Medicare Billing Records Spotlight the Increasing Role of NPs and PAs

USA Today analyzed Medicare billing records to examine the role of nurse practitioners and physician assistants in the country’s healthcare system. These records showed that payments for NPs increased by 15%, while those for PAs increased by 11% between 2012 and 2013. In contrast, the number of general practice physicians paid by Medicare dropped by 5%.

These findings demonstrate the high-level of care provided by nurse practitioners and physician assistants. The current healthcare system is beset by a shortage of physicians as more people gain access to healthcare through the Affordable Care Act.

While NPs and PAs have been providing high-quality care for many years, they are becoming increasingly visible for the high-level procedures that frequently carry out. For instance, in 2013, NPs billed for pelvic exams and high-severity ER visits in addition to office visits. Nearly 900 PAs acted as first assistants to doctors and were paid for heart artery bypasses, while an additional 950 were paid for spinal fusion procedures.

As the number of psychiatrists not taking insurance increases, NPs are stepping in to fill the void by providing psychotherapy for Medicare patients and their families. More than 1,000 nurse practitioners billed for nearly 200,000 psychotherapy visits in 2013.

Unfortunately, there have been cases of physicians billing under their own name to get a higher payment, since NPs and PAs typically charge 85% of what physicians charge for similar office visits. The federal government is cracking down on fraudulent, incorrect, or careless Medicare billing.

Many analysts think that having more non-physicians providing care should save money for the taxpayers, since every time a PA provides care in place of a physician, it saves Medicare money.

Although NPs and PAs have been gaining more independence to provide the quality of care they are capable of, this trend is not without controversy. The AMA contends that physician-led teams are a much better model for improving patient health and care while reducing costs. Despite this view, it appears that NPs and PAs will continue on the path to providing specialized, high-quality care to patients.


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