Advanced Practice Provider-Attributed Outpatient Visits and Procedures for Urologic Oncology Care in the United States.

INTRODUCTION

Integration of advanced practice providers (APPs) into the clinic setting holds potential to streamline care in urologic oncology. The impact of APP-attributed care in genitourinary oncology has not been well described. We sought to characterize national trends and the financial impact of APP-attributed outpatient visits and procedures within a privately insured urologic oncology population.

METHODS

We identified bladder, kidney, prostate, and testis cancer claims within the Merative MarketScan database from 2010 to 2023. Annual proportions of first-visit, overall, and select procedural APP-attributed claims were assessed descriptively. Comparisons by geographic status, urbanicity, insurance plan, and metastatic status were evaluated using chi-squared testing and multivariable modeling. Overall and out-of-pocket twelve-month health expenditures were assessed by whether first oncologic visit was APP-attributed.

RESULTS

There were 507,053 APP-attributed claims, increasing from 0.88% in 2010 to 3.38% in 2023. In adjusted analysis, later calendar year (OR: 1.1; p<0.001) had significantly higher odds of APP involvement, while residence within the Northeast (OR: 0.68; p<0.001) had significantly lower odds. APP-attributed first visits were associated with lower 12-month insurer-paid (SR: 0.81; p<0.001) and out-of-pocket (SR: 0.90; p<0.001) spending. Rates of APP-attributed cystoscopy and prostate biopsy remained modest.

CONCLUSION

APP-attributed office and procedural outpatient visits are increasing, with variations in uptake present by practice region and patient characteristics. APP-attributed first visits were associated with lower 12-month insurer-paid spending without increased patient out-of-pocket spending.