Quality and Cost of Care by Nurse Practitioners vs. Physicians

Purpose and Research Questions

Cost and quality of healthcare access are two interrelated concepts central to the healthcare debate in the United States. This study narrows its focus to the costs and quality of care delivered by nurse practitioners (NPs) and compares their effectiveness with that of physicians on both dimensions. The study is guided by two research questions:

i. How does the cost of care provided by nurse practitioners compare to that of physicians?

ii. How is the quality of care provided by nurse practitioners?

Literature Review

According to Fletcher, Copeland, and Lowery (2011), nurse practitioners can provide primary care that is underutilized within the healthcare environment. By acquiring skills in patient care management and physical assessment, NPs can become primary care providers delivering services such as diagnosing, ambulatory care settings, and providing treatments for a variety of health problems. Based on this skill set, NPs are expected to provide services that are less costly. Fletcher et al. (2011) reveal that the number of Veterans seeking primary healthcare services from nurse practitioners since 1996 has increased by more than 200%, an increase attributed to high-quality and cost-effective services.

Litaker, Mion, and Planavsky (2003) demonstrate that there are modest incremental costs associated with a complementary team approach to the management of chronic disease. The authors reveal that the intervention of NPs and medical practitioners increases HDL-c prevalence by 7%; however, HbA1c for diabetes patients decreases from 7.9% to 7.0%. Microvascular complications were reduced by 25%, and a reduction of 16% for non-fatal and fatal sudden death and myocardial infarction was recorded. Despite the cost-effectiveness analysis carried out for NPs, the authors did not include personnel costs in their evaluation.

Allen et al. (2014) studied the cost-effectiveness of NP intervention on patients suffering from cardiovascular disease (CVD). While evidence-based practice for managing CVD is available, patient adherence to therapies remains slow. The authors argue that nurse practitioners can assist in providing quality care at lower costs comparable to services delivered by other healthcare professionals. With NP intervention, the authors calculated the total costs per patient to manage CVD. The findings reveal that total costs per patient are $627. Cost-effectiveness analysis shows a $157 reduction in cost for every 1% drop in systolic blood pressure, a $190 decline for every 1% drop in diastolic blood pressure, a $149 decline per 1% drop in HbA1c, and a $40 decline per 1% drop in LDL cholesterol. The research demonstrates that management of CVD by NPs is cost-effective for patients at high risk of the disease.

Kapu, Kleinpell, and Pilon (2014) investigated the financial impact of NPs on inpatients at a hospital setting. The investigation was carried out in the context of national initiatives targeting the cost-effectiveness of NPs in optimal healthcare environments, based on the belief among health administrators that NPs can deliver cost savings while also reducing administrative costs. The authors analyzed the return on investment (ROI) after adding five NP teams, using software to evaluate length of stay and NP quality metrics. Data collected were compared with the previous year's data. The findings reveal that NPs demonstrated a substantial decline in costs, using fewer resources to deliver a standardized quality of care.

Even though significant research exists on the quality and costs of NP-provided healthcare, further inquiry is necessary given that healthcare delivery is dynamic — services and technologies change continuously. With specific relevance to the U.S. healthcare system, this research is needed to uncover the effects of ongoing healthcare policy changes.

Theoretical Framework

Jean Watson's Theory of Human Caring is adopted as the theoretical framework for this study. The theory asserts that a human being cannot be healed as an object, but rather as part of an environment, nature, and the larger universe (Ozan, Okumus, & Lash, 2015). This study addresses environmental influences on healing — specifically cost and quality of care — which are considered to affect healing through the satisfaction perceived by a patient. The objective of the theory is to establish a harmonious balance between health and illness experience, which aligns directly with this study's purpose of examining cost and quality of care.

According to Watson's theory, nursing is a humanitarian science characterized by scientific, personal, ethical, and aesthetic practice (Ozan et al., 2015). This framework is particularly well suited to this research because it is specific to people and acknowledges the various dimensions of human integrity while simultaneously accounting for the mind-body-spirit connection.

References

Allen, J. K., Himmelfarb, C. R. D., Szanton, S. L., & Frick, K. D. (2014). Cost-effectiveness of nurse practitioner/community health worker care to reduce cardiovascular health disparities. The Journal of Cardiovascular Nursing, 29(4), 308.

Fletcher, C. E., Copeland, L. A., Lowery, J. C., & Reeves, P. J. (2011). Nurse practitioners as primary care providers within the VA. Military Medicine, 176(7), 791–797.

Kapu, A. N., Kleinpell, R., & Pilon, B. (2014). Quality and financial impact of adding nurse practitioners to inpatient care teams. Journal of Nursing Administration, 44(2), 87–96.

Litaker, D., Mion, L. C., Planavsky, L., Kippes, C., Mehta, N., & Frolkis, J. (2003). Physician–nurse practitioner teams in chronic disease management: The impact on costs, clinical effectiveness, and patients' perception of care. Journal of Interprofessional Care, 17(3), 223–237.

Ozan, Y. D., Okumus, H., & Lash, A. A. (2015). Implementation of Watson's Theory of Human Caring: A case study. International Journal of Caring Sciences, 8(1), 25.

Stanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., & Weiner, J. P. (2013). The quality and effectiveness of care provided by nurse practitioners. The Journal for Nurse Practitioners, 9(8), 492–500.