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Five New Studies: Nurse Practitioners Expand Access to Health Care, Lower Costs, Improve Outcomes

Tuesday, March 1, 2016  
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Rural Patients, Medicaid Patients, Taxpayers All Benefit from NPs


Harrisburg – As lawmakers consider proposals to update Pennsylvania’s outdated nurse practitioner law, five recently released academic studies underscore the quality of nurse practitioner-delivered health care.


Five separate studies concluded that nurse practitioners (NPs) expand access to care, improve patient health outcomes, boost rural health care, lower primary care costs and reduce emergency room admissions.


“These studies along with hundreds before them prove that nurse practitioners provide safe, effective and affordable care. Pennsylvania’s choice is to modernize our laws to serve patients, or face the prospect of talented providers relocating to states like Maryland that have already adopted reform,” said Lorraine Bock, President of the Pennsylvania Coalition of Nurse Practitioners.


Researchers at George Mason University, Montana State University, the University of California San Francisco and the University of Texas Medical Branch at Galveston released the studies in January and February.


·         The MSU study found that NP care represented a cost savings of 11 to 29 percent with no decrease in care quality.


·         Dr. Amitesh Agarwal, a physician with the University of Texas Medical Branch, found lower hospital admission rates among NP patients suffering from COPD. “And for some processes of care, the outcomes are somewhat better with nurse practitioners and physician assistants [compared with physicians],” he said.


·         “State policymakers (and taxpayers) interested in reducing the cost of care for citizens on Medicaid should consider relaxing restrictions on nurse practitioners and physician assistants,” researchers at George Mason University recommended.


Summaries of all five studies are below.


Currently, in order to practice in Pennsylvania, a nurse practitioner must secure business contracts called collaborative agreements with two physicians. These contracts can cost tens of thousands of dollars per year, enough to make practice impossible for individual nurse practitioners.


Lawmakers are currently considering Senate Bill 717 and House Bill 765 which would eliminate this outdated mandate.  21 states and Washington, DC have already adopted this reform.


The Institute of Medicine, AARP, and dozens of non-partisan health care experts cited extensive research when they endorsed efforts to modernize NP law.


Opponents, on the other hand, are unable to point to a single study that shows negative patient results under nurse practitioner reform.


Nurse practitioners (NPs) have graduate, advanced education, with master’s degrees or doctorates and are nationally certified in their specialty areas. Among their many services, NPs order, perform and interpret diagnostic tests; diagnose and treat acute and chronic conditions such as diabetes, high blood pressure, infections and injuries; prescribe medications and other treatments; and manage a patient’s care. 




Montana State University: Nurse practitioner patients less costly to Medicare than physician patients


·         “Across all five measures, the cost of care for patients with a nurse practitioner primary care provider ranged between 11 to 29 percent less than the patients with a physician primary care provider.”


·         “We examined national data and found large differences that persist even after taking into account the fact that nurse practitioners are paid at 85 percent of the rate paid to physicians for the same services,” said Peter Buerhaus, a nursing economist at Montana State. “In contrast to earlier research, this study suggests that nurse practitioners provide less expensive care across a range of different measures when considering the cost of services provided to Medicare beneficiaries over longer time periods, like one year, as opposed to examining a single encounter with a patient.”


Montana State University: MSU study finds nurse practitioners more likely than medical doctors to work in rural areas


·         “Nurse practitioners were relatively more likely to practice in rural areas than in urban areas. Further, the percentage of individuals with access to primary care differed depending on the state’s scope-of-practice laws, Buerhaus noted.


·         “For the 17 states that did not restrict scope-of-practice laws governing nurse practitioners at the time of the study, 62 percent of the state’s population had high geographic accessibility to a primary care nurse practitioner,” Buerhaus said. “In contrast, in the 21 states that fully restricted the practice of nurse practitioners, the percent of the population with high accessibility to a primary care clinician decreased considerably.”


University of Texas Medical Branch at Galveston: Study backs quality of nurse practitioner, physician assistant care


·         “Examining Medicare billing records for more than 7,200 patients, the researchers found that advance practice providers were more likely to follow guidelines for COPD care, prescribing short-acting inhalers or oxygen therapy. They were more likely to refer patients to pulmonary specialists, but less likely than doctors to give flu or pneumonia shots.”


·         “’There is no difference (in outcomes)’ said Dr. Amitesh Agarwal, a physician in UTMB's division of pulmonary critical care and sleep medicine and lead author of the study. ‘And for some processes of care, the outcomes are somewhat better with nurse practitioners and physician assistants.’”


University of California, San Francisco: Full Practice Authority for Nurse Practitioners Lowers Primary Care Costs


·         “Provider prices for primary care services fell by 1-4% following the implementation of independent SOP [scope of practice] for NPs.”


·         “Evidence suggests that states that successfully introduced independent NP SOP were able to increase the number of routine check-ups, lowered body mass index, and achieved a lower rate of ER admissions for conditions that are sensitive to ambulatory care. Research also suggests that restrictive scope-of-practice regulations may hinder the expansion of health care utilization when provider supply grows.”


·         Study authors attributed any cost increases to the fact that NP reform increases overall access to care: “The increase in total costs may be related to an increase in volume of services provided by NPs, which may result from increased access to care if independent SOP leads to growth in NP supply.”


George Mason University:  "Scope of Practice" Laws Raise Health Care Costs for Poor


·         “State policymakers (and taxpayers) interested in reducing the cost of care for citizens on Medicaid should consider relaxing restrictions on nurse practitioners and physician assistants.”


·         “The results of this paper, combined with findings of other researchers, suggest that broader scope of practice for NPs and PAs has little effect on the quality of care delivered, increases access to health care, and also potentially reduces the cost of providing health care to patients. More generally, broadening the scope of practice of nonphysician healthcare providers and reducing the monopoly power of physicians in the healthcare market is very likely to improve consumer welfare.”


About the Pennsylvania Coalition of Nurse Practitioners


PCNP is the state organization that promotes and protects the practice of over 9,000 Certified Registered Nurse Practitioners (CRNPs) in Pennsylvania whose mission is to improve access to care. Formed in the 1980s by three forward-thinking NPs, PCNP now has 18 regional groups across the Commonwealth.


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