1116 - The Role of Advanced Practice Providers in Functional Radiotherapy

Purpose/Objective(s): Advanced practice providers (APPs) are not widely utilized in radiation oncology though the role has been evolving. APPs in radiation oncology are associated with expediting inpatient palliative radiotherapy and increasing clinical capacity. We hypothesize that an APP has an integral role in coordinating and scaling a low dose functional radiotherapy (LDRT) program.

Materials/Methods: We conducted a retrospective single institution analysis of osteoarthritis (OA) patients who had undergone LDRT at an academic medical center. The program initiated in April 2024 and scaled through marketing efforts and community and colleague outreach in May 2025. Initiation period is defined as April 2024-April 2025 (13 mo) and the Scaled period is defined as May 2025–January 2026 (9 mo). The APP performs dedicated consultations to assess LDRT candidacy and return visits for response assessment/additional treatment with increasing role during the Scaled period. We analyzed patient characteristics, referral and encounter data, worked relative value units (wRVU), and ancillary service data with descriptive statistics.

Results: 194 patients were evaluated and 130 patients underwent LDRT to 265 unique joints for 328 total courses of treatment. During the Initiation period, 21 patients were treated (16.2%, 1.6 per mo), and during the Scaled period 109 patients were treated (83.8%, 12.1 per mo). Of the 194 patients evaluated, the APP independently evaluated and billed 170 patients (87.6%) with a total WRVU production of 515.5. In the Scaled period, the APP evaluated and billed 142 patients (15.8 per mo) with wRVU of 435.1 (48.3 wRVU/mo). The APP also performed non-billable 90-day follow up visits (n=39). Of the 170 billed patients, 28 (16.5%) were new to the health system since program conception, and 22 of those were new (78.6%, 2.4/mo) during the Scaled period. Since program conception, 11 of those 28 (39.3%) were referred for other health services including 10 of the 22 (45.4%) during the Scaled period. Referrals for ancillary services were initiated for 47 patients including Xray (31), orthopedics (5), physical therapy (4), pacemaker clinic (3), mammography (2), rheumatology (2), emergency department (1), pain management (1), podiatry (1), and positron emission tomography (1).

Conclusion: APPs can play a central and scalable role in the development and operationalization of LDRT programs for OA in radiation oncology clinics. An APP-led model facilitates efficient screening for LDRT candidacy, longitudinal follow-up, and coordination of multidisciplinary care and ancillary services, while generating sufficient wRVU to support program sustainability. This model demonstrates a viable framework for expanding access to functional radiotherapy while increasing departmental clinical capacity.