Working with APPs FY26

WORKING WITH APPS APP stands for Advanced Practice Provider. In the DHM, APPs are either Nurse Practitioners (NPs) or Physician Assistants (PAs). They are licensed providers allowed to assess, diagnose, prescribe, and provide comprehensive patient care. Our APPs independently care for an assigned panel of patients performing all patient care and documentation Main Campus direct care services: - The APP should be listed as the attending provider for the patients on their team - The PineAPP service is a 7 day a week service; the remaining direct care teams only have APP coverage on non-holiday Monday-Friday - Physicians-APPs are paired based on team assignment (ie Cedar MD paired with Cedar APP). - On arrival in the morning, MDs should cover the APP pager until APP arrives - MD should touch base with APP at least twice daily, in the morning and afternoon - MD should respond to any rapid response, code, or emergency on the paired APP’s team - Discharge summaries require co-signature per UNC by-laws. MD must document they were available. Daily progress notes, treatment notes, procedure notes etc do not require co-signature. - For complicated patients, APPs may request assistance from their paired physician. If the patient is seen and assistance is given, attendings may co-sign an APP note or attest for a shared visit, which may provide additional reimbursement. In order to show added value, the attending must document 3 separate pieces of information in their attestation: - They were the attending of record: “I was the attending of record” suffices. - Objective exam findings that attest to the fact that they saw the patient: “On my exam, pt was sitting in the chair and non-toxic.” - Individual contribution: Listing who the attending communicated with, what the attending ordered or reviewed, or what the attending instructed others to do suffices. - If an APP reviews or sees a patient and feel that they are an inappropriate for an APP service, they should discuss swapping a patient with their paired MD - APP team census is determined as follows: - CedarAPP/DogwoodAPP/PineAPP can be assigned up to 7 patients if all MD teams have 10 or more patients; if all MD teams have 14 or more patients, APP team cap rises to 8 - MagnoliaAPP census is up to 8 long-term patients plus up to 3 acute patients for a total of up to 11 patients - MagnoliaAPP should not be assigned additional acute patients when the long-term census is less than 8 OR more than 8 long-term patients when acute census is less than 3 unless approval is given by DHM leadership or the APP covering the service at that time - Whenever there is an anticipated gap in an APP team coverage (weekends/vacation/PTO etc) the APP is responsible for reassigning their patients to other teams. This should include: - Assigning the new team with consideration for regionalization (see attached regionalization grid), team census, and acuity. - Ortho co-management patients on MagnoliaAPP should be assigned to the Magnolia MD team - Only acute patients on the MagnoliaAPP team should be transitioned to a new team. Long-term patients on MagonilaAPP remain on their assigned team and are seen by consult provider when there is no MagnoliaAPP - Removing the corresponding APP team from the treatment team - Giving signout in the agreed upon format to the provider who will be assuming care - Making the CedarAPP/DogwoodAPP/PineAPP team pager unavailable in the directory; MagnoliaAPP should assigned to consult MD pager or New Admit pager accordingly

Teams Target Units
Dogwood MD/APP 6BT
Pine MD/APP 7BT
Cedar MD/APP 4ONC/ BMTU
Magnolia MD 8 BT
Magnolia APP Non-regionalized