Abstract
Objective
As nurse practitioners (NPs) and physician assistants (PAs) become an integral part
of delivering emergency medical services, we examined the involvement of NPs and PAs
who billed independently in emergency departments (EDs).
Methods
We used Medicare provider utilization and payment data from 2012 to 2016 to conduct
a retrospective analysis. We examined the changes in the number of each clinician
type who billed independently for four common emergency services (CPT codes: 99282-5),
the change in their service volume, and the change in their average number of services
billed.
Results
Between 2012 and 2016, the proportion of NPs and PAs billing independently increased
from 18% to 22% for ED visits of low severity (99282), 23% to 29% for visits with
moderate severity (99283), 21% to 27% for visits with high severity (99284), 18% to
24% for visit with the highest severity (99285), and 23% to 29% across all four services.
The proportion of services provided by emergency physicians decreased from 66% to
63% across all four services, and from 11% to 9% for internists and family physicians.
The number of NPs, PAs billing independently, and emergency physicians increased by
65%, 35% and 12% respectively.
Conclusions
NPs and PAs are increasingly billing emergency services of all levels of severity,
independent of physicians. This trend is driven by a growing number of NPs and PAs
independently billing services, despite a relatively stable number of emergency physicians
(excepting the decline in rural areas), and diminished involvement of family physicians
and internists in EDs.
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Article Info
Publication History
Published online: January 31, 2019
Accepted:
January 29,
2019
Received in revised form:
January 28,
2019
Received:
December 3,
2018
Footnotes
☆The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. This research is not funded by any organization. We thank Tianxin Li for research assistance.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
