1298: CRITICAL CARE PREPAREDNESS IN LAW ENFORCEMENT: TALES OF TWO TYPES OF CITIES

Learning Objectives: With the increased use of Advanced Practice Providers (APPs), Physician Assistants, and Nurse Practitioners in ICU roles, the financial reimbursement of these providers must be considered and fully understood with respect to their utilization. Reimbursement for APP billing for Medicare / Medicaid is ~ 85% of physician reimbursement for similar services such as evaluation/ management (E/M) and procedures. Commercial insurance does not always follow this pattern and in most cases reimburses at 100% physician reimbursement. The authors sought to understand the true financial reimbursement differences of APPs and physicians for a Trauma/Surgical ICU in an academic university hospital. The null hypothesis is that there is overall no significant difference in APP reimbursement compared to physician reimbursement across a variety of common E/M and procedure codes as well as insurance carriers. Methods: We obtained a sample of 19670 services (1727 provided by APPs and 17943 provided by physicians) from the hospital financial database. To evaluate the difference between APPs and physicians in the proportion of bill recovered, we used a linear regression model to analyze 1454 procedures performed by PAs/NPs and 3722 procedures performed by physicians, matched on propensity score (probability of a procedure being performed by an APP versus a physician) in a 1:3 ratio using a nearest-neighbor approach. We used a matching caliper of 0.02 standard deviations. Results: After matching on propensity score, the model predicts a difference in proportion of bill recovered to be on average 1% lower for APPs compared to physicians (see Table 1). Conclusions: This study showed a statistically significant difference in reimbursement of only 1% for all payers for our payer mix (39% commercial, 25% Medicaid, 32% Medicare). The difference across all insurance carriers may not be meaningful over the total financial reimbursement due to the smaller number of billing done by the APP only. Economic value and ability of physician to perform other services was not evaluated. Further study of APP reimbursement is warranted.