From under-utilized to highly valued: How UVA elevated the role of APPs ahead of CMS split/shared billing changes

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.

THE COST OF INCONSISTENT APP ROLES & EXPECTATIONS:

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.

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.