The Client Challenge

The academic medical center and 500+ advanced practice providers (APPs) at UVA Health wanted to prepare for the Centers for Medicare and Medicaid Services’ (CMS) upcoming split/shared billing changes. Leadership also sought to reaffirm and elevate the role of APPs to propel clinical growth and access, and support inpatient coverage needs—which would positively impact financials in the wake of the policy change.

  • Untapped ambulatory capacity
  • Higher APP turnover
  • Uncaptured revenue
  • Higher labor costs

Navigating to Next: The Solution

Survey results found only 50% of APPs felt their skills were being fully utilized. Multiple opportunities were highlighted: lack of clear role expectations, insufficient team support, limited exam room availability, and burdensome administrative tasks. The challenges suggested support systems were needed for APPs to operate efficiently under the new CMS rules.

To begin, Chartis collaborated with department leaders to design, test, and establish expectations for APPs, including: (1) operating standards; (2) ambulatory and acute care models; (3) department-specific playbooks; and (4) a roll-out plan.

Chartis also established a Center for Advanced Practice (CAP) to support professional development and standardized financial arrangements between the provider group and medical center to enable APP billing. The CAP infrastructure was leveraged to integrate performance measurement systems, combine provider position reviews, and streamline credentialing.

The additional clarity on role division helped practices chart a path to both improving access to care and maximizing wRVUs attributed to each physician and APP under the new CMS rules.

Navigating to Next: Key Components

Align on Objectives


Discuss the reason for action.



Document current state.



Communicate leading practice operating standards for APPs.



Recognize common barriers to meeting new expectations and develop a solution pathway.



Join physician, APP, and administrative leaders together in moving forward.



Open feedback pathways and track progress to enable targeted implementation support.

Client Impact

Results ultimately spanned the health system. Chartis gained support from department chairs by engaging physicians early in identifying solutions. Working with the newly established CAP, department-specific plans were developed, with clear owners and internal alignment. By the end of the engagement, and in anticipation of the rule changes, 18 departments had agreed to the opportunity to collectively increase access by about 200,000 annual visits over 2 years. They also agreed to new standard financial arrangements with the medical center. Tactics were established to hold departments accountable to the new role expectations. This work was met with high appreciation by the APPs, who felt their voices were heard.

With the new arrangements, expectations, and infrastructure in place across all 500+ APPs, projected results included: 
200 K

incremental increase in visits annually from APPs


clinical departments with new financial arrangements that support increased capacity

$5 M

of revenue losses in the acute care setting avoided

How We Are Making Healthcare Better

Chartis helped us meaningfully change how APPs were viewed and utilized across our clinical enterprise. They created the foundation for us to realize their true value and maximize their contributions to patient care—truly propelling us forward.

Kathy Baker, CNO, and Reid Adams, MD, CMO of UVA Medical Center

Next Intelligence

APP optimization can be advanced through:
  • Aligning physicians, APPs, and support staff to address clinical culture change.
  • Maximizing available space via level-loaded schedules and dynamic room assignments.
  • Providing billing education and comprehensive resources to maximize revenue.

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