Moderator ventana Posted June 18, 2019 Moderator Share Posted June 18, 2019 https://www.aapa.org/news-central/2019/06/duke-professor-highlights-health-care-cost-savings-for-pa-patients-at-the-va/?utm_source=medwatch&utm_campaign=news_central_article&utm_medium=email Duke Professor Highlights Health Care Cost Savings for PA Patients at the VA Experts Discuss Care for High-Need Patients June 13, 2019 By Jenni Roberson The need to expand the U.S. healthcare workforce to ensure care for the aging population living with chronic conditions – and the associated costs for patients – was the topic of a recent briefing hosted by the journal Health Affairs in Washington, D.C. Perri Morgan, PhD, PA-C, professor and director of research for the PA Division in the Department of Family Medicine and Community Health at Duke University Medical School, joined a panel of experts to discuss research that underscores how PAs and NPs can continue to be a part of efforts to address the growing need for high-quality healthcare professionals. [Reforming American’s Healthcare System Through Choice and Competition: Statements Relevant to the PA Profession] During her presentation, Morgan discussed research conclusions that used U.S. Department of Veterans Affairs (VA) data on a cohort of 47,236 medically complex patients with diabetes to compare health services use and costs over one year depending on whether the primary care provider was a physician, NP, or PA. An article about this research, “Impact of Physicians, Nurse Practitioners, and Physician Assistants on Utilization and Costs for Complex Patients,” was recently published in Health Affairs, a peer-reviewed journal of health policy thought and research. The VA is a unique health care system that functions as a patient-centered medical home and in which PAs, NPS, and physicians lead their own teams responsible for patient care. In addition, PAs and NPs are granted a permissive scope of practice. The similar roles of physicians, PAs, and NPs in this care model allows researchers to accurately compare the outcomes of the three types of care teams. The research in question looked specifically at the most complex patients with diabetes within the VA system; the average patient within this study was three and a half times more medically complex than the average Medicare patient and had over six chronic conditions. Using EHR data and controlling for differences in patient demographics and medical and social complexity, the researchers found that physician patients had statistically significantly higher overall costs than patients of NPs and PAs. The higher costs were driven by more emergency department visits and more inpatient admissions for patients with physician primary care providers. Patients of NPs and PAs had nearly identical mean per patient expenditures in all categories. Patients of PAs and NPs incurred lower annual per patient pharmacy expenditures than patients of physicians (9%, 95% CI: 4, 13%; 8%, 95% CI: 1, 14, respectively), translating to a mean per patient annual difference of approximately $300 in pharmaceutical expenditures. Smaller differences were seen in outpatient expenditures between provider types: Compared to patients of physicians, patients of NPs incurred 3% lower (95% CI: 0.04, 6) outpatient expenditures in the year, and patients of PAs incurred 5% lower (95% CI: 1, 9) outpatient expenditures. [National Rural Health Association Releases Policy Brief on PAs] The cumulative effect led to a reduction in total per patient health care costs for patients of NPs and PAs, compared to those of physicians. Overall, patients of NPs incurred 6% lower expenditures compared to those of physicians (95% CI: 3, 9), while patients of PAs incurred 7% lower expenditures (95% CI: 2, 11). This translated to a difference of $2,005 and $2,300 in per patient annual total health care costs, respectively.1 While both patients of both PAs and NPs had had more primary care visits, they had less utilization of inpatient visits, and had fewer days with an emergency department visit. The work of the researchers demonstrates that PAs and NPs, when practicing under permissive scopes of practice, can provide primary care services for the most medically complex patients with diabetes mellitus, without raising costs. More ResourcesAAPA ResearchDiabetes is Daunting. Finding a Quality Provider Shouldn’t Be.PAs Can Bring Cost-Effective Care to Complex PatientsCare Costs 6-7% Lower for Complex Patients Treated by NPs, PAs References Health Affairs. Impact of Physicians, Nurse Practitioners, and Physician Assistants on Utilization and Costs for Complex Patients. Health Affairs website. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.00014 FacebookTwitterLinkedInEmail You might also like Medicare’s “Incident to” Billing Hinders the Recognition and Assessment of PA Value June 17, 2019 American Academy of PAs Responds to MedPAC’s Report on Medicare and the Health Care Delivery System June 17, 2019 New PAs Can Close the Wage Gap by Knowing Their Worth June 17, 2019 AAPA Announces Leadership Change June 12, 2019 Quote Link to comment Share on other sites More sharing options...
WeBuyAndSellJunk Posted June 18, 2019 Share Posted June 18, 2019 (edited) Interesting, but there are some potential issues here. 1) There are obvious conflicts of interests as the first author receives grants from PAEA and is a PA. 2) Confidence intervals are either really broad or they sit on the border of non-significance. This was a lot of subjects and I wonder if it was over powered. 3) Even if we cost patients less, I want to see equivalent morbidity and mortality and that wasn’t assessed. It matters if you got admitted to the hospital but didn’t die or maybe salvaged some QALYs. Edited June 18, 2019 by printer2100 3 Quote Link to comment Share on other sites More sharing options...
surgblumm Posted July 18, 2019 Share Posted July 18, 2019 Super study. To get traction in the correct places call upon AAPA or PAFT to get the ball rolling and develop a quick plan to get this out to every major insurance executive. We have not because we ask not---research, to be effective, must be placed in action. 1 Quote Link to comment Share on other sites More sharing options...
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