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Greater use of primary-care NPs seen as perhaps cutting costs

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study compares the cost of care provided to Medicare beneficiaries assigned to primary-care nurse practitioners and physicians. It suggests that increasing the use of nurse practitioners to meet the demand for primary-care services for Medicare beneficiaries is unlikely to cost more and may actually reduce  overall costs.

Tom G. Bartol, a nurse practitioner, perhaps not unexpectedly, writes:

“Some might argue that NP care is cheaper because the care is not as good, that NPs have fewer years of education than physicians, and that the extra cost of physician care means better care. However, more years of education does not inherently equate to better care. What this study indicates is that NPs may be providing excellent care at a better price, or more efficient care.”

“Three years ago in my family practice setting, I changed from 15-minute appointments to 30-minute appointments. This gave me time to get to know my patients better, and to have time to understand whether chest pain might be caused by anxiety or cardiac issues, or whether rising blood sugar levels meant that the patient needed more medications for diabetes or was experiencing issues at home that were resulting in poorer eating habits, stress, or unhealthy coping behaviors. Since increasing visit length, the number of prescriptions, diagnostic tests and referrals attributed to me for all of my patients has declined significantly. Using electronic health record data, I have found I write about one half as many prescriptions as the average clinician in our multiclinic practice (with 57 total clinicians), order less than one third the number of diagnostic tests, and make less than one half as many referrals.”

“The goal in healthcare must not be to give cheaper care, but to give more efficient care. 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. This is the heart of nursing. Investing more time in patient care is a key to achieving the triple aim of quality, cost, and patient experience.”

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