Advanced Practice Providers in Total Joint Arthroplasty: A National Assessment Demonstrates Increasing Prevalence and...

Advanced practice providers (APPs) are increasingly involved in surgical care delivery. This study analyzed Medicare data for total joint arthroplasty services delivered by APPs and explored their geographic distribution and practice characteristics.

A retrospective analysis was conducted using Medicare data from 2014 to 2023. Providers submitting claims for arthroplasty-related services were identified and classified by provider type. Demographic characteristics, practice locations, billing trends, and payment ratios were analyzed over the study period. Monetary values were adjusted for inflation to 2023 dollars.

There were 187,481 unique providers providing arthroplasty-related services over the study period. Most were orthopaedic surgeons (n = 121,087, 65%), and fewer were APPs (n = 66,394, 35%). The number of APPs increased 87% over the study period compared with a 17% increase observed among surgeons. The APPs were more likely to practice in rural areas (11 versus 7%), be newer in practice (11 versus 23 years), and have fewer office visits (32 versus 43) (all P < 0.001). The mean payment ratios were lower for APPs than surgeons (0.14 versus 0.22; P < 0.001) and decreased for both provider groups over the study period. Projections to 2030 demonstrated 15,782 orthopaedic surgeons (56%), 9,752 physician assistants (34%), and 2,884 nurse practitioners (10%) providing arthroplasty-related services.

The proportion of APPs providing arthroplasty-related services increased significantly from 2014 to 2023. Further work is needed to delineate APP responsibilities in total joint arthroplasty, including the development of standardized training pathways and evidence-based guidelines to support multidisciplinary care delivery.