Langston Joshua P, Duszak Richard, Orcutt Venetia L, Schultz Heather, Hornberger Brad, Jenkins Lawrence C, Hemingway Jennifer, Hughes Danny R, Pruthi Raj S, Nielsen Matthew E
Department of Urology, Eastern Virginia Medical School, Urology of Virginia PLLC, Norfolk, VA.
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA; Harvey L. Neiman Health Policy Institute, Reston, VA.
Urology. 2017 Aug;106:70-75. doi: 10.1016/j.urology.2017.03.047. Epub 2017 Apr 20.
To understand the role of Advanced Practice Providers (APPs) in urologic procedural care and its change over time. As the population ages and the urologic workforce struggles to meet patient access demands, the role of APPs in the provision of all aspects of urologic care is increasing. However, little is currently known about their role in procedural care.
Commonly performed urologic procedures were linked to Current Procedural Terminology (CPT) codes from 1994 to 2012. National Medicare Part B beneficiary claims frequency was identified using Physician Supplier Procedure Summary Master Files. Trends were studied for APPs, urologists, and all other providers nationally across numerous procedures spanning complexity, acuity, and technical skill set requirements.
Between 1994 and 2012, annual Medicare claims for urologic procedures by APPs increased dramatically. Cystoscopy increased from 24 to 1820 (+7483%), transrectal prostate biopsy from 17 to 834 (+4806%), complex Foley catheter placement from 471 to 2929 (+522%), urodynamics testing from 41 to 9358 (+22,727%), and renal ultrasound from 18 to 4500 (+24,900%) CONCLUSION: We found dramatic growth in the provision of urologic procedural care by APPs over the past 2 decades. These data reinforce the known expansion of the APP role in urology and support the timeliness of ongoing collaborative multidisciplinary educational efforts to address unmet needs in education, training, and guideline formation to maximize access to urologic procedural services.
了解高级执业提供者（APPs）在泌尿外科手术护理中的作用及其随时间的变化。随着人口老龄化以及泌尿外科医疗队伍难以满足患者就诊需求，APPs在提供泌尿外科各方面护理中的作用日益增强。然而，目前对于他们在手术护理中的作用知之甚少。
1994年至2012年期间，将常见的泌尿外科手术与现行手术操作术语（CPT）编码相关联。使用医师供应商手术摘要主文件确定国家医疗保险B部分受益人的索赔频率。研究了全国范围内APPs、泌尿外科医生以及所有其他提供者在众多跨越复杂性、急性程度和技术技能要求的手术中的趋势。
1994年至2012年期间，APPs进行的泌尿外科手术的年度医疗保险索赔大幅增加。膀胱镜检查从24例增加到1820例（增长7483%），经直肠前列腺活检从17例增加到834例（增长4806%），复杂的 Foley 导管置入从471例增加到2929例（增长522%），尿动力学测试从41例增加到9358例（增长22727%），肾脏超声从18例增加到4500例（增长24900%）。结论：我们发现过去20年中APPs在泌尿外科手术护理方面有显著增长。这些数据强化了APPs在泌尿外科中作用的已知扩展，并支持了正在进行的协作多学科教育努力的及时性，以满足教育、培训和指南制定方面未满足的需求，从而最大限度地提供泌尿外科手术服务。
