NEW: APP Angle: Productivity, E&M Coding and Burnout

Advanced Practice Providers are an integral part of the GI team in delivering high-quality and efficient care to patients. ASGE each month will provide APPs useful tips and resources to help APPs in the GI practice. This month’s topics on benchmarking APP productivity, E&M coding and burnout were discussed at the recent ASGE Annual GI Advanced Practice Provider Course.

1. How do you measure productivity for APPs?

Several compensation models have been used to benchmark APP productivity including work relative value units (RVUs), patient panel size, and number of patient visits. These models do not account for the non-RVU generating tasks such as patient education, care coordination, medication refills, procedural counseling, prior authorization requests and electronic patient messages. One study from a tertiary academic medical center found that over 35% of APPs time at work was spent on non-RVU generating tasks (in both inpatient and outpatient models).1 The target numbers for wRVUs and patient visits should be adjusted keeping that in mind. Additionally, administrators may be able to run reports in electronic medical record systems to review individual inbasket activity, such as number of messages received, sent and completed. This information may also be helpful in monitoring APP productivity.

2. What parts of the patient encounter can I include in time-based billing?

In the 2021 evaluation and management (E/M) guidelines, the new patient and established patient code sets (99202-99205 and 99212-99215, respectively) can be used to bill based on medical complexity or time. Time-based billing includes the total time spent on the date of the visit encounter. This includes non-face-to-face activities performed by the qualified provider on the date of encounter such as record and imaging review and documentation. If billing based on time, include a single statement in the visit encounter documentation such as, “I spent a total of *** minutes reviewing the patient’s referral records and diagnostic tests, seeing the patient, collaborating with other providers and documenting in the medical record”.

3. Burnout is a very real concern, especially now with increased staff shortages and limited resources. There is no robust data available related to rates of APP burnout, prevention and management. What are some strategies that can be used to help reduce compassion fatigue and burnout?

Burnout is characterized by emotional exhaustion, depersonalization and the perception of lack of personal accomplishment. Job stressors and personal stressors may contribute to burn-out, including increased demands at work and difficulty achieving family-work balance. Strategies that foster well-being and resilience are necessary and these interventions should occur at a personal and institutional level. From a personal standpoint, this may include setting boundaries, ensuring time for exercise or hobbies, finding value in your job through teaching, research, and committee work, and taking time off. Institutions should promote a balanced work environment with supportive leaders. Communication is key!

Reference:

Ogunfiditimi, Folusho DM, PA-C, manager, Advanced Practice Providers; Council;, Provider; Council, Practice Provider CSSBB, project manager; Assessing the Productivity of Advanced Practice Providers Using a Time and Motion Study, Journal of Healthcare Management: 2013; 58(3): 173-185.