2017 HSC Section 2 - Practice Management

TABLE II. Top 10 Diagnosis Codes Seen by Physician Assistants and Nurse Practitioners.

PA

NP

Diagnosis

No.

Diagnosis

No.

(381) Nonsuppurative otitis media and . . .

223,440 140,130

(380) Disorders of external ear

85,981 56,589

(380) Disorders of external ear

(474) Chronic disease of tonsils and . . . (784) Symptoms involving head and neck

(784) Symptoms involving head and neck

110,734

35,071

(706) Diseases of sebaceous glands

100,332

(530) Diseases of esophagus

32,387 32,387

(780) General symptoms

96,839

(995) Certain adverse effects, not el . . .

(472) Chronic pharyngitis and nasopha . . . (701) Other hypertrophic and atrophic . . . (781) Symptoms involving nervous and . . . (785) Symptoms involving cardiovascul . . .

89,491

(V67) Follow-up examination

32,387

63,366 36,366

(382) Suppurative and unspecified oti . . .

26,797 26,797

(477) Allergic rhinitis

63,366

(462) Acute pharyngitis

18,863

(473) Chronic sinusitis

61,521

(472) Chronic pharyngitis and nasopha . . .

18,863

PA ¼ physician assistant; NP ¼ nurse practitioner.

coming in contact with a nurse during their outpatient otolaryngology visit. Nurses may provide a broad spec- trum of care, including assistance with cerumen removal, patient education, and allergy testing, among others. However, because visits provided by nurses alone are not typically subject to billing for clinical services, it is not surprising that almost all visits in which a nurse was involved also had a corresponding physician-pro- vider component (Fig. 1). This lends to the validity of the current data. Currently, a relative minority of otolaryngologic office visits are provided for by APCs, currently standing at only 6.3%. When APC care was involved, NPs were significantly more likely to see patients independent of a physician during the office visit relative to care provided by a PA. The greater fraction of independent NP care is to be expected given that NPs are governed by the state boards of nursing, and correspondingly, may be allowed a greater degree of autonomy than PAs. 3 In some states, NPs may be able to practice completely independently (i.e., without collaboration) of a physician for diagnosis and treatment. 2 In contrast, PA training and education are strongly geared toward physician collaboration, and

example, societies are developing online training courses for education and certification for APCs in otolaryngology. 10 The role of APCs in providing outpatient care in multiple different surgical disciplines, including otolar- yngology, has been studied, particularly in countries with national health services. For example, patient satis- faction surveys have been conducted in Great Britain regarding NPs in management of snoring and aural care, among other conditions. Generally, care rendered by these APCs has been viewed as good or very good in these settings. 11,12 Similar data suggest that patients are satisfied with the care offered by surgical nurse practitioners in the Veterans Health Administration. 13 As the penetration of physician assistants in otolaryngol- ogy remains limited, there are limited data regarding patient satisfaction with visits incorporating PAs in oto- laryngology. This is likely an area warranting future research. The current data provide a national estimate of the type of care being provided by APCs and RNs in outpatient, ambulatory, otolaryngology practices. A sub- stantial fraction (25.1%) of ambulatory patients are

TABLE III. Top 10 Diagnosis Codes Seen by Nurses and Physicians.

RN

MD Alone

Diagnosis

No.

Diagnosis

No.

(381) Nonsuppurative otitis media and . . .

795,353

(380) Disorders of external ear

2,513,272

(380) Disorders of external ear

766,185

(381) Nonsuppurative otitis media and . . .

1,938,697

(382) Suppurative and unspecified oti . . . (784) Symptoms involving head and neck

615,322 493,870

(473) Chronic sinusitis

1,694,074 1,478,966

(784) Symptoms involving head and neck

(473) Chronic sinusitis

491,677

(477) Allergic rhinitis

1,438,415

(389) Deafness

474,400 361,161

(382) Suppurative and unspecified oti . . .

1,430,729 1,306,010

(477) Allergic rhinitis

(389) Deafness

(474) Chronic disease of tonsils and . . .

349,586

(478) Other diseases of upper respira . . .

1,033,903

(388) Other disorders of ear

331,049 316,126

(388) Other disorders of ear

884,837 844,266

(478) Other diseases of upper respira . . .

(V67) Follow-up examination

RN ¼ registered nurse; MD ¼ medical doctor.

Laryngoscope 122: May 2012

Bhattacharyya: Physician Extenders in Otolaryngology

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