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Trends in Nurse Practitioner and Physician Assistant Practice in Nursing Homes, 20002010

Keywords: Medicare claims; Online Survey Certification and Reporting (OSCAR) system; scope-of-practice; physician visits in nursing homes; organization of medical staff.

Objective: To examine nurse practitioner (NP) and physician assistant (PA) practice in nursing homes (NHs) during 2000–2010.

Data Sources: Data were derived from the Online Survey Certification and Reporting system and Medicare Part B claims (20 percent sample).

Methods: NP/PA state average employment, visit per bed year (VPBY), and providers per NH were examined. State fixed-effect models examined the association between state regulations and NP/PA use.

Principal Findings: NHs using any NPs/PAs increased from 20.4 to 35.0 percent during 2000–2010. Average NP/PA VPBY increased from 1.0/0.3 to 3.0/0.6 during 2000–2010. Average number of NPs/PAs per NH increased from 0.2/0.09 to 0.5/0.14 during 2000–2010. The impact of state scope-of-practice regulations was mixed.

Conclusions: NP and PA scope-of-practice regulations impact their practice in NHs, not always as intended.

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