The following is the summary of “Analysis of trends in nurse practitioner billing for emergency medical services: 2015–2018” published in the December 2022 issue of Emergency medicine by Veenema, et al.

Nurse practitioners (NPs) are increasingly staffing Emergency departments  as hospitals seek to contain costs while expanding services, despite predictions of an oversupply of residency-trained emergency medicine physicians by 2030 and amidst intensifying national debate over NP qualifications to practice independently and unsupervised. Their goal was to better understand nurse practitioner (NP) work in the emergency department by analyzing NP-independent billing by illness severity, practice authority, state Medicaid expansion status, and rurality. The authors analyzed Medicare use and payment data from 2015 to 2018 to analyze nurse practitioner (NP) billing compared to 5 other clinician provider categories for frequent emergency services acuity codes (CPT codes 99281-30285). The relationship between state rules on NP practice authority, location, demographic characteristics and the number of services billed by clinician provider type was investigated.

There was a rise in the number of NPs independently billing for ED CPT codes (99282-99285) throughout this time period, but the number of billing for acuity code 99281 fell (minor and self-limiting). The highest severity CPT codes, 99284 and 99285, have seen the greatest growth among NPs compared to all other providers. The percentage of the population over 65 (as measured by zip code) and the total population size were found to be significant predictors of billed services, as were the kind of clinician, the policy of the state practice authority, the number of NPs, and the size of the population. Non-English speaking residents, rural locations, states that opted out of the Medicaid expansion, and primary care physicians were the unfavorable predictors.

The fraction of the highest acuity CPT codes billed by NPs as a share of all clinicians independently billing in the ED suggests that NPs increasingly handle patients with more severe conditions (99,284 and 99,285). A similar decline in billing by ED physicians was seen over this time span. To increase services for underserved populations in rural areas, among the elderly, and those with limited English proficiency, NPs are currently employed in the emergency department (ED). However, this may not be achieving the original vision of employing NPs in the ED to care for patients with lower acuity so that MDs could focus on the most acute and critically ill patients. More study is needed to determine why nurse practitioners (NPs) rather than physicians (MDs) are seeing patients with higher severity codes in the emergency department.

Source: sciencedirect.com/science/article/abs/pii/S073567572200612X