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Advanced Practice Provider-Attributed Outpatient Visits and Procedures for Urologic Oncology Care in the United
Aidan S Weitzner1, Achyutha Kodavatikanti2, Laura Alvim1
1Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Introduction:
Integration of advanced practice providers (APPs) into the clinic setting holds potential to streamline care in urologic oncology. The impact of APP-attributed care in genitourinary oncology has not been well described. We sought to characterize national trends and the financial impact of APP-attributed outpatient visits and procedures within a privately insured urologic oncology population.
Methods:
We identified bladder, kidney, prostate, and testis cancer claims within the Merative MarketScan database from 2010 to 2023. Annual proportions of first-visit, overall, and select procedural APP-attributed claims were assessed descriptively. Comparisons by geographic status, urbanicity, insurance plan, and metastatic status were evaluated using chi-squared testing and multivariable modeling. Overall and out-of-pocket twelve-month health expenditures were assessed by whether first oncologic visit was APP-attributed.
Results:
There were 507,053 APP-attributed claims, increasing from 0.88% in 2010 to 3.38% in 2023. In adjusted analysis, later calendar year (OR: 1.1; p<0.001) had significantly higher odds of APP involvement, while residence within the Northeast (OR: 0.68; p<0.001) had significantly lower odds. APP-attributed first visits were associated with lower 12-month insurer-paid (SR: 0.81; p<0.001) and out-of-pocket (SR: 0.90; p<0.001) spending. Rates of APP-attributed cystoscopy and prostate biopsy remained modest.
Conclusion:
APP-attributed office and procedural outpatient visits are increasing, with variations in uptake present by practice region and patient characteristics. APP-attributed first visits were associated with lower 12-month insurer-paid spending without increased patient out-of-pocket spending.
