3-Year Study of NPs in the Emergency Department: Worse Outcomes, Higher Costs

3-Year Study of NPs in the Emergency Department: Worse Outcomes, Higher Costs

According to a working paper published by the National Bureau of Economic Research.

This higher preventable hospitalization rate “may reflect two possibilities,” says the paper, authored by David Chan, MD, PhD, associate professor of health policy at Stanford University School of Medicine, and Yiqun Chen, PhD, assistant professor of economics at the University of Illinois at Chicago.

The first is that “NPs have weaker decision-making about who to admit to hospital, resulting in under-admission of patients who should have been admitted and a net increase in return hospitalizations, although NPs use longer lengths of stay to assess the needs of hospitalized patients. admission.”

The other possibility is that “nurse practitioners produce substandard care provided they accept decisions, despite

spending more resources to treat the patient (as measured by emergency department costs). Both possibilities imply lower skills of NPs compared to physicians. »

Overall, the study shows that NPs increase the cost of ED care by 7%, or about $66 per patient. Increasing the number of NPs on duty to reduce wait times increased total health care spending by 15%, or $238 per case, not including the cost of additional NP salaries. In total, assigning 25% of emergencies to NPs results in net costs to the VHA of $74 million annually.

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“Increasing the number of IPs in service reduces wait times, but increases resource utilization and negative outcomes,” the working paper states. The main contributor to these higher costs was “low productivity,” that is, NPs were more likely to order tests such as x-rays and CT scans and request formal consultations than physicians. emergency.

Patients deserve care led by physicians, the most educated, trained and skilled health care professionals. That’s why the AMA is vigorously defending the practice of medicine against scope of practice extensions that threaten patient safety under the AMA’s stimulus package for American physicians.

Dr. Chan, of Stanford, is due to speak about his research at the upcoming AMA State Advocacy Summit, Jan. 12-14, 2023, in Marana, Arizona.

The registration deadline is Dec. 30 for the meeting, which focuses on key health issues that state lawmakers are likely to address in the 2023 legislative sessions, including prior authorization, scope of practice, telehealth, physician wellness, the overdose epidemic, and reproductive health. . Learn more and register now.

What sets this study apart

Unlike other research comparing the performance of physicians and non-physicians and the impact of expanding scope of practice on cost and quality of care, this economic study goes beyond correlation by using a high quality causal analysis.

And while many other studies attempt to draw comparisons based on NPs or other non-physicians who actually practice under collaborative arrangements with physicians, this study relies on data from a time – 2017 to 2020, just before the pandemic – when NPs within the VHA were really practical without the supervision of a doctor.

The study found that the gap between physicians and nurse practitioners in cost and quality increased with patient complexity, with nurse practitioners more likely to admit patients with complex conditions to hospital or serious. The effect of PIs on length of stay and medical costs also increased with the complexity of the patient’s condition.

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Physicians complete between 10,000 and 16,000 hours of clinical education and training – four years of medical school and another three to seven years of residency training. In comparison, NPs complete between 500 and 720 hours of clinical training over two or three years of graduate school.

A study by researchers from Johns Hopkins University, the University of New Mexico and other institutions found that few NPs are certified to provide emergency care and that NPs’ qualifications to practice in emergency departments vary widely from state to state.

Visit AMA Advocacy in Action to find out what’s at stake in the fight against scope creep and other advocacy priorities that AMA is actively working on.

Also learn why patients deserve greater clarity about who is a doctor and who isn’t.

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