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In response to  the changing needs of hospitals, surgeons and Advanced Practice Providers, J. Toby Gray, CEO, announces the rebranding of Advancing Practitioners, the company he founded in 2014. He unveils the new name, AP Health, as the company makes significant investments in technology to improve internal efficiencies. As more hospitals look to outsource Advanced Practice Providers (APPs), AP Health realized the need to increase the scalability of its service offerings.

“Whether a hospital’s surgical program is mature or brand new, they generally have limited resources to manage it.” There is a lot that goes into managing a team of SFA’s: recruiting, training, scheduling, retaining and billing,” says Gray,“ and they’re not  equipped for it–that’s where we come in.” 

More hospitals throughout the country are coming to that realization, which has driven the company’s significant growth over the past six years. “AP Health understands the market for Nurse Practitioners, Physician Assistants, Certified Surgical Assistants, and Registered Nurse First Assistants; it’s all we do-we’re meeting an acute need,” Gray says. 

In fact, AP Health has seen a 12-fold increase in the number of patient-encounters for the company in just the past four years. Gray sees that trend continuing and even accelerating. Keeping pace requires technology-driven modernization. “AP Health is in the business of making hospitals and surgeons more productive, profitable and efficient. In order to meet the growing demand, we had to improve our internal productivity and efficiency-which we did!”  

AP Health developed a new proprietary mobile application, LogistiSx 2.0, an efficiency tool for AP Health practitioners in the field and its administrative staff. LogistiSx 2.0 enables each AP Health practitioner to securely capture and report all pertinent surgical case information on-site at the hospital, creating a centralized document-of-record that drives everything from practitioner scheduling to case-coding and hospital and insurance billing. 

“It provides all stakeholders – our practitioners, hospital clients, surgeons and our administrators with a single source of real-time truth on each case,” says AP Health COO Greg Flanagan. He points out that LogistiSx integrates with hospital scheduling systems, automatically uploading each hospital’s 5-day surgical care schedules each afternoon. Every AP Health practitioner receives his/her next-day schedule through the mobile app and receives text alerts regarding any change to that schedule. “This ultimately improves the quality of service we deliver to hospital clients, surgeons and patients and allows us to scale staffing quickly based on surgical needs on any given day.” 

Flanagan believes such real-time data integration and front-line/back-office efficiency gains are crucial to improving AP Health practitioners’ productivity and satisfaction. “We’ve built AP Health by attracting and retaining the most qualified Advanced Practitioners in surgical care and by providing our hospital clients with a consistently high level of service. This is central to our continued success as a company.” 

Gray also adds that, “Recruiting qualified surgical practitioners and creating a culture that increases job satisfaction by honoring the work/life balance limits the turnover of staff. LogistiSx removes much of the administrative burden from our practitioners, allowing them to focus on their clinical mission, which, in the end, is all that matters to them and our clients.”  

AP Health’s surgeon-centric approach is another factor that contributes to the success of our hospital partners’ surgical programs. We provide our surgeons with a team that can anticipate their needs and work seamlessly alongside them. This betters revenue, time/patient management, and outcomes in the OR. AP Health’s outsourcing model helps the surgeon be more productive by giving them the ultimate support and control in and out of the operating room. 

“We are being selective with our growth; we’re looking for opportunities to provide value to surgeons, and hospitals,” Gray says. “Ultimately, this rebranding effort is the front-facing piece of a much deeper organizational commitment to delivering an ever-higher level of service and efficiency to all stakeholders as we grow.” 

Cardiothoracic programs place more demands on hospitals than any other surgical specialty. This is due to the highly specialized procedures that are performed and the elevated risk of morbidity and mortality of Cardiothoracic patients . This program’s critical nature calls for quick-to-act surgical teams that anticipate rapid changes and are able to perform minute-by-minute assessments-the stakes couldn’t be higher.

When Jupiter Medical Center and its Cardiothoracic surgeon, Dr. Arthur Katz, started a new Cardiothoracic program in April 2020, they partnered with AP Health to meet their surgical staffing needs. AP Health provides Jupiter Medical Center with highly-skilled Advanced Practice Providers (APPs) that can meet the demands of this new program. The team began with a three-person group of practitioners to ensure the hospital of proper coverage and  help maintain the work/life balance that is important to practitioner- job satisfaction. 

Directing AP Health’s Jupiter Medical Center team of Cardiothoracic APPs is Daniel Teller, a Certified Physician Assistant with over three decades of experience. Teller oversees the patients’ care under Dr. Katz’s supervision and operates as an extension of him. Teller has a wealth of knowledge in establishing, managing and expanding Cardiovascular and Thoracic surgery programs.  

