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

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.