Claims‐Based Trends in Outpatient Otolaryngology Care: Contributions of Nurse Practitioners and Physician Associates

Abstract

Abstract Objective To evaluate temporal and geographic trends in outpatient otolaryngology services billed by nurse practitioners (NPs) and physician associates (PAs). Study Design Serial cross‐sectional analysis. Setting National commercial claims database. Methods We queried Merative MarketScan for adults aged 18 to 64 who received 25 common outpatient otolaryngology procedures or services from 2009 to 2023. Professional claims were categorized by provider type (NP/PA vs physician). We assessed trends in the proportion of claims billed by NPs/PAs and compared characteristics between NP/PA and physician claims. Results There were 12,099,097 otolaryngology‐specific claims, among which 423,635 (3.5%) were billed by NPs/PAs, and 14,130,340 otolaryngology‐relevant claims, among which 3,800,352 (26.9%) were billed by NPs/PAs. The proportion of otolaryngology‐specific claims attributable to NPs/PAs increased more than tenfold, from 1.1% in 2009 to 12.9% in 2023 ( P < .001), and these claims were more likely to be in rural areas compared to physicians (18.4% vs 9.0%; P < .001). North Dakota, South Dakota, and Vermont were among the top states by percentage of claims attributable to NPs/PAs, while Georgia and South Carolina were among the bottom states for both otolaryngology‐specific and otolaryngology‐relevant claims. Claims billed by NPs/PAs were more likely to be for younger, male, and actively employed patients, and those with high‐deductible health plans and in‐network insurance plans ( P < .001 for all). Conclusion Outpatient otolaryngology procedures billed by NPs/PAs have increased substantially over the past decade and account for a greater share of claims in rural areas.