Abstract
Background
To mitigate shortages of primary care physicians and ensure access to health care
services for a growing number of Medicare beneficiaries, some policy makers have recommended
expanding the supply and roles of nurse practitioners (NPs). Little is known about
the number of NPs billing Medicare or their practice patterns.
Purpose
This study examines the geographic distribution and county characteristics of NPs
billing Medicare, compares the types and quantities of primary care services provided
to Medicare beneficiaries by NPs and primary care physicians, and analyzes the characteristics
of beneficiaries receiving primary care from each type of clinician.
Methods
We performed a cross-sectional analysis of 2008 Medicare administrative data from
959,848 aged and/or disabled beneficiaries continuously enrolled in fee-for-service
Medicare during the study period. Outcome measures included geographic distribution
of NPs measured by the rate of NPs per 1,000 Medicare beneficiaries by state, average
utilization, and patient characteristics.
Discussion
States with the highest rate of NPs billing were rural. Over 80% of the payments received
by both NPs and primary care physicians were for evaluation and management services.
Beneficiaries assigned to an NP were more likely to be female, to be dually eligible
for Medicare and Medicaid, and to have qualified for Medicare because of a disability.
NPs with assigned beneficiaries were significantly more likely than similar primary
care physicians to practice in federally designated primary care shortage areas.
Conclusions
Approximately 45,000 NPs were providing services to beneficiaries and billing under
their own provider numbers in 2008. Aspects of NP practice patterns were different
from primary care physicians, and NPs appeared more likely to provide services to
disadvantaged Medicare beneficiaries.
Keywords
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Article info
Publication history
Published online: July 19, 2013
Accepted:
May 7,
2013
Received in revised form:
April 24,
2013
Received:
December 21,
2012
Footnotes
Supported by the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation, and Johnson and Johnson' Campaign for Nursing's Future. Drs. DesRoches, Perloff, Gaudet, and Buerhaus received grant support from Johnson and Johnson's Campaign for Nursing's Future.
The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and the preparation, review, or approval of the manuscript. Dr. DesRoches had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
