Objective To examine the proportion of healthcare visits are delivered by nurse practitioners and physician assistants versus physicians and how this has changed over time and by clinical setting, diagnosis, and patient demographics.
Design Cross-sectional time series study.
Setting National data from the traditional Medicare insurance program in the USA.
Participants Of people using Medicare (ie, those older than 65 years, permanently disabled, and people with end stage renal disease), a 20% random sample was taken.
Main outcome measures The proportion of physician, nurse practitioner, and physician assistant visits in the outpatient and skilled nursing facility settings delivered by physicians, nurse practitioners, and physician assistants, and how this proportion varies by type of visit and diagnosis.
Results From 1 January 2013 to 31 December 2019, 276 million visits were included in the sample. The proportion of all visits delivered by nurse practitioners and physician assist
A direct-to-consumer telemedicine service resulted in lower per-episode unit costs for care within 7 days and only marginally increased the use of services overall.
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