Effects of Advanced Practice Providers on Single-specialty Surgical Practice

Abstract

Objective: To assess the effects of adding advanced practice providers to surgical practices on surgical complications, readmissions, mortality, episode spending, length of stay, and access to care. Summary Background Data: There has been substantial growth in the number of nurse practitioners and physician assistants (ie, advanced practice providers) in the United States. The extent to which advanced practice providers have been integrated into surgical practice, and their impact on surgical outcomes and access is unclear. Methods: Using a 20% sample of national Medicare claims, we performed a retrospective cohort study of fee-for-service beneficiaries undergoing one of 4 major procedures (coronary artery bypass graft, colectomy, major joint replacement, and cystectomy) between 2010 and 2016. We limited our study population for each procedure to patients treated by single-specialty surgical groups to ensure that the advanced practice providers have direct interactions with its surgeons and patients. All outcomes were measured at the practice level for the year before and the year after the addition of the first advanced practice provider. Outcomes included: complications, readmission, mortality, episode payments, length of stay. Models were adjusted for age, race, sex, comorbidity, socioeconomic class and procedure type. Secondary outcome: practice-level office visits by surgical group type. Results: The number of advanced practice providers increased by 13%, from 6713 to 7596 between 2010 and 2016. The largest relative increases occurred in general (46.9%) and urologic (27.6%) surgical practices. The year after an advanced practice provider was added to a surgical practice, the odds of complications were 17% and 16% lower at 30-and 90-days postprocedure, respectively. Additionally, 90-day readmissions were 18% less likely and length of stay was 0.33 days shorter (a 7.1% reduction). Average 30-day and 90-day episode spending was $1294.73 and $1427.76 lower, respectively (P < 0.001). General surgical, orthopedic, and urology practices realized increases of 49.0 (95% CI 13.5-84.5), 112.0 (95% CI 83.0-140.5), and 205.0 (95% CI 117.5-292.0) in-office visits per surgeon, respectively. Conclusions: The addition of advanced practice providers to singlespecialty surgical groups is associated with improvements in surgical outcomes and access. Future work should clarify the mechanisms by which advanced practice providers within surgical practices contribute to health outcomes to identify best practices for deployment.

Advanced Practice Providers and Wait Times in Urology Offices: A Secret Shopper Study

“…14 While APPs have historically been focused on office-based primary care, specialist and surgical offices employ a growing share of APPs. 15,16 American Urological Association census data from 2018 demonstrated that 68% of urban urology offices employ an APP in their office, with 78% of APPs working primarily in an ambulatory clinic setting. 17 We are not aware of any data detailing the role of APPs in new patient visits in urology.…”

Projected US Urology Workforce per Capita, 2020-2060

“… 5 However, it is crucial to sustain growth in the number of urologists alongside that of advanced practice practitioners given that urologists are key practitioners of surgical services and the extent of advanced practice practitioners’ practice within urology is understudied at this time. 26 Physician burnout remains a constant threat to a stable urology workforce. 14 Creating organizational cultures where urologists are supported through greater autonomy and flexibility, improvements in work-life balance, more diverse and inclusive work communities, and greater efficiency will help buffer against burnout and lead to a more robust, stable, and productive workforce.…”

“…Continued utilization of advanced practice practitioners may bridge the gap between patient’s access to care by serving as vital partners in providing quality care to patients . However, it is crucial to sustain growth in the number of urologists alongside that of advanced practice practitioners given that urologists are key practitioners of surgical services and the extent of advanced practice practitioners’ practice within urology is understudied at this time . Physician burnout remains a constant threat to a stable urology workforce .…”

Positionspapier der Deutschen Gesellschaft für Thorax-, Herz- und Gefäßchirurgie zum Einsatz von Physician Assistants in der Herzchirurgie

“…Des Weiteren zeigte sich durch die Einführung eines APP-Programmes auch ein ökonomischer Vorteil mit einer signifikanten Reduktion der 30-Tage-Behandlungskosten um 1294,73 US Dollar (p < 0.001). 10 Eine…”