{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T12:45:54Z","timestamp":1792241154816,"version":"4.4.0"},"reference-count":39,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate temporal and geographic trends in outpatient otolaryngology services billed by nurse practitioners (NPs) and physician associates (PAs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Serial cross\u2010sectional analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>National commercial claims database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We queried Merative MarketScan for adults aged 18 to 64 who received 25 common outpatient otolaryngology procedures or services from 2009 to 2023. Professional claims were categorized by provider type (NP\/PA vs physician). We assessed trends in the proportion of claims billed by NPs\/PAs and compared characteristics between NP\/PA and physician claims.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 12,099,097 otolaryngology\u2010specific claims, among which 423,635 (3.5%) were billed by NPs\/PAs, and 14,130,340 otolaryngology\u2010relevant claims, among which 3,800,352 (26.9%) were billed by NPs\/PAs. The proportion of otolaryngology\u2010specific claims attributable to NPs\/PAs increased more than tenfold, from 1.1% in 2009 to 12.9% in 2023 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001), and these claims were more likely to be in rural areas compared to physicians (18.4% vs 9.0%;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001). North Dakota, South Dakota, and Vermont were among the top states by percentage of claims attributable to NPs\/PAs, while Georgia and South Carolina were among the bottom states for both otolaryngology\u2010specific and otolaryngology\u2010relevant claims. Claims billed by NPs\/PAs were more likely to be for younger, male, and actively employed patients, and those with high\u2010deductible health plans and in\u2010network insurance plans (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001 for all).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Outpatient otolaryngology procedures billed by NPs\/PAs have increased substantially over the past decade and account for a greater share of claims in rural areas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.70464","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T12:00:13Z","timestamp":1792238413000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Claims\u2010Based Trends in Outpatient Otolaryngology Care: Contributions of Nurse Practitioners and Physician Associates"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2126-6663","authenticated-orcid":false,"given":"Nicholas R.","family":"Lenze","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Michigan Medical School Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aya M.","family":"Dakroub","sequence":"additional","affiliation":[{"name":"University of Toledo College of Medicine and Life Sciences Toledo Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chamila D.","family":"Perera","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Michigan Medical School Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard J.","family":"Ritz","sequence":"additional","affiliation":[{"name":"Albany Med Health System Glens Falls New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinciya","family":"Pandian","sequence":"additional","affiliation":[{"name":"Ross and Carol Nese College of Nursing The Pennsylvania State University University Park Pennsylvania USA"},{"name":"Center for Immersive Learning and Digital Innovation The Pennsylvania State University University Park Pennsylvania USA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, College of Medicine The Pennsylvania State University Hershey Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Brenner","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Michigan Medical School Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pratyusha","family":"Yalamanchi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Michigan Medical School Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599811433977"},{"issue":"9","key":"e_1_2_8_3_1","first-page":"5","article-title":"Otolaryngology workforce analysis","volume":"126","author":"Hughes CA","year":"2016","journal-title":"Laryngoscope"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23476"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/01945998211020314"},{"key":"e_1_2_8_6_1","unstructured":"Andrew.The State of the Workforce: Advanced Practice Providers in Otolaryngology. 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