Advanced practitioners: Expanded role, bigger impact
Posted almost 10 years ago by Nicholas M Perrino
"Recent studies suggest that the savings resulting from increased use of physician assistants (PAs) and nurse practitioners (NPs) could be significant. Still, legislative barriers at the state level related to scope of practice guidelines may be keeping their full cost-savings benefits at bay.
A recent study by Roderick S. Hooker, PhD, MBA, PA, a health policy consultant, and Ashley N. Muchow, a RAND Corporation assistant policy analyst, evaluated how revising state scope of practice laws would impact healthcare costs.
The analysis focused on Alabama, which researchers identified as one of the states with the most restrictive PA and NP legislation. In fact, the American Association of Nurse Practitioners (AANP) places the state in its 'reduced practice category,' meaning 'state practice and licensure law reduces the ability of nurse practitioners to engage in at least one element of NP practice.'
The Hooker-Muchow analysis found that if Alabama's laws were aligned with less-restrictive laws in other states, such as Washington and Arizona, more PAs and NPs would practice there, which would lead to higher NP and PA utilization. This would lead to a net savings of $729 million over a 10-year period, according to the study findings.
Cost and quality
Much of the potential cost benefit associated with PA/NP utilization can be attributed to the reimbursement environment. Medicare and Medicaid tend to pay PAs and NPs approximately 85% of what they pay physicians for the same services.
Increased PA/NP utilization may also increase patient access to care. This could lead to higher patient use of primary-care services, which could lead to cost-savings in the long term.
While quality of care remains a common question surrounding increased use of PAs and NPs, many studies, including a 2009 study by the RAND Corporation, find that NPs and PAs provide the same quality of care at lower costs when compared to primary-care physicians."