Tracking Productivity in IBD Care for APPs

Kimberly Orleck, PA-C, MPH, reviews a discussion among APPs that focused on the "unmeasurables"—key aspects of providing great patient care in IBD that add to the APP's workload, but do not necessarily factor into trackable productivity—and the importance of emphasizing the impact of these factors when negotiating with your practice.

Kimberly Orleck, PA-C, MPH, is an advanced practice provider with Atlanta Gastroenterology Associates in Atlanta, Georgia, and director of advanced practice providers for United Digestive, a gastroenterology practice with sites throughout the Southeast.

Hi there. I'm Kim Orleck. I'm a practicing physician assistant in Atlanta, Georgia, at Atlanta Gastroenterology Associates and have been for the last 14 plus years. I'm also the Director of Advanced Practice Providers for United Digestive, a large GI group throughout the southeast. I was fortunate enough to be a part of a IBD 2023 and led a focus breakout group for apps discussing productivity of APPs in GI. I'm now going share a few key takeaways from this session.

The first thing that was really important to note is that it's evident that more APPs are caring for and often becoming the main provider for IBD patients. This is not only in academic institutions, but has really increased especially in community practices. In addition to them taking care of these patients, we all know there's been increased complexity of providing care for IBD patients. This can include the many new therapies that have come to market, which has really shifted how we think about positioning therapies, as well as the fact that many APPs are really filling in as primary care providers for our young IBD patients.

So we also have to make sure we keep up with their health maintenance. This means that we're making sure they get referrals to other specialists like dermatologists, rheumatologists, gynecologists, et cetera, as well as we guide our patients in terms of vaccines that may be required for their IBD and the therapies that they go on.

One of the other interesting discussions we had at this breakout was really focusing on what we call the unmeasurables. And this is regardless of academic center, community practice, and whether you work inpatient or outpatient. But what these unmeasurables are are these are the things that take up our time to be great GI clinicians, but really don't affect our productivity. What we discussed is many APPs in GI are familiar with RVs or a relative value unit, which is often used to measure what is being done by providers from a billable standpoint, but many don't really have transparency to their RVU.

But again, what was highlighted is a lot of things that take our time and lead to good care and good outcomes for patients are things that aren't necessarily tracked, built, or compensated for. Some examples of these unmeasurables include on the inpatient side where you may be checking labs, you may be checking in with the nurse for preps for patients who are having procedures done. You're certainly answering a lot of phone calls from the emergency room and from the floor on patients who are on your list. But again, not things that you're able to add to your billing or to your note on the outpatient side. Similarly, there are a lot of phone calls, a lot of portal messages, a lot of peer-to-peers that take a significant amount of time. But again, these are currently those unmeasurables and really add to our workloads, but not necessarily to that trackable productivity.

So we discussed this as something that APPs want to be aware of and when it comes time for negotiating and explaining to your practice what you do for that practice, just remember that it really does go beyond those RVs and we all know that caring for IBD patients is very rewarding, but it also takes a significant amount of time and follow up beyond just those clinic and hospital visits. Thank you.