A methodology for identifying behavioral health advanced practice registered nurses in administrative claims

Abstract

Objective (study question): Advanced practice registered nurses (APRNs) play an increased role in mental illness treatment. Health services research that uses claims to study mental health is often limited because behavioral health nurse practitioners (i.e., APRNs who specialize in mental illness, also known as psychiatric mental health APRNs) cannot be easily identified in claims data. We describe two methodologies to identify behavioral health APRNs in administrative claims. DATA SOURCES/STUDY SETTING (W/ HOSPITAL/INSTITUTION SETTING ANONYMIZED): We use 2010-2018 claims from the traditional Medicare fee-for-service program along with 2010-2019 commercial claims and Medicare Advantage data from the OptumLabs Data Warehouse (OLDW). Self-reported specialty data from the National Plan & Provider Enumeration System (NPPES) were used for validation.

Study design: For each APRN, we calculated the percentage of visit diagnoses and of prescriptions in each database that were for mental health and classified those with ≥80% as behavioral health APRNs. We validated our definition with NPPES self-reported specialty for Medicare data.

Data collection/extraction methods: Not applicable.

Principal findings: Among APRNs with 10+ visits, 10,978 (8.1%) in Medicare and 9829 (11.7%) in commercial claims data met our visit-based criteria as behavioral health APRNs. Among APRNs with 10+ prescriptions, 8160 (6.2%) in Medicare and 16,538 (9.0%) in commercial claims data met our prescription-based criteria as behavioral health APRNs. Among the APRNs who self-reported they were behavioral health APRNs, 92.8% and 90.5% met our visit-based and prescription-based criteria, respectively.

Conclusions: We present and validate two methods of identifying behavioral health APRNs in claims that can be used by other researchers.

Keywords: Medicare; administrative claims; advanced practice providers; advanced practice registered nurses; mental health; methods.

FIGURE 1

Classifying advanced practice registered nurses (APRNs) as behavioral health APRNs based on visit diagnoses or prescriptions in Medicare and commercial claims data. Medicare data covers 2010–2018 and includes 136,693 APRNs who have 10 or more visits, 149,987 APRNs who have 10 or more prescriptions, and 113,772 APRNs who have 10 or more both visits and prescriptions. Commercial claims dataset data covers 2010–2019 and includes 84,369 APRNs who have 10 or more visits, 183,759 APRNs who have 10 or more prescriptions, and 80,743 APRNs who have 10 or more both visits and prescriptions. (A) Distribution of APRNs based on fraction of visits or prescriptions that are for mental health treatment. (B) Concordance of visit‐based and prescription‐based methods of classifying behavioral health APRNs among APRNs who have 10+ visits and 10+ prescriptions [Color figure can be viewed at wileyonlinelibrary.com]