PAs and NPs are cheaper hence why a lot of PAs and NPs run a lot of ICUs
Critical care operates differently than fields like Anesthesiology or Emergency Medicine. In most hospital systems, reimbursement is tied to DRG-based bundled payments. That means resources aren't limitless, and insurers don't simply reimburse whatever is billed. You're working within a defined framework—every decision impacts the bottom line.
NPs, by billing standards, are reimbursed at 85% of the physician rate. On top of that, claim denial rates are statistically higher when NPs are the primary providers. This directly affects revenue capture.
Over time, experienced hospital administrators have learned that relying heavily on NPs isn't always the cost-saving strategy it appears to be. In fact, care delivery by NPs can often result in
higher overall costs—more consultations, increased rates of complications, and ultimately greater resource utilization.
There’s also a legal dimension. In the event of adverse outcomes, juries may scrutinize decisions where hospitals opted to prioritize NPs over physicians purely to cut costs. In certain states, the financial liability can be catastrophic—enough to threaten the hospital's survival.
So while NPs play some role to fill some gaps, assuming they always equate to cost savings is a dangerous oversimplification. At the end of the day, the numbers don’t lie—and everything checks out financially.
If having us financially does not make any sense for the hospital we would be deemed a dying species!
