With the start of CMS' Radiation Oncology Model approaching, more radiation therapy facilities are considering employing advanced practice providers (APPs) to maximize capacity and improve efficiency. Keep reading to find out how your peers are using APPs in their radiation programs.
Radiation therapy facilities typically employ around 1 APP for every 3 radiation oncologists
Respondents to our 2016 Radiation Therapy Benchmarking Survey reported that for each radiation oncologist, they employ a median of 0.3 APPs, including nurse practitioners and physician assistants. This equates to about one APP for every 48 total daily patients (including new patient consults, follow-up appointments, simulation visits, and radiation treatments).
But these reported benchmarks are not necessarily the ideal for cancer programs: data from the same survey also showed a 33% APP vacancy rate among respondents*. As demand for APPs in radiation oncology increases, cancer programs may look to attract and retain APPs by guaranteeing they can practice at top-of-license and providing opportunities for career advancement.
Most radiation therapy APPs are involved in symptom management and patient visits
Nearly all survey respondents indicated that their radiation therapy APPs are responsible for providing symptom management (86%) and conducting follow-up patient visits (82%). In many cases, APPs also assist with new patient visits (62%) and dictate patient notes (50%).
However, fewer APPs are responsible for tasks such as managing survivorship clinic (28%) or conducting new patient visits (8%). The responsibilities reported for radiation therapy APPs are similar to the tasks often performed by oncology APPs more generally.
APP role varies by organization
There doesn't seem to be consensus on how independently radiation oncology APPs should practice. In some organizations we've spoken with, APPs are directly supervised by physicians and play more of a support role during patient visits.
In others, APPs independently conduct follow-up and survivorship visits and, in some cases, new patient consults. While APPs commonly work in a generalist role, we have also heard from a few larger members whose APPs specialize within specific tumor sites.
APP supervision of radiation therapy is still rare
Only 6% of radiation therapy facilities allowed APPs to supervise radiation therapy in 2016, which is consistent with data from more recent surveys. However, changes to supervision requirements over the past few years have made it easier for APPs to supervise outpatient radiation therapy services, and despite disapproval from some professional organizations, we have heard from several cancer programs that are considering allowing APPs to supervise radiation therapy.
Last month, CMS proposed authorizing physician assistants to bill Medicare directly for services they provide under Part B, which could further drive outpatient radiation therapy facilities to allow for APP supervision. APP supervision is likely to become more common as participation in value-based care models increases.
*While this survey data is five years old, it is still directionally valuable. We hope to re-collect and update our benchmarks once we are confident that volumes have restabilized.