Trends in Participation in Medicare Among Psychiatrists and Psychiatric Mental Health Nurse Practitioners, 2013-2019.
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ABSTRACT:
SUBMITTER: Oh S
PROVIDER: S-EPMC9338410 | biostudies-literature | 2022 Jul
REPOSITORIES: biostudies-literature
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Trends in Participation in Medicare Among Psychiatrists and Psychiatric Mental Health Nurse Practitioners, 2013-2019.
Oh Seokmin S McDowell Alex A Benson Nicole M NM Cook Benjamin Lê BL Fung Vicki V
JAMA network open 20220701 7
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Project description:The supply of psychiatrists in the United States is inadequate to address the unmet demand for mental health care. Psychiatric mental health nurse practitioners (PMHNPs) may fill the widening gap between supply of and demand for mental health specialists with prescribing privileges. Using Medicare claims for a 100 percent sample of fee-for-service beneficiaries (average age, sixty-one years) who had an office visit for either a psychiatrist or a PMHNP during the period 2011-19, we examined how the supply and use of psychiatrists and PMHNPs changed over time, and we compared their practice patterns. Psychiatrists and PMHNPs treated roughly comparable patient populations with similar services and prescriptions. From 2011 to 2019 the number of PMHNPs treating Medicare beneficiaries grew 162 percent, compared with a 6 percent relative decrease in the number of psychiatrists doing so. During the same period, total annual mental health office visits per 100 beneficiaries decreased 11.5 percent from 27.4 to 24.2, the net result of a 29.0 percent drop in psychiatrist visits being offset by a 111.3 percent increase in PMHNP visits. The proportion of all mental health prescriber visits provided by PMHNPs increased from 12.5 percent to 29.8 percent during 2011-19, exceeding 50 percent in rural, full-scope-of-practice regions. PMHNPs are a rapidly growing workforce that may be instrumental in improving mental health care access.
| S-EPMC9769920 | biostudies-literature
Project description:BackgroundProviding care for mental health problems concerns General Practitioners (GPs), Private Psychiatrists (PrPs) and Public Psychiatrists (PuPs). As patient distribution and patterns of practice among these professionals are not well known, a survey was planned prior to a re-organisation of mental health services in an area close to ParisMethodsAll GPs (n = 492), PrPs (n = 82) and PuPs (n = 78) in the South-Yvelines area in France were informed of the implementation of a local mental health program. Practitioners interested in taking part were invited to include prospectively all patients with mental health problem they saw over an 8-day period and to complete a 6-month retrospective questionnaire on their mental health practice. 180 GPs (36.6%), 45 PrPs (54.9%) and 63 PuPs (84.0%) responded.ResultsGPs and PrPs were very similar but very different from PuPs for the proportion of patients with anxious or depressive disorders (70% v. 65% v. 38%, p < .001), psychotic disorders (5% v. 7% v. 30%, p < .001), previous psychiatric hospitalization (22% v. 26 v. 61%, p < .001) and receiving disability allowance (16% v. 18% v. 52%, p < .001). GPs had fewer patients with long-standing psychiatric disorders than PrPs and PuPs (52%, 64% v. 63%, p < .001). Time-lapse between consultations was longest for GPs, intermediate for PuPs and shortest for PrPs (36 days v. 26 v. 18, p < .001). Access to care had been delayed longer for Psychiatrists (PrPs, PuPs) than for GPs (61% v. 53% v. 25%, p < .001). GPs and PuPs frequently felt a need for collaboration for their patients, PrPs rarely (42% v. 61%. v. 10%, p < .001). Satisfaction with mental health practice was low for all categories of physicians (42.6% encountered difficulties hospitalizing patients and 61.4% had patients they would prefer not to cater for). GPs more often reported unsatisfactory relationships with mental health professionals than did PrPs and PuPs (54% v. 15% v. 8%, p < .001).ConclusionGP patients with mental health problems are very similar to patients of private psychiatrists; there is a lack of the collaboration felt to be necessary, because of psychiatrists' workload, and because GPs have specific needs in this respect. The "Yvelines-Sud Mental Health Network" has been created to enhance collaboration.
