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Employing More Physician Assistants Reduces Healthcare Costs

A recent study showed that higher physician assistant-to-physician ratios can significantly cut healthcare costs related to hospitalist groups while maintaining care quality.

By Jacqueline Belliveau

- Adding more physician assistants to hospitalist care teams can lower healthcare costs while maintaining quality of care, a new study in the Journal of Clinical Outcomes Management contended.

Higher physician assistant-to-physician ratios in hospitalist teams can reduce healthcare costs, argues a new study

Researchers found that a hospitalist care team that employed higher physician assistant-to-physician ratios had mean patient charges between $7,822 and $7,755 versus a conventional hospitalist staffing group that had mean patient charges between $8,307 and $10,034.

Despite lower healthcare costs, the study showed no significant differences in quality of care, including patient mortality, hospital readmissions within 30 days, length of stay, and specialty consultant use rates.

“We believe this is the first study of its kind to directly compare outcomes and costs between different staffing models using hospitalist PAs [physicians assistants] and hospitalist physicians,” Henry Michtalik, MD, MPH, MHS, Assistant Professor of Medicine at Johns Hopkins University School of Medicine and the study’ senior author, stated in a press release. “It shows that the expanded use of well-trained PAs within a formal PA-physician collaboration arrangement can provide similar clinical outcomes with lower costs, potentially allowing hospitalists to provide additional or different services.”

The study noted that hospitalist care teams typically consist of nine physicians and three physician assistants who care for about nine patients a day. But maintaining a hospitalist care team represented a major expense for most hospitals.

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For hospitalist groups treating adults, the average institutional support was over $156,000 per full time equivalent physician, according to a cited Society of Hospital Medicine report. Roughly 94 percent of hospital groups required financial assistance beyond professional fees to manage the healthcare costs associated with the care team.

Many hospitalist groups also employed nurse practitioners and physician assistants to complement physician staffing, the study added. Hospitalist groups employed a median of 0.25 nurse practitioners and 0.28 physician assistants.

However, boosting physician assistant staffing could significantly drive down healthcare costs associated with hospitalist groups, researchers argued. The median salary for a hospitalist physician assistant was $102,960, while the median internal medicine physician hospitalist salary was $253,977.

In a case study at a Maryland-based medical center, researchers implemented an expanded physician assistant staffing model that consisted of three physicians and three physician assistants that worked alongside the conventional hospitalist care team between January 2012 and June 2013.

The study showed that an expanded staffing model reduced patient charges by $80 for a typical patient, who was between 80 and 89 years old with Medicare insurance and had a categorized major severity of illness, defined as the extent of physiologic decompensation or organ system loss of function.

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While healthcare costs went down, researchers noted that quality of care was similar across both hospitalist groups. For example, the expanded staffing group had a 14.05 percent hospital readmissions rate, while the conventional group’s rate was 13.69 percent. The expanded staffing model also had a 1.3 percent inpatient morality rate, while the conventional group had a 0.99 percent rate.

Similarly, average length of patient stays was not significantly different, researchers continued. The unadjusted mean length of stay was between 3.9 and 4.1 days for the expanded staffing group and between 4.3 and 5.6 days for the conventional group.

Researchers added that the expanded staffing group did not disproportionately use specialist consultants to achieve similar care quality. The expanded staffing team used a mean of 0.55 consultants per case versus 0.56 at the conventional group.

The study indicated that adding more physician assistants to a hospitalist care team could optimize physician workflows. In the conventional group, physicians oversaw approximately 94 percent of patient visits. However, almost 36 percent of visits with the expanded staffing group were conducted by a physician assistant and about 65 percent were conducted by a physician or by a physician assistant with a billable physician “co-visit.”

Physician assistants in the expanded staffing model also conducted more visits without a same-day physician visit (35.75 percent of visits) than the conventional group (5.89 percent).

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“The expanded PA model could free up physicians’ time to focus on more complex cases or allow hospitalists to provide additional or different services.” said Michtalik.

To successfully implement an expanded physician assistant staffing model, researchers advised healthcare organizations to develop a structured collaboration framework. In the study, physician assistants in the expanded staffing group followed collaboration protocol, which outlined how physicians and physician assistants should discuss and treat patients together.

Healthcare organizations should also establish an educational program for physician assistants, researchers added. The program should include 80 hours of didactic sessions over several months and be based on the Society of Hospital Medicine Core Competencies framework. Physician assistants should also go through six months of supervised bedside education with increasing clinical responsibilities under an experienced physician or physician assistant.

“As we address the challenges of an expanding older and more complex patient population in the setting of healthcare reforms and financial pressures, optimizing the patient care team and outcomes are high priorities,” stated Michtalik. “Support, education and teamwork are essential for any staffing model to be successful.”

Additionally, a September report from the American Academy of PAs (AAPA) stated that physician assistant demand and provider compensation was on the rise. Physician assistant compensation increased by 3.4 percent from 2014 to 2015, while the physician assistant workforce grew by more than 33 percent between 2010 and 2015.

“The growth of the PA profession in terms of size and compensation is just the tip of the iceberg,” said Jennifer L. Dorn, AAPA CEO. “PAs are going beyond just healthcare by taking on new leadership roles in health systems around the country. They are well positioned to drive change as the US healthcare system adapts to a growing and aging population, the shift towards value-based care, and a renewed focus on patient education and prevention. In short, the state of the PA profession has never been stronger.”

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