Amid doctor shortage, NPs and PAs seemed like a fix. Data’s in: Nope.

[wamcp]

Amid doctor shortage, NPs and PAs seemed like a fix. Data’s in: Nope.

One health system turned to these nonphysician providers in a pinch, only to find they needed to rethink the strategy after reviewing their data.

www.ama-assn.org

Nephrologist John M. Fitzpatrick, MD, president of Hattiesburg Clinic and another co-author of the study, said “four of the five top highest-cost providers were nurse practitioners.” That finding “prompted us to really analyze the whole population and, ultimately, led to the findings in the paper.”

In fact, patients who saw a nondoctor as their primary care provider (PCP) had higher rates of ED use than patients without a PCP.

The data also showed that physicians performed better on nine of 10 quality measures, with double-digit differences in flu and pneumococcal vaccination rates.

“This was surprising, as these are typically considered ‘process’ measures that can be adequately handled by nonphysician staff,” the study says.

Physicians also had higher average patient-satisfaction scores across six domains measured by Press Ganey.

“…based on a wealth of information and experiences with them functioning in collaborative relationships with physicians, we believe very strongly that nurse practitioners and physician assistants should not function independently,” the study says.

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[Mehena]

This is a really great observational study. Kudos to Drs Batson and Fitzpatrick! Need more data such as this one in other specialities to stem the alarming encorachment by NPs.

 

[CCM-MD]

We need more of this.

 

[DrMetal]

Amid doctor shortage, NPs and PAs seemed like a fix. Data’s in: Nope.

One health system turned to these nonphysician providers in a pinch, only to find they needed to rethink the strategy after reviewing their data.

www.ama-assn.org

Nephrologist John M. Fitzpatrick, MD, president of Hattiesburg Clinic and another co-author of the study, said “four of the five top highest-cost providers were nurse practitioners.” That finding “prompted us to really analyze the whole population and, ultimately, led to the findings in the paper.”

In fact, patients who saw a nondoctor as their primary care provider (PCP) had higher rates of ED use than patients without a PCP.

The data also showed that physicians performed better on nine of 10 quality measures, with double-digit differences in flu and pneumococcal vaccination rates.

“This was surprising, as these are typically considered ‘process’ measures that can be adequately handled by nonphysician staff,” the study says.

Physicians also had higher average patient-satisfaction scores across six domains measured by Press Ganey.

“…based on a wealth of information and experiences with them functioning in collaborative relationships with physicians, we believe very strongly that nurse practitioners and physician assistants should not function independently,” the study says.

We're all preaching to the choir here. Question is, will hospital admin recognize this delta? Will they hire more physicians, pay them better, and stop dicking with them?

Sadly I think not. I think the hospital industry and the megacomplex it's become is ok with reduced metrics and diminished care. It's saving them too much money.

Look at the plethora of bs "what do you think of this offer?" contracts posted here.

 

[Redpancreas]

Amid doctor shortage, NPs and PAs seemed like a fix. Data’s in: Nope.

One health system turned to these nonphysician providers in a pinch, only to find they needed to rethink the strategy after reviewing their data.

www.ama-assn.org

Nephrologist John M. Fitzpatrick, MD, president of Hattiesburg Clinic and another co-author of the study, said “four of the five top highest-cost providers were nurse practitioners.” That finding “prompted us to really analyze the whole population and, ultimately, led to the findings in the paper.”

In fact, patients who saw a nondoctor as their primary care provider (PCP) had higher rates of ED use than patients without a PCP.

The data also showed that physicians performed better on nine of 10 quality measures, with double-digit differences in flu and pneumococcal vaccination rates.

“This was surprising, as these are typically considered ‘process’ measures that can be adequately handled by nonphysician staff,” the study says.

Physicians also had higher average patient-satisfaction scores across six domains measured by Press Ganey.

“…based on a wealth of information and experiences with them functioning in collaborative relationships with physicians, we believe very strongly that nurse practitioners and physician assistants should not function independently,” the study says.

It sounds almost too good to be true in that it’s what all doctors have been saying for years. Part of me wonders if someone went looking for this conclusion and found results to be consistent with it. If I was good at critically appraising literature, I’d take a look, but I’ll leave that to others if they wish to. The fact that it’s published in the AMA is nice, but how a nice piece about it in the WSJ or NYT?

 

[Chemist0157]

We're all preaching to the choir here. Question is, will hospital admin recognize this delta? Will they hire more physicians, pay them better, and stop dicking with them?

Sadly I think not. I think the hospital industry and the megacomplex it's become is ok with reduced metrics and diminished care. It's saving them too much money.

Look at the plethora of bs "what do you think of this offer?" contracts posted here.

It’s a numbers game, and the numbers will have to come from CMS. We are going to see more and more value based care, and CMS could arrange it in such a way to be incentivizing to hit certain metrics and save money…or punishing if the metrics are not met. Hospital systems will then run the numbers and see what makes them the most money, using midlevels at less cost to the business but more cost to CMS and loss of revenue as a business under value based care. Or using physicians…maybe pay more and get more.

CMS has a lot of levers they can pull. I think it’s just hard to make a political move against some of the entrenched mid level advocacy groups.