INFOGRAPHIC | Advanced Practice Provider Productivity

Learn more about emerging trends and data in advanced practice provider productivity

As health care organizations look for ways to improve patient access and control costs, effectively measuring and projecting the clinical productivity of their advanced practice providers (APPs), including nurse practitioners and physician assistants, is imperative.

View related highlights from SullivanCotter’s 2019 Advanced Practice Provider Compensation and Pay Practices Survey, which reports productivity data and ratios, including collections, work RVUs and patient visits, from 562 participating organizations.


From Volume to Value: Managing Provider Performance

Managing provider performance and compensation has grown increasingly complex.

Without the proper strategy, technology and resources to support this process, many organizations are struggling to effectively drive performance and engage physicians in the transition to value-based care.

To help uncover some of the opportunities for improvement, SullivanCotter facilitated a series of focus groups with hospitals, health systems and medical groups ranging in size from 500 - 2,000 providers.

Learn more about how Provider Performance Management Technology can help.

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INFOGRAPHIC | Unrestricted On-Call Pay for Advanced Practice Providers

Insight into on-call pay practices for Advanced Practice Providers

Advanced practice providers (APPs) continue to be an important resource as organizations strive to meet patient demand. Developing an effective on-call pay approach for APPs helps to increase patient access and support care coverage needs, and understanding the data and benchmarks regarding this premium pay practice is critical. This infographic highlights important unrestricted on-call pay trends and metrics including prevalence, thresholds, hourly rates for call coverage, compensation methods and important considerations in developing or updating your organization's related policies.

Learn more about SullivanCotter's Advanced Practice Provider Compensation and Pay Practices Survey, featuring data from more than 600 organizations on nearly 67,000 individual APPs.

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CASE STUDY | The Value of APPs in Driving Organizational Performance

Advanced practice providers (APPs) are one of the fastest growing workforces in health care.

Not only has the APP workforce more than doubled in the last 15 years, but physician assistants and nurse  practitioners are also ranked as the third and fourth best overall jobs in 2018 by U.S. News & World Report. The focus on team-based care continues to intensify and, in order to truly help transform care delivery, the role of APPs must be more clearly defined to better partner with physicians. Health systems and medical groups nationwide seek to drive better performance as the industry transitions from volume- to value-based care, and achieving the strategic goals of access, quality, affordability and provider satisfaction is a top priority.

As one of the top 10 largest children’s hospitals in the country and Arizona’s only pediatric quaternary care hospital for high acuity, complex conditions, leadership at Phoenix Children’s Hospital (PCH) recognized the need to utilize APPs more effectively to help transform patient care delivery.

Learn how SullivanCotter partnered with PCH to develop a comprehensive APP workforce and utilization strategy aligned with system-wide goals and objectives – helping to drive organizational performance while enhancing patient access, quality of care, and APP retention and satisfaction.

This case study outlines their journey and highlights their background the process they utilized, lessons learned along the way and key results to date.

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HFMA | Advanced Practice Providers Optimize Efficiency and Improve Financial Performance

Advanced practice providers (APPs) play a critical role in transforming care delivery

With a looming physician shortage and an ever-increasing population of patients, access to primary care and specialty providers remains a chief concern for health care organizations nationwide. To help meet this demand and avoid potential disruption to quality, service and cost, many hospitals and health systems are rapidly expanding the number employed APPs.

To support the critical role APPs play in transforming care delivery, improving performance and helping to achieve key financial results, organizations must undertake a deliberate and strategic review of the scope of practice, care team role, levels of engagement, governance, and compensation and payment structures for all APPs.

Featured in a recent edition of the Healthcare Financial Management Association’s CFO Forum, learn how SullivanCotter partnered with Phoenix Children’s Hospital to develop a comprehensive APP workforce and utilization strategy aligned with organizational goals and objectives – helping to improve overall financial performance while enhancing patient access, quality of care, and APP retention and satisfaction.

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INFOGRAPHIC | 2018 Advanced Practice Provider Compensation and Pay Practices Survey

With the demand for advanced practice providers (APPs) on the rise, organizations are looking for better ways to attract, engage and retain the best talent.

As health care evolves, APPs play a critical role in helping to achieve greater access, lower the cost of care and address the growing physician shortage. Understanding trends in compensation, pay practices, productivity, work effort and more is critical as health care organizations develop comprehensive strategies to manage and utilize their growing APP workforce.

View highlights from SullivanCotter's Advanced Practice Provider Compensation and Pay Practices Survey, featuring data from more than 600 organizations on nearly 67,000 individual APPs.

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INFOGRAPHIC | APP Leadership Practices and Structures

Supporting APP retention and engagement

Advanced practice providers (APPs) comprise one of the fastest growing workforces in the United States and are integral to effective and efficient health care delivery.

