Tower Health CMO: Advanced Practice Providers Poised to Lead Care Teams

Physician-led care teams are no longer the only option, this CMO says.

Advanced practice providers (APPs) such as nurse practitioners and physician assistants are going to play leading roles on care teams more often, says the CMO of Tower Health.

With a physician shortage across the country, health systems, hospitals, and physician practices have turned to APPs to maintain access to medical services. In some states APPs can practice autonomously, but many states require APPs to practice under the supervision of a physician.

Historically, CMOs and other healthcare leaders have thought that physicians should lead care teams under all circumstances, but that view is changing, according to Suzanne Wenderoth, executive vice president and CMO of Tower Health as well as HealthLeaders CMO Exchange member.

"Now, we recognize with both changes to laws in the states, which allow for full practice authority for advanced practice providers, and the physician shortage in the post-COVID era, there has been an evolution in our thinking," she says.

At Tower Health, APPs are under consideration for leadership roles on care teams, Wenderoth explains.

"At Tower Health, we do believe that every care team should have access to a physician," she says. "But whether care teams need to be led by a physician is up for discussion."

There are circumstances where a care team can be led by an APP or a nurse, according to Wenderoth.

"When we talk about leading care teams, we are really talking about making sure the leader has leadership skills such as maintaining accountability, demonstrating professionalism, and having good facilitation skills," she says. "That can be done by a physician, advanced practice provider, or nurse."

It is ideal for APPs to operate at the height of their license and capability, Wenderoth explains.

"Their role depends on their level of expertise and experience," she says.

Inexperienced APPs at Tower Health are often paired with a peer mentor, Wenderoth says, adding that APPs are subject to ongoing professional practice evaluations as part of the medical staff process.

"We want to make sure that they feel confident and competent," she says. "We also make sure they have completed enough supervised procedures before they move into more independent work."

More experienced APPs can take on more responsibilities at Tower Health, according to Wenderoth.

"There are some advanced practice providers who are very skilled and have been practicing for a long time," she says. "They can take the lead of a care team."

Tower Health operates facilities in Pennsylvania, where Gov. Josh Shapiro is considering allowing full practice authority for nurse practitioners who have worked under a physician for at least three years.

"When you have that kind of statutory or regulatory approval in combination with the ability to be reimbursed for nurse practitioner services, you can broaden the care team," Wenderoth says. As there are more statutory and regulatory changes, we will see more advanced practice providers leading care teams. We will use physicians as resources more in the background than they have been in the past."

Suzanne Wenderoth, MD, is executive vice president and CMO of Tower Health. Photo courtesy of Tower Health.

Inpatient care teams

At Tower Health, inpatient care teams are physician-led in a classic way, with APPs on the team working at the height of their scope of practice, according to Wenderoth.

"For example, with a cardiology team, a cardiologist leads the team and conducts consultations for undiagnosed patients," she says. "Advanced practice providers may conduct follow-up visits or encounters for protocolized care such as heart failure."

A physician leads other care team members in the inpatient setting, including clinical pharmacists, nurse care managers, wound care nurses, and respiratory therapists, Wenderoth says.

Outpatient care teams

Care team models are more flexible in the outpatient setting at Tower Health, Wenderoth explains.

In the first model, there are physicians and APPs in parallel practice. For example, in primary care there are physicians and APPs seeing patients in parallel, with the patients having similar levels of complexity. This arrangement includes urgent care and family medicine clinics.

In the second model, there is a physician leader of a care team that includes APPs, where the APPs are operating at the height of their scope of practice, but they are seeing more protocolized and straightforward cases.

The third model is for particular specialty clinics, according to Wenderoth.

"For example, we have a weight management center, which includes dieticians and experts in physical medicine and rehabilitation, who can guide patients who are losing weight rapidly through a physical recovery period," she says. "We have physicians who work with dieticians, social workers, and physical therapists."

Easing physician burdens

Tower Health is utilizing the full effort of the health system's physicians by relying on technology and other care team members, Wenderoth explains.

"Telemedicine in combination with remote patient monitoring has allowed us to off-load work from physicians," she says. "You can have equipment available for the patient to use at home, whether it is iPads, Bluetooth-enabled scales, blood pressure monitors, or other devices. The information can be imported to the physicians and other care team members can be involved in assessments."

In some circumstances, APPs can conduct telemedicine visits with little support from physicians, according to Wenderoth.

"At the most basic level, an advanced practice provider could conduct telemedicine visits in primary care or urgent care with autonomy," she says. "They have access to a physician in the background, but they would rarely need to consult with a physician."

Clinical pharmacists are an example of how Tower Health is using care team members to ease the administrative burdens on physicians, Wenderoth explains.

"We have a retail pharmacy program, where clinical pharmacists can essentially do the prior authorization of medicines, then we can mail the medication to the patient's home," she says. "We have seen that improve medication compliance, reduces readmission rates, and off-loads administrative work from physicians."

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