“As the surgeon, he (Dr. Katz) exercises ultimate control over the team’s hiring and composition, as well as the day-to-day operations of the program” says Teller. “I’m responsible for rounding on pre- and postoperative patients in the ICU, the step-down floor, consults, daily notes and discharge summaries. I also lead ongoing education for the Cardiothoracic team and train other nurses to make sure everybody’s on the same page about what heart surgery demands.” 

Teller estimates his time is equally divided between non-surgical duties and the operating room, where his skill set includes endovascular vein harvesting and endovascular radial harvesting. “Dan’s a unique individual who’s started Cardiothoracic programs in the past – Jupiter is his third. He has decades of experience caring for these patients, enjoys teaching and has a wide range of clinical skills, including the manual dexterity needed for vein harvesting,” says J. Toby Gray, CEO of AP Health. “Hospitals generally have a difficult time recruiting people like Dan. Not only because of their unique skill set, but because they are in such high demand. AP Health specializes in finding and retaining highly trained and skilled practitioners like him- I know he’s extremely valuable to Dr. Katz.” 

The placement of the APPs on the new Cardiothoracic surgical team reflects the surgeon-centric approach fundamental to AP Health’s outsourcing business model.  With Teller as program director and Dr. Katz as the ultimate decision-maker, AP Health made sure their skills aligned directly with Dr. Katz’s methods and preferences. “AP Health put together an exceptional team to help launch our Cardiothoracic program,” says Dr. Katz. “They understood the importance of achieving quality results in year-one, so they recruited Dan Teller – a senior-level, highly skilled cardiac PA – to help build our program.”  

For his part, Teller is excited about starting and directing a new Cardiothoracic program. “I’ve started two other programs, and I’ve always enjoyed the challenge. I know from experience what we need to continue to train and focus on to be successful and expand the program at Jupiter Medical Center.”  

New web capabilities simplify surgical case scheduling, improving revenue cycle and service delivery to hospital clients.

NASHVILLE, TN – AP Health, a Nashville, TN provider of credentialed surgical Advanced Practice Providers to hospitals and surgery centers, announces the launch of LogistiSx 2.0.

A web and mobile application, LogistSx 2.0 enables each AP Health practitioner to securely capture and report all pertinent surgical case information on-site at the hospital. This creates a centralized document-of-record that AP Health back-office administrators use to drive everything from practitioner scheduling to case-coding and hospital and insurance billing.  The newest release enhances our scheduling of providers to achieve the highest level of quality by assigning the appropriate provider to the case.

“It’s an efficiency tool for our practitioners in the field and our administrative staff, which ultimately improves the quality of service we deliver to hospital clients, surgeons and patients,” says Chief Operating Officer, Greg Flanagan.

AP Health practitioners work an average of 3 surgical cases per day and collect, assimilate and report a significant amount of information for each – time-in and time-out, procedure information, insurance information, notes about the surgery and more. “That used to be a paper-based process, but LogistiSx 2.0 technology streamlines and foolproofs those workflow processes,” says Flanagan. “It provides all stakeholders – our practitioners, our hospital clients and our administrators with a single source of real-time truth on each case.”

LogistiSx 2.0 integrates with hospital scheduling systems, automatically uploading each hospitals’ 5-day surgical care schedules each afternoon. Every AP Health practitioner receives his/her next-day schedule through the mobile app at 5:00 pm and receives text alerts regarding any change to that schedule.

Flanagan believes such real-time data integration and front-line/back-office efficiency gains are key to improving the productivity and satisfaction of AP Health practitioners. “We’ve built AP Health by attracting and retaining the most qualified advanced practitioners in surgical care and by providing our hospital clients with a consistent high level of service. LogistiSx 2.0 removes much of the administrative burden from our practitioners, allowing them to focus on their clinical mission, which, in the end, is all that matters to our clients. It’s central to our continued success as a company.”

About AP Health

AP Health is a privately held healthcare services company based in Nashville, TN.  The company is a surgeon-centric outsource provider of surgical care staffing for hospitals. AP Health recruits, manages, schedules and trains skilled advanced practice providers, tailoring a team to meet each surgeon’s requirements and to assist with the full continuum of pre, intra, and post-surgical care services. 

When Greg Flanagan joined AP Health as an equity partner and COO, the business was operating as many small and midsized organizations do. Manual, paper-based and spreadsheet-based workflows were stifling the healthcare services company. Inefficient processes, susceptible to human error, were adding costs, exposing the business to risk and constraining growth.

AP Health provides credentialed Advanced Practice Providers (APPs) staff to hospitals and surgery centers. Its Practitioners work an average of 3 surgical cases per day, and the company uses what it calls a ‘Facesheet’ – a one-page case summary completed by each Practitioner – as a document-of-record for each case. Facesheets include all pertinent case information – the names of the hospital and surgeon, time-in and time-out, patient information, insurance information, notes about the surgery, and more –, and they drive the company’s back-office workflow, from scheduling to billing.

