This blog post is adapted from the Q&A “Introducing the Advanced Practice Radiation Therapist” published in Radiation Oncology News for Administrators, Vol 33, No. 5.
By Tammy McCausland
Mount Sinai Health System (MSHS) was the first health facility in the U.S. to have an advanced practice radiation therapist (APRT) position. “The APRT is an innovative solution to some of the care delivery challenges we’re all grappling with and what the future state of oncology will look like,” says Samantha Skubish, chief technical director, Radiation Oncology at Mount Sinai Health System. “Internationally the APRT has been proven to be successful in increasing efficiency and creating a better experience for patients.”
Skubish and her colleagues looked at different international models, and ultimately decided to use the U.K.’s four-pillar framework—clinical, leadership, education, and research—to craft the APRT position. “Our APRT earned an international master’s degree in advanced clinical practice, so we are able to draw from that experience. She is a leader in the department,” says Skubish. The APRT is the go-to for troubleshooting technical issues at the machine. She’s teaching a course on image review to train medical residents, and she also teaches other senior-level therapists and therapy students.
The APRT is similar to any other advanced practice level in health care––like a nurse (RN) versus a nurse practitioner (NP) or a physician assistant (PA). “It’s taking the RT’s existing skillset and elevating it so that they have higher-level clinical knowledge, skills and judgment to support physicians and patients in novel ways,” Skubish says.
They waited six months before backfilling the open RT position to prove the model works. Being apply a research grant directly to the APRT’s salary helped secure institutional support.
Benefits of Having an APRT
As Smith explains, shifting tasks so that the APRT, rather than a physician, goes to the floor to make initial assessments, have conversations with the patient and their family, and ask questions to gain understanding about the patient’s perspective, gives the physician back valuable time. It can take up to three hours out of a physician’s day to assess one patient, only to find out they may not be a candidate for treatment in the inpatient setting. The APRT also helps save time physicists’ spend creating plans in simulation for a patient that may not be able to tolerate treatment.
“Our preliminary survey results indicate that many physicians appreciate the care coordination aspect—creating continuity for inpatients from end to end—which is something we didn’t have before,” says Skubish. “Also, because many patients’ care is complex, being able to have a point person that communicates with the multiple providers involved has really helped streamline communication.”
With an ASRT grant-funded initiative, they’re looking to determine if they can decrease the number of patients that are scheduled and never simulated, or simulated and never treated. Tasks being done by the APRT, such as seeing the patient first, knowing the history and where the patient’s at in the care process, and bridging the gap between providers, have reduced a lot of inefficiencies already. “Part of our workflow involves the APRT assessing the patient on the inpatient floor from a therapy perspective to determine if the patient can hold their arms above their head; what type of pain are they in today versus yesterday or this morning; can they lay flat, etc.,” says Skubish.
From a quality perspective, our APRT also helps ensure that many steps in our inpatient workflow are completed every single day for our patients, keeping quality metrics for internal departmental QA reporting around documentation and for care coordination.
No APRT Designation—Yet
There’s no formal APRT designation yet, but Mount Sinai is leading a national effort. It established a National Advanced Practice Radiation Therapy Working Group in the U.S., and more than 40 organizations are involved. There’s collaboration with professional organizations, including the American Society of Radiologic Technologists (ASRT), which wants the profession to grow. International colleagues are also providing support and mentorship.
Outcomes of the working group include several publications already published plus several more in development. All efforts are aimed at proving the model in the U.S. works effectively, including both clinical and educational frameworks. “The goal is that there will be a recognized credential or designation, but we have to build up our library of evidence-based practice first before we get to that point. That is exactly what the working group is setting out to do,” says Skubish.
Reimbursement for APRT Services
Part of the business model was calculating savings, because currently, there is no formal recognition for the APRT. Smith says they looked at the number of times a patient was simulated and not treated. They calculated the time for everything involved—the time spent by the physicist, the RT, the physician and the billers who spent time getting the authorization, as well as the number of times the patient didn’t get treated—and they were able to calculate an actual number. “We saw how we were able to decrease the cost of care, which also helped provide justification for the position,” she says. “There’s also the physical and mental effort—which may not be tangible or easy to calculate a value for—but it’s very real for the physicians and the staff involved.”
Advice for Administrators
Listening to staff members is so important, Smith says: “Engaging with your staff to solve problems not only helps you but also helps them feel valued and heard, and this is so important. We have to focus on retaining our staff. Administrators also have to listen to their physicians and understand their pain points. . . . When you elevate staff, they feel valued and they’re creating new ways to collaborate with physicians.” She encourages administrators to take time and figure out where an APRT might fit in their department, and to keep in mind that multi-center facilities might have a completely different set of tasks for the APRT at each location.
Elevating the RT skillset can provide new solutions to unique pain points or specific challenges in each department. “Administrators should look at their RTs as an untapped resource . . . when we elevate RTs with higher education, training and clinical judgment, they can really make a significant impact by creating novel models of care,” says Skubish.
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