The Growth of Advanced Practice Providers in Urology Procedural Care: Evidence from Public and Private Health Insurers.

OBJECTIVE

To understand the growing role of advanced practice providers (APPs) in urologic care, we investigated urology procedural claims submitted to public and private health insurers.

METHODS

We used Medicare summary and commercial health insurance claims from 2010 to 2020 to calculate the number and proportion of common urologic procedures performed by APPs. To characterize broader trends across urology, we categorized the urologic procedures into five groups: cancer procedures, cystoscopy procedures, imaging procedures, urgent procedures, and voiding dysfunction.

RESULTS

APPs submitted an increasing proportion of Medicare and commercial urology procedural claims between 2010 and 2020 (2% and 1% more claims, respectively), including several procedure groups: voiding dysfunction (12% and 4%), urgent procedures (8% and 5%), cancer procedures (3% and 2%), and cystoscopy procedures (1% and 1%). APPs consistently submitted a larger proportion of claims to Medicare than private insurers and, as of 2019, voiding dysfunction and cancer procedures were the most common urologic procedures performed by APPs in the Medicare data (82,749 and 73,837 procedures, respectively). In 2020, procedures with the greatest proportion of Medicare and commercial claims submitted by APPs included percutaneous tibial nerve stimulation (24% and 10% of claims, respectively), bladder installations (16% and 8%), neurostimulator programming (14% and 7%), and complicated Foley catheter placement (12% and 7%).

CONCLUSION

APPs account for a growing proportion of urology procedural claims submitted to public and private health insurers. Stakeholders need to be aware of these changes in the urologic workforce to maintain the standard of care across urology.