• Sara Westergaard, Kasey Bowden, Gopi J Astik, Greg Bowling, Angela Keniston, Anne Linker, Matthew Sakumoto, Natalie Schwatka, Andrew Auerbach, and Marisha Burden.
• Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
• J Hosp Med. 2024 Apr 10.

BackgroundMedicare previously announced plans for new billing reforms for inpatient visits that are shared by physicians and advanced practice providers (APPs) whereby the clinician spending the most time on the patient visit would bill for the visit.ObjectiveTo understand how inpatient hospital medicine teams utilize APPs in patient care and how the proposed billing policies might impact future APP utilization.Design, Setting And ParticipantsWe conducted focus groups with hospitalist physicians, APPs, and other leaders from 21 academic hospitals across the United States. Utilizing rapid qualitative methods, focus groups were analyzed using a mixed inductive and deductive method at the semantic level with templated summaries and matrix analysis. Thirty-three individuals (physicians [n = 21], APPs [n = 10], practice manager [n = 1], and patient representative [n = 1]) participated in six focus groups.ResultsFour themes emerged from the analysis of the focus groups, including: (1) staffing models with APPs are rapidly evolving, (2) these changes were felt to be driven by staffing shortages, financial models, and governance with minimal consideration to teamwork and relationships, (3) time-based billing was perceived to value tasks over cognitive workload, and (4) that the proposed billing changes may create unintended consequences impacting collaboration and professional satisfaction.ConclusionsPhysician and APP collaborative care models are increasingly evolving to independent visits often driven by workloads, financial drivers, and local regulations such as medical staff rules and hospital bylaws. Understanding which staffing models produce optimal patient, clinician, and organizational outcomes should inform billing policies rather than the reverse.© 2024 The Authors. Journal of Hospital Medicine published by Wiley Periodicals LLC on behalf of Society of Hospital Medicine.

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