Advanced Practice Providers

1. Advanced Practice Providers Massachusetts Association of Medical Staff Services May 19, 2016 Kimberley M. Coon, BA, CPMSM, CPCSDirector – Medical Staff Services/Payer Credentialing Southcoast Health System

2. Advanced Practice Provider • The APP is a health care professional distinct from nursing, medicine and pharmacy. They work in health care teams to make the health care system function by providing a range of diagnostic, technical, therapeutic and direct patient care and support services that are critical to the other health professionals they work with and the patients they serve.

3. Contributing to the Organization • Work collaboratively with physicians, nurses, pharmacists and many other members of the health care setting. • Provide comprehensive patient-centered care. • Act as a “change agent” within the healthcare organization. • Future of the continuum of care within the healthcare organization.

4. Opportunities for Improvement • The lack of a clear definition of an APP • The wide range of clinical scopes of the APP • Varying and unclear licensure requirements from state to state • Continuous changes in accreditation standards • An increasing number of physicians employing APPs for clinical assistance in the inpatient care setting

5. Current & Future Providers • Nurse Practitioner • CRNA • Physician Assistant • Certified Nurse Midwife • Clinical Nurse Specialist • Psychologist • Chiropractor

6. Credentialed Providers • Nurse Practitioner • CRNA • Physician Assistant • Certified Nurse Midwife • Clinical Nurse Specialist • Psychologist • Chiropractor

7. Non-Credentialed Providers • Acupuncturists • Cardiovascular Technologists • Dialysis Nurses • Sonographers • Licensed Clinical Social Workers • Audiologists

8. APP Review Committee

9. APP Review Committee • Responsible for establishing specialty specific credentialing criteria, FPPE & OPPE metrics and ongoing development of the APP professional in the inpatient and outpatient setting. • The APP Committee reports directly to the system Credentials Committee and serves as a sub-committee of the system Credentials Committee.

10. APP Review Committee Members • Credentials Chair • Director – Medical Staff Services/Payer Credentialing • Two physician members from varying specialties (preferably one inpatient member and one outpatient member. • Various APP members with a focus on specialties inclusive of inpatient and outpatient care services.

11. APP Review Committee Functions • Credentialing Process • General Practice Parameters • Guidelines to determine the need for additional categories of credentialed & non-credentialed APPs • Physician supervisory standards/requirements as determined by the state(s) and hospital rules & regulations • Stay current with the current roles & responsibilities of the APPs • Develop and Recommend policies

12. In-House Training

13. In-House Training • Credentialing Criteria • FPPE Parameters • Proctoring Requirements and Forms • Set expectations • Document!

14. In-House Training • Educational Services Policy • Expansion/”train-up” policy for APPs • APP & collaborative MD to submit written request to “train-up” to the Medical Staff Services Department: • The specific privilege(s) requested • The name(s) of preceptor(s) • The anticipated length of training • Competency measures • Patient population (if applicable)

15. Documentation & In-House Training • Organization specific Rules & Regulations • Countersigned by the Supervising Physician • Clearly • Timely • Completely • Legible

16. Specific Privileging Forms for APPs

17. Privileging Forms • Clinical Privilege White Paper • NP in Cardiovascular Surgery • PA in Cardiovascular Surgery • NP in Bariatric Surgery • CNM • NP in the Emergency Department • PA in the Emergency Department • CRNA • PA in Critical Care

18. Privileging Forms • Clinical Privilege White Paper • PA in Orthopedic Surgery • PA in Urology • PA in Women’s Health

19. Privileging Forms • Category 1 • APP core privileges • Category 2 • Critical care privileges (ICU/CCU/Stepdown/Telemetry, etc..) to be eligible the APP has to be a “trained” APP in these areas

20. Privileging Forms • Category 3 • Subspecialty • Assist in OR • Neurosurgery • Vascular Surgery • Orthopedic Surgery • General Surgery • Assist in Cath Lab

21. Privileging Forms • Category 3 • Subspecialty (continued) • Assist in Procedures • G.I. • Bronchoscopy, etc… • Training background will vary • What kind of experience is acceptable to the Credentials Committee? • Establish guidelines/protocol per specialty

22. Advanced Practice Provider and OPPE

23. OPPE • Establish timelines as defined by the regulatory bodies • Develop and FOLLOW organization OPPE policy! • Supervising physician accountability and • Department Chair collaboration and “buy-in” • Involvement of the APPs

24. OPPE • Specialty Specific Checklists • Privilege Specific • Clinical Competency • Professionalism • Ongoing CMEs • Number of procedures not enough to deem competency. Focus continues on complication rates and peer review data.

25. Cultural Competency

26. Definition • Cultural competency is defined as a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency or those professionals, to work effectively in cross-cultural situations.

27. Cultural Competency • “Culture” refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious or social groups. • “Competence” implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.

28. Importance of Cultural Competency • Health care services that are delivered without regard for cultural differences will put the patients at risk for sub-optimal care. Patients may be unable or unwilling to communicate their healthcare needs in a culturally insensitive environment, reducing the effectiveness of the healthcare process. • The need to understand the fundamental elements of culturally appropriate services is necessary.

29. Cultural Competency • Evidence-based documentation to the assertion that the U.S. health care system is not color blind. Comprehensive evidence to an uncomfortable reality in which some cultures in the U.S. were more likely to die from cancer, heart disease, and diabetes simply because of their race, not just because they lack access to health care.

30. APPs & Cultural Competency • Effective communication between APP and Supervising physician an ongoing concern. • Effective communication between APP and the patient population. • Effective communication between the APP and the Medical Staff Services Department.

31. Back to Basics….. • Communicate effectively • Show compassion and empathy • Communicate with the patient in terminology that they understand • When appropriate “reach-out” to the patient by a touch on the shoulder or the hand • Truly listen

32. Back to Basics….

33. Road to Success !! • Board of Trustees • Medical Staff Services Department • Medical Staff Leadership • Credentials Committee • Medical Executive Committee • Advanced Practice Provider Committee • Physician Recruitment • Human Resources

34. References • HC Pro Clinical Privilege White Papers • The Greeley Company • Joint Commission • https://www.jointcommission.org/ • Pelletier, S., Core Privileges for AHPs, Develop and Implement Criteria-Based Privileging for Nonphysician Practitioners, 2011, 2nd Edition