| S-EPMC1266376 | biostudies-literature
Project description:BackgroundStroke is the fifth leading cause of death in the United States, one of the leading contributors to Medicare cost, including through Medicare hospice benefits, and the rate of stroke mortality has been increasing since 2013. We hypothesized that hospice utilization among Medicare beneficiaries with stroke has increased over time and that the increase is associated with trends in stroke death rate.MethodsUsing Medicare Part A claims data and Centers for Disease Control mortality data at a national and state level from 2013 to 2019, we report the proportion and count of Medicare hospice beneficiaries with stroke as well as the stroke death rate (per 100 000) in Medicare-eligible individuals aged ≥65 years.ResultsFrom 2013 to 2019, the number of Medicare hospice beneficiaries with stroke as their primary diagnosis increased 104.1% from 78 812 to 160 884. The number of stroke deaths in the United States in individuals aged ≥65 years also increased from 109 602 in 2013 to 129 193 in 2019 (17.9% increase). In 2013, stroke was the sixth most common primary diagnosis for Medicare hospice, while in 2019 it was the third most common, surpassed only by cancer and dementia. The correlation between the change from 2013 to 2019 in state-level Medicare hospice for stroke and stroke death rate for Medicare-eligible adults was significant (Spearman ρ=0.5; P<0.001). In a mixed-effects model, the variance in the state-level proportion of Medicare hospice for stroke explained by the state-level stroke death rate was 48.2%.ConclusionsFrom 2013 to 2019, the number of Medicare hospice beneficiaries with a primary diagnosis of stroke more than doubled and stroke jumped from the sixth most common indication for hospice to the third most common. While increases in stroke mortality in the Medicare-eligible population accounts for some of the increase of Medicare hospice beneficiaries, over half the variance remains unexplained and requires additional research.
| S-EPMC10752263 | biostudies-literature
Project description:ObjectiveTo examine the proportion of healthcare visits are delivered by nurse practitioners and physician assistants versus physicians and how this has changed over time and by clinical setting, diagnosis, and patient demographics.DesignCross-sectional time series study.SettingNational data from the traditional Medicare insurance program in the USA.ParticipantsOf people using Medicare (ie, those older than 65 years, permanently disabled, and people with end stage renal disease), a 20% random sample was taken.Main outcome measuresThe proportion of physician, nurse practitioner, and physician assistant visits in the outpatient and skilled nursing facility settings delivered by physicians, nurse practitioners, and physician assistants, and how this proportion varies by type of visit and diagnosis.ResultsFrom 1 January 2013 to 31 December 2019, 276 million visits were included in the sample. The proportion of all visits delivered by nurse practitioners and physician assistants in a year increased from 14.0% (95% confidence interval 14.0% to 14.0%) to 25.6% (25.6% to 25.6%). In 2019, the proportion of visits delivered by a nurse practitioner or physician assistant varied across conditions, ranging from 13.2% for eye disorders and 20.4% for hypertension to 36.7% for anxiety disorders and 41.5% for respiratory infections. Among all patients with at least one visit in 2019, 41.9% had one or more nurse practitioner or physician assistant visits. Compared with patients who had no visits from a nurse practitioner or physician assistant, the likelihood of receiving any care was greatest among patients who were lower income (2.9% greater), rural residents (19.7%), and disabled (5.6%).ConclusionThe proportion of visits delivered by nurse practitioners and physician assistants in the USA is increasing rapidly and now accounts for a quarter of all healthcare visits.
| S-EPMC10498453 | biostudies-literature
Project description:One approach to the patient-centered medical home, particularly for patients with chronic illnesses, is to include physician assistants (PAs) and nurse practitioners (NPs) on primary care teams. Using Medicare claims and electronic health record data from a large physician group, we compared outcomes for two groups of adult Medicare patients with diabetes whose conditions were at various levels of complexity: those whose care teams included PAs or NPs in various roles, and those who received care from physicians only. Outcomes were generally equivalent in thirteen comparisons. In four comparisons, outcomes were superior for the patients receiving care from PAs or NPs, but in three other comparisons the outcomes were superior for patients receiving care from physicians only. Specific roles performed by PAs and NPs were associated with different patterns in the measure of the quality of diabetes care and use of health care services. No role was best for all outcomes. Our findings suggest that patient characteristics, as well as patients' and organizations' goals, should be considered when determining when and how to deploy PAs and NPs on primary care teams. Accordingly, training and policy should continue to support role flexibility for these health professionals.
