Trends in Operating Room Assistance for Major Urologic Surgical Procedures: An Increasing Role for Advanced Practice Providers

Swanton, Amanda; Alzubaidi, Ahmad; Han, Yu; Nepple, Kenneth G.; Erickson, Beth

doi:10.1016/j.urology.2017.05.007

Cited by 13 publications

(6 citation statements)

References 12 publications

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“…[1][2][3] Currently, APPs have become fixtures in the clinical setting, serving a critical role across the spectrum of medical disciplines, from delivery of primary care in rural settings to assisting in the operating room in highly specialized surgery. [4][5][6][7][8][9][10][11] There have been numerous studies examining the impact of APPs, with the majority demonstrating equivalent financial and clinical outcomes between teams that do employ APPs and those that do not. 12,13 Other studies quantifying the effects of APPs in field found APPs increase the efficiency of attending surgeons.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Risks and Rewards of Advanced Practice Providers in Cardiothoracic Surgery Training: National Survey

Blitzer

Tchantchaleishvili

Lou

et al. 2019

The Annals of Thoracic Surgery

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Background. Changes in healthcare have led to increasing utilization of Advanced Practice Providers (APPs), but their role in Cardiothoracic Surgery (CTS) education remains undefined. This study aimed to analyze the extent of APP utilization on the CTS team, their role within the hierarchy of clinical care, and the impact of PEs on CTS training from the resident perspective. Methods. CTS residents' responses to the 2017 Thoracic Surgery Residents Association (TSRA)/Thoracic Surgery Directors Association (TSDA) In-Service Training Examination (ITE) survey regarding the role of APPs in specific clinical scenarios, and perception of APP contribution to residents' educational environment were analyzed. Statistical analysis of categorical variables was performed in SPSS using a Fisher's exact test and Pearson Chi-Square with statistical significance set at p<0.05. Results. Response rate was 82.1% (280/341). The median number of employed APPs was 16-20 and 50.4% (n=141) reported 11-25 PEs at their institution. The median forAPPs in the operating room, floor, and intensive care unit was 3, 3, and 2 respectively. Overall impression of APPs was positive in 87.5% (n=245) of respondents, with 47.7% (n=133) being "very positive" and 40.1% being "positive" (n=112). In general, residents reported greater resident involvement in post-operative issues and operative consults and greater APP involvement in floor issues. 72.5% of residents had not missed a surgical opportunity due to APPs while, 9.6% missed an opportunity due to a APP despite being at an appropriate level of training. Of those that reported missed opportunities, 44% were I-6 residents. There were no significant differences in APPs' operative role based on resident seniority. Conclusions. The overall impression of APPs among CTS residents is favorable, and they more commonly are involved assisting on the floor or the operating room. Occasionally, residents report missing a surgical opportunity due to APPs. There is further opportunity to optimize and standardize their role

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Section: Accepted Manuscriptmentioning

confidence: 99%

Risks and Rewards of Advanced Practice Providers in Cardiothoracic Surgery Training: National Survey

Blitzer

Tchantchaleishvili

Lou

et al. 2019

The Annals of Thoracic Surgery

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“…The proportion of cases assisted by APPs rose significantly for all major urological procedures in a study period from 2003–2014. While this increased utilization does help to address the workforce shortage, 8 many surgeons feel that that the reduced fee (<20% of the primary surgeon rate) they are reimbursed as an assistant is not worthy of their time commitment in the operating room and that their time can be more effectively utilized in other clinical activities.…”

Section: Resultsmentioning

confidence: 99%

Current State of Advanced Practice Providers in Urological Practice

et al. 2022

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Introduction:This document provides an update to the 2015 consensus statement with new content on inpatient utilization, procedural data, and compensation. The full document is available on the American Urological Association (AUA) website (https://www.auanet.org/ guidelines/guidelines/current-state-of-advanced-practice-providers-in-urologic-practice). This document was created by an ad-hoc group of urological providers formed by the AUA board of directors.Methods: A workforce shortage of 65,000 physicians is projected by the year 2025. In 2018, there were 3.89 urologists per capita, which is amongst the most severe specialty shortages. Urology has the second oldest surgical subspecialty workforce with an average age of 52.5 years. According to the 2018 census, 72.5% of urologists used an advanced practice provider (APP) in their practice, and APPs accounted for 41% of a medical doctor/doctor of osteopathy full-time equivalent. The AUA endorses the use of APPs in the care of patients through a formally defined, supervised role with a board certified urologist under the auspices of applicable state law. This physician-led, teambased approach provides the highest quality urological care.Results: Urologists work with APPs frequently, but many may not know the most efficient way to incorporate them into their practice. This document examines APP integration from a regulatory and practice management approach, as well as provides information on inpatient utilization, procedural data, and compensation.Conclusions: This document supports the AUA's policy statement that in a team-based approach with a board certified urologist in a supervisory role, APPs contribute to the care of the patient with genitourinary disease and, therefore, encourages the proper use of APPs.

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“…15 Additionally, APPs have increased their involvement in performing both urology office procedures and acting as surgical assistants for urologic operations. 3,16 APPs have also increased their involvement in nonvascular invasive radiology procedures. 17 This corresponds to our findings that APPs have increased their reimbursement and procedure proportion of many uroradiology procedures.…”

Section: Discussionmentioning

confidence: 99%

The Changing Roles of Urologists, Radiologists, and Advanced Practice Providers in Uroradiology Procedures

Lee,

Campbell,

Ceraolo

et al. 2024

Urology Practice

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Study Need and Importance: Urology has seen shifts in the management of many urologic conditions with the advent of noninvasive procedures that rely on multidisciplinary radiological modalities. This study seeks to analyze changes in urologists, radiologists, and advanced practice providers (APPs) performing uroradiology procedures over time. What We Found: There were significant changes in all examined uroradiology procedures when examining procedure Medicare reimbursement distribution between urologists, radiologists, and APPs in 2010 to 2021 (P < .001; Table ). During the period, urology saw decreases in reimbursement proportion as large as 28.7% for kidney cryoablation and increases as large as 14.2% for nephrostomy tube removals. Radiology saw the largest decreases in reimbursement proportion with an 18.9% decrease for nephrostograms, while the largest increase was 23.6% for suprapubic tube placements. APPs saw the largest increase in suprapubic tube changes reimbursement proportion, which rose 14.2% from 2010 to 2021. There were also significant changes in proportion of Medicare procedure count in all uroradiology procedures, except for antegrade stent, renal cryoablation, renal biopsy, and renal thermoablation. Limitations: The data for the study only include Medicare beneficiaries and do not represent all uroradiology procedures. Additionally, these data do not provide the context in which APPs were involved with these procedures or their affiliated specialty. Lastly, the context of procedures cannot be extrapolated from the dataset.Interpretation for Patient Care: The provider type that performs uroradiology procedures has seen shifts for each examined procedure. Most large changes in reimbursement and procedure proportion were shifted between urology and radiology, with APPs seeing smaller changes. Management of many urologic conditions for patients subsequently may be influenced by who performs each procedure, with potential differences in outcomes, complications, and follow-up management.

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Trends in Operating Room Assistance for Major Urologic Surgical Procedures: An Increasing Role for Advanced Practice Providers

Cited by 13 publications

References 12 publications

Risks and Rewards of Advanced Practice Providers in Cardiothoracic Surgery Training: National Survey

Risks and Rewards of Advanced Practice Providers in Cardiothoracic Surgery Training: National Survey

Current State of Advanced Practice Providers in Urological Practice

The Changing Roles of Urologists, Radiologists, and Advanced Practice Providers in Uroradiology Procedures

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