Impact of Changing Patient Appointment Workflow in a Surgery Practice

Objectives: Surgeons (MDs) rely on an efficient clinic workflow for patients with surgical conditions to maximize throughput toward the operating room. Surgical practices are increasingly incorporating Advanced practice Providers (APPs) to assist with the clinical practice demands. Practice models demonstrating ideal utilization of APPs in a surgical subspecialty are lacking. We sought to evaluate a new clinical workflow utilizing APPs for new patient surgical consultation.

Methods: This was a retrospective cohort study of an academic Urogynecology & Reconstructive Pelvic Surgery (URPS) practice with a collaborative APP practice model. Prior to March 2023, all new patients were seen by APPs or MDs, based on earliest appointment availability or patient preferences. Between March 2023 and June 2023, the practice model was modified to schedule new patients with APPs. APP patients who desired a surgical consult were subsequently scheduled with an MD. Patients with specific conditions (e.g. urogenital fistula) or a planned co-surgery with another surgical specialty were initially scheduled with an MD only. Clinical and surgical volume preceding (7/1/22-12/31/22) and following (7/1/23-12/31/23) the changes were compared. Fellows participated in the clinical and surgical practice similarly during the study period and participated in the MD clinic; there is no fellows clinic in this academic practice.

Results: After implementation of the new practice model, APPs saw more new patient consultations and established patients (Table 1). MDs saw more surgical consultations and performed more surgeries, despite a reduction in MD clinical full-time equivalent (cFTE) by 0.3. Clinical schedule fill rates for APPs and MDs were increased. Net revenue increased by $23,308 when accounting for the reduced cFTE.

Conclusions: A URPS practice model that schedules new patients with APPs is associated with more patients being seen by MDs and higher clinical fill rates. The financial impact was a positive net profit when accounting for a reduced MD cFTE. Although APPs are reimbursed for new patient visits at 85% of MD billing, this practice model demonstrates profitability by offsetting this loss with increased surgical volume. This model supports utilization of APPs for new patient visits in a surgical practice.