Medicare costs lower when care is provided from nurse practitioners instead of primary care docs

A recent study found costs were lower when Medicare patients received care from nurse practitioners (NP) compared to care provided by primary care physicians across inpatient and office-based settings.

The research suggests that the different practice styles of the two types of clinicians may be at play. Indeed, it's the time spent with patients that ultimately makes a difference, writes Tom G. Bartol, a family nurse practitioner, Richmond Area Health Center in Maine, in a Medscape commentary.

The study, published in Health Services Research, found that after controlling for other factors, Medicare costs for patients of NPs were more cost-effective than for physicians' patients. Medicare outpatient evaluation and management payments were $207, or 29 percent, less for patients who saw NPs than those assigned to primary care physicians. The same pattern held true for inpatient visits (11 percent less) and office visits (18 percent less). The researchers accounted for the difference in Medicare reimbursement rates for physicians and NPs.

The researchers said their results suggest that increasing the use of NPs to meet the demand for primary care services will not increase costs for the Medicare program and may in fact save costs.

The findings indicates that NPs may provide excellent care at a better price, or more efficient care, Bartol writes. He notes that the study found the average number of Medicare patients seen by each physician was double that seen by each NP (367 versus 183). The reason may be that NPs spend more time with their patients to give more in-depth care, he says.

Three years ago, Bartol says he extended his patient appointments from 15 minutes to 30 minutes in the family practice where he works. Since increasing the time with patients, he says the number of prescriptions, diagnostic tests and referrals for all of his patients has declined significantly. For instance, he writes about half as many prescriptions compared to the other 57 clinicians in the multi-clinic practice and makes less than half as many referrals.

Spending more time with patients may allow clinicians to elicit other causes for the patient's symptoms that can be managed without medications or diagnostic tests, he says.

"Better patient-centered care, where the patient is involved and feels heard and understood, will result in the 'side effect' of lower-cost care. NPs are not cheaper. They have been trained to go beyond the medical condition or symptoms to the biological and psychosocial factors that may be affecting each person," he says.

NPs are helping to fill the demand for primary care services. For instance, Americans living in the most rural areas of the country continue to lack access to primary care clinicians, with NPs far more likely to serve these areas, as FiercePracticeManagement reported.

NPs also provide quality care. Recent studies have found that patients with certain chronic diseases get equal or better quality of care when nonphysician providers deliver their primary care.

To learn more:
- read the commentary
- here's the study abstract