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Reply to “Response to rising high‐acuity emergency care services independently billed by advanced practice providers, 2013 to 2019”

Reply to “Response to rising high‐acuity emergency care services independently billed by advanced... We thank Mr. Wu and Dr. Darracq for their interest in our research regarding the billing of high‐acuity emergency care services by advanced practice providers (APPs) from 2013 to 2019.1 We agree that descriptive data, such as this, can be used to inform discussions about the changing dynamics of the emergency medical workforce.2,3Wu et al. note our inclusion of certified registered nurse anesthetists (CRNAs) and certified nurse midwives (CNMs) as part of the APP definition, in addition to physician assistants (PAs) and nurse practitioners (NPs). We included CRNAs and CNMs to align with the definition of APP in prior literature analyzing this data set.4 This decision did not have a meaningful impact as only three CRNAs and no CNMs were included in our analytic sample.1The “proportion of high‐acuity charts” has been accepted as one reference standard for measuring ED “actual clinical acuity” given its ability to retrospectively account for resource intensity and patient level of illness.5 Furthermore, a trends analysis using Medicare claims data revealed that models estimating high‐intensity emergency care provision are increasingly explained with the addition of patient characteristics, comorbidities, and in‐ED services provided.6 As relative increases in high‐acuity billing were considerably greater for APPs compared to http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Academic Emergency Medicine Wiley

Reply to “Response to rising high‐acuity emergency care services independently billed by advanced practice providers, 2013 to 2019”

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Publisher
Wiley
Copyright
© 2023 Society for Academic Emergency Medicine
ISSN
1069-6563
eISSN
1553-2712
DOI
10.1111/acem.14715
Publisher site
See Article on Publisher Site

Abstract

We thank Mr. Wu and Dr. Darracq for their interest in our research regarding the billing of high‐acuity emergency care services by advanced practice providers (APPs) from 2013 to 2019.1 We agree that descriptive data, such as this, can be used to inform discussions about the changing dynamics of the emergency medical workforce.2,3Wu et al. note our inclusion of certified registered nurse anesthetists (CRNAs) and certified nurse midwives (CNMs) as part of the APP definition, in addition to physician assistants (PAs) and nurse practitioners (NPs). We included CRNAs and CNMs to align with the definition of APP in prior literature analyzing this data set.4 This decision did not have a meaningful impact as only three CRNAs and no CNMs were included in our analytic sample.1The “proportion of high‐acuity charts” has been accepted as one reference standard for measuring ED “actual clinical acuity” given its ability to retrospectively account for resource intensity and patient level of illness.5 Furthermore, a trends analysis using Medicare claims data revealed that models estimating high‐intensity emergency care provision are increasingly explained with the addition of patient characteristics, comorbidities, and in‐ED services provided.6 As relative increases in high‐acuity billing were considerably greater for APPs compared to

Journal

Academic Emergency MedicineWiley

Published: Mar 4, 2023

References