Commentaries on health services research

As the population ages and the urologic workforce struggles to meet patient access demands, the role of PAs and NPs in the provision of all aspects of urologic care is increasing. However, little is known about their role in procedural care. Commonly performed urologic procedures were linked to CPT codes from 1994 to 2012. National Medicare Part B beneficiary claims frequency was identified using Physician Supplier Procedure Summary Master Files. Trends were studied for PAs and NPs, urologists, and all other providers nationally across numerous procedures spanning complexity, acuity, and technical skill set requirements. Between 1994 and 2012, annual Medicare claims for urologic procedures by PAs and NPs increased dramatically. Cystoscopy increased from 24 to 1,820 (+7,483%), transrectal prostate biopsy from 17 to 834 (+4,806%), complex indwelling urinary catheter placement from 471 to 2,929 (+522%), urodynamics testing from 41 to 9,358 (+22,727%), and renal ultrasound from 18 to 4,500 (+24,900%). The authors found dramatic growth in the provision of urologic procedural care by PAs and NPs over the past 2 decades. These data reinforce the known expansion of the PA and NP role in urology and support the timeliness of ongoing collaborative multidisciplinary educational efforts to address unmet needs in education, training, and guideline formation to maximize access to urologic procedural services.