As an advanced practice provider, who has worked in Bend for the past eight years, it was disconcerting to hear that St. Charles Health System recently terminated four of their six hospitalist APPs. Patients under my care have been managed by hospitalist physicians and APPs while at St. Charles, and I find little difference in the quality of care received. The rumor mill has run rampant with the termination of clinicians speculated to be financially and politically motivated. A major concern is this move, presented as a financially sound choice, lacks substantive evidence to support the financial benefit at the expense of patient care.

APPs undergo extensive medical education and, as graduates of their respective programs, are able to diagnose and apply therapeutic measures for their patients. Nurse practitioners and physician assistants hold prescriptive privilege’s in all 50 states and have been working in the field of medicine for nearly 60 years. While these providers are distinct from each other, together, they represent a health care workforce of certified and state-licensed medical professionals who are essential to operations in inpatient and outpatient settings.

As has been reported in many reputable journals, since the implementation of the Affordable Care Act, the number of advanced practitioners has risen. This is due, in part, to the increasing costs of providing affordable care, the relative bargain of utilizing APPs and the proven outcomes in utilization of APPs in most areas of medicine. Working as part of the hospitalist team, APPs have significant financial value and are shown to be cost effective and improve patient outcomes.

According to an analysis of multiple studies conducted by the American Academy of Physician Assistants, hospital-based physician assistants help to decrease hospital readmission rates, length of stays and infection rates, and several studies agree that broadening the scope of practice for APPs results in increased access to care and overall cost savings, which has far-reaching implications for every taxpayer. This is what concerns me about the move by St. Charles Health System to limit the hospitalist staff of APPs. Evidence shows this will not lead to cost savings and will impact patient care. In addition, physician hospitalists will carry an extra burden in trying to cover more patients with less resources when they lose the asset of APPs as part of the team-based care model.

The Centers for Medicare & Medicaid Services recognize the keystone position APPs have within the health care system. In the coming wave of new requirements restructuring reimbursements, which are demanded by the Medicare Access and Children’s Health Insurance Program Reauthorization Act, CMS has chosen to include APPs alongside physicians as providers that are part of its quality payment program. In times of financial uncertainty, why any organization would move toward elimination of these valuable and cost-effective members of the team raises curiosity and concern.

In my interactions with physicians and APPs in the Bend community, I have found providers driven to meet the needs of patients with a shared goal of providing quality and comprehensive care.

I have been fortunate to work as part of a team with a patient-centered goal of meeting the needs of the patients and working together to improve patient outcomes.

While I can appreciate concerns regarding finances, the APP model has proven to reduce costs without compromising outcomes so it concerns me that our community medical center has chosen to terminate these valuable providers in a move to address the financial deficit the hospital is facing.

Evidence continues to show equal outcomes in care while saving on costs by utilizing APPs in roles they are trained for and including them as part of a well-balanced team. I’m concerned about the impact this will have on patient care and patient outcomes, as well as the potential marginalization of the contributions of advanced practice providers in our medical community.

— Billie Cartwright is a physician assistant and lives in Bend.