Expanding Access to Otolaryngologic Care: The Growing Role of Advanced Practice Providers in Medicare

To evaluate national trends in Advanced Practice Provider (APP) participation in Otolaryngology (ear-nose-throat [ENT]) care and assess their role in improving access to ENT services within the Medicare population from 2018 to 2022.

We analyzed Medicare Provider Utilization and Payment Data from 2018 to 2022, including the Physician and Other Supplier Detailed and Aggregate Files. We examined 25 ENT-relevant CPT codes for provider type, procedural volume, and Medicare reimbursement. Providers were categorized as either ENTs or APPs based on their reported formal specialty designation. Descriptive statistics, t-tests, chi-square tests, and regression analyses were utilized to evaluate differences in service delivery, geographic distribution, and provider trends over time.

Between 2018 and 2022, the number of ENTs declined by 2.1% (95% CI, -2.4% to -1.8%), while the number of APPs increased by 36.1% (95% CI, 35.8%-36.4%). APPs performed an increasing share of ENT procedures, including diagnostic nasal endoscopy, laryngoscopy, and sinus debridement, and were more likely to practice in rural areas. APP participation grew across all U.S. regions. Although ENTs maintained higher mean procedural volumes and reimbursement rates, APPs demonstrated a broader geographic distribution and expanded independent billing capabilities.

APPs have become essential contributors to the delivery of ENT care in the United States. Their involvement in procedures and presence in underserved areas highlight their role as an effective strategy to address workforce shortages and improve access to otolaryngologic services.