The Impact of Using Mid-level Providers in Face-to-Face Primary Care on Health Care Utilization. Issue 1 (January 2017)

• Record Type: Journal Article
• Authors: Liu, Hangsheng; Robbins, Michael; Mehrotra, Ateev; Auerbach, David; Robinson, Brandi E.; Cromwell, Lee F.; Roblin, Douglas W.
• Is Part Of: Medical care. Volume 55:Issue 1(2017)
• Publication Date: 2017-01
• Subjects: primary care -- nurse practitioner -- physician assistant -- healthcare utilization; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000000590
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: There has been concern that greater use of nurse practitioners (NP) and physician assistants (PA) in face-to-face primary care may increase utilization and spending. Objective: To evaluate a natural experiment within Kaiser Permanente in Georgia in the use of NP/PA in primary care. Study Design: From 2006 through early 2008 (the preperiod), each NP or PA was paired with a physician to manage a patient panel. In early 2008, NPs and PAs were removed from all face-to-face primary care. Using the 2006–2010 data, we applied a difference-in-differences analytic approach at the clinic level due to patient triage between a NP/PA and a physician. Clinics were classified into 3 different groups based on the percentage of visits by NP/PA during the preperiod: high (over 20% in-person primary care visits attended by NP/PAs), medium (5%–20%), and low (<5%) NP/PA model clinics. Measures: Referrals to specialist physicians; emergency department visits and inpatient admissions; and advanced diagnostic imaging services. Results: Compared with the low NP/PA model, the high NP/PA model and the medium NP/PA model were associated with 4.9% and 5.1% fewer specialist referrals, respectively ( P <0.05 for both estimates); the high NP/PA model and the medium NP/PA model also showed fewer hospitalizations and emergency department visits and fewer advanced diagnostic imaging services, but none of these was statistically significant. Conclusions: We find no evidence to support concerns that under a physician's supervision, NPs and PAs increase utilization and spending. Abstract : Supplemental Digital Content is available in the text.