How are you using/training your APPs in ordnance with CMS and ACR?

[d32]

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Outside of consults and follow ups? OTV? supervision of machines? SBRT?

 

[BobbyHeenan]

Only follow ups and inpatient consults (on inpatients the APP may see the patient and order some work up before the doc sees the patient) . We also have APP's do notes for tx summaries. They see patients under treatment for management if a new issue arises that is not on the OTV day.

It is our understanding that you cannot bill OTV's if the patient is only seeing the APP, so they don't see weekly visits routinely unless they see the patient first, then the MD comes in room later.

We occasionally use our NP to "babysit" clinic if a doc is not on site (doc remotely reviewing films), but will not do an SBRT with an APP. CT sims, verification sims/new starts, HDR, SBRT is all MD-only.

 

[HolySmokes]

Only follow ups and inpatient consults (on inpatients the APP may see the patient and order some work up before the doc sees the patient) . We also have APP's do notes for tx summaries. They see patients under treatment for management if a new issue arises that is not on the OTV day.

It is our understanding that you cannot bill OTV's if the patient is only seeing the APP, so they don't see weekly visits routinely unless they see the patient first, then the MD comes in room later.

We occasionally use our NP to "babysit" clinic if a doc is not on site (doc remotely reviewing films), but will not do an SBRT with an APP. CT sims, verification sims/new starts, HDR, SBRT is all MD-only.

This is our exact set up.

 

[TheWallnerus]

It is our understanding that you cannot bill OTV's if the patient is only seeing the APP, so they don't see weekly visits routinely unless they see the patient first, then the MD comes in room later.

PAs are billing Medicare for 77427 and getting paid (at the usual 85% rate) according to publicly available data. I am not opining on the rightness or wrongness of this!

 

[BobbyHeenan]

PAs are billing Medicare for 77427 and getting paid (at the usual 85% rate) according to publicly available data. I am not opining on the rightness or wrongness of this!

I’m sorry to hear that.

That’s a really important part of my job and think it’s a dis service to patients to farm that out.

It’s also not some rare thing where if I see a toxicity more severe than I’d expect and or some borderline call on a target volume or plan I may adjust my plan based on toxicity.

Just last week I re planned a lung mid treatment to be colder on the esophagus due to esophagitis I was having a hard time managing in a very frail patient. So pushed it harder with dosimetry and made adjustments and judgement calls … calls a rad onc can make not an NP.

 

[kimplera]

I’m sorry to hear that.

That’s a really important part of my job and think it’s a dis service to patients to farm that out.

It’s also not some rare thing where if I see a toxicity more severe than I’d expect and or some borderline call on a target volume or plan I may adjust my plan based on toxicity.

Just last week I re planned a lung mid treatment to be colder on the esophagus due to esophagitis I was having a hard time managing in a very frail patient. So pushed it harder with dosimetry and made adjustments and judgement calls … calls a rad onc can make not an NP.

we are also using them in the post-RT setting - my H&N who struggle to the end of treatment see the APP 2 weeks out. Considering moving all visits to 90 days to the APP (at our facility the metric for APPs is appointment slots booked so within the global window is a great use). we are encouraged to transition all f/u to APPs, but honestly i am struggling with that cause i really like seeing most of the patients

 

[BobbyHeenan]

we are also using them in the post-RT setting - my H&N who struggle to the end of treatment see the APP 2 weeks out. Considering moving all visits to 90 days to the APP (at our facility the metric for APPs is appointment slots booked so within the global window is a great use). we are encouraged to transition all f/u to APPs, but honestly i am struggling with that cause i really like seeing most of the patients

I'm with you. My partner(s) use the APP's much more than I do.

I have control issues and just enjoy seeing them, really want to know what is up.

But yes, that's a great use of APP. I end up seeing my head/necks weekly with IVF's often first few weeks after treatment and would be agood slot for an NP to be helping them with acute post tx issues.

 

[yesmaster]

I don’t use or train APP’s.

 

[metallica81788]

This is great info so please keep it coming

An APP is probably my only route to a 4 day work week and my organization seems surprisingly supportive right now

 

[BobbyHeenan]

This is great info so please keep it coming

An APP is probably my only route to a 4 day work week and my organization seems surprisingly supportive right now

Because they're probably thinking it will be like med onc where they bill above what they get paid. They aren't realizing that you can't bill anything in the 90-day window after treatment and/or symptom management during XRT isn't billable for them and that can be a big chunk of their work. Managing chemo side effects doesn't have these bundling periods.

But don't let them in on it and go for it.

One thing we are exploring is having the NP be involved as a hybrid NP/navigator for the radiopharm program. If the hospital won't give us a cut of that massive $ they make off radiopharm (and pro codes /RVU's are ABYSMAL), then at least they can provide an NP to help monitor/coordinate and assist with symptom management.