Prevalence and Practice Characteristics of Advanced Practice Providers in Upper-Extremity Surgery, 2013-2021

Area of Science:

• Orthopedics and Sports Medicine
• Health Services Research

Background:

• The diagnosis and treatment of hand, wrist, and upper extremity conditions require specialized care.
• Advanced Practice Providers (APPs), including nurse practitioners and physician assistants, play an increasingly vital role in healthcare delivery.
• Understanding the scope and trends of APP involvement in upper extremity care is crucial for healthcare planning.

Purpose of the Study:

• To evaluate the prevalence, characteristics, and reimbursement of APPs providing upper extremity care in the U.S. from 2013 to 2021.
• To analyze the trends in APP utilization for hand, wrist, and upper extremity diagnoses and treatments.

Main Methods:

• A retrospective cohort study utilizing Medicare Provider Utilization and Payment Data Public Use Files (2013-2021).
• Identification of APPs and their services through provider type and billing codes for upper extremity care.
• Analysis of trends in diagnostic, procedural, and therapeutic services provided by APPs over the study period.

Main Results:

• From 2013 to 2021, APPs constituted 35.3% of upper extremity care providers, with physician assistants (25.2%) and nurse practitioners (10.1%) showing significant presence.
• The number of APPs billing for upper extremity care surged by 170.9%, from 1,965 in 2013 to 5,324 in 2021.
• Non-surgeon APPs were more likely to be female and practice in rural areas compared to upper extremity surgeons.

Conclusions:

• There is a substantial and growing prevalence of APPs in the field of upper extremity care.
• The trend of increasing APP involvement in upper extremity care is expected to persist.
• Given projected surgeon workforce shortages and rising demand, further discussion on the scope of practice and integration of APPs is warranted.