Increasing Utilization of Advanced Practice Providers in Spine Surgery from 2013 to 2022: A Medicare Part B Analysis

In modern healthcare systems, the role of advanced practice providers (APPs), including nurse practitioners (NP) and physician assistants (PA), has increased in many settings, in step with the increased demand for healthcare services. The purpose of the present investigation was to evaluate trends in the prevalence, reimbursement, and characteristics of care provided by APPs in the treatment of spinal disorders in the United States from 2013 to 2022.

A retrospective cohort study using the publicly available Medicare Provider Utilization and Payment database from the Centers for Medicare and Medicare Services was conducted on diagnostic, procedural, and therapeutic services provided by advanced practice providers from 2013 to 2022. Provider-type and billing codes were used to identify healthcare professionals providing care for spine patients, such as ordering radiographs, assisting in surgical procedures, or performing office visits. Trends were analyzed using linear regression modeling with projections generated through 2030.

Over the study period, the number of surgeons involved in spine care decreased from 3953 (71.2%) in 2013 to 3951 (66.7%) in 2022. The number of APPs who billed for the care of spine patients increased 23.3% from 1600 in 2013 to 1974 in 2022. The most common services billed for by APPs included radiographs and office visits. There were increased odds (OR: 1.20, 95% CI, 1.03-1.41, P < 0.001) of a spine provider in rural areas being an APP versus spine surgeon. Forecasting analysis for 2030 demonstrated continuation of these trends regarding the number of providers, services, and geographic distribution.

Increased utilization of APPs in the care of patients with spinal pathology is likely to continue with the growing prevalence of patients with spinal disorders.