APEx FAQs

No, the Standards Guide is proprietary information and is only shared with the radiation oncology practice after payment is processed.

APEx provides flexibility in the accreditation timeline so practices may choose the best option for them. APEx accreditation is valid for three or four years from the date of the practice's APEx determination. This choice is made during the application process.

Each practice's time frame varies and is dependent on several things, such as the amount of time and staff dedicated to the accreditation process and what level of standardization and documentation is already in place.

Below are the four main phases of APEx and approximate time frames:

Application: Consists of general practice information, legal agreements and submission of payment. ASTRO suggests sending the legal agreements to legal representatives for review as soon as the ROP starts an application. The practice information can be completed in one day.

Self-Assessment: Consists of an internal review by practice staff to assess compliance with APEx Standards.

• Practices have six months to complete the Self-Assessment, but some practices have been able to finish in two months. 
  • The Document Uploads section requires an external review once submitted, which takes between four to six weeks.
  • The Medical Record Review and Physics Checklist can be completed in one day and provide instantaneous results.

Facility Visit Prep: Consists of preparing for the facility visit. Facility visits are usually finalized within four weeks.

Determination: Consists of the final accreditation decision, made by ASTRO’s Practice Accreditation Subcommittee, based on the findings collected during the Facility Visit. The accreditation determination is communicated to the ROP between four to six weeks after the facility visit.

To meet the APEx requirement, a radiation oncologist should provide direct supervision, immediately available to provide assistance throughout the duration of the procedure. While APEx understands that a radiation oncologist may need to step away for a meeting or consultation with inpatients, a physician should be present at the facility to assure patient safety.

Exclusions may apply for facilities in rural exemption areas. Please contact APEx Support with any questions.

Yes, APEx is accepted throughout the U.S. and is recognized by all state regulations where applicable.

Yes, the U.S. Department of Veterans Affairs accepts APEx as an accrediting body for community-based facilities that treat veterans in the absence of a VA medical center.

Yes, the new APEx Portal opened in May 2024 and updated Standards are now available. Start your registration now.

Unique Qualities of APEx: Key Highlights Explored provides an overview of what sets APEx apart from other accreditation programs. The document highlights distinctive APEx requirements, such as the culture of safety, intradisciplinary peer review for all professions and patient education/referrals. This document can help your practice make an informed accreditation decision.

ASTRO has created a library of presentation slides called Transitioning to APEx Accreditation that you can customize depending on your audience (e.g., administration, physics, etc.). These slides will help you effectively communicate the advantages of APEx to your team and address any questions they may have.

Hearing from colleagues who have completed the APEx process can provide valuable insights. You can request a teleconference with a knowledgeable radiation oncology professional from your chosen discipline by completing the peer-to-peer request form. This meeting will allow you to ask specific questions and learn from their experiences.

In order to qualify as a multi-facility practice, you need:

• Common policies and procedures of key evidence indicators.
• An individual or committee from within radiation oncology practice leadership who is responsible for overseeing the operations of the multi-facility practice, including the culture of safety.
• A medical director, who is a radiation oncologist, responsible for each facility.
• All facilities located within a 50-mile radius of the main facility.

Satellite facilities that are located within 50 miles of a main facility, and meet all satellite requirements, may be included in the application as part of a multi-facility practice; however the application will be placed on hold. Please contact ASTRO for further guidance. If accepted, there may be an additional fee of $3,000 for each satellite in this range. Satellite facilities located more than 150 miles from the main facility are required to do a separate application.

To make APEx scalable, ASTRO’s legal agreements must be used and ASTRO generally cannot accept changes to these agreements. Contact APEx Support with questions.

 

These prices are inclusive of all program-related expenses (e.g., program participation, surveyor travel costs) and is the only payment required throughout the accreditation cycle.

Yes, discounted rates are available for entities that have more than 10 facilities active within the APEx program. Once 10 facilities, under the same ownership or affiliation, have entered into facility agreements and submitted payment for the APEx program, a discount is available for $2,000 off the price of any subsequent main facility applying for a four-year APEx cycle. ROPs must notify ASTRO of their eligibility for the discount rate at APEx Support prior to submitting payment.

The Self-Assessment is a unique aspect, and acts as a self-study of the practice's compliance with the APEx Standards. The Self-Assessment helps practices identify deficiencies and promotes quality improvement. This activity leads to higher compliance during the facility visit, as it allows the facility to set a baseline and implement changes or confirm their compliance with APEx Standards before the facility visit.

The Self-Assessment is conducted by the main facility in a multi-facility practice. Some information will be required from any satellite locations if they treat with unique techniques not found at the main facility.

APEx staff work with your schedule and that of the APEx surveyors to identify the best time for all parties. 

Yes. The main facility will have an all-day facility visit, while each satellite location will have a half-day facility visit. All facility visits in a multi-facility practice occur on the same day.

No, determinations are not made during the facility visit. It takes four to six weeks after the facility visit to receive an APEx accreditation determination.

ASTRO's  Practice Accreditation Subcommittee is charged with issuing accreditation determinations based on the review of blinded facility reports from the facility visit. The committee is multi-disciplinary and includes radiation oncologists, medical physicists, radiation therapists and medical dosimetrists who are trained APEx Surveyors.

Practices may receive one of three accreditation determinations:

1. Full accreditation
2. Provisional accreditation
3. Denial

No, a multi-facility practice will receive a single determination based on the lowest-performing facility.

Example: A multi-facility practice of four facilities applies for APEx. After the facility visit, three facilities receive full accreditation and one facility receives provisional accreditation. The entire multi-facility practice would be awarded provisional accreditation.

Practices that receive provisional accreditation must submit a corrective action plan (CAP) for low performing evidence indicators outlining how compliance will be achieved. CAPs are submitted and blinded before review by the Practice Accreditation Subcommittee. If the CAP is accepted, the practice will receive full accreditation. If the practice's CAP is not accepted or not submitted within the required time frame, the ROP is denied accreditation.

A practice has the right to appeal their decision based on specific criteria (see APEx Procedures for more information). The appeal request must be submitted to APEx Support within 30 days of the determination.

To avoid a lapse in your accreditation status, ASTRO recommends starting the reaccreditation process 12 months before the expiration of a current accreditation cycle. 

The practice can add/remove any satellites as necessary, during the registration process. The registration is prepopulated with information from the initial application. Practices can update each facility’s information (e.g., treatment modalities, physicians).

There may be several reasons why the option isn't available.

• It is too early to start. The reaccreditation registration opens 12 months prior to the current expiration date.
• You are not the APEx Administrator. Only one person at a practice has access to the registration. Please contact APExSupport to find out who that person is or to update the information. 

The practice will begin by reviewing and submitting their application, legal agreements and payment to ASTRO. Once this is complete, the practice will gain access to the Self-Assessment and facility resources. Each main facility must complete the Self-Assessment to be deemed ready to schedule a facility visit.

A practice's time frames vary and are dependent on several things, such as the amount of time and staff dedicated to the accreditation process and what level of standardization and documentation was retained from the initial accreditation process. The data shows that most practices going through reaccreditation with APEx complete the process faster than the initial process.

To avoid a lapse in your APEx accreditation status, the ROP should receive a reaccreditation determination before your current accreditation expires. Extensions of your accreditation status will be granted if 1) the facility visit is finalized before your expiration date and 2) the facility visit occurs within 90 days of your expiration date. Accreditation extensions are valid until a new determination is given.

Example: If an ROP’s accreditation is set to expire on March 31, an extension will be granted if a facility visit is finalized before March 31 and occurs before June 29.