(P137) Midlevel Providers in Radiation Oncology and Their Role in Brachytherapy

Amy Hacker-Prietz, MS, PAC, Joseph Herman, MSc, MD; Johns Hopkins University

Background: With the increasing patient population in the oncology world and advancing technologies in radiation oncology in particular, there is an increasing need for assistance in providing high-quality care. In the setting of radiation oncology, brachytherapy has broadened its scope over the last decade, and assistance with procedure-based aspects of implementing brachytherapy has increased in demand. The implementation of nonphysician practitioner roles, such as midlevel providers and physician assistants, can provide an improvement in the workflow of brachytherapy procedures. Physician assistants can perform procedures under a license agreement with their attending physician, once well trained and experienced, as part of the delegation with the Board of Physicians. This allows midlevel providers to set patients up for brachytherapy procedures, construct equipment devices, insert appropriate devices, assess applicator localization images, and assess treatment fields, all prior to the physician being present to initiate treatment. Physician assistants also have the ability to charge for brachytherapy services while freeing up physician time to focus on treatment planning and target delineation, as well as other clinic demands.

Methods: Review of literature of midlevel provider roles in radiation oncology, personal experience, and investigation of billing reimbursement for brachytherapy procedures for midlevel providers.

Results: Physician assistant billing allows for 85% to 100% of the physician fee schedule, depending on the payer. Midlevel providers qualify to bill for Current Procedural Terminology (CPT) codes, including catheter placement and device placement for brachytherapy procedures. These advanced duties, performed under the supervision of a radiation oncologist, can be incorporated into delegation agreements with procedure logs for brachytherapy procedures, including vaginal/gynecological, endorectal, skin, interoperative, prostate, and bile duct sites. At our institution, we use midlevel providers for the GI group, which consists of intraoperative, endorectal, skin, and bile duct procedures, which includes simulation and treatment setup. Quite frequently, these procedures can take considerable time, therefore freeing up the physician during certain time points of the brachytherapy process.

Conclusion: The emergent role of midlevel providers has been increasing in awareness and utilization and is promising to assist in improving patient treatment flow, provider workflow, and overall patient care and patient experience. Integrating physician assistants with onsite training experience into brachytherapy procedures can be cost- and time-effective for radiation oncology departments. There is now more of a demand for experienced providers for brachytherapy procedures, and midlevel providers, such as physician assistants, can be well trained, experienced, and specialized to help fill the deficit. In an academic setting, establishing the role of physician assistants in brachytherapy technology is not meant to minimize the experience of the resident but to act as an additional enhancement to the teaching, allowing more time for the procedure-based aspect while the physicians will remain the integral part of the prescribing of treatment.