NPs, PAs can lower care costs for complex patients

In recent years, nurse practitioners and physician assistants have been taking on ever-greater roles as primary care providers, especially for patients with chronic complex conditions. Their expanded use has been driven largely by the shortage of primary care physicians.

A new study suggests that they can also reduce the costs of caring for these patients. The study, published in the June issue of Health Affairs, focuses on approximately 47,000 medically complex patients with diabetes who received care at Veterans Affairs facilities in 2013. It compares the costs and outcomes of those who had physicians as their primary care provider with those who received care from an NP or PA.

About half the patients were older than 65. On average, patients receiving care from physicians had 6.9 chronic conditions, while NP and PA patients had 6.7 and 6.8 conditions, respectively.

The study found that patients getting care from NPs and PAs had fewer emergency department visits and in-patient stays than those who were cared for by physicians. That, in turn, led to lower inpatient, outpatient and pharmacy expenditures. Inpatient spending was 8.7 percent lower for patients of NPs and 6 percent lower for patients of PAs. For outpatient expenditures the differences were 2.9 percent and 5.3 percent, respectively, and for pharmacy the differences were 8.9 percent and 7.7 percent.

Overall, expenditures on patients of NPs were 6 percent lower than on patients of doctors, while for PAs the difference was 7 percent. That translates to a difference of $2,000 and $2,300, respectively, in annual per-patient healthcare costs.

The authors say their findings refute the belief held by some physicians and administrators that using NPs and PAs to treat complex patients drives up care costs, because these providers are less able to handle acute illness exacerbations than doctors, and therefore their patients are more likely to require expensive ED visits or hospital admissions.

Consequently, they say, the study “provides further evidence that NPs and PAs be appropriately used as primary care providers, as opposed to being limited to supplementing the care of physicians within primary care settings.”