compliance when APPs join the organized medical staff can prove to be a real headache. To build a culture that is truly inclusive of APPs participating in the organized medical staff, hospitals and health systems need to revise medical staff guidelines, according to Ms. Pelletier. "Key areas that will need to be addressed are medical staff categories, including voting rights and other prerogatives, committee composition and fair hearing rights," she says. "And of course, the definition of who is included in the organized medical staff will need to be revised." Healthcare organizations may need to update other accessory documents, such as rules and regulations and advanced practice policies, as applicable. Hospitals and health systems must also understand the current regulatory landscape surrounding APPs, which is constantly changing. Each state has a different policy regarding NPs' and PAs' practice and prescriptive authority. While most states still require PAs to practice medicine through a supervisory relationship with a physician, some are moving toward looser regulations, according to Scope of Practice Policy, a collaborative project providing information on practice policy for various APP roles. In December 2016, the U.S. Department of Veterans Affairs granted full practice authority to advanced practice registered nurses working in VA facilities, regardless of state restrictions. NPs can practice independent of physician oversight in 21 states and Washington, D.C., as of 2018, according to Stat News. Another six states have pending legislation to allow NPs to practice independently, according to Scope of Practice Policy's legislative database. PAs — once universally required to practice under physician supervision — are now also allowed to practice under a collaborative agreement in a handful of states with more legislation proposed to reduce restrictions, according to Ms. Pelletier. If hospitals do not stay up-to-date with current regulatory restrictions and accreditation requirements, they may miss rules prohibiting or limiting APPs from specific leadership roles within the organized medical staff. Furthermore, a potential conflict of interest may occur if an APP is allowed to hold a leadership position within the medical staff, but still held internally to the requirement of having a supervisory relationship with a physician. "It would be very awkward to have a supervised APP in a position of oversight for their supervisor," says Ms. Pelletier. "So while an organization wouldn't have to allow for a more independent practice for the APP (as allowed by state law) to align with increasing responsibilities and inclusivity into the medical staff, practicality indicates these two design decisions should align." Conclusion The medical staff of the future will look different from what hospitals are accustomed to due to changing healthcare demands and a transitioning medical workforce. The organized medical staff's transformation is already underway, and the inclusion of APPs in leadership roles is just one example, according to Ms. Pelletier. She cited additional innovative leadership models, such as service line co-management and other hybrid models, in which non-physician leaders directly oversee physicians. Hospitals and health systems can be proactive by updating bylaws and ensuring regulatory compliance to achieve a smooth transition for APPs stepping into medical staff leadership roles. While these efforts can prove complicated and time-consuming, implementing proper protocols and regulatory considerations will translate into greater success for APPs on the medical staff and, ultimately, greater efficiency for hospitals and health systems. n The Greeley Company is a full-service healthcare consulting practice with specialties in regulatory compliance, accreditation, bylaws and governance, physician-hospital alignment and collaboration, medical staff optimization and training, business process outsourcing, external peer review, and credentialing and privileging. Greeley also offers interim staffing and customized onsite education, as well as resort-destination seminars for hospital executives, physician leaders, and medical staff professionals.