AMGA: Medical Groups Turning to APCs to Maintain Productivity

Despite the fact that median staffing levels in medical clinics has returned to pre-COVID levels, a new survey from AMGA, the Alexandria, Va.-based American Medical Group Association, is showing clinics to be under pressure to maximize staff productivity.

AMGA leaders published a press releasee to their website on Oct. 23 under the headline “New AMGA Staffing Survey Reveals Staffing Increases Behind Gates in Productivity.” The press release began thus: “While groups continue to add clinical staff to support provider needs, increases to productivity coupled with challenges with patient access overshadow any gains in staffing support. While looking to balance patient demand and physician shortages, medical groups are relying more on advanced practice clinicians (APCs), creating unique challenges to staffing models, especially amid evolving reimbursement environments and value-based care arrangements. “

AMGA’s new “2024 Medical Clinic Staffing Survey” finds that medical groups’ and health systems’ medical staffing, on a per-provider basis, has returned to pre-COVID pandemic levels. “Tracking total clinic staff per provider (including both physicians and APCs), the median for all groups is 2.15 total clinic staff FTEs per provider FTE, which is virtually identical to 2020 staff FTEs per provider median of 2.13,” the association noted, adding that “total clinic staff” includes “both front- and back-office clinical staff along with any ancillary or other direct patient care staff,” while excluding leadership staff.

AMGA has found that, “While clinic staff per provider has returned to pre-COVID levels, staffing levels adjusted for productivity (e.g., work relative value units or wRVUs) show a different trend. According to AMGA’s 2024 Medical Group Compensation and Productivity Survey, groups reported an overall 5.2% increase in median productivity (wRVUs) and a 3.0% increase in median visits compared to the prior years’ survey data, while staffing levels only increased 1.3% on a per-provider basis over the same timeframe. Increases in production overshadow any gains in support staffing, which translates to continually decreasing clinic staff per 10,000 wRVUs produced. In 2020, total clinic staff per 10,000 wRVUs was 4.35 FTEs at the median compared to 3.71 total clinic staff FTEs per 10,000 wRVUs today, reflecting a 14.7-percent decrease in staffing on a volume-adjusted basis.”

Per that, AMGA Consulting vice president and chief operating officer Mike Coppola was quoted in the press release as stating that “It is important to note that productivity-adjusted staffing is artificially deflated due to the Centers for Medicare and Medicaid Services (CMS) changes in wRVU values over the last couple of years. Medical groups continue to face staffing challenges in the overall economic environment,” he said.

The press release went on to note that “Increasing demand also affects patient access, which continues to be top-of-mind for many medical groups. Tracking access, many groups reported an increase in wait times to schedule appointments and increased schedule utilization. Within system-affiliated groups, wait times for established patients (third next available) have risen from 1.1 days in 2022 to 4.4 days in 2024. Schedule fill rates have increased almost 5 percent for system-affiliated groups over the same period.”

What’s more, the association noted that, “As medical groups look to combat access issues and provider shortages, many organizations continue to look to APCs to fill the gap, especially in states where they can provide care independent of physicians. In 2020, APCs in system-affiliated organizations comprised 39.6% of the provider workforce in primary care. This has grown to 48.1% in the current 2024 survey, showing that almost 8.5% more of the provider workforce is comprised of APCs today than in the 2020 survey. “

Indeed, “Increased utilization of APCs, while helping with access, has other implications relative to provider production and staffing roles and responsibilities. Based on data represented in AMGA’s 2024 Medical Group Compensation and Productivity Survey, APCs generate about 77 percent of physicians’ wRVU productivity. Along with financial implications, evolving roles and responsibilities of APCs and clinical staff to support managed care arrangements create unique challenges when caring for a patient population/panel.

Per all that, Coppola commented that, “As organizations continue to refine care models through the use of APCs, there has been continued increase in the percentage of APCs to total providers across all specialties over the last several years. Organizations continue to navigate the varying state regulations on the scope of practice for APCs, while attempting to address overall physician shortages.”