Surgical Oncology APP Productivity: wRVUS and Continuity of Care Measures

Abstract

With the evolution of the electronic health records (EHR), the volume of non-billable work including direct patient emails, order entry, and numerous notifications has potential to affect provider productivity, well-being, and in some cases quality of patient care. Non-billable care coordination tasks, described as Service Value Activities (SVAs), is often not considered when evaluating productivity of providers despite the significant time spent on these tasks. This workflow redesign project evaluated the impact of a Team-Based Model of Care implementation focused on delegation of SVAs to the appropriate health care team member based on the optimal scope of practice in a Gastrointestinal (GI) Surgical Oncology clinic. Role specific outcomes were evaluated including time spent on SVAs and change in work Relative Value Units (wRVU) and clinic visit productivity for surgical Advanced Practice Providers (APPs). The project goals were to decrease APP time spent on SVAs and increase billable activities by implementing an “In Basket” Management workflow redesign based on a Team-Based Care Model. Before implementation, GI Surgical Oncology APPs spent 55.4 minutes per day in “In-Basket” management and saw 46.3 patients per month. Following implementation of the Team-Based Care Model, the GI Surgical Oncology APPs spent 38.5 minutes per day in “In Basket” management and saw 50.2 patients per month. The wRVUs for the APPs increased by 58% which increases potential for increased revenue. Through scope of practice role delineation and task delegation, health systems can improve patient access, patient care, staff utilization, and well-being.