On September 13, WHA held its first ever advanced practice clinician (APC) conference in Wisconsin Dells. The conference was designed to help hospitals and clinics understand and navigate unique regulatory, billing and reimbursement, scope of practice, education and training, and onboarding and retention trends that impact APC practice in team-based care delivery models.
“With the growth in WHA members’ APC workforce, so too has WHA’s agenda grown to support and advance our members’ ability to maximize its APC workforce to provide high-quality, cost-efficient team-based care,” said Ann Zenk, WHA Vice President, Workforce and Clinical Practice, who kicked off the day’s educational sessions.
“There are unique challenges and opportunities facing advanced practice clinicians and our organizations, and those challenges and opportunities can differ across urban, rural, hospital and clinic settings,” said Zenk. “That is why WHA is very pleased to further explore those opportunities and challenges today, together with our supporting partners, the Wisconsin Medical Group Management Association, the Wisconsin Organization of Nurse Leaders, and the Rural Wisconsin Health Cooperative.”
Attorneys Sarah Coyne, partner with Quarles & Brady, and Lori Wink, attorney for Hall, Render, Killian, Heath & Lyman, each discussed the complex array of regulations and payment policies that impact organizations that employ advanced practice clinicians. Coyne provided an overview of state scope of practice laws, federal hospital conditions of participation regulations, and other state and federal requirements that impact advanced practice clinicians and the organizations that employ them. Wink walked through the complex array of federal billing and reimbursement requirements that uniquely apply to advanced practice clinicians and their organizations.
Both attorneys discussed the applicable collaboration and supervision requirements for nurse practitioners and physician assistants, respectively, in the Medicare conditions of payment.
Matthew Stanford, WHA General Counsel, presented WHA’s APC workforce and team-based care agenda, noting the importance of APCs to Wisconsin’s integrated care workforce. Stanford said that agenda includes both an education and a public policy component. The education component is aimed at helping to address misconceptions about APC practice and regulation and to help WHA members navigate APC challenges and opportunities. The public policy component seeks to increase APC workforce supply and to reduce regulatory burden that prevents APCs working in a team-based setting from practice at “top-of-license.”
“WHA’s 2019-2020 legislative agenda includes several public policy reforms that would remove barriers to and provide greater clarity for APC practice,” said Stanford. “Working with partner organizations and prioritization of meaningful, impactful policy proposals will be important to achieve needed updates to Wisconsin’s statutes impacting APC practice.”
Kurt Mosley, Vice President for Merritt Hawkins & Associates, presented on current trends and best practices for recruitment, onboarding, and retention of APCs. Some of the strategies Mosley discussed included APC compensation expectations, cultural issues across generations, and provider engagement. Mosley also emphasized there is currently a high demand for APCs and how important it is for organizations recruiting APCs to have a process in place to act quickly in extending an offer following a recruitment.
Two panels built on the foundation provided by Coyne, Wink, Stanford and Mosley.
APCs from a variety of settings provided their expertise during the panel Education, Training, and Experience: Understanding and Growing the Advanced Practice Clinician Workforce to Meet Your Organization’s Needs. Panelists Tina DeGroot, Advanced Practice Nurse Prescriber, Edgewood College; Sheryl Krause, Clinical Nurse Specialist, Fort Healthcare; Tara Streit, Physician Assistant, University Hospital; and Pat Campbell, Physician Assistant, UW-La Crosse answered questions related to APC curriculum and programs in Wisconsin, hospital and clinic partnership opportunities with APC programs, and how education, training, and experience defines an APC’s scope of practice.
The second panel, Lessons Learned in Advanced Practice Clinician Utilization to Advance Integrated Care Delivery, included clinician leaders with experience and success in integrating APCs into their practice. Shishir Sheth, MD, Ascension Medical Group-Wisconsin; Esteban Miller, MD, Black River Memorial Hospital; Laura Hieb, Bellin Health System; and Jamie R. Silkey, PA-C, Froedtert and the Medical College of Wisconsin served on this panel.
During the Education, Training, and Experience panel discussion, panelists described the roles of advanced practice nurses, clinical nurse specialists and physician assistants. As one panelist noted, “Helping health care leaders better understand what our profession does will help them better utilize our unique expertise and talents.” Speakers, panelists and participants agreed coming together to discuss this complex topic provided an important way to break down barriers to top of license practice for advanced practice clinicians.
Common themes of clinical rotations as a powerful recruitment and retention tool, up-front investment in onboarding, and incorporating APCs into a learning culture resonated during both panel discussions. Key factors to best support APC practice to the highest level of training were shared by panelists during Lessons Learned in Advanced Practice Clinician Utilization to Advance Integrated Care Delivery. These strategies include clearly recognizing and identifying APCs as partners in care, training paced to experience and comfort level, and integrating APCs into medical staff structures and aligning incentives to promote a team-based approach.
Both panels discussed the continuum of education, onboarding, and continuous learning throughout a clinical career, noting APCs come to employment ready to practice what they’ve learned, but the length of orientation and onboarding, and their readiness to advance to full practice can take three months, six months, even up to a year, depending on the specialty or setting.
“WHA has made a concerted and strategic effort to broaden our public policy agenda to reach beyond the walls of the hospital, across the health care system,” WHA President Eric Borgerding said. “The attendance at the conference reflected an excellent balance of providers, all interested in better understanding the complexities of the APC regulatory and payment landscape and best practices already in place in Wisconsin to continue to grow this important segment of our health care workforce, both in numbers and utility.”