Abstract
Background: The contributions of advance practice providers (APPs) to an oncology practice are complex, and it can be challenging to discern and measure how their unique contributions are impacting their practice. Two terms, productivity and value, are used to measure contributions. APPs should have a clear understanding of their practice’s definition of these terms and their expectations for evaluation of APP contributions, because when APPs’ contributions are valued, their job satisfaction and team productivity are likely to improve. In addition, proper documentation of the quality and cost-effectiveness of the care provided by the APP is crucial to the overall success of the practice and to ensuring that APPs continue to contribute and thrive in the oncology arena. Methods: We surveyed APPs and nurses to assess whether and how their contributions were being measured. An overview of the tools currently used in clinical practice is also provided. Results: The survey had an approximately 10% response rate and was answered by 59 APPs (who constituted 80% of the respondents). APP productivity was formally (36%) or informally (42%) measured for the majority of respondents, but only 25% believed that their productivity was being measured accurately. Relative value units (RVU, 39%) and hours per patient day (19%) were used; however, most APPs considered RVU an ineffective measure of both productivity and value. Value was not measured for many respondents (46%), and 29% did not know whether their value was being assessed. This is despite the fact that respondents spent an average of 19.8 hours per week on value-added activities that improve patient care and satisfaction. Conclusions and Recommendations: The crux of the issue is whether APPs can realistically gauge their value and contribution to a practice if the care they provide for their patients is not accurately assessed. APPS should ask whether they feel valued by their practice, patients, and physicians and how this impacts their overall job satisfaction. These answers could be important for retention of APPs and should be used to initiate conversations to increase awareness of APP contributions to the practice. We recommend that APPs consider tracking their work activity and the time it takes to complete tasks, especially those that are non-billable services. APPs should also consider asking the practice to review productivity of the team before and after the APP joined the practice to raise awareness of their contributions.
