Advanced practice providers (APPs) are among the most clinically flexible groups of health care professionals. Not only are they the primary health care providers in many community and rural settings, they also have skill sets which make them strategically important in the event of a health crisis, such as COVID-19.
With the worldwide spread of coronavirus, health care workers have been needed more than ever to care for patients who have become ill with COVID-19 from the virus. The volume of COVID-19 patients greatly outnumbered the physicians available to provide critical care, which is why APPs stepped in and provided treatment.
In this Q&A with Ben Reynolds, PA-C, chief advanced practice officer, UPMC, we discuss the importance of APPs during COVID-19, how UPMC has pivoted their APP program, and how changing APP practice rules has been critical.
Q: First, can you explain what APPs are?
A: APPs are health care professionals who underwent specialized education, training, and certification to provide health care services, including medical diagnosis and treatment. They include physician assistants (PAs), nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs) and certified nurse midwives (CNMs). NPs and PAs make up a largest part of our APP workforce.
Q: How would you say UPMC prepared and pivoted APPs during COVID-19?
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A: UPMC took three critical steps that were central to preparing our workforce to care for patients with COVID-19, which included:
- Identifying APPs who had previously worked in critical care medicine, emergency medicine, and inpatient hospitalist medicine settings so that they could be deployed to support existing providers if a surge were to happen.
- Familiarizing all APPs–no matter their specialty–on how to manage a critically ill COVID-19 patient. Partnering with the Society of Critical Care Medicine, we asked all APPs without previous experience in acute inpatient care to take an online course.
- Providing online training to the entire APP workforce on the proper use of personal protective equipment (PPE).
Q: What are some key changes you have seen in APPs — across health care systems — since COVID-19?
A: One of the biggest changes has been the integration of APPs into telehealth services. As the number of COVID-19 cases began to rise in Pennsylvania, appropriate patient visits were transitioned to virtual rather than in person. The only way to accommodate the dramatic increase in volume was to integrate APPs into telemedicine more deeply and broadly. This approach was only made possible through Governor Wolf’s April 2020 waiver allowing licensed health care providers of all types to see patients through virtual online audio and video technology platforms. Without this waiver, access to care for patients across the state would have been severely limited.
Q: How do you think COVID-19 has changed the health care landscape for APPs?
A: COVID-19 has opened the eyes of many elected leaders and policymakers to the importance of APPs. Governor Wolf’s and the Department of State’s regulatory waivers have improved the health of Pennsylvanians by unleashing the full potential of PAs, NPs, nurse anesthetists, and nurse midwives across all specialties and care settings. My hope is that these waivers will result in legislative action to permanently enhance the APP scope of practice, even after this coronavirus pandemic runs its course.
Q: What do you think the new APP scope of practice is going to look like post-COVID-19?
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A: No one can deny that increasing the APP scope of practice has saved lives during the pandemic. To return the APP scope of practice to its previous restrictions would mean taking away access to high-quality health care that Pennsylvanians have now come to expect. I believe that the APP scope of practice post-COVID-19 will look like it does during this pandemic because that is the right thing to do.
Q: Why is it important to re-evaluate APP regulation and utilization?
A: There are many good reasons, but one of the most important is that Pennsylvania has a rapidly growing aging population. Nationally, the group of older adults age 65+ will be the number one users of health care resources into 2030, and APPs can be used strategically to expand access, minimize wait times, and manage costs.
The second key reason is that with the expansion of Medicaid, more individuals in Pennsylvania now have health insurance coverage. Many of these individuals live in rural and underserved communities where APP practices are most needed.
But, the most important reason to relax APP scope of practice regulations is that the restrictions have not served any meaningful purpose in protecting the public; rather, they have held back a workforce that is demonstrating every single day that they can deliver high-value health care during this pandemic.
Q: How has UPMC’s Government Affairs team been advocating for APPs to reach their maximum potential during a global pandemic? Have there been previous advocacy efforts to expand the scope for APPs?
A: The UPMC Government Affairs team has been a leader in advocating for changes to the APP scope of practice. Through this team, we have been able to conduct productive conversations with all levels of government, including the governor’s team, the Department of State, and key leaders in the legislature. That level of engagement has resulted in what can only be described as an unprecedented issuance of waivers to relax regulations that would otherwise stand in the way of UPMC’s APP workforce reaching its fullest potential.
Q: What efforts has the state taken to relax and waive rules for better APP regulation and utilization?
A: In an effort to reinforce and better prepare health care systems across Pennsylvania, Governor Wolf eased a number of restrictions and regulations during the COVID-19 disaster declaration, including:
- Allowing licensed health care practitioners to provide services through telemedicine instead of in person
- Allowing NPs to assist in COVID-19 response efforts by lifting the requirement that they practice within a specific clinical specialty
- Streamlining the reactivation of licenses for retired health care professionals, including PAs and NPs
- Suspending restrictions that prohibited NPs from prescribing drugs outside of the established formulary
- Extending all NP licenses and certificates set to expire on April 30 for an additional three months
UPMC has supported these efforts and will continue to advocate for expanded scope of practice for APPs. These highly skilled health care professionals should be able to continue providing greater access to quality care long after the pandemic is over.
Learn more about APPs: https://www.upmc.com/healthcare-professionals/education/advance-practice-providers
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