Contributors – Donna Goestenkors, CPMSM, and MJ Sexton-Tosh, MSA
As early as the 1990s, and well before the implementation of the Affordable Care Act (ACA), several trends brought about the reshaping of American healthcare, causing a shift in the provision of care from physician to non-physician providers. The number of non-physician providers graduating from training programs more than doubled during 1992-1997, and by 1997, many states had already enacted laws expanding the scope of practice for this group. Additionally, the 90s witnessed rapid growth in managed care networks, which further shifted the focus of the role of the non-physician in the provision of care, and was a method for containing costs and utilization.
This influx and use of non-physician providers skyrocketed with the implementation of the ACA, and the increase of millions of lives into the US Healthcare system via the state insurance exchanges. With it came not only issues with billing and reimbursements, but also special circumstances for the Medical Staff Services Department.
For the MSSDs, it meant a shift not only in the practice of medicine and the process of credentialing, but also in measuring performance and in terminology. MSPs expanded their vocabulary to include the professional terms given to non-physician practitioners by their national organizations: Physician Assistants, Nurse Practitioners, Certified Registered Nurse Anesthetist, etc., but also in collaboration with the national organizations and state licensure boards. As a result, MSPs have identified scopes of practice and the essential competencies of each specialty, thus allowing for effective and efficient measures of non-physician performance.
The current physician shortage, combined with the additional covered lives entering the health system, has increased the workload of the MSP who now, unlike previous years, has three types of non-physicians to work with: Advanced Practice Professionals (APPs), Allied Health Professionals (AHPs), and Limited Staff Professionals (LSPs). Because of the special training and advanced education of the APP and AHP, it is within the scope of the MSP to bring the non-physician into the credentialing fold and incorporate them into the verification process.
It is by this incorporation of the non-physician scope and competence into the overall credentialing process and system, into the onboarding process, and into organizational and Medical Staff governance that the MSP is paramount in solidifying the non-physician provider into the healthcare team.