Advanced Practice RN Independent Model of Care Positions Cancer Center for Success

WASHINGTON, DC—The Advanced Practice RN (APRN) independent model of care provides appropriate utilization, efficiency, and professional development in an oncology outpatient setting, according to research presented at the Oncology Nursing Society (ONS) 38th Annual Congress.

In fact, the model positions the University Hospitals Seidman Cancer Center “for success in management of oncology patients over the trajectory of cancer therapy, surveillance, and/or end of life care,” reported Wendy Miano, DNP, MSN, RN, AOCN®, of the cancer center.

University Hospitals Seidman Cancer Center, an NCI Comprehensive Cancer Center, was charged with maximizing APRNs, an essential workforce, in the oncology outpatient setting. Their goal was to define parameters for patient management as well as productivity metrics for an APRN independent provider model of care. Miano explained that historically, APRNs worked directly with collaborating physicians, who collected billing. A pilot project with two APRNs as independent providers found that within the first two years, they received enough revenue to cover their salaries.

During 2012, APRNs were transitioned to the faculty practice employment model, resulting in an APRN and collaborating physician joint practice model of care. “Patient management parameters were defined with input from both APRNs and collaborating physicians,” Maino stated. “A proposed practice algorithm was established to clearly define physician and APRN appropriate patient management.”

Guidelines for outpatient clinic volume were specified and, in the first year, an apprenticeship role was defined that took into account the learner's role. Also identified were infrastructure support through the clinical secretary and nursing. APRNs were trained in billing metrics and the structured revenue generating unit, used to measure productivity.

A successful transition in employment model and practice structure has been observed,” Miano stated. “Established productivity benchmarks and clear patient parameters in defining a joint practice enhanced APRN performance.”

The revenue generating unit productivity reports “have aligned APRNs for success in independent patient management,” she concluded. “In addition, this model of care change has afforded APRN opportunities in clinical privilege development, subspecialization, and disease team expertise.”

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