QuikStats--2012 APRNs in Medicare Part B

By Peter McMenamin posted 03-28-2014 16:45


APRNs’ participation as Medicare Part B Providers in 2012

The government shutdown in the fall of 2013 delayed the production and release of many of the national and State specific Part B operating statistics for 2012.  However, some of the national data have been released so there are now available initial results with respect to the utilization statistics of APRNs enrolled as Medicare Part B providers for 2012.  I will be using a new QuikStats format to try to succinctly present results in table form.

In the aggregate total Medicare approved charges for all Part B providers increased by 1.2% from 2011 to 2012.  In comparison, the total approved charges earned by APRNs (billing under their own NPIs) increased by 12.7%.  All four APRN roles exhibited above Part B average increases.  NPs showed the largest increase at 15.5%.  CNMs—perhaps still reveling in the ACA increase in their approved charges to 100% of the physician fee schedule amounts—experienced an increase of 13.2%, also above the APRN average.

2012 was the first year of experience with respect to persons aging into Medicare who were born in 1947, one full year following the cessation of WWII hostilities in Europe and the Pacific (August 15, 1945).  Medicare eligibles increased by 2 million persons in 2012 resulting in an increase of 3.3% in the Part B population, compared to increases of 2.5% experienced in the three preceding years.  In the face of this substantial increase in the beneficiary population, all four APRN roles nonetheless increased their Medicare persons served statistics by more than proportionate amounts.

In 2012 APRNs (billing under their own NPI) provided one or more services to 11.4 million fee-for-service Medicare Part B beneficiaries, just more than 1 million additional patients compared to 2011.  This was an increase in persons served of 9.7%.  NPs led the pace with a 12.4% increase in persons served, or 718,660 additional patients. 

The final statistics have not yet been published with respect to the exact number in the population of Medicare fee-for-service beneficiaries eligible at any point during 2012.  That number has been estimated using the 2011 eligible statistics and data available in the Medicare Trustees Report from 2013.  As so calculated, the fee-for-service eligible count increased by 1,165,930.  In effect, the increase in APRN persons served covered 87% of the additional beneficiaries who aged into Medicare in 2012. 

With respect to the percentage of Medicare fee-for-service patients who have received one or more Part B services from an APRN billing under her or his own NPI, there has been a 2% increase each year for the last four years on record.  26% of eligible beneficiaries received at least one APRN service in 2009.  It was 28% in 2010, 30% in 2011, and 32% in 2012.  Finally, for 2012 CMS data indicate that 32,900,220 Medicare fee-for-service beneficiaries received at least one service from any Part B provider regardless of specialty.  Separately billing APRNs provided services to 35% of those beneficiaries. 

These statistics understate the total provision of APRN services to Medicare patients.  They do not include APRN services provided to Medicare Advantage patients.  They do not reflect APRN services provided in institutional settings and reimbursed under Medicare Part A.  And they do not include services provided by APRNs but billed “incident to” physician services under Part B.