The Rise of Physician Assistants and Nurse Practitioners in Medically Necessary, Noninvasive Aesthetic Procedures for Medicare Beneficiaries.

Abstract

Physician assistants and nurse practitioners have a vital role in a successful plastic surgery practice, often executing multiple essential tasks. These include wound care, floor management, follow-up care, and even procedures. While the role of physician assistants and nurse practitioners in noninvasive surgical care has been explored in other specialties (e.g., urology), the extent of their involvement in noninvasive aesthetic procedures is unknown.1 This study elucidates trends in the role of physician assistants and nurse practitioners in performing plastic surgery procedures for Medicare beneficiaries. A retrospective review of common noninvasive aesthetic procedures performed by physician assistants and nurse practitioners was conducted.2 These procedures were extracted from the 2019 American Society of Plastic Surgeons Statistics Report.3 Percentage changes in the number of procedures performed from 2010 to 2018 were recorded. In addition, compound annual growth rates were calculated from 2010 to 2018 for both number of procedures and total payment value. In 2018, a total of 7,561,309 noninvasive aesthetic procedures, amounting to $433,788,296, was performed by nurse practitioners (n = 2,825,274, $140,786,303) and physician assistants (n = 4,735,936, $293,001,993) (Table 1). From 2010 to 2018, there was a 24 percent increase in the number of procedures performed by nurse practitioners, a 19 percent increase in those performed by physician assistants, and a 21 percent increase for the combined cohort. By total payment amount, there was an increase in compound annual growth rates of 22 percent for nurse practitioners, 20 percent for physician assistants, and 20 percent for the combined cohort. Botulinum toxin type A had the highest percentage increase (4431 percent), followed by soft-tissue fillers (990 percent), chemical peel (484 percent), laser hair removal (467 percent), laser tattoo removal (353 percent), intense pulsed light treatment (346 percent), laser treatment of leg veins (316 percent), laser skin resurfacing (254 percent), microdermabrasion (120 percent), and sclerotherapy (44 percent) (Fig. 1). Table 1. - Nurse Practitioners and Physician Assistants in Noninvasive Aesthetic Procedures for Medicare Beneficiaries in 2018 Characteristic Overall Nurse Practitioners Physician Assistants Combined Total no. of noninvasive cosmetic services (2018) 2,825,274 4,735,936 7,561,309 CAGR of noninvasive cosmetic services (2010–2018) 24% 19% 21% Total noninvasive cosmetic payments (2018) $140,786,303 $293,001,993 $433,788,296 CAGR of noninvasive cosmetic payments (2010–2018) 22% 20% 20% CAGR, compound annual growth rate. Fig. 1.: Percent change in the top 10 medically necessary aesthetic procedures performed by nurse practitioners and physician assistants from 2010 to 2018.Our results confirm the prominence of physician assistants and nurse practitioners in performing noninvasive aesthetic procedures. Moreover, physician assistants performed the majority of procedures (62 percent), whereas nurse practitioners maintained a higher compound annual growth rate (24 percent) from 2010 to 2018. This is likely a reflection of the larger census of physician assistants relative to nurse practitioners in plastic surgery; nonetheless, such trends suggest a growing potential for nurse practitioners to engage in procedural-based care.4,5 To further explain these finding, future studies could assess how clinical responsibilities and reimbursements have evolved for nurse practitioners and physician assistants. Furthermore, of all procedures, botulinum toxin injections represented the highest growth over time. This could be attributed to a combination of factors, including patient demand, procedural ease, and increased clinical exposure.3 This study has a couple of limitations that warrant consideration. First, only the top 10 highest-volume aesthetic procedures were included. In doing so, we excluded other common procedures in our analyses. Second, we examined Medicare beneficiaries, and therefore did not analyze data from healthier or younger patients perhaps better suited to receive these types of procedures. Thus, our study likely underestimates the engagement of advanced practice providers in “medically necessary” aesthetic procedures. With the increasing demand of aesthetic surgery among older patients, the role of physician assistants and nurse practitioners may be crucial in order to ensure adequate access to care. Future studies should further explore their engagement in aesthetic medicine, with respect to quality, patient satisfaction, and educational training. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. No funding was received for this work.