IAMSS Educational Conference APNs & PAs: Here to Stay and Part of the Team April 28, 2016

Transcription

1 IAMSS Annual Educational Program APNs & PAs: Here to Stay and Part of the Team! By: Stephanie Russell, CPMSM, CPCS Recognize current & future trends in health care affecting APPs in both the clinic inpatient and medical office settings. Identify a strategy to allow APPs expand the scope of their privileges Discuss the benefits of APPs involvement in credentialing & privileging processes. Allied Health Staff Medical Staff Resistance Held Physician Hands PA vs. APN Fear of the Unknown 1. 1

2 Advanced Practice Professionals Part of the Team mostly Still Allied Health Staff Needed Specialized Practice Independently 16 states Advanced Practice Nurses Midwives Nurse Anesthetists 65% Clinical Nurse Specialists Primary Care/Urgent Care Women s Health Wound Care Cardiology Surgery Mental Health Home Care and Beyond Physician Assistants Emergency Medicine Orthopedic Surgery Radiology General Surgery Urgent Care Dermatology Mental Health 1. 2

3 Physician Assistants 30% increase by 2020 Nurse Practitioners 130% increase by 2025 Virtually Every Area of Medicine Survival Cohesiveness Cost Effective Florida - Broadening Scope of APNs could yield Medical savings of $7 million annually Texas Increase State s economic output by $8 BILLION If APNs allowed to practice at the tope of their training - Shortage of Physicians Lower Costs Comparable (or better) Care Consults/Higher Level of Care Health Care Reform 1. 3

4 Demand Exceeds Supply Time Health Plans Reimbursement Local Market National Health Plans Every Area of Access 1. 4

5 Team Based Models Continuum of Care Primary Acute Case Management/Discharge Planning Home/Long Term Access Cost Effective MSPs Medical Staff Education Administration Education Advanced Leaders in Industry Will APPs be allowed to learn new skills? If so, what methodology will be used? 1. 5

6 Dr. Blocked Aorta has requested permission to train his PA to do vein harvesting. He states the PA has excellent surgical technique thus, this procedure would fall under the PA s current privileges for surgical assisting. The department chair (newly diligent about following policy) consulted the MSSD and learned there was no related policy. Review of the PA s performance did not indicate any competency issues although PAs were not included in the OPPE process The PA was currently approved for surgical assisting State licensure allowed any delegated activity to be performed if the surgeon was privileged for the procedure Therefore, the surgery chair has recommended to the credentials committee (CC) that the PA be allowed to train for this procedure under direct supervision of Dr. Aorta. What should the CC do? What factors should be considered? No! That is the good news! 1. 6

7 First, answer three simple diagnostic questions! Does your organization adequately address the expanding skills or scope of practice of APPs? Are APPs allowed to expand privileges through on-site training? Have APPs expanded their scope of privileges without authorization (i.e., scope creep )? Does the organization s current culture support training up of APPs? Governing body Medical staff Does the hospital s liability carrier allow training up? If training up is permitted, will patient consent be obtained? Develop a policy! 1. 7

8 Protect patients Protect hospital Protect APP and physician sponsor Create process to expand skills of APPs Permit physicians to fully utilize APPs skills What authorization process will be used to allow APPs to expand knowledge and/or skills? Medical staff privileging process to include governing body approval What type of privileges should be considered? Privileging under direct supervision clearly defined Will temporary privileges be granted to allow the train up process to proceed? Not recommended What criteria must the APP meet prior to applying for permission to expand privileges under direct supervision? Currently meets eligibility criteria for privileges held No issues identified Clinical competence Professional conduct 1. 8

9 What if the APP requests privileges that previously have been granted only to physicians? Establish moratorium Determine through medical staff recommendation to governing body whether privilege will be extended to nonphysicians If yes, create eligibility criteria for APPs Consider the APP request What will be the procedure to request train up privileges? Written request from APP and collaborating/supervising physician Specific procedure(s) requested Name of preceptor(s) Anticipated length of training Competency measurement criteria Patient population (as appropriate) Will there be a time limit to complete the training and establish competency? If so, who determines the time limit? What method will be used to obtain patient consent? 1. 9

10 What will be the process when an APP and supervising physician are approved for train up privileges? Clear communication, including expectations APP applicant Supervising physician Nursing and ancillary services staff How does the APP request privileges without direct supervision? Complete the training period Collaborating physician confirms competence Eligibility criteria met for requested privilege Request submitted through normal medical staff channels Medical staff recommends Governing body approves FPPE begins (TJC & HFAP requirement) 1. 10

11 Questions? /