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Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019.

Cameron J Gettel1,2, Jeremiah D Schuur3, Jay B Mullen4

  • 1Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|November 5, 2022
PubMed
Summary

Advanced practice providers (APPs) are increasingly billing for high-acuity emergency care, especially in rural areas. Their independent billing for these services more than doubled between 2013 and 2019.

Keywords:
emergency medicinenurse practitionersphysician assistantsrural healthvisit acuity

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Area of Science:

  • Emergency Medicine
  • Healthcare Workforce Analysis
  • Health Services Research

Background:

  • Advanced practice providers (APPs) represent a growing segment of the emergency medicine (EM) workforce, particularly in rural settings.
  • Understanding the evolving practice patterns of APPs in emergency care is crucial for healthcare planning.
  • This study investigates trends in independent emergency care billing by APPs.

Purpose of the Study:

  • To evaluate trends in independent emergency care services billed by APPs from 2013 to 2019.
  • To assess the proportion of high-acuity emergency encounters managed independently by APPs.
  • To compare the practice patterns of APPs with those of emergency medicine physicians.

Main Methods:

  • A repeated cross-sectional analysis of Medicare Part B data from 2013 to 2019.
  • Included emergency clinicians independently reimbursed for at least 50 evaluation and management (E/M) services.
  • Stratified analyses by clinician type (APP, EM physician, non-EM physician) and geography (rural vs. urban).

Main Results:

  • APP independent billing for high-acuity emergency care increased from 5.1% in 2013 to 9.7% in 2019.
  • In rural areas, APP billing for high-acuity services rose from 7.3% to 16.4% during the study period.
  • Rural APPs showed a 58.8% relative increase in independently billed high-acuity services from 2013 to 2019, outpacing EM physicians.

Conclusions:

  • By 2019, APPs handled approximately 1 in 6 high-acuity rural ED encounters and 1 in 11 urban encounters independently.
  • Over one-third of average APP encounters were high-acuity E/M services.
  • Further research is needed on emergency care staffing decisions, considering training and reimbursement differences.