Organizations are seeing the need for leadership structures and practices to help support this important workforce.

Looking to gain additional insight? Contact us to learn more about developing effective APP leadership practices, structures and compensation strategies to help support your growing APP workforce.

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Employers Choose Bonuses Over Raises

SullivanCotter Featured in the Wall Street Journal

In today's competitive talent market, organizations are looking for ways to attract and retain talent while controlling costs. The increasing use of incentives over traditional raises in base pay is trending across all industries. As health care organizations continue to focus on driving performance and enhancing organizational alignment, incentive compensation remains a key component of competitive total rewards programs. SullivanCotter was proud to contribute to this recent article, published in the Wall Street Journal, highlighting this shift in pay practices.

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Q&A | What Comes After Physician Compensation Design?

Developing physician and APP compensation plans

As health care revenue sources continue to shift from volume to value and organizations take on more risk, new physician and advanced practice provider (APP) compensation strategies are emerging. The health care industry is adapting to new payment and care delivery structures with increasingly complex compensation models to match. Organizations must now consider a growing number of components when developing these plans, including recruitment, retention and engagement, patient satisfaction, access, quality of care, governmental regulations and more.

You’ve put time and effort into designing an effective physician compensation plan. How can you make your implementation equally transparent, accurate and successful?

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INFOGRAPHIC: 2017 Advanced Practice Provider Compensation and Pay Practices Survey

The role of the advanced practice provider (APP) is changing to reflect increasing specialization and variation by practice setting as care models evolve. Hospital-based roles continue to grow, primary care practitioners are starting to function more independently, and roles in medical and surgical specialties are helping to improve patient access and efficiency of service lines.

This diversity of roles means a 'one size fits all' compensation model is no longer effective and can create obstacles to delivering high-quality and effective care.

As the demand for APPs continues to grow, compensation strategies should be tailored to align with overall provider optimization and organization strategies.

Learn more and view highlights from the 2017 Advanced Practice Provider Compensation and Pay Practices Survey.

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Infographic: Spotlight on Advanced Practice Provider Compensation

Advanced practice providers (APPs) remain one of the fastest growing workforces in health care, and their role in transforming care delivery has expanded as focus on team-based care continues to increase. Understanding trends in APP compensation and pay practices is a key step in attracting, engaging and retaining this important provider group.

Our 2017 Advanced Practice Provider Compensation and Practices Survey is currently open for participation. This survey provides critical benchmarking data on physician assistants, nurse practitioners and other certified clinicians across a number of emerging specialty areas.

Learn more about this survey and register to participate.

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Compliance Risk Considerations with the Integration of Advanced Practice Providers

As the focus on team-based care intensifies, advanced practice providers (APPs) remain one of the fastest growing segments of the health care workforce. The role of the APP in transforming care delivery is critical, and health care organizations nationwide continue look for better ways to meet their goals around access, quality, service and affordability.

Featured in the American Health Lawyers Association's (AHLA) Health Care Transactions Resource Guide, SullivanCotter examines three regulatory requirements that must be met to help ensure compliance and mitigate risk when integrating APPs into the care delivery team:

  • Evaluation of APP competency standards
  • Third-party payer policies as they relate to billing for services provided by APPs
  • Appropriate attribution of APP work effort in production-based physician compensation plans

Read the full article


Infographic: Integrating Advanced Practice Providers

Ensuring Compliance and Mitigating Risk

The demand for advanced practice providers continues to grow, and health care organizations nationwide must understand how to effectively integrate, optimize and engage this increasingly important provider group while operating within the framework of federal and state laws, regulations and accreditation standards.

Learn more by reading the full article - featured in AHLA's 2017 Health Care Transaction Resource Guide.

 

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Learn more about our APP Workforce Practice


Infographic: Advanced Practice Provider Compensation

Emerging Pay Practices and Trends in Compensation

The demand for advanced practice providers (APP) continues to grow as health care organizations focus more on population health, access, quality and cost-effective care. In order to benchmark and assess pay practices for this increasingly important provider group, organizations require critical compensation and incentive data on physician assistants, nurse practitioners and other APPs.

The infographic below highlights data from our 2015 Advanced Practice Provider Compensation and Pay Practices Survey and provides insight into emerging pay practices and trends in compensation.

Learn more about our Advanced Practice Provider Provider and Pay Practices Survey.

SullivanCotter_APC_Compensation_PayPractices


The Emerging Role of the Advanced Practice Provider Leader/Manager

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Since the inception of our Advanced Practice Provider and Pay Practices Survey in 2012, SullivanCotter (SullivanCotter) has seen a 10 percent average increase in the number of advanced practice providers (APP) added to the workforce every year.

