Increasing the use of nurse practitioners to meet the growing demand for primary care services for Medicare beneficiaries may actually reduce costs for the government program while still providing beneficiaries with high-quality care, according to a study by Medscape.
In the study, researchers used retrospective cohort design to compare the amount Medicare paid on claims submitted by NPs with the amount paid to primary care physicians in inpatient and ambulatory care settings over a 12-month period. The findings show that across all payment categories, Medicare payments for NP-assigned beneficiaries were consistently lower than payments for PCP-assigned beneficiaries.
Here is a comparison between payments to PCPs and NPs.
- Inpatient services — PCP ($22,898); NP ($20,380); Difference (-11 percent)
- Part B services — PCP ($2,955); NP ($2,433); Difference (-18 percent)
- Outpatient evaluation and management — PCP ($705); NP ($498); Difference (-29 percent)
- Adjusted work relative value unit — PCP ($1,911); NP ($1,629); Difference (-15 percent)
- Evaluation and management relative value unit — PCP ($713); NP (585); Difference (-18 percent)
Some may argue care provided by NPs is cheaper because they have fewer years of education than PCPs and provide lower-quality care. However, the study indicates NPs may be providing excellent, efficient care at a lower price, as the average number of Medicare beneficiaries seen by each PCP was double that seen by each NP (367 beneficiaries compared with 183, respectively).
While it is possible PCPs work more quickly, it is likely that NPs spend more time with each patient to provide more in-depth care, which in turn enhances quality, efficiency and better outcomes, according to the report. On the other hand, shorter, more rushed visits may result in more diagnostic tests ordered, more medications prescribed and more referral requests.