The Impact of Nurse Practitioner-Led Primary Care on Quality and Cost for Medicaid-Enrolled Patients in States With Pay Parity

Abstract

Studies have established that nurse practitioners (NPs) deliver primary care comparable to physicians in quality and cost, but most focus on Medicare, a program that reimburses NPs less than physicians. In this retrospective cohort study, we evaluated the quality and cost implications of receiving primary care from NPs compared to physicians in 14 states that reimburse NPs at the Medicaid fee-for-service (FFS) physician rate (i.e., pay parity). We linked national provider and practice data with Medicaid data for adults with diabetes and children with asthma (2012-2013). We attributed patients to primary care NPs and physicians based on 2012 evaluation & management claims. Using 2013 data, we constructed claims-based primary care quality measures and condition-specific costs of care for FFS enrollees. We estimated the effect of NP-led care on quality and costs using: (1) weighting to balance observable confounders and (2) an instrumental variable (IV) analysis using differential distance from patients’ residences to primary care practices. Adults with diabetes received comparable quality of care from NPs and physicians at similar cost. Weighted results showed no differences between NP- and physician-attributed patients in receipt of recommended care or diabetes-related hospitalizations. For children with asthma, costs of NP-led care were lower but quality findings were mixed: NP-led care was associated with lower use of appropriate medications and higher rates of asthma-related emergency department visits but similar rates of asthma-related hospitalization. IV analyses revealed no evidence of differences in quality between NP- and physician-led care. Our findings suggest that in states with Medicaid pay parity, NP-led care is comparable to physician-led care for adults with diabetes, while associations between NP-led care and quality were mixed for children with asthma. Increased use of NP-led primary care may be cost-neutral or cost-saving, even under pay parity.

Prevalence of Amputations in Diabetic Individuals Treated at a Referral Center

“…The nurse, as a fundamental part of the multidisciplinary Primary Care team, has an essential role in promoting health education and encouraging self-care for all patients with diabetes, even without the risk of ulceration, care for initial injuries, assistance For patients undergoing limb amputation, skills and training to deal with biopsychosocial aspects and referral to rehabilitation is part of the care and assistance plan. Actions that significantly contribute to solving problems inherent to people with diabetes [24][25] .…”

Prevalência De Amputações Em Indivíduos Diabéticos Atendidos Em Um Centro De Referência

“…A figura do enfermeiro, enquanto peça fundamental na equipe multiprofissional da Atenção Básica, tem importante papel na promoção, educação em saúde e estímulo ao autocuidado de todos os pacientes com diabetes, mesmo sem risco para ulceração, o cuidado com as lesões iniciais, o auxílio aos pacientes submetidos à amputação de membros, habilidades e treinamentos para lidar com aspectos biopsicossociais e o encaminhamento à reabilitação, fazem parte do plano de cuidados e assistência. Ações que contribuem, sobremaneira, na resolução de problemas inerentes à pessoa com diabetes [24][25] .…”

Rural Nurse Practitioner Workforce Issues: Rural RNs as Potential Untapped Resource

“…Additionally, the cost differences, even specifically in states with pay parity between NPs and physicians, was found to be neutral or cost-saving (Harrison, 2023). Examination of patient outcomes and costs at the Veteran Administration (VA), the largest employer of NPs in the U.S., likewise reveals no significant difference between those treated by NPs versus physicians (Liu et al, 2020).…”

“…Expanded utilization of NPs is viewed as a potential method for providing universally accessible and cost-effective care to minimize disparities (Ortiz et al, 2018;Rosa et al, 2020). The gap in primary care services is most pronounced in rural areas and among vulnerable populations, where a higher percentage of NPs choose to practice compared to their physician counterparts (Harrison, 2023;Zhang et al, 2020).…”