Nurse Practitioners and Physician Assistants Provide an Increasing Proportion of Outpatient Care

The number of nurse practitioners (NPs) and physician assistants (PAs) in the U.S. has increased steadily, but studying the care delivered by these providers has been difficult because claims for their visits often are attributed to physicians (“indirect billing”).

Researchers analyzed 275,000,000 traditional Medicare claims for outpatient and nursing home visits between 2013 and 2019. Visits billed by physicians for which NPs or PAs signed associated prescriptions within 1 day of the visit were categorized as indirectly billed and were attributed to the NP or PA who signed the prescriptions. Visits for which the care provider was unclear (e.g., when multiple providers signed prescriptions) were excluded. Visits without prescriptions were an…