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www.melnic.com Melnic Consulting Group Jill Gilliland, President & C (800) 886-7906 [email protected]
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Table of Contents
1. Overview2. Structures within an Organization3. Billing4. Conclusion & Recommendation
Melnic Consulting GroupSummary- Advanced Practice Structures
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Overview:Advanced Practice Structures
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• Acute Care– Cardiology– GI– Hem Onc– Nephrology– Immunology– Pulmonary– Hospitalist– ED
• Intensive Care– PICU/CICU
• Surgery– Thoracic– Bariatric– Surg Onc– Vascular– Solid Organ transplantation– ENT– Orthopedic– Neurosurgery– Cardiac Surgery
Carmel McComiskey, Director Advanced Practice UMMC
Unit-based Services Provided
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Basis for the Model
• Fragmented reporting Structures• Lack of standardized process for hiring, credentialing and
orientation• Multiple entry points into practice within the campus• Variable scope of practice among NP• Inefficiencies in addressing NP professional issues• Difficulty with recruitment and retention• Lack of centralized budgeting and resource utilization creating
duplication and waste • Lack of a Professional ladder• Role confusion
Basis For Model
Carmel McComiskey, Director Advanced Practice UMMC
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Blending of the NP/PA role into the Academic Teaching Model
• Great challenges versus Great Variability• How NP/PAs entered the system, through different
doors with different paths• ‘Intern’ role that morphs into ‘fellow role’ as NP/PA
gains expertise• Resident replacement role• Lack of awareness of AC scope of practice• NP/PAs practicing differently in different places
• Establishing financially independent NP/PA practices within critical care areas
Blending of the NP/PA role into the Academic Teaching Model
Carmel McComiskey, Director Advanced Practice UMMC
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Role of the Director of Advanced Practice• Recruitment and Retention
• Professional support• Mentoring Novice• Clarification of the NP/PA Role• System Wide NP/PA Team Building• Communication and planning for NP/PA resources• Managing Performance/Expectations• Implement Billing• Professional Development-Program Development
Role of the Director of Advanced Practice
Carmel McComiskey, Director Advanced Practice UMMC
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Case Study:Children’s Medical Center Dallas
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Scope of Problem at CMC in 2003
• Disconnected group• Disparity (Pay, Travel/Ed support)• Lack of APN/PA practice understanding by
nursing managers• Increased complexity of practice (scope of
practice as well as BON rules & regs)• Growing numbers of APNs/PAs– Increasing cost without associated revenue
generation
Scope of Problem at CMC in 2003
Joe Don Cavender, ACNO Children’s Medical Center Dallas
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Plan
• Create a ‘service line’ for all APNs and PAs• Director, APN Managers
– Director, Managers are all practicing APNs/PAs
• Budgeting all within a single cost center• Standardization of support/compensation• Creation of a “Sense of Community”• Quantification of productivity• Begin to explore opportunities for reimbursement
Plan-Children’s Medical Center Dallas
Joe Don Cavender, ACNO Children’s Medical Center Dallas
www.melnic.comJoe Don Cavender, ACNO Children’s Medical Center Dallas
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Overview:Impact of Advanced Practice Providers
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Adding NPs to Inpatient Practices
Source Findings
Burns, et al., 2002 Per pt. savings $16,293.
Burns, et al., 2003 Over $3,000,000 in cost savings.
Butler et al., 2011 Increase in charge capture by 48%.
Chen et al., 2009 Total drug costs per patient for $208
Cowan, et al., 2006 Increased hospital profit by $952 per pt.
Ettner, et al., 2006 Net cost savings of $978 per patient.
Meyer, et al., 2005 Total cost decreased by $5039 per pt.
Russell, et al., 2002 Total cost savings of $2,467,328.
Sise et al., 2011 Decreased complications by 28.4%, LOS by 36.2%, costs of care by 30.4%
April Kapu, Chief Advanced Practice Vanderbilt
Adding NPs to Inpatient Practices
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April Kapu, Chief Advanced Practice Vanderbilt
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Length of Stay
• Description of service – gap solution• Evidence supporting practice model in terms of cost savings
associated with quality.• FTE requirement based on coverage, acuity and other
providers.• Proforma of total expenses and gross collections. With ramp
up• Estimated ROI related to specific quality measures and time
frame• Potential challenges• Overall anticipated impact
Vanderbilt-Business Case
April Kapu, Chief Advanced Practice Vanderbilt
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NP Specific Dashboards
Balanced Scorecard-NP Specific Dashboard
April Kapu, Chief Advanced Practice Vanderbilt
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• National health initiatives have created the optimal setting for NPs to showcase their abilities and contributions.
• Structural empowerment provides the environment and resources necessary for NPs practice at the top of their license.
• NP associated outcomes quantified in terms of dollars can make a powerful statement in the valuation of NP practice.
Impact on Practice
April Kapu, Chief Advanced Practice Vanderbilt
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Overview:Heart Center APP Structure Integration
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Lindy Moake, Manager APP Children’s Medical Center Dallas
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Lindy Moake, Manager APP Children’s Medical Center Dallas
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Lindy Moake, Manager APP Children’s Medical Center Dallas
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Lindy Moake, Manager APP Children’s Medical Center Dallas
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Conclusion and Recommendation
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Define the RolesAPP Director Lead NPStrategic Planning Team PlanningOrganizational Representation of APP Providers
Represents a team of NP/PAs who are responsible for a patient focused population
Manager responsibility for hiring Lead NP/PAs, contributing to model development, Lead mentoring
Manager responsibility forhiring, orientation, annual appraisal,corrective action, mentoring
Fiscal direction and accountability forSalary, market analysis, salary equity, professional advancement, credentialing process, medical staff office and risk, quality and safety reporting
Local team responsibility for managing moonlighting and allocation of manpower within the teams
Utilization of the NP /PA Provider Role across departments
Utilization of the NP/PA Provider Role within teams
Carmel McComiskey, Director of Advanced PracticeUniversity of Maryland
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At the Table• CNO, CEO, CMO and APP Leadership – APP Council Leaders: APP Council or Advisory
Group is step one to establishing an APP Structure• Discuss roles, expectations, initiatives– Billing– Credentialing– Recruitment and Retention– Physician/Nursing buy-in, relationships– Structure
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Essential Keys to Success• Buy-in From the Top Down
– Agreement on resource support– Agreement regarding APP Structure
• Role of Director of APPs– 95% Administrative
• Structure of APPs– Leads/Managers (unit/service line bases)– NPs/PAs report to Leads/Managers– Leads/Managers report to Director APP
• Seat at the table– C-suite meeting– Physician Executive Meetings
• Resourced: budget, assistants, hiring authority APPs
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Links to Presentations and Resources• Advanced Practice (APN) Leadership Structure and Billing (Power Point Document)
• Advanced Practice (APN) Leadership Structure and Billing (PDF)
• Summary Creating an Advanced Practice Service Summary
• Advanced Practice Business Case Template
• Advanced Practice Value Proposition – Team Based Care- April N. Kapu, DNP, RN, ACNP-BC, FAANP
• Clinical Standard Work Pathways and Tools
• The Development of an APP Leadership Model in the Hospital Setting - Carmel A. McComiskey, DNP, CRNP
• Evolving Roles of Advanced Practice Nurses and Structures that Work - Lindy Moake, RN, MSN, PCCNP
• Advanced Practice Providers Leading Process Improvement - Shari Simone, DNP, CPNP-AC, FCCMRun presentation to activate links, or go to- to find all the resources http://melnic.com/advanced-practice-nursing-pediatric-jobs.php
