Optimizing APP Deployment to Address COVID-19: Five Key Tactics to Get it Done

The spread of COVID-19 has forced health systems to evaluate their workforce, raising questions that include:

Creating a plan to address these questions is required to ramp up and sustain care for the influx of COVID-19 patients and the immediate aftermath. Leaders need to think broadly about the capabilities of their clinicians and staff. One group primed for elevation and expansion of role is advanced practice providers (APPs), including nurse practitioners, physician assistants, certified nurse midwives, clinical nurse specialists and certified registered nurse anesthetists.

Rethink the Role of APPs

The workforce plan and response to COVID-19 will challenge your organization to rapidly rethink the role of APPs, moving to elevate roles and optimize the APP workforce value.

Representative APPs from across disciplines along with physicians need to be engaged in the implementation of an elevated APP model. Key roles for an APP to support the COVID-19 response include:

Five Key Tactics to Position APPs for Expanded Roles

1. Ensure APPs Work Within the Full Extent of Their License Scope of Service: Unless the state declares otherwise, an organization cannot define a role that would exceed the APP’s scope of practice under his or her license. Review your state licensing/scope of practice laws for each APP type prior to implementing any proposed expansion of role.

    2. Authorize APPs to Provide Expanded Services: Practitioners new in role must be authorized through one of three mechanisms to provide patient care within your organization.

    3. Anticipate and Address Physician Concerns About Expanded APP Roles: Physicians may feel threatened or may feel a sense of loss as the health system changes the role of APPs. This is particularly true for physicians who previously considered “their APP” as an assistant who could be delegated certain clinical and administrative tasks. Identifying physician champions for the change and engaging with physicians, in partnership with APPs, to deploy APPs during the COVID-19 pandemic and to clarify their roles after the crisis will be vital to the sustainability of the expanded role.

    4. Clarify Who Will Assume the Clinical and Administrative Tasks Previously Completed by APPs: As the role of APP is elevated, so too must be the roles of nurses, nursing assistants, or medical assistants and clerks. Ensure the APP has the time and capacity to meet expanded clinical expectations and that the work does not get rerouted to physicians.

    5. Ensure APP Services Are Billable to the Fullest Extent Possible: Credentialing APPs to work at the top of their license with all payors establishes the foundation necessary for full realization of APP revenue potential. Even with disaster/temporary/emergency privileges, practitioners must still be credentialed by payors to secure reimbursement for the authorized care they provide. Most payors retroactively credential to the date they receive an application. While there will be an inherent delay in the associated cashflow, simultaneously submitting the credentialing application to all payors will minimize the potential for lost reimbursement.

    Rapidly building a workforce plan to support the care for COVID-19 patients will be critical for health system leaders, including the broad deployment of APPs in new sites of care and in expanded roles. Successfully doing so will act as a catalyst for longer-term expansion of the APP role. Even before the pandemic, the need for expanded roles for APPs was well documented — with national provider shortages, provider burnout and an aging workforce. Post-pandemic, organizations will need to approach their workforce management with purpose and intention to sustain these enhancements to their APP model.


        Sue Fletcher, RN
        [email protected]

        Melissa McCain
        [email protected]

        Akofa Bonsi
        [email protected]

        Richard A. Sheff, MD
        Chief Medical Officer and National Director of External Peer Review
        [email protected]

        Sally Pelletier, CPMSM, CPCS
        Advisory Consultant and Chief Credentialing Officer
        [email protected]

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