Advanced practice providers and children's hospital-based pediatric otolarynology practices.

INTRODUCTION: Advanced practice providers (APPs), including nurse practitioners and physician assistants, have been deployed in children's hospital-based academic pediatric otolaryngology practices for many years. However, this relationship in terms of prevalence, roles, financial consequences and satisfaction has not been examined. The objective of this study is to explore how APPs impact healthcare delivery in this setting. METHODS: Pediatric otolaryngology chiefs of all academic children's hospitals in the US were electronically surveyed about the ways APPs intersected clinically and financially in their respective practice. RESULTS: A total of 29 of 36 children's hospital-based pediatric otolaryngology practices completed the survey, of which 26 practices (90%) utilized APP. There were large variances within the APP practice cohort in faculty size (mean/median/range = 9.4/8.5/3-29); annual patient visits (mean/median = 18,373/17,600); number of practice site (mean/median/range = 4.3/4/2-9) and number of outpatient APP (mean/median/range = 6.3/5/1-30). No factors (faculty size, annual visits and number of practice sites) differentiated between the APP and non-APP practices. Among APP practices, significant correlation (p<.00001) was observed between size of APP cohort to faculty size and annual visits. 69% of the practices did not differentiate job functions of nurse practitioners and physician assistants. 85% of the practices utilized APPs in all practice sites and 19% utilized APPs in the operating room. 77% of APPs billed independently and 46% had on-site supervision. The most prevalent APP salary bracket based on 0-5, 6-10 and > 11 years of tenure were $76-100K (65%), $100-150K (77%) and $100-150K (86%), respectively. In 46% of the practices, APPs were able to generate enough revenue to cover more than 75% of their salary and 23% of practices generated a profit. 81% of the chiefs ranked the effectiveness of APPs as high (4 and 5) on a 5-point Likert scale. DISCUSSION: The majority of academic pediatric otolaryngology practices employed APPs. Despite the diversity seen in practice complexity, APP functionality and financial impact, most found the APP model to be beneficial in improving patient care, patient access and faculty productivity.

Health care reform: pediatric elective surgery payer mix and utilization under Tenncare managed competition.

UNLABELLED: Managed care decreases reimbursement for surgical referral care and may decrease access for elective procedures. This study seeks to determine the impact of Medicaid managed competition on elective pediatric otolaryngology surgery. DESIGN AND SETTING: Payer mix was analyzed for tonsillectomy and adenoidectomy (T&A) and bilateral myringotomy with ventilation tube insertion (BM&VT) charges for an eight-year period surrounding TennCare implementation. The payer mix for hospital gross charges was analyzed for the same period as a control. RESULTS: After TennCare implementation, hospital gross charges shifted toward increased TennCare/Medicaid and decreased commercial insurance, whereas charges for the two elective procedures shifted toward increased commercial insurance and decreased TennCare/Medicaid. CONCLUSION: Otolaryngologists avoided impending losses under TennCare through indirect cost shifting. Numbers of T&A and BM&VT procedures performed on Tenncare/Medicaid patients remained constant, while numbers of these procedures performed on commercially-insured patients increased.

Health care reform: pediatric elective surgery payer mix and utilization under TennCare managed competition.

UNLABELLED: Managed care decreases reimbursement for surgical referral care and may decrease access for elective procedures. This study seeks to determine the impact of Medicaid managed competition on elective pediatric otolaryngology surgery. DESIGN AND SETTING: Payer mix was analyzed for tonsillectomy and adenoidectomy (T&A) and bilateral myringotomy with ventilation tube insertion (BM&VT) charges for an eight-year period surrounding TennCare implementation. The payer mix for hospital gross charges was analyzed for the same period as a control. RESULTS: After TennCare implementation, hospital gross charges shifted toward increased TennCare/Medicaid and decreased commercial insurance, whereas charges for the two elective procedures shifted toward increased commercial insurance and decreased TennCare/Medicaid. CONCLUSION: Otolaryngologists avoided impending losses under TennCare through indirect cost shifting. Numbers of T&A and BM&VT procedures performed on Tenncare/Medicaid patients remained constant, while numbers of these procedures performed on commercially-insured patients increased.