March 2023

Miami Cancer Institute First to Use APEx's New Satellite Synchronization Process

By Charlotte Raley, Quality Improvement Analyst, ASTRO

Accreditation’s importance is growing among radiation oncology practices for ensuring safety and quality of patient care. With the trend of practice consolidation and growth, ASTRO’s APEx - Accreditation Program for Excellence® has seen a surge in requests to synchronize new or acquired facilities into existing accreditation cycles. This reflects a practice’s desire to ensure continuous quality improvement and alignment of processes, especially for those with new facilities.

Previously, requests to add facilities to an existing accreditation had to wait until the next cycle, delaying the process of solidifying or aligning procedures in newly acquired or built facilities. To address this, APEx initiated a satellite synchronization process that allows practices to add new facilities to their current accreditation cycle. Any new satellite(s) will be assessed on their compliance with the APEx Standards, going through the same rigorous process as the previously accredited facilities. This process is open to APEx-accredited practices that want to add new facilities during the accreditation process or within the first three years of their four-year accreditation cycle.

The first practice to take advantage of this option was the Miami Cancer Institute. They opted to bring their new facility in Plantation, Florida, into alignment with their main facility in Miami, which received APEx accreditation in 2021 and was the first APEx-accredited proton center in south Florida. The newly added satellite at Plantation is also the first APEx-accredited facility in Broward County. We spoke with Alonso Gutierrez, PhD, MBA, Assistant Vice President, Chief Physicist at Miami Cancer Institute and Vice Chair of Medical Physics and Dosimetry at Florida International University, and Shandelle Castillo, MHA, Radiation Oncology Program Coordinator at Miami Cancer Institute, to get a firsthand account of what influenced their decision to choose APEx and their experience with the satellite synchronization process.

Gutierrez stated, “We wanted to have the same standards across all our radiation oncology centers within the Baptist Health South Florida enterprise and given that our satellite functions identically to our main site, just at a different physical location, it was something that was somewhat of a no-brainer for us to do.” Gutierrez says he expects that any future satellites within their network will also be APEx-accredited. “We didn’t really question [why APEx] because we feel it’s very RO-specific and RO-dedicated, and from a quality of standards perspective, we firmly believe in the practice standards that APEx sets forth [for patient care].”

When asked about the process itself, Castillo reported “the process was fairly easy; [ASTRO staff] gave us a timeline for everything and provided all the documentation that we needed, and then the on-site review was very well organized.” Gutierrez added, “We had a kickoff meeting to really talk about the expectations of [the process], and it was very much in sync with the main site accreditation, making it easy for us to leverage a lot of the work we had previously done.”

The process consists of a practice submitting an application for synchronization, paying an additional fee and scheduling an in-person facility visit. The visit results are sent to ASTRO’s Practice Accreditation Subcommittee and follows the normal process to determine the facility's accreditation status. If the facility receives full accreditation, it will be added and “synced” to the practice's cycle.

“Synchronization is a great word because it actually parallels the expectations of the main site, but it’s done at a level of efficiency. The process is done just as rigorously, but efficiently and streamlined, so redundancy gets minimized. You can focus on the key aspects of the program, knowing that the main site has already gone through the more demanding documentation and process development [components].”

The new APEx satellite synchronization process is intended for practices to maintain high standards of care as they grow and ensure those standards are maintained across all facilities within a practice. “We thought the process was well organized and well structured”, says Gutierrez. He notes that accreditation is important to patients as well. “They may not know what it entails, but for [us] to say [we’ve] gone through a rigorous process for high quality [care] adds credibility to the organization.”

If your practice could benefit from the APEx satellite synchronization process, contact ASTRO staff and get started today!

Posted: March 15, 2023 | 0 comments

Balance in Radiation Oncology Workforce Supply and Demand Predicted through 2030

By Geraldine Jacobson, MD, MBA, MPH, FASTRO; Bruce Haffty, MD, FASTRO; Pranshu Mohindra, MD, MPH; and Chirag Shah, MD

On behalf of the ASTRO Board of Directors and the ASTRO Workforce Task Force, we are pleased to announce that the wait is over. The final report of the radiation oncology workforce study commissioned by ASTRO and conducted by Health Management Associates (HMA) is now out.

