Is the right person performing the right tasks at the right time in your cardiology practice? Advanced care practitioners (ACPs), such as physician assistants (PAs) and nurse practitioners (NPs), have long supported the delivery of cardiac care. In many physician practices and hospitals, however, ACPs are simply not being leveraged as effectively as they could be. Instead, lingering assumptions about the role of ACPs and long-held practice models are restricting their true capacity to improve productivity and enhance patient access. The use of PAs and NPs is not new or novel, yet ACPs continue to be untapped resources for improving the delivery of cardiac care.
ACP Utilization and Responsibilities
The employment of ACPs has grown over the past 5 years; however, increased employment does not necessarily reflect optimal usage. There is often an opportunity to safely increase the scope of work for PAs and NPs, from providing follow-up care for more complex patients to administering stress tests and even diagnostic cardiac catheterizations (primarily in select academic settings). Various studies confirm this, including a Duke University study showing that trained and supervised PAs performed diagnostic caths on par with cardiology fellows.
Emphasizing the benefits of a “care team” approach may be helpful for those of you who may experience difficulty in “selling” a visit with a PA/NP to patients. Care teams are assigned a panel of patients who will always see one of the team providers, allowing for more efficient follow-up scheduling and a greater sense of continuity. As the initial operational challenges of team practice are identified and addressed, the teams are often able to handle a panel size greater than would have been possible as independent providers, increasing patient access.
Many high-performing cardiology practices use “shared visits” or “double schedules” as another way to increase the integration of ACPs into their practices. In these types of appointments, the PA/NP gathers the majority of information from the patient and conducts most of the appointment, with a brief visit from the physician at the end. One of our clients remarked that this approach allowed physicians and ACPs to see up to a combined 35 to 38 patients in a day. Shared visits can also help improve patient satisfaction, as patients may prefer a timely appointment with an ACP and brief visit with their physician over lengthy waits for a physician-only visit.
Optimize Your Resources
Becoming more effective, efficient, and cost-conscious requires physicians and physician practices to think innovatively about care delivery; but that doesn’t necessarily mean reinventing the wheel. With ACPs continuing to be available but underutilized resources, it’s time to rethink their involvement in advancing care, not just supporting it.
This post is adapted from a column that originally appeared in the October 2014 issue of CardioSource WorldNews, a publication of the American College of Cardiology.