Timothy Capstack Highlights Workforce Management of PAs and NPs

Physician Discusses Provider-Specific Data at ELC

By Jennifer Walker

As Director of Clinical Integration at Adfinitas Health in Hanover, Maryland, Timothy Capstack, MD, FACP, SFHM, is responsible for managing the company’s 200-person PA and nurse practitioner (NP) workforce. What is workforce management? The term refers to managing the activities that are needed to maintain a productive workforce— for example, training and education programs and opportunities for advancement—while also focusing on financial efficiency.

Timothy Capstack, MD, FACP, SFHM

“In other words,” says Capstack, who is also a partner at Adfinitas Health, “not costing more than you need to cost, but at the same time making sure you have adequate and sufficient staffing to provide safe and effective patient care.”

Collecting data that is broken down by provider group can help hospital leaders more effectively manage their workforce. At the Center for Healthcare Leadership and Management (CHLM)’s 2018 Executive Leadership Conference in November, Capstack led the session “Measuring Your Workforce/ Outcomes Research.” He developed the content with CHLM director Bianca Belcher, PA-C, MPH, and focused on collecting data specifically for PAs and NPs. “If you’re able to collect the data that relates to PAs and NPs, you’re able to act on that data in whatever way needs to be done to make improvements,” he says.

A Path to Leadership  

In 1998, Capstack began his career as a hospitalist working at Eastern Maine Medical Center in Bangor, Maine. A decade later, he joined a private practice hospitalist group called Physician Inpatient Care Specialists (MDICS), where he was on the partnership track. “It was a new company at the time, and it came with an ownership interest in the practice itself. That was appealing to me,” he says. Capstack began providing care at Anne Arundel Medical Center in Annapolis, Maryland, where he became the lead hospitalist after only one year. In this role, he managed 25 people, including 10 physicians and 15 PAs and NPs; provided quality control; and worked with hospital administration to further their objectives.

In 2013, Capstack moved up to become Regional Director with MDICS. Then, in addition to his role at Anne Arundel Medical Center, he also became responsible for the financial and administrative oversight of three other MDICS programs located on Maryland’s Eastern Shore.

Today, at Adfinitas Health—MDICS was renamed Adfinitas Health in January 2017—Capstack is responsible for incorporating the company’s PAs and NPs into its hospitalist practice, which is based at 15 hospitals located in Maryland, Michigan, Pennsylvania, and Virginia. Capstack sets up student rotations, manages the company’s internal training program and its collaborative framework with physicians, and develops educational materials.

At Anne Arundel Medical Center in Annapolis, MD, in 2012 with Melissa Strege, PA-C, (left) and Kelly Corcoran, PA-C (right).

Collecting Provider-Specific Data

Adfinitas Health had been comfortable using PAs and NPs for years, but the company wanted to explore whether this care model was as good as they thought it was, Capstack says. So Capstack began collecting data that specifically related to PAs in 2012; the resulting study was published in the Journal of Clinical Outcomes Management in 2016. Providers at a 384-bed community hospital were split into two groups, one that had an expanded PA group with three physicians and three PAs, and the other that had a conventional PA group with nine physicians and two PAs. Data was collected for 16,964 patients between January 2012 and June 2013, and the PAs participated in a comprehensive training program as part of the study. A formal collaboration framework was also in place to govern the interaction between the PAs and the physicians. Capstack found no significant difference between the two groups for several patient outcomes, including mortality in the hospital, readmission rates, and length of stay. In addition to this, the expanded PA group had another advantage: it provided the same level of care at a lower cost.

The data supported our intuition,” Capstack says. “We were then able to use the peer-reviewed study to confirm that finding to our clients and to continue to grow our successful business model.”

Managing the PA and NP Workforce

At Anne Arundel Medical Center in Annapolis, MD, in 2012 with Kelly London PA-C, Majid Cina MD, Laurie Gezelle PA-C, Rachel Howard PA-C, Kelly Corcoran PA-C and Shilpa Horlacher, MD.

Adfinitas Health has continued to require that PAs and NPs who are new to hospital medicine participate in the same training program that was used in Capstack’s study. This program includes about 60 hours of lecture-style education based on the 21 core competencies developed by the Society of Hospital Medicine, including asthma, heart failure, pain management, and stroke. PAs and NPs also participate in a six-month bedside training program, providing patient care alongside an experienced physician or PA.

Capstack says the company also offers several leadership opportunities for PAs and NPs. These roles include lead hospitalists, who oversee other PAs and NPs for particular departments; clinical documentation improvement specialists, who focus on billing and coding of electronic medical records; and directors of observation units, who coordinate with hospital administration and nursing staff on protocols along with providing patient care. “A lot of times, we’re able to tailor a position to a PA’s interests,” he says.

Jennifer Walker is a freelance writer in Baltimore, MD. Contact Jennifer at [email protected].