The Value of Advanced Practice Providers Performing Office Cystoscopy

The Value of Advanced Practice Providers Performing Office Cystoscopy Posted By:
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As the advanced practice provider (APP) community continues to grow and various areas are identified where they can make a difference in patient care, patient access, and growth of a practice, it may be helpful to look at the value of urology APPs.

There is a workforce shortage in urology—and the literature and real-world data support the need for, and value in, supplementing urology practices with APPs. This is especially relevant in rural areas across the country, as 73% of counties have no urologists available. Therefore, access to a urology APP may provide increased care access—a value that has already been shown in academic centers.

In many institutions, APPs in urology have performed office procedures for some time; however, the number of procedures they perform has increased in the last several years. For example, at my institution, APPs now perform office cystoscopy and cystourethroscopy with ureteral stent removal. We began this process as an arm of a research project looking at the role of tele-cystoscopy for patients with bladder cancer receiving cystoscopy at distant sites. In our study, APPs would perform the cystoscopy, which would then be interpreted through tele-cystoscopy by a urologist at the home site. That process led us to adopt a training program for APPs in office cystoscopy. This year we took a hard look at what value this added to the department from several angles.

Looking at cost-effectiveness and productivity is 1 way to analyze value that APPs may add to a practice. A good measure of productivity is the work relative value unit (wRVU), as reimbursement collections may vary based on institution. At my institution, as of May 2021, office cystourethroscopy and stent removal equals 2.79 wRVU. Correspondingly, a level 4 Evaluation & Management (E&M) initial office visit equals 1.92 wRVU. APPs bill and are reimbursed at the same rate as physicians for this procedure, so this is clearly a plus for the practice. APPs can increase profitability, as well as decrease provider burnout, while helping bring in higher physician compensation by freeing up time for the urologists to see patients for surgical consultation.

Let's look at this in terms of satisfaction: Physician satisfaction, patient satisfaction, and APP and team satisfaction. In our division, there was improved team satisfaction when more providers were available to provide cystoscopy; patient satisfaction due to increased provider access was also high. Additionally, there is improved APP job satisfaction with an increased skill set and ability to contribute and earn wRVU within the department.

Last but not least, we know that APPs add value across the patient experience. There are long and well-recognized track records of cost-effective quality care by APPs, increasing access to care, and optimized team delivery of care with increased work group productivity. Studies have shown APPs provide reliable documentation, improve patient satisfaction, increase team satisfaction, and often their care leads to earlier discharge.

In addition to office cystoscopy urology APPs may also perform prostate biopsy, posterior tibial nerve stimulation, and video-urodynamics. Thus, urology APPs provide added value to virtually any urology practice.

References
  • Bauer JC. Nurse practitioners as an underutilized resource for health reform: evidence-based demonstrations of cost-effectiveness. J Am Acad Nurse Pract. 2010;22:228.
  • Brooks PB, Fulton ME. Demonstrating advanced practice provider value: Implementing a new advanced practice provider billing algorithm. JAAPA. 2019;32:1.
  • Donald F, et al. A systematic review of the effectiveness of advanced practice nurses in long-term care. J Adv Nurs. 2013;69:2148.
  • Green LV, et al. Primary care physician shortages could be eliminated through use of teams, nonphysicians, and electronic communication. Health Aff (Millwood). 2013;32:11.
  • Kacik A. Advanced practice and nurse practitioners bring more profit, productivity to medical practices. www.modernhealthcare.com/article/20180720/NEWS/180729986/advanced-practice-and-nurse-practitioners-bring-more-profit-productivity-to-medical-practices. Accessed Oct 29, 2021.

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Filed under: Urology , Practice Management/Career

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