Impact Of Physicians, Nurse Practitioners, And Physician Assistants On Utilization And Costs For Complex Patients

Because of workforce needs and demographic and chronic disease trends, nurse practitioners (NPs) and physician assistants (PAs) are taking a larger role in the primary care of medically complex patients with chronic conditions. Research shows good quality outcomes, but concerns persist that NPs'...

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Bibliographic Details
Published in:Health Affairs 2019-06, Vol.38 (6), p.1028-1036
Main Authors: Morgan, Perri A., Smith, Valerie A., Berkowitz, Theodore S. Z., Edelman, David, Van Houtven, Courtney H., Woolson, Sandra L., Hendrix, Cristina C., Everett, Christine M., White, Brandolyn S., Jackson, George L.
Format: Article
Language:English
Subjects:
Acute services
Ambulatory care
Assistants
Chronic conditions
Chronic illnesses
Complex patients
Costs
Demographics
Diabetes
Diabetes mellitus
Doctors' assistants
Electronic health records
Emergency medical care
Endocrinology
Generalized linear models
Health care
Health care expenditures
Health care policy
Health services
Inpatient care
Medical personnel
Medicare
Nurse practitioners
Patients
Pharmacy
Physician assistants
Physicians
Primary care
Roles
Services
Veterans
Vulnerability
Workforce
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Summary:Because of workforce needs and demographic and chronic disease trends, nurse practitioners (NPs) and physician assistants (PAs) are taking a larger role in the primary care of medically complex patients with chronic conditions. Research shows good quality outcomes, but concerns persist that NPs' and PAs' care of vulnerable populations could increase care costs compared to the traditional physician-dominated system. We used 2012-13 Veterans Affairs data on a cohort of medically complex patients with diabetes to compare health services use and costs depending on whether the primary care provider was a physician, NP, or PA. Case-mix-adjusted total care costs were 6-7 percent lower for NP and PA patients than for physician patients, driven by more use of emergency and inpatient services by the latter. We found that use of NPs and PAs as primary care providers for complex patients with diabetes was associated with less use of acute care services and lower total costs.
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.2019.00014