“Our practitioners were faxing Facesheets to the office, or they were dropping the paper sheets in our coordinators’ mailboxes at the end of the day. Collecting, assimilating and passing along all that information among departments efficiently was a huge challenge. Our coordinators were typing information into spreadsheets. Errors were common, and we had stacks of unbilled cases,” Flanagan recalls.

Often, staff would work into the evening to schedule providers for the next day’s cases, manually entering schedules into an Excel spreadsheet and emailing each provider. “Everybody was waiting for the schedule email to come out, and inevitably there were changes. We needed a way for the provider to see their schedule in real-time,” Flanagan says.

At the time, AP Health had only 12 employees and two client contracts. Scaling the business was Flanagan’s primary objective. “That first day I walked out and went, oh, my God, this isn’t going to scale.”

Partnering with FortyAU – a ‘casual agile’ development methodology

“Every small business gets to a point where they ask, can I get by with nothing, or do I make an investment in software and let my business grow? And if they make that investment, as Advancing Practitioners has, it has to pay off,” says Andrew Kerr, Managing Partner of FortyAU. “But they didn’t try to eat the whole elephant at once. That’s important. It’s been an incremental process, an ongoing collaborative partnership.”

That collaboration began with a process review, with Flanagan outlining AP Health’s requirements and explaining its business workflow to a small team from FortyAU. “They’d listen and ask questions,” Flanagan says. “Andrew, who has a deep healthcare background, understood most of what I was saying immediately, so he translated our requirements into system design. From there, FortyAU took over architecture, design, programming and project management, coming up with designs and estimates. We’d iterate on that and then lock it in.”

From the start, AP Health has prioritized feature development to satisfy a current need rather than what might be nice to have, a wise approach for a small business, in Kerr’s judgment. “We’ll work on features important to their business now, knowing we can table other development for later,” he says. “That fits perfectly with FortyAU’s ability to scale our development resources to match their requirements at any given time. They’re not paying for a developer when they’re not using one.”

FortyAU works in two-week sprints, what Flanagan calls a ‘casual agile’ approach to developing custom solutions. “They employ an agile development methodology, but there’s no scrum master or project management line item. It’s just weaved into their development process, and Andrew invests a lot of time personally in the project.” FortyAU also provides an online portal to facilitate collaboration as Advancing Practitioners’ requirements moved from development to testing, QA and production.

Building a mobile app and a back-office portal

Flanagan’s initial priorities were to build a web portal replacing the spreadsheets used in the back-office and to deploy a mobile app for the company’s practitioners use to securely capture and submit their surgical case information from the hospital.

With the administrative portal, FortyAU built what is essentially an internal workflow engine, a centralized, single source of real-time truth on each case. AP Health’s back-office team manages the scheduling of cases, reconciling data, coding cases for billing and sending that data to a billing module, ensuring data integrity throughout the process. An SQL database enables Advancing Practitioners to enforce master data management methods and other practices not feasible using Excel spreadsheets.

Through the mobile app, practitioners in the field capture case details and feed information into the case pipeline. FortyAU built an integration with Azure Directory to manage employee sign-ins and with One Drive to store the Face Sheet images uploaded by the practitioners, while ensuring security. Next-day case schedules for each practitioner are published to the mobile app at 5:00 each day, with text alerts to any changes in that schedule. FortyAU later built an integration with hospital scheduling systems, automatically uploading their surgical case schedules at each afternoon, looking forward five days. “Data integration is the key to administrative simplification and improved productivity,” says Flanagan.  “We need to be as efficient as we can to be successful with delivering high quality service to our hospital clients”

Over two years into his partnership with FortyAU, Flanagan says, “My vision was and remains, anything we can automate at a reasonable expense, let’s do it. Let’s take manual data entry and cumbersome processes off the plates of our clinicians” In his own case, Flanagan estimates he used to spend 80%-90% of his time managing back-office administration. He now dedicates about a quarter of his time. “My life has completely changed. I’ve reclaimed that time to focus on improving revenue cycles and business development,” he says. “And our accounting team has gotten three days back every month because our invoicing process is now a push of a button.”

“I’ve always dreamed about running a company that has no full-time IT employees, and with my infrastructure housed with Microsoft and my apps developed by FortyAU, I’m able to achieve that,” Flanagan says. “We are an internet native company and we’ve grown into a company with close to 100 employees, and none of them are in IT. I think that’s the value of the partnership with FortyAU. Their price-to-service value is great. It makes it easy to say I’d rather partner than try to build it myself.”