Rising high‐acuity emergency care services independently billed by advanced practice providers, 2013 to 2019

Abstract

Background: Advanced practice providers (APPs) comprise an increasing proportion of the emergency medicine (EM) workforce, particularly in rural geographies. With little known regarding potential expanding practice patterns, we sought to evaluate trends in independent emergency care services billed by APPs from 2013 to 2019. Methods: We performed a repeated cross-sectional analysis of emergency clinicians independently reimbursed for at least 50 evaluation and management (E/M) services (99281-99285, 99291) from Medicare Part B, with high-acuity services including Codes 99285 and 99291. We describe the outcome proportion of E/M services by acuity level and report at (1) the encounter level and (2) at the clinician level. We stratified analyses by clinician type and geography.

Attrition From the US Emergency Medicine Workforce During Early Stages of the COVID-19 Pandemic

“…3 We included emergency physicians receiving reimbursement for at least 50 evaluation and management services (99281 to 99285) per year from Medicare part B. 1 , 4 …”

How to effectively integrate advanced practice providers into the ED workforce

“…Gettel et al 1 showed that APP use has increased since 2013. Other data show that APP use has been increasing for decades.…”

“…In this issue of Academic Emergency Medicine, Gettel et al 1 show increasing numbers of U.S. emergency departments (EDs) and high‐acuity visits billed by advanced practice providers (APPs) from 2013 to 2019. The term APP refers to physician assistants (PA) and nurse practitioners (NP).…”

“…The third issue is to understand why EDs current use APPs. Gettel et al 1 showed that APP use has increased since 2013. Other data show that APP use has been increasing for decades 6,7 .…”

Reply to “Response to rising high‐acuity emergency care services independently billed by advanced practice providers, 2013 to 2019”

“…We thank Mr. Wu and Dr. Darracq for their interest in our research regarding the billing of high‐acuity emergency care services by advanced practice providers (APPs) from 2013 to 2019 1 . We agree that descriptive data, such as this, can be used to inform discussions about the changing dynamics of the emergency medical workforce 2,3 …”