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UPJ INSIGHT Increasing Role of the Advanced Practice Provider in Men’s Health Clinics

By: Omer A. Raheem , MD, MSc, MCh Urol, MRCS, University of Chicago, Illinois; Monica H. Xing, BA Pritzker School of Medicine, University of Chicago, Illinois; Caleb A. Cooper, MD, University of Chicago, Illinois; Max J. Hyman, BA, The Center for Health and the Social Sciences, University of Chicago, Illinois; Mohit Khera, MD, MBA, Baylor College of Medicine, Houston, Texas; Parth K. Modi, MD, MS, University of Chicago, Illinois | Posted on: 20 Jul 2023

Raheem OA, Xing MH, Cooper CA, Hyman MJ, Khera M, Modi PK. Increasing role of the advanced practice provider in men’s health clinics: an analysis of Medicare and commercial claims in the United States. Urol Pract. 2023;10(4):319-326.

Study Need and Importance

As urological care delivery in the US continues to evolve to meet patient needs, we aim to clarify the role of advanced practice providers (APPs) for publicly and privately insured patients in the treatment of male urological conditions commonly encountered in men’s health clinics (testicular hypofunction, erectile dysfunction [ED] and Peyronie’s disease [PD], benign prostatic hyperplasia, and scrotal pain). The compositional changes to the urological care team are important to consider in the context of men’s health because the increasing involvement of APPs may be a unique mechanism to further bridge men’s urology to their general health.

What We Found

From 2010 to 2021, the proportion of APP-submitted service counts for all conditions within the MarketScan group increased up to 5-fold, with benign prostatic hyperplasia representing the greatest growth (Figure 1). The proportion of APP-submitted service counts within the Medicare group increased up to 8-fold, with ED/PD representing the greatest fold change (Figure 2). The proportion of claims submitted by APPs treating all conditions was higher in 2021 than 2010 in both publicly and privately insured groups.

Figure 1. The proportion of urological procedural claims submitted by advanced practice providers (APPs) to MarketScan (2010-2021).

Figure 2. The proportion of urological procedural claims submitted by advanced practice providers (APPs) to Medicare (2010-2021). CMS indicates Centers for Medicare and Medicaid services.

Limitations

While our selected procedures within each condition are commonly seen in men’s health clinics, we recognize that the Common Procedural Terminology (CPT) code counts are not exclusively unique to male patients (eg, cystoscopy). Further, as CPT codes only capture procedure type, we were not able to distinguish the clinical indication for each procedure needed to assign each CPT code to a single condition of interest.

Interpretation for Patient Care

The role of APPs in men’s urological health is increasing for privately and publicly insured patient populations. These trends are likely to continue with the worsening shortage of urologists, and have implications for clinical care, policy, costs, and the training, supervision, and certification of APPs. APPs play a critical role in urological care and can help to improve access to men’s health.

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