In this section , nurse practitioners , pharmacists , physician assistants , and other advanced practice providers discuss issues specific to their practices – from implementing quality improvement initiatives to staying up-to-date in the latest hematologic advances .
APs Take the Lead in Achieving Programmatic Goals : Part One
● ADVANCED PRACTITIONERS ( APs ) are uniquely positioned within their practices to implement change , and make sure that the changes stick . ASH Clinical News ’ Associate Editor Sandy Kurtin , ANP-C , PhD , invited three AP leaders to speak about their experiences . Jason Astrin , DMSc , MBA , PA-C , DFAAPA , is the director of advanced practice provider services for the US Oncology Network , supported by McKesson , an affiliation of privately held community-oncology practices around the country . Gabrielle Zecha , PA-C , MHA , is the director of advanced practice providers at Seattle Cancer Care Alliance . Mailey Wilks , DNP , APRN , is an outpatient nurse practitioner and physician assistant manager at Cleveland Clinic .
In part one of this conversation , the participants discuss how they achieve quality , fiscal , and accreditation outcomes within their institutions . Look for part two in our November issue .
This interview has been edited for length and clarity .
Sandy Kurtin , ANP-C , PhD
Jason Astrin , DMSc , MBA , PA-C , DFAAPA
Dr . Kurtin : This is a great opportunity to share ideas as we all represent different practice types . Our aim is to talk about how APs are involved in achieving quality metrics and clinical outcomes across key programs in our institutions . To start , can you each talk about your roles in your institutions , and how you have helped to achieve quality , fiscal , or accreditation outcomes ?
Dr . Astrin : Because The US Oncology Network isn ’ t an academic institution or tied to a hospital , we do not have the associated regulatory issues . Our standards around quality and accreditation are all payer-based , such as the Oncology Care Model , the Radiation Oncology Alternative Payment Model , and commercial value-based care programs . My role is twofold : ensuring that our APs understand what those quality programs involve and what role they play in them .
Ms . Zecha : We have a much different approach , as I work in a large academic center affiliated with the University of Washington . From a quality perspective , we have APs embedded in many of our quality and safety committees . I am chair for the Patient Safety Council , which is a multidisciplinary team of operational clinical and provider leaders , and I serve on our organizational quality committee , which will allow us to provide better support and oversight for our entire oncology program .
Dr . Wilks : At Cleveland Clinic , I mainly oversee the outpatient main campus . We also have several regional sites in Northeastern Ohio , so I work closely with our AP director to maintain the quality of the projects on a broader scope . Between our regional and main campus and our inpatient teams , we have more than 100 APs .
Dr . Astrin : In our experience , many of the metrics that we measure , particularly in the outpatient
Gabrielle Zecha , PA-C , MHA
Mailey Wilks , DNP , APRN
setting , can be AP-led . Several years ago , we recognized that we needed to do a better job of defining these models – why were these programs created , what is the value to the patient , and what is the value to the payer ? Then , we went to each independent practice and helped with the transformation from a traditional fee-for-service model to quality-based models , bundled payments , and shared savings . The transformation required workflow modifications around delivering value-added services such as distress screening , pain management , emergency department ( ED )/ hospitalization avoidance , and advance care planning / hospice utilization .
Ms . Zecha : From a fiscal standpoint , we ’ ve been able to work with our organizational leaders to do things like make sure that APs are working at the top of their scope of practice . Our organization set a goal that no more than 15 % of visits would be shared visits for return patients . That has been a gamechanger for us , and the benefit is evident in our financials . By using people appropriately , we have improved our access to care .
We work closely with our regulatory team to maintain accreditation . As we all know , there are many hoops to jump through – making sure that we ’ re prepared for Joint Commission , Department of Health visits , for example . We have a PA who chairs our medical emergency response committee to meet the new Joint Commission accreditation requirements around rapid response teams .
Dr . Wilks : We work on regulatory and fiscal outcomes as well . On the regulatory side , like Gabrielle ’ s team , we are also trying to keep our APs updated on their continuing education credits and all the new regulations and policies .
The rapid access clinic is one of our biggest priorities . Like Gabrielle ’ s center , we are focused on having APs working to their full scope of practice .
8 ASH Clinical News October 2021