Nurse Practitioner Workforce

Nurse Practitioners: Better Care Savings Crosspost: Nurse Practitioner Workforce Nurse Practitioners: Potential Better Care Savings Nurse Practitioners: Potential Better Care Savings With passage of the Patient Protection and Affordable Care Act (ACA) of 2010 and its stated agenda for controlling the cost of healthcare in America, many are advocating for expansion of the nurse practitioner (NP) workforce and its scope of practice (Poghosyan, Lucero, Rauch, and Berkowitz, 2012). The concerns about current and projected healthcare costs are warranted. In 2009, the U.S.

allocated just over 17% of its gross domestic product to health care spending, which is at least 5% above that spent by other Western nations (Squires, 2012). Half of this was spent through Medicare and Medicaid, which provides coverage for retirees, the disabled, and those living in poverty. This is important because the latter two patient populations are those traditionally served by NPs (Poghosyan, Lucero, Rauch, and Berkowitz, 2012).

While many NP workforce advocates have highlighted the limitations that several states have placed NP's scope of practice and the lost healthcare savings thus incurred (Poghosyan, Lucero, Rauch, and Berkowitz, 2012), the potential savings means little unless the care provided is at least equivalent to physicians. Horrocks and colleagues (2002) conducted a systematic literature review of empirical studies that had investigated quality of care issues surrounding NPs and found no difference in health status, prescriptions written, return consultations, or referrals.

However, NPs tended to spend significantly more time with patients and conduct more tests. This would probably explain why patients reported greater satisfaction with NP care. A more recent systematic review of the literature encompassed 37 studies, many of which had been published since Horrock and colleagues (2002) conducted their study (Newhouse et al., 2011).

Based on this analysis, NPs are equivalent to physicians in terms of patient satisfaction, health status, hypertension control, emergency department visits, hospitalizations, ventilation duration, length of hospital stay, and mortality; however, NP patients tended to control their serum glucose and lipid levels better. These findings suggest primary care provided by NPs is at least equal to that provided by physicians.

Based on the studies mentioned above, NPs could potentially be a source of healthcare costs savings apart from lower fees and eliminating the overhead physicians charge for allowing NPs to practice in their office (Poghosyan, Lucero, Rauch, and Berkowitz, 2012). The estimated annual, direct health care costs of diabetes and coronary atherosclerosis in 2006/2007 were $176 million (CDC, 2011) and $45 billion (CHRT, 2010), respectively. In fact, a diagnosis of coronary atherosclerosis represented the most expensive diagnosis nationally for hospital discharges, averaging almost $47,000 per discharge.

Conclusions Many advocates for expanding the NP workforce have cited lower fees as the primary source of healthcare savings; however, if the quality of care is not equivalent to that provided by physicians, then the savings benefit would be doubtful. Two systematic literature reviews, one done in the United Kingdom and the other in the U.S., both discovered that the quality of care is essentially equivalent across a number of indicators, if not better. The healthcare cost savings due to lower fees is therefore a valid claim.

References CDC (U.S. Centers for Disease Control and Prevention). (2011). National diabetes fact sheet, 2011. CDC.gov. Retrieved 25 Mar. 2013 from http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf CHRT.