Overcome attribution challenges with APPs

Attribution of patient care for advanced practice professionals (APP) has the same implications as it does for physicians in regard to monitoring quality data and billing. Most APPs are allowed to bill independently for their services; therefore, they must be able to appropriately track the care that they provide to ensure accurate billing.

Many organizations continue to struggle with appropriately attributing care provided by APPs, in particular, when there are specific supervision requirements that must be met before the patient encounter can be closed. When this occurs, coding these encounters appropriately for billing purposes can be challenging due to limited resources/technological capabilities. Organizations must find a way to resolve these challenges for many reasons, including patient safety, performance improvement endeavors, risk management, and regulatory and accreditation requirements. Until organizations are capable of accurately capturing the activity of APPs, a temporary solution is to request that APPs provide a log of patients seen. Another option is to attribute the outcome data to both the physician and the APP, as appropriate. For example, attribution of a postoperative infection would be to both the surgeon and the assisting physician assistant, unless the record documents a clear break of technique or complication caused by one of the individuals. 

Additionally, whenever a case has been evaluated by a peer review committee and it is determined that care deviated from expected standards, the committee should attribute the case separately to each member of the care team as appropriate. For example, the committee would need to identify whether specific concerns regarding the care, treatment, or services that did not meet expectations should be attributed to the APP (or other members of the care team) rather than solely to the attending physician. When a complication is identified and attributed to the APP, it is also important to determine if the complication resulted from the lack of appropriate supervision. If so, then the complication and supervision concerns would also be attributed to the responsible attending.

Source: News & Analysis