| S-EPMC3909681 | biostudies-literature
Project description:BackgroundStudies show that digoxin use is declining but is still prevalent. Recent data on digoxin prescription and characteristics of digoxin prescribers are unknown, which can help understand its contemporary use.MethodsUsing Medicare Part D data from 2013 to 2019, we studied the change in number and proportion of digoxin prescriptions and digoxin prescribers, overall and by specialty. Using logistic regression, we identified prescriber characteristics associated with digoxin prescription.ResultsFrom 2013 to 2019, total digoxin prescriptions (4.6 to 1.8 million) and proportion of digoxin prescribers decreased (9.1% to 4.3% overall; 26.6% to 11.8% among General Medicine prescribers and 65.4% to 48.9% among Cardiology). Of digoxin prescribers from 2013 practicing in 2019 (91.2% remained active), 59.1% did not prescribe digoxin at all, 31.7% reduced, and 9.2% maintained or increased prescriptions. The proportion of all digoxin prescriptions that were prescribed by General Medicine prescribers declined from 59.7% to 48.2% and increased for Cardiology (29% to 38.5%). Among new prescribers in 2019 (N = 85,508), only 1.9% prescribed digoxin. Digoxin prescribers when compared to non-digoxin prescribers were more likely male, graduated from medical school earlier, were located in the Midwest or South, and belonged to Cardiology (all P < .001).ConclusionsDigoxin prescriptions continue to decline with over half of 2013 prescribers no longer prescribing digoxin in 2019. This may be a result of the increasing availability of newer heart failure therapies. The decline in digoxin prescription was greater among general medicine physicians than cardiologists, suggesting a change in digoxin use to a medication prescribed increasingly by specialists.
| S-EPMC10783702 | biostudies-literature
Project description:BackgroundThere has been a recent rise in antidepressant prescriptions. After the episode for which it was prescribed, the patient should ideally be supported in withdrawing the medication. There is increasing evidence for withdrawal symptoms (sometimes called discontinuation symptoms) occurring on ceasing treatment, sometimes having severe or prolonged effects.AimsTo identify and compare current knowledge, attitudes and practices of general practitioners (GPs) and psychiatrists in Cornwall, UK, concerning antidepressant withdrawal symptoms.MethodQuestions about withdrawal symptoms and management were asked of GPs and psychiatrists in a multiple-choice cross-sectional study co-designed with a lived experience expert.ResultsPsychiatrists thought that withdrawal symptoms were more severe than GPs did (P = 0.003); 53% (22/42) of GPs and 69% (18/26) of psychiatrists thought that withdrawal symptoms typically last between 1 and 4 weeks, although there was a wide range of answers given; 35% (9/26) of psychiatrists but no GPs identified a pharmacist as someone they may use to help manage antidepressant withdrawal. About three-quarters of respondents claimed they usually or always informed patients of potential withdrawal symptoms when they started a patient on antidepressants, but patient surveys say only 1% are warned.ConclusionsPsychiatrists and GPs need to effectively warn patients of potential withdrawal effects. Community pharmacists might be useful in supporting GP-managed antidepressant withdrawal. The wide variation in responses to most questions posed to participants reflects the variation in results of research on the topic. This highlights a need for more reproducible studies to be carried out on antidepressant withdrawal, which could inform future guidelines.
