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Prevalence and scope of advanced practice provider oncology care among Medicare beneficiaries with breast cancer

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Abstract

Purpose

Advanced practice providers (APPs) have increasingly become members of the oncology care team. Little is known about the scope of care that APPs are performing nationally. We determined the prevalence and extent of APP practice and examined associations between APP care and scope of practice regulations, phase of cancer care, and patient characteristics.

Methods

We performed an observational study among women identified from Medicare claims as having had incident breast cancer in 2008 with claims through 2012. Outpatient APP care included at least one APP independently billing for cancer visits/services. APP scope of practice was classified as independent, reduced, or restricted. A logistic regression model with patient-level random effects was estimated to determine the probability of receiving APP care at any point during active treatment or surveillance.

Results

Among 42,550 women, 6583 (15%) received APP care, of whom 83% had APP care during the surveillance phase and 41% during the treatment phase. Among women who received APP care during a given year of surveillance, the overall proportion of APP-billed clinic visits increased with each additional year of surveillance (36% in Year 1 to 61% in Year 4). Logistic regression model results indicate that women were more likely to receive APP care if they were younger, black, healthier, had higher income status, or lived in a rural county or state with independent APP scope of practice.

Conclusions

This study provides important clinical and policy-relevant findings regarding national practice patterns of APP oncology care. Among Medicare beneficiaries with incident breast cancer, 15% received outpatient oncology care that included APPs who were billing; most of this care was during the surveillance phase. Future studies are needed to define the degree of APP oncology practice and training that maximizes patient access and satisfaction while optimizing the efficiency and quality of cancer care.

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Funding

This research was supported by a grant from the State of Wisconsin Tax Check-Off Program for Breast Cancer Research and the Cancer Center of the Medical College of Wisconsin (PI: Yen)

Author information

Authors and Affiliations

  1. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Tina W. F. Yen

  2. Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA

    Purushottam W. Laud

  3. Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Liliana E. Pezzin & Ann B. Nattinger

  4. Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA

    Tina W. F. Yen, Purushottam W. Laud, Emily L. McGinley, Liliana E. Pezzin & Ann B. Nattinger

  5. Division of Surgical Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Tina W. F. Yen

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  1. Tina W. F. Yen
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  2. Purushottam W. Laud
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  3. Emily L. McGinley
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  4. Liliana E. Pezzin
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  5. Ann B. Nattinger
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Corresponding author

Correspondence to Tina W. F. Yen.

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Conflict of interest

Dr. Yen has received the above research grant to support this study. All other authors declare no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This retrospective database study (PRO000024771) has received ethical approval by the Medical College of Wisconsin/Froedtert Hospital Institutional Review Board #5 as it satisfies requirements of 45 CFR 46.111.

Informed consent

A waiver of the informed consent process was granted by the institutional IRB as this retrospective database study was deemed “minimal risk”. The waiver of informed consent does not adversely affect the rights and welfare of the subjects and it would not be practical to conduct the research without a waiver.

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Yen, T.W.F., Laud, P.W., McGinley, E.L. et al. Prevalence and scope of advanced practice provider oncology care among Medicare beneficiaries with breast cancer. Breast Cancer Res Treat 179, 57–65 (2020). https://doi.org/10.1007/s10549-019-05447-x

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  • DOI: https://doi.org/10.1007/s10549-019-05447-x

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