Oncology APP Productivity Cannot Be Measured by RVUs Alone

By Leah Lawrence - Last Updated: September 6, 2022

Productivity of advanced practice providers (APPs) can be best captured by reducing the focus on relative value units (RVUs) and accounting for important non-RVU-generating activities, according to a study published in the Journal of the Advanced Practitioner in Oncology.

“APPs specializing in oncology are critical team members in cancer centers across the US,” study researchers wrote. “Despite this, there is currently no standard method for assessing an APP’s contributions to oncology care or measuring APP productivity.”

The National Comprehensive Cancer Network (NCCN) Best Practices Committee created an APP Workgroup, and part of the group’s efforts have been to conduct surveys to better understand the current state of APP program structure, staffing models, and productivity measures and metrics.

The Workgroup developed the APP Structure and Productivity survey and the APP Productivity and Professional Development Survey in March 2019.  In all, 23 of 28 institutions responded to the Structure and Productivity Survey, and 492 APPs responded to the Productivity and Professional Development Survey.

Although more than half (54%) of member institution respondents indicated that they utilize RVU targets for independent APP visits, the majority (88%) of APPs are either unsure or do not believe RVUs are an effective measurement of overall productivity.

For example, RVUs do not reflect non-billable hours, and APPs perform a lot of non-billable tasks that are important to oncology practices.

“Most APPs spend a vast amount of time answering patient phone calls and emails, providing care coordination, and assisting with obtaining prior authorizations,” researchers wrote. “It was also noted that RVUs do not account for the complexities of caring for high acuity cancer patients who suffer from multiple comorbidities.”

Instead, 66% of APP believed that measuring disease-based team productivity was a more reasonable assessment of APP productivity than measuring it on an individual level. These metrics could include patient volume, discharge times, patient satisfaction scores, length of stay, team RVUs, and number of medication errors.

“Our recommendation for cancer centers is to focus on the value that APPs provide to care delivery more holistically,” the researchers wrote. “Advanced practice provider productivity metrics should consider not only the number of patients that APPs see, but also the high-quality care they provide that contributes to the health of their patients and the health of the practice.”



Measuring Advanced Practice Provider Productivity at the National Comprehensive Cancer Network’s Member Institutions