Care Costs 6-7% Lower for Complex Patients Treated by NPs, PAs
In comparison to physician patients, complex patients using NPs and PAs for primary care incurred lower inpatient, outpatient, and pharmacy expenses, a study finds.
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By - Medically complex patients with diabetes cared for by nurse practitioners (NPs) and physician assistants (PAs) incurred total costs six to seven percent lower compared to patients treated by physicians, according to a new Health Affairs study.
Nurse practitioners (NPs) and physician assistants (PAs) have taken on greater roles in primary care because of the significant physician shortage and the increasing number of older patients requiring more and more healthcare services.
The new study conducted by researchers from Duke University School of Medicine and Durham VA Health Care System suggested that NPs and PAs deliver lower-cost care compared to their physician counterparts.
The study of VA EHR data focused on over 47,200 medically complex patients with diabetes who received care at VA facilities in 2012 and 2013. Researchers compared the total costs of care and utilization patterns of patients receiving primary care services from physicians, NPs, and PAs.
The data revealed that patients of NPs and PAs experienced fewer emergency department visits and hospitalizations compared to those treated largely by physicians for primary care.
Consequently, NP and PA patients had lower inpatient, pharmacy, and outpatient spending during the study year. Specifically, the study found that, in comparison to physician patients, patients of NPs And PAs incurred:
- Inpatient expenditures that were nine percent and six percent lower, respectively
- Annual per patient pharmacy expenditures that were nine percent and eight percent lower, respectively
- Outpatient expenditures that were three percent and five percent, respectively
Overall, spending on patients of NPs was about six percent lower than on patients of physicians, and the difference for patients of PAs was approximately seven percent. This translated to a difference of $2,005 and $2,300 in per patient annual total costs, respectively, the study stated.
The findings refute claims that NPs and PAs generate higher care costs compared to physicians, researchers stated.
Some industry experts argue that NPs and PAs actually increase costs of care because they tend to use more diagnostic tests and specialty referrals, as well as generate more return visits. Others also say that the advanced practice providers are less equipped to manage acute illness exacerbations, resulting in costly, preventable utilization of healthcare services.
The beliefs have led many healthcare organizations to assign less complex patients to NPs and PAs.
However, recent research shows that the advanced practice providers are delivering care quality at a comparable or better level than physicians. One such study published in the June 2019 edition of the Journal of the American Academy of Physician Assistants found that VA diabetes patients experienced similar health outcomes regardless of what type of provider delivered primary care.
Researchers from Duke University School of Medicine and Durham VA Health Care System add that their study “provides further evidence that NPs and PAs may be appropriately used as primary care providers, as opposed to being limited to supplementing the care of physicians within primary care settings.”
Healthcare organizations are facing a serious conundrum: physician and other skilled labor demand is significantly outpacing demand. While organizations are focusing on filling critical care gaps, leaders are just as concerned about delivering high-quality care at lower costs, especially as the industry transitions to value-based care.
Relying on NPs and PAs to meet primary care demands may be an appropriate solution for healthcare organizations. The advanced practice providers are also increasingly interested in primary care, with 78 percent of NPs and 28 percent of PA practicing primary care versus just 33 percent of physicians.
A recent report from the Medical Group Management Association (MGMA) also found that primary care practices with more non-physician providers earned over $100,000 more in revenue.
