Advanced Practice Providers Utilization Trends in Otolaryngology From 2012 to 2017 in the Medicare Population

Ge, Marshall; Kim, Jeehong; Smith, Stephanie Shintani; PAUL, Julianna V; Park, Christine; Su, Pei-Yi; Ference, Elisabeth H.

doi:10.1177/0194599820971186

Cited by 17 publications

(36 citation statements)

References 16 publications

(36 reference statements)

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“…28 Given the recent increase in the prevalence of advanced practice providers in otolaryngology practices, particularly nurse practitioners and physician assistants, the trend in consolidation of services may be even more pronounced than what our study suggests, as the overall volume of care being delivered per site is consolidated. 29,30 Last, it is important to note that our results and analysis compare the trends of size of practice, and in this way, we are unable to conclude anything on the trends relating to private vs academic practices. While many small practices are private ventures, further research is needed to assess whether these changes are being similarly seen with regard to private practice consolidation.…”

Section: Discussionmentioning

confidence: 84%

Practice Consolidation in Otolaryngology: The Decline of the Single‐Provider Practice

et al. 2022

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Objective To observe trends in practice consolidation within otolaryngology by analyzing changes in size and geographic distribution of practices within the United States from 2014 to 2021. Study Design Retrospective analysis based on the Physician Compare National Database from the US Centers for Medicare and Medicaid Services. Setting United States. Methods Annual files from the Physician Compare National Database between 2014 and 2021 were filtered for all providers that listed “otolaryngology” as their primary specialty. Organization affiliations were sorted by size of practice and categorized into quantiles (1 or 2 providers, 3-9, 10-24, 25-49, and ≥50). Both the number of practices and the number of surgeons within a practice were collected annually for each quantile. Providers were also stratified geographically within the 9 US Census Bureau divisions. Chi-square analysis was conducted to test significance for the change in surgeon and practice distributions between 2014 and 2021. Results Over the study period, the number of active otolaryngology providers increased from 7763 to 9150, while the number of practices fell from 3584 to 3152 in that time span. Practices with just 1 or 2 otolaryngology providers accounted for 80.2% of all practices in 2014 and fell to 73.1% in 2021. Similar trends were observed at the individual provider level. Regional analysis revealed that New England had the largest percentage decrease in otolaryngologists employed by practices of 1 or 2 active providers at 45.7% and the Mountain region had the lowest percentage decrease at 17.4%. Conclusion The otolaryngology practice marketplace has demonstrated a global trend toward practice consolidation.

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Section: Discussionmentioning

confidence: 84%

Practice Consolidation in Otolaryngology: The Decline of the Single‐Provider Practice

et al. 2022

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“…8 Given the increasing role of APPs in otolaryngology and the increased likelihood of APPs to practice in rural communities, understanding the geographic distribution of APPs providing otolaryngology services is necessary to address future shortages. 15…”

Section: Discussionmentioning

confidence: 99%

“…10-12 APPs are also playing a rapidly growing role within otolaryngology, increasing by 51% in number from 2012 to 2017, as compared with just 2.2% growth in otolaryngology physicians over the same period. 13-15 APPs can independently provide otolaryngologic services and bill Medicare under their own National Provider Identifiers, and NPs can practice with full independence in 22 states and the District of Columbia. 16 This study analyzes the geographic distribution of APPs independently billing Medicare for otolaryngology services with a focus on urban-rural disparities.…”

mentioning

confidence: 99%

Geographic Distribution of Otolaryngology Advance Practice Providers and Physicians

Liu

Smith³

et al. 2021

Otolaryngol.--head neck surg.

