Here - American Geriatrics Society

P APER
A BSTRACTS
growth in NP care of Medicare patients from 1997-2008 and its relationship
with state regulations and also with the availability of primary
care physicians.
Methods: Medicare beneficiaries aged 65 or above with Parts A
and B coverage who were not enrolled in a health maintenance organization
for the entire 12 months of each year during 1996-2008
were selected. We assessed the percentage of community-dwelling
and long term nursing home residents billed by an NP or who received
the majority of their primary care from NPs.
Results: The percentage of community-dwelling Medicare beneficiaries
billed for outpatient NP services rose from 0.3% in 1997 to
7.9% in 2008, while for nursing home patients the increase was from
3.0% to 24.7%. By 2008, 2.2% of community-dwelling and 15.5% of
nursing home residents received the majority of their primary care
from NPs. The percent of community dwelling residents receiving the
majority of their primary care from NPs in 2008 ranged from 0.7% in
Hawaii to 10.8% in Alaska, while for nursing home patients it ranged
from 0% in Wyoming to 44.3% in Tennessee. Compared with states
with the most restrictive regulations, the odds of receiving the majority
of primary care from NPs was 2.5 fold higher for communitydwelling
patients in states with the most liberal regulations. Similar
associations with state laws were found when we measured the number
of NPs practicing per 100,000 adults in the state, using data from
state licensing boards. The availability of primary care physicians
modestly affected NP activity in community-dwelling patients. Neither
availability of primary care physicians nor state regulations were
associated with odds of receiving care from NPs for long term nursing
home residents. In five states that modified their regulations during
1997-2007, the percentage of patients with an NP as PCP increased
significantly (P