Make it out of sticky situations with a smart APP policy
This week, CRC Daily covers the governance of advanced practice professionals (APP). As the presence and roles of APPs on the medical staff continue to expand, their distinctive skillsets call for MSPs and medical staff leaders to evaluate—and sometimes amend—vetting and governance processes that have traditionally focused on physicians.
Among the first steps in bringing APPs into the governance fold is determining who at the hospital will make up this category. Specific definitions can vary from one organization to the next, but generally speaking, an APP is an individual—other than a licensed physician, dentist, or podiatrist—who provides direct patient care services in the hospital under a defined degree of supervision by a physician medical staff member who has been granted clinical privileges.
To help put parameters on this broad definition, a hospital should develop (or revise an existing) APP policy. If a policy doesn’t currently exist, start by evaluating the current scope of practitioners allowed to practice within the facility. If the organization wishes to expand the services offered, evaluate the additional disciplines that leaders wish to add and include these disciplines in the policy.
From there, form or designate a board to shape the policy. Consider creating a task force that includes representation from the governing board, hospital administration, medical staff, and community leaders, as appropriate.
Organizations must not only create, but also adhere to APP policies. Organizations often make the mistake of consulting the organized medical staff about the inclusion of specific advanced practice disciplines, but officially this route could lead to charges of antitrust activities.
Abiding by a clear and thoughtful policy can help organizations handle tricky medical staff situations swiftly and effectively. For example, a physician who wishes to have his or her employee (an APP) assist within the hospital may request permission to include particular APPs in medical staff committee meetings. A comprehensive APP policy could allow the hospital to quickly grant permission if the physician’s employee is included in the listing of those already authorized to provide clinical services. If the individual is not listed, the organization should not grant permission to the physician to use this support person within the hospital setting. However, if the organization is interested in the practitioner's request, it should place a moratorium on the request and refer the issue to a board-level task force.