As this workforce has grown, health care organizations have recognized a need to provide leadership for this unique provider group to ensure effective alignment with other members of the care delivery team. While APPs may still report up through a variety of roles, as noted in the table below, an increasing number of organizations have created new leadership/management positions specific to APCs:

 

APC Emerging Leader 1
 

Nearly three-quarters of the 158 organizations in our 2015 survey reported that some of their APPs serve in leader/manager roles, with “lead” being the primary designation (49 percent).

However, over 70 percent of organizations reported having an APP in a leader/manager role with the title of vice president, director, manager, or supervisor.

Based on our survey, the prevalence of using APP leaders/managers has increased dramatically in the last few years, as shown below:

 

Determining appropriate cash compensation for these roles is essential but challenging, given the rapid emergence of the roles and the inherent lag in the reporting and availability of robust market data. Over 90 percent of organizations with APPs in one of the leader/manager roles discussed previously provide additional compensation to these APPs over what is provided to non management APPs. This additional compensation is primarily provided in the form of a higher rate of pay or placement in a higher salary grade/range. The table below provides both mean and median salary range data for nurse practitioners (NPs), physician assistants (PAs) and certified registered nurse anesthetists (CRNAs) in management roles:

 

 

SullivanCotter expects that the organizational trend to create and more fully define APP leader/manager roles will continue for at least the next two to five years, and given the number of APPs within large health systems, more than one level of APP leader/manager will likely need to be defined and developed, up to and including executive levels. Many organizations also now include APleaders/managers in provider compensation committees, quality committees, and other functional and operational decision-making areas to facilitate greater alignment between organizational goals and strategies and the health care delivery team. Additionally, these roles will increasingly require full-time allocation to leadership/management work efforts with little or no clinical work time.

Given the evolving responsibilities and increasing existence of APCs in leadership/management roles, simply promoting strong clinicians into these roles without a thoughtful approach to alignment within the care team and a structured management development plan may result in less than optimal results. There is a critical need to properly develop the skills of these new APP leaders/managers by providing them with training in areas such as people management, strategy development, and business analytics. Doing so will enable them to thrive in their roles, successfully lead their teams, and help the organizations that they work for meet their goals and objectives.

SullivanCotter’s 2016 APP survey will seek additional data on management level jobs, and while those data will be helpful, it will be important for organizations to consider their compensation philosophies and strategies for this key leadership group. Important questions to ask include:

  1. To whom in the organization does it make the most sense to have these APP leaders/managers report?
  2. How should we structure our organization to ensure strong communication and teamwork across the entire clinical leadership team (including physicians, APPs, and nursing leaders)?
  3. How should we consider internal equity as we set pay levels (i.e., how should pay for these positions compare to nursing managers or directors)?
  4. In addition to competitive base pay, should there be an incentive plan for APP leaders/managers? And, if so, what are appropriate goals and metrics?

Learn more about SullivanCotter's Advanced Practice Provider Workforce Consulting


Addressing APC and Staff Pay Disparities

The SullivanCotter white paper titled “Staff and Advanced Practice Clinician Compensation Programs: Addressing Payroll Disparities to Improve Value and Reduce Cost” outlines an approach to help health care organizations understand market standards and best practices to effectively manage APC and staff compensation. Gain additional insight from the paper's case studies that review how two prominent health care systems approached their special pay compensation challenges.

read the full White Paper


Advanced Practice Clinician Pay – What's Happening and What's Coming

  • In theory, APCs can be “more cost efficient” than physicians on a straight salary basis or even when paid base salaries and incentive compensation.
  • Because their time is less expensive, they can be leveraged to do more time-consuming patient education, patient monitoring and follow-up tasks that can improve outcomes while freeing physician time for direct care or managing more complex patients.

In fact, demand is increasing. According to SullivanCotter’s 2011 Physician Compensation and Productivity Survey, over half (59 percent) of survey participants have increased the size of their APC workforce within the past 12 months. Of these, the average increase was seven APCs. Sixty-one percent of survey participants indicated that they plan to increase the size of their APC workforce in the next 12 months. Of these, the average increase will be six APCs.

Salaries are trending up as well. For example, data from the American Medical Group Association’s (AMGA’s) 2011 Medical Group Compensation and Financial Survey show salaries for primary care Nurse Practitioners (NPs) went up approximately 8 percent at the market median over the two-year period between 2009 and 2011 (from $86,841 to $93,642); Physician Assistants (PAs) in medical specialties salaries went up approximately 9 percent over the same period (from $90,151 to $96,575).

