Eligible applicants can access the application through the Facility Portal.

• Create a user registration within MedConcert and begin the APEx application.
• The ROP submits information about facilities including, annual number of new patients treated, treatments offered, equipment and physician names. 
• Information on all currently commissioned radiation therapy equipment. 
• A signed facility agreement and HIPAA business associate agreement. 
• Nonrefundable payment.

The application is officially in process when ASTRO receives a completed facility agreement and HIPAA business associate agreement and all required fees.

If you have any questions regarding the application, please contact APEx Support.

Practices assess their compliance with APEx accreditation standards by completing the Web-based self-assessment tool and using the APEx Self-assessment Guide, which provides a step-by-step process for completing the self-assessment. Practices submit their self-assessment, which includes medical record review, uploaded policies and procedures and other supportive materials.

During the self-assessment, data obtained through medical record review are derived from medical records chosen by the main facility. The information provided to ASTRO as a result of this self-assessment will not be patient protected health information. The medical records chosen by the facility for the self-assessment must meet the following requirements: 

• Records must be pulled proportionate to the number of physicians in the practice (e.g., three physicians in practice with 300 patients per year, each physician should be represented by five medical records). 
• Diversity in modality must be present; Each modality the practice uses must be represented by a minimum of one record.

ASTRO staff and surveyors review self-assessment and supporting documentation. An interim report is issued identifying strengths and gaps in compliance with the standards.

Interim report. The facility will be provided with a detailed interim feedback report that identifies the extent to which the facility is in compliance with each of the APEx evaluation criteria and may indicate deficiencies that must be addressed in order to progress to the facility visit. Applicants are notifi ed if they are ready to proceed for a facility visit or if they must complete the self-assessment again. The facility will have time to correct defi ciencies and has three (3) opportunities to pass the self-assessment. In addition, if the interim report identifi es new policies or processes that a facility must implement, the facility must demonstrate implementation, including that it has trained staff on the updated procedures. ASTRO will keep this report confi dential and only share it with the facility itself or as specifi ed in the APEx Policies and Procedures, unless otherwise required by law. A facility will be cleared for a facility visit when, in the judgment of ASTRO staff , a facility demonstrates compliance with each element of the APEx standards. The interim report is a preliminary indication of readiness for a facility visit; it is not a guarantee of accreditation.

If you have any questions regarding the self-assessment contact APExSupport@astro.org. 

ASTRO assigns a visiting team to conduct the facility visit. The team is selected from a list of names in the pool of approved surveyors who have undergone extensive APEx training. The team is selected based on:

• A conflict of interest review; 
• Geographic proximity to the facility (must be greater than 200 miles); and
• Expertise with the facility’s electronic health records (EHRs), treatment planning systems and modalities, among other considerations.

Prior to the facility visit, the surveyor team will have access to ROP’s APEx file, including the application (which describes the staffing, modalities, treatment planning system, electronic medical record system, etc.), and the document uploads from the self-assessment.

A pre-facility visit teleconference is conducted with the radiation oncology practice and ASTRO staff. The purpose of the teleconference is to staff availability, equipment, changes to the application, facility expectations, HIPAA security policies and other logistical arrangements. 

ROPs are expected to provide the following resources during the facility visit: 

• Patient list by name and case identification numbers. 
• Access to medical records/paper charts. 
• Two computers per surveyor. (One computer is needed to access the electronic medical record and another for the Web-based electronic data entry platform). 
• Staff resource to guide the surveyor through the medical record. 
• Dedicated work space for the surveyor team. 
• Access to key staff for interviews.

Each survey team assigned to a single location practice or “main campus” will generally consist of two radiation oncology professionals, including one medical physicist and one radiation oncologist (or other member of the radiation oncology team). This team will conduct an in-depth review at the main location that will last one business day. If an ROP has additional satellite facilities, an additional medical physicist surveyor will conduct expedited reviews of the Level 1 evidence indicators at the satellite facilities. One additional medical physicist surveyor will be added for every two satellite facilities. Satellite facility visits will be performed exclusively by medical physicists to confirm appropriate quality assurance activities.

• Surveyors submit final report. 
• Practice Accreditation Committee makes final determination (accredit, provisionally accredit, deny). 
• ASTRO notifies facility of determination.