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Objectives Advanced practice providers (APPs), namely physician assistants (PAs) and nurse practitioners (NPs), play an increasing role in meeting growing demands for otolaryngologic services, particularly in rural communities. This study analyzes the geographic distribution of otolaryngology providers, which is essential to addressing future demands. Study Design Cross-sectional study. Setting Medicare Provider Utilization and Payment Data for 2017. Methods Current Procedural Terminology codes were used to identify APPs providing 10 common otolaryngologic services. Geographic distribution was evaluated by calculating densities of APPs and otolaryngologists per 100,000 persons in urban versus rural counties as defined by the National Center for Health Statistics Urban-Rural Classification Scheme. Results We identified cohorts of 8573 otolaryngologists, 1148 NPs, and 895 PAs. There were significantly higher population-controlled densities of otolaryngologists and APPs in urban counties as compared with rural counties. The majority of otolaryngologists (92.1%) and APPs (83.3%) were in urban counties. However, the proportion of APPs (16.7%) in rural counties was significantly higher than the proportion of otolaryngologists (7.9%) in rural counties ( P < .01). A significant majority of rural counties (72.2%) had zero identified providers, and a greater proportion of rural counties (5.0%) were served exclusively by APPs as compared with urban counties (3.2%). Conclusions Although otolaryngologists and APPs mostly practiced in urban counties, a relatively higher proportion of APPs practiced in rural counties when compared with otolaryngology physicians. The majority of rural counties did not have any otolaryngologic providers. Given the expected shortages of otolaryngology physicians, APPs may play a critical role in addressing these gaps in access.

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“…2 The present study found that advanced practice providers had fewer reviews than did physicians. In one study of Medicare data for years 2012-2017, there was no difference over time in number of patient visits performed annually per provider according to provider type, 28 but another study found that otolaryngology physicians provided more services and higher median number of Medicare patients than did advanced practice providers. 29 We speculate that the explanation for the difference in volume of PSS between advanced practice providers and The present study also found there are fewer women providers in academic otolaryngology, but women and men had similar overall and subgroup PSS.…”

Section: Discussionmentioning

confidence: 99%

Publicly Reported Patient Satisfaction Scores in Academic Otolaryngology Departments

et al. 2021

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Objectives/Hypothesis: Despite controversy regarding their impact and validity, there is a rising national focus on patient satisfaction scores (PSS). We describe the landscape of online PSS as posted by academic otolaryngology practices.Study Design: Retrospective cross-sectional study. Methods: Websites of academic otolaryngology programs were reviewed for PSS scores, provider type, and geographic location. Gender was determined by picture or profile pronouns. Years of experience were determined by year of initial American Board of Otolaryngology-Head and Neck Surgery certification. We defined PSS derived from Press-Ganey or Clinician and Group Consumer Assessment of Healthcare Providers and Systems surveys as "standardized PSS". We determined potential associations between provider characteristics and standardized PSS.Results: Out of 115 Otolaryngology-Head and Neck Surgery academic programs, 40 (35%) posted a total of 64,638 online PSS surveys (nonstandardized plus standardized) of 507 unique otolaryngology care providers. Standardized PSS were posted for 473 providers (370 [78%] male; 446 physicians; 27 advanced practice providers). Median overall standardized PSS was 4.8 (interquartile range 4.7-4.9; range 3.8-5.0). PSS were similar between gender, provider type, and years of experience. Male providers had more surveys than female providers (149 vs. 93; P < .01). There was a linear relationship between number of surveys and years of experience (P < .01), but no relationship between number of surveys and overall standardized PSS.Conclusions: Patient satisfaction with otolaryngology providers at academic institutions is consistently high, as demonstrated by high online PSS with little variability. The limited variation in PSS may limit their usefulness in differentiating providers and quality of care.

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Advanced Practice Providers Utilization Trends in Otolaryngology From 2012 to 2017 in the Medicare Population

Cited by 17 publications

References 16 publications

Practice Consolidation in Otolaryngology: The Decline of the Single‐Provider Practice

Practice Consolidation in Otolaryngology: The Decline of the Single‐Provider Practice

Geographic Distribution of Otolaryngology Advance Practice Providers and Physicians

Publicly Reported Patient Satisfaction Scores in Academic Otolaryngology Departments

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