SHM Converge Scientific Abstract ePoster Gallery-Physician and Advanced Practice Provider Collaboration: A Qualitative Study

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This qualitative study examined how proposed CMS billing reforms affect collaboration between hospitalist physicians and advanced practice providers (APPs). Hospital medicine teams increasingly rely on mixed physician-APP staffing models, but these arrangements have been shaped mainly by staffing shortages, finances, and regulations rather than by teamwork or patient care goals.<br /><br />Using rapid qualitative analysis of six focus groups and a brief survey, researchers studied 33 participants from 21 academic institutions in the HOMERuN network, including physicians, APPs, a practice manager, and a patient representative. Most survey respondents reported that APPs either bill independently or share billing with physicians, while a smaller group said APPs do not bill.<br /><br />Four themes emerged:<br />1. Collaborative models are shifting toward more independent visits.<br />2. These shifts are driven by workloads, financial incentives, and local rules.<br />3. Time-based billing may reward tasks more than cognitive work and teamwork.<br />4. Billing changes may create unintended negative effects on team culture, satisfaction, and patient assignment.<br /><br />Participants worried that policies based mainly on billing efficiency could weaken collaboration and reduce the value of shared care. Some APPs feared they might be limited to less complex patients if billing rules push teams to separate visits. The study concludes that hospitals should identify staffing models that produce the best outcomes for patients, clinicians, and organizations, and that billing policies should follow those findings rather than shape care delivery in reverse.

Asset Subtitle

Sara Westergaard

Meta Tag

Author List Andrew D. Auerbach, Angela Keniston, Anne S. Linker, Gopi J. Astik, Gregory Bowling, Kasey Bowden, Marisha Burden, Matthew Sakumoto, Natalie v. Schwatka, Sara Westergaard

Category Research

Concept Billing Reforms

Concept Collaboration

Concept Hospital Medicine Physician

Concept Advanced Practice Provider

Concept CMS Billing Rule Changes

Distinguished Non-Finalist

Presenter Organization University of Wisconsin School of Medicine and Public Health

Presenting Author Sara Westergaard

Track Value in Hospital Medicine

Keywords

CMS billing reforms

hospital medicine

hospitalist physicians

advanced practice providers

APP collaboration

mixed staffing models

time-based billing

teamwork

qualitative study

patient care

Billing Reforms

Collaboration

Hospital Medicine Physician

Advanced Practice Provider

CMS Billing Rule Changes