| S-EPMC7345735 | biostudies-literature
Project description:ObjectiveThis study is designed to assess the cost of services provided to Medicare beneficiaries by nurse practitioners (NPs) billing under their own National Provider Identification number as compared to primary care physicians (PCMDs).Data sourceMedicare Part A (inpatient) and Part B (office visit) claims for 2009-2010.Study designRetrospective cohort design using propensity score weighted regression.Data extraction methodsBeneficiaries cared for by a random sample of NPs and primary care physicians.Principal findingsAfter adjusting for demographic characteristics, geography, comorbidities, and the propensity to see an NP, Medicare evaluation and management payments for beneficiaries assigned to an NP were $207, or 29 percent, less than PCMD assigned beneficiaries. The same pattern was observed for inpatient and total office visit paid amounts, with 11 and 18 percent less for NP assigned beneficiaries, respectively. Results are similar for the work component of relative value units as well.ConclusionsThis study provides new evidence of the lower cost of care for beneficiaries managed by NPs, as compared to those managed by PCMDs across inpatient and office-based settings. Results suggest that increasing access to NP primary care will not increase costs for the Medicare program and may be cost saving.
| S-EPMC4946030 | biostudies-literature
Project description:Few comparisons exist of the quality of primary care provided by nurse practitioners (NPs) versus physicians.Patients with a diagnosis of diabetes in 2007-2010 (n=345,819) who received all primary care from NPs or from generalist physicians in a given year were selected from a national sample of Medicare beneficiaries. We compared the rate of potentially preventable hospitalizations among patients who received primary care from NPs versus generalist physicians. Various statistical methods-including multivariable analysis, inverse probability weighting of propensity score, nonpooling propensity score adjustment and matching, and instrumental variable (IV) analysis-were used to control for differences in patient characteristics between the 2 groups.Patients who received all of their primary care from NPs or from physicians differed by age, sex, race/ethnicity, socioeconomic status, residential area, and number of provider visits in the previous year. Nonpooling propensity score matching substantially reduced the differences, but neither IV approach satisfactorily reduced the differences. In multivariable analyses, receipt of primary care from an NP was associated with a decreased risk of hospitalization for potentially preventable conditions (OR: 0.90; 95% CI, 0.87-0.93). Similar results were found using conditional logistic regression models with propensity methods. We found smaller reductions in our analyses of "other hospitalizations" (OR: 0.96; 95% CI, 0.95-0.98). Both IV analyses showed associations between NP care and lower potentially preventable hospitalizations, but only 1 result was statistically significant.Using potentially preventable hospitalizations as a quality indicator, primary care provided by NPs was at least comparable with that provided by generalist physicians.
| S-EPMC4536572 | biostudies-other
Project description:IntroductionOpioid use disorder has grown rapidly over the years and is a public health crisis in the U.S. Although opioid use disorder is widely studied, relatively little is known about it among older adults. The goal of this study is to gain a better understanding of opioid use disorder among older Medicare beneficiaries over time and across several sociodemographic dimensions.MethodsData from the 2013-2018 Centers for Medicare & Medicaid Services Master Beneficiary Summary Files were analyzed in 2020 to examine the trends in opioid use disorder prevalence among Fee-for-Service Medicare beneficiaries aged ≥65 years. Utilizing the overarching opioid use disorder flag, trends in opioid use disorder prevalence were examined for the following sociodemographic dimensions: age, sex, race/ethnicity, and dual eligibility status (i.e., enrolled in both Medicare and Medicaid owing to low income). Chi-square tests were used to compare opioid use disorder prevalence across groups.ResultsSince 2013, estimated rates of opioid use disorder among older adults have increased by >3-fold overall in the U.S. Estimated opioid use disorder is more prevalent among the young-old (i.e., ages 65-69 years) beneficiaries than among other older adults, and dually eligible beneficiaries have consistently shared a heavier burden of opioid use disorder than Medicare-only beneficiaries. Regarding race/ethnicity, Blacks and American Indians/Alaskan Natives are more vulnerable to opioid use disorder than other groups.ConclusionsThe descriptive trends between 2013 and 2018 indicate that estimated opioid use disorder prevalence has increased greatly over the study period in all sociodemographic subgroups of older adults, highlighting an urgent challenge for public health professionals and gerontologists.
| S-EPMC8154702 | biostudies-literature