These salary increases, however, stand in contrast to what NPs and PAs just entering the workforce are expecting. An organization that attended graduations this spring for large PA and NP programs reported that PAs were being told to expect a starting salary of $120,000. The NP graduates were told a less optimistic starting salary of $98,000.The different expectations being set by the two programs are almost as disconcerting as the salary levels quoted – both well above reported salary range medians. These expectations are frequently reinforced by APC professional associations in articles and on websites.

For hiring authorities, this creates real challenges when balancing the need to hire more and more APCs while dealing with salary levels of current staff which may, despite years of experience, lag the expectations of the new graduates. In these situations it is critical to be prepared with accurate market competitive data and a strong recruitment strategy that focuses on additional factors (beyond base salary) for choosing your organization

So what are those additional factors?

TO PROVIDE INCENTIVES OR NOT TO PROVIDE INCENTIVES

While the majority of health care organizations do not offer individual performance bonuses to APCs (less than 15 percent of organizations according to the Integrated Healthcare Strategies’ 2011 Advanced Practice Clinician Survey), the data are likely affected negatively by the number of hospitals that responded to the survey compared to the number of physician group practices. Overall, hospitals are less likely to provide incentives than group practices.

It may seem that, with the movement from encounter-based to outcomes-based reimbursement, offering or developing productivity based incentive plans is counterintuitive. However, SullivanCotter cautions against abandoning these programs or rewards too quickly. There is still significant value in measuring and rewarding for productivity as long as the following conditions are true

  1. Productivity isn’t the only incentive plan measure. The best plans include measures and rewards for other components such as patient satisfaction, compliance with established protocols, participation in process improvement activities and good citizenship (timely charting, referrals, etc.).
  2. The plans make economic sense. You would think this would be intuitive, but we have seen plans that have paid PAs 80 percent of the pay and incentive provided to their supervising physician – even when the physician was a neurosurgeon.
  3. The plans don’t set up a competition between the physicians and APCs. No APC should be influenced by a bonus plan when deciding whether to refer a patient to a physician.
  4. The design doesn’t violate regulatory requirements. The following is according to legal guidance provided to SullivanCotter:
    1. There can be private inurement from an Internal Revenue Service (IRS) perspective if APC compensation is above fair market value (FMV).
    2. Because APCs order items or services that can be reimbursed by Medicare or Medicaid, the financial arrangements with APCs do implicate the Anti-Kickback Statute.
    3. Although Stark does not apply to APCs directly, as Stark is targeted only to physicians, if a hospital has an agreement with a physician organization and some of the contracted services are to be performed by an APC, Stark can be implicated.

Of course, there can be another regulatory issue if an APC’s productivity is “added” to that of a physician’s in order to calculate the physician’s productivity bonus.

 WHAT ABOUT THE WORK ENVIRONMENT?

The level of physician support for APCs in an organization, as well as the level of independence APCs are allowed, can be a source of satisfaction or dissatisfaction for an APC. The physicians need to view APCs as partners and not competitors or an added burden. Stipends for APC oversight and team-based reward systems can go a long way in addressing this issue, but ultimately it’s a matter of an organization’s culture whether APCs will feel they are valued.

Of course, state practice laws will also determine the level of APC independence and it appears the trend is toward more APC independence. The following are examples: Nurse practitioners in Virginia have been lobbying for autonomy in practice for more than two years. Currently the law requires that doctors supervise and direct NPs and until very recently physicians in Virginia had resisted any changes to the law.

The proposed changes would require NPs to work in teams led by physicians, which would provide more flexibility in coordinating patient care and the bill being written would allow for electronic collaboration.

On April 4, 2012, Nebraska’s unicameral legislature cast the final vote to approve changes to the law that will allow PAs to order respiratory therapy when delegated by the supervising physician.

Finally, what other factors will APCs consider in assessing the rewards an organization offers? Pay for evening, night and weekend shifts, being on-call, working extra shifts – these “extra” pay offerings cut two ways. They may be perceived as valuable to the APC, but can also reduce the value proposition for the organization. It is not uncommon for SullivanCotter to find, in helping a client catalogue all their special pay practices for APCs, situations where pay for these “extras” has driven take home pay up more than 25 percent above the base salary.

 WHAT’S NEXT AND HOW TO PREPARE?

The growth in demand for APCs will fuel competition and thus salary increases. The need to balance salary costs against reimbursement will (for forward thinking organizations) provide opportunities to reward the best performing APCs and health care teams.

The best strategy is to have a strategy. That may require assessing what you are doing now in terms of base pay, extra pay, the work environment and in comparison to market practices and trends; getting the key stakeholders together to identify what’s good, what’s working and what is not so good about what you’re doing; establishing a total compensation strategy; and articulating and implementing that strategy in a way that provides a true competitive advantage