Medicare Part B statistics for 2011 show that growth in APRN approved charges continues to exceed Part B growth for all other providers. Non-APRN growth was 2.8%. APRN approved charges increased by 11.0% in 2011 to $2.4 billion. In fact, this was a slight slowdown from the recent trend. Average annual growth in APRN approved charges from 2006 to 2011 was 11.9%.
2011 was also the first year of increased approved charges for certified nurse-midwives under the Affordable Care Act. Prior to 2011 CNMs’ approved charges were limited to 65% of physicians’ allowances under the Medicare Fee Schedule. As a result of the ACA, CNMs’ allowances were raised to 100% of physician fees. Other things being equal, that alone would have increased allowances for midwives by 53%. In fact, CNM total approved charges in 2011 were almost exactly double the amount from 2010. The one year increase was 100.5%. In fact, 15% more CNMs directly participated in Part B. They provided services to 20% more beneficiaries. And approved charges per service increased by 60%. That means they were performing a more complicated mix of services in 2011 compared to 2010.
Nurse Practitioners, Certified Registered Nurse Anesthetists, and Clinical Nurse Specialists all exhibited growth in 2011 as well. NPs represent more than 50% of the total for APRNs and their Part B revenues from 2006 to 2011 have increased by a greater amount than any of the others. NP approved charges have increased at an average annual rate of 15.4%. NP approved charges in 2011 increased by more than $200 million over the 2010 total. From 2007 onward both CRNAs and CNSs have exhibited increases in approved charges every year, averaging 7.7% and 4.9%, respectively.
Even at $2.4 billion APRN revenues are peanuts relative to Part B as a whole: $127 billion. For 2011 the APRN share of the total was 1.91%. That was up from 1.25% in 2006. Every year over that timeframe has seen an increase over the prior year. Note, however, that APRNs in 2010 represented 9% of all Part B providers. And in 2011, 30% of all Medicare Part B fee-for-service beneficiaries received one or more services from an APRN directly billing Medicare Part B. (More on new Medicare “persons-served” statistics in a forthcoming blog.)