Let’s back up a bit for those of you who may be unfamiliar with the actions of the ASTRO Board more than a year and a half ago. In June 2021, then-ASTRO Chair Tom Eichler, MD, FASTRO, called for the formation of a Workforce Task Force to look into the concerns that many felt about a potential radiation oncologist supply and demand imbalance given a drop in interest in the specialty during the NRMP Match process. The Task Force was comprised of a diverse group of radiation oncologists, including representatives from the Society of Chairs of Radiation Oncology Programs (SCAROP), Association of Directors of Radiation Oncology Programs (ADROP), Association of Residents in Radiation Oncology (ARRO), ASTRO’s Committee (now Council) on Health, Equity, Diversity and Inclusion (CHEDI) and both community-based and academic practitioners.

Our first recommendation to the ASTRO Board was to authorize a Request for Proposal (RFP) to conduct an independent, unbiased workforce analysis. A formal RFP was issued to third-party consulting companies experienced in conducting this type of analysis. After a thorough evaluation of the proposals, the task force recommended, and the Board approved, hiring HMA, a research firm with strong expertise in this complex analysis. Specifically, HMA was tasked with evaluating the current and future supply of radiation oncologists, demand for radiation oncology services and projecting future trends through 2030. It is important to emphasize, while the study was funded by ASTRO, significant steps were taken to ensure an independent analysis, with ASTRO leadership maintaining an arm’s length from the HMA team. The task force served as representatives of the specialty who were available to HMA as resources to provide iterative feedback in the development of the model.

Meanwhile, the task force also proposed, and the Board approved, an updated ASTRO Workforce Statement in February 2022 focusing on issues impacting residency training programs, including the size, selection process and scope of training programs and published an editorial in the Red Journal that provided more context on the statement. ASTRO members also had the opportunity to learn more about the process and provide their feedback during the 2022 Annual Meeting, which resulted in meaningful changes to HMA’s methodology that reflected members’ real-world experiences.

We are pleased to announce the final HMA report, “Projected Supply and Demand for Radiation Oncologists in the U.S. in 2025 and 2030,” is now available. The analysis includes an evaluation of radiation oncologist supply (new graduates, exits from the specialty) and potential changes in demand (growth of Medicare beneficiaries, hypofractionation, loss of indications, new indications) as well as radiation oncologist productivity (measured as work RVUs produced per radiation oncologist) and demand per beneficiary. The results of the analysis and what HMA deemed the most likely scenario demonstrated a relative balance between radiation oncologist supply and demand for radiation services through 2030; the growth in radiation oncologists was balanced by the rapid growth of Medicare beneficiaries over the same time period. The primary factors driving the model were found to be growth of Medicare beneficiaries and changes in work RVU productivity, with hypofractionation and loss of indications having only a moderate impact. While the most likely scenario was a balance of workforce supply and demand, some scenarios did demonstrate the possibility of over- and undersupply.

While the analysis took into consideration multiple parameters and evaluated multiple scenarios, it is recognized that no model is perfect. Given the heterogeneity of our specialty, it is not surprising that the scenarios presented in the report lead to variable conclusions. HMA also developed a modeling tool that allows programs and practices to evaluate different scenarios. We encourage individuals to use this tool to assess the workforce using the unique variables specific to their own environment. We also recognize that continuing study will be needed as new data emerge, including Medicare beneficiary and wRVUs, to evaluate the balance of supply and demand in radiation oncology in the years beyond 2030. The ASTRO Board and Workforce Subcommittee remains vigilant in monitoring the need for future assessment.

We invite you to read the task force’s interpretation of the study, which is available online in the Red Journal as an open access Article in Press. The HMA final report is available as a supplement to the paper and the modeling tool is available for download. Please submit your questions in the comments below or on the ROhub.

Read previous posts:

A Look Ahead at the Radiation Oncology Workforce in the United States – Bruce Haffty, MD, FASTRO; Chirag Shah, MD; and Pranshu Mohindra, MD, MPH, March 1, 2022

The Future of our Field – Thomas Eichler, MD, FASTRO, January 5, 2021

A Commitment to the Field - Theodore DeWeese, MD, FASTRO, March 10, 2020

The Residency Training Landscape, Continued - Paul Harari, MD, FASTRO, May 28, 2019

The Residency Training Landscape - Paul Harari, MD, FASTRO, March 20, 2019

Posted: March 7, 2023 | 0 comments