How Banner Health tackled doctors' skepticism over increased use of advanced practitioners

A physician's stethoscope
Banner Health is putting its 900 advanced practice clinicians to greater use, said James Agnew, regional vice president for delivery. (Getty/millionsjoker)

WASHINGTON—When Banner Health wanted to rethink its approach to care delivery, leaders at the system decided to take advantage of the advanced practitioners in its ranks.

There was one major hurdle, however: getting the system's doctors on board.

Advanced practice clinicians, such as physician assistants or advanced practice nurses, can play a crucial part in building a more consumer-centric healthcare experience and addressing workforce shortages. But physicians may be hesitant to buy in, said James Agnew, R.N., the system's regional vice president of delivery, speaking at the World Health Care Congress last week.


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"[Nursing leadership] knew we had to lean in and demonstrate how nursing can be leveraged to create value," Agnew said. 

Health systems seeking to expand the use of advanced practice clinicians have faced significant pushback from their doctors over quality concerns outside a physician-led team.

The Department of Veterans Affairs, for example, announced in 2016 that it would give its advanced practice registered nurses full practice authority to address the shortage of doctors in its health system and allow for more timely access to care in the wake of its wait times scandal. Physicians, however, including the American Medical Association, opposed the measure and some actively campaigned against it.

RELATED: Specialty practices increasingly rely on nurse practitioners, physician assistants 

Banner Health has 18,000 nurses, and of those 900 are advanced practice, Agnew said. The 15-hospital health system examined the role of nursing across the continuum of care beginning in 2015, when it launched a series of projects aimed at transforming its approach to care delivery. 

In 2017, Banner kicked off a program that integrates advanced practice providers into primary care, he said. 

They started by searching out physician champions who supported the plan, Agnew said. Banner's nursing leaders also consulted with doctors frequently throughout the process to avoid working in silos that could alienate stakeholders. 

RELATED: Docs and advanced practitioners equally likely to provide low-value care 

Banner embedded advanced practitioners in its emergency departments, Agnew said, and also has a number working almost as hospitalists in its intensive care units. 

Deploying advanced practice clinicians in telehealth is one solution for addressing access while cutting back on unneeded visits to the ER, he said. For example, a patient who needs to see an ophthalmologist in a rural area may visit the emergency department because he or she cannot reach an eye doctor. 

These patients are connected to an ophthalmologist through a virtual visit by the advanced practice team when they present to the ER, eliminating one patient from the ER doctors' slate and connecting them to needed specialty care they may not otherwise be able to access. 

RELATED: How one health system makes work life easier for its doctors and advanced practice providers 

They also focused on getting patients on board. Banner began offering those patients calling for a primary care visit the chance to visit with one of the clinic's advanced practice clinicians, Agnew said. Those visits are guaranteed within 24 hours, while waits for physicians may be much longer. However, if a patient requests it, the clinics will schedule a visit with a doctor instead, he said. 

Agnew said maintaining options for patients is crucial. "I think patient choice is one of the most important things we've done," Agnew said. 

To date, about 30% of Banner's hospitals have expanded their use of advanced practice clinicians. "Historically, we've taken nurses out of clinics," Agnew said, "and now we're putting them back in because there's value there."

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