Comparing the Cost of Care Provided to Medicare Beneficiaries Assigned to Primary Care Nurse Practitioners and Physicians
Open accessAbstract
Objective: This study is designed to assess the cost of services provided to Medicare beneficiaries by nurse practitioners ( NP s) billing under their own National Provider Identification number as compared to primary care physicians ( PCMDs ). Data Source: Medicare Part A (inpatient) and Part B (office visit) claims for 2009–2010. Study Design: Retrospective cohort design using propensity score weighted regression. Data Extraction Methods: Beneficiaries cared for by a random sample of NP s and primary care physicians. Principal Findings: After adjusting for demographic characteristics, geography, comorbidities, and the propensity to see an NP , Medicare evaluation and management payments for beneficiaries assigned to an NP were $207, or 29 percent, less than PCMD assigned beneficiaries. The same pattern was observed for inpatient and total office visit paid amounts, with 11 and 18 percent less for NP assigned beneficiaries, respectively. Results are similar for the work component of relative value units as well. Conclusions: This study provides new evidence of the lower cost of care for beneficiaries managed by NP s, as compared to those managed by PCMD s across inpatient and office‐based settings. Results suggest that increasing access to NP primary care will not increase costs for the Medicare program and may be cost saving.
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The literature generally reports similar or marginally lower costs for nurse-led services.
“This literature generally reports similar27,34-37 or marginally lower29,38-41 costs for nurse-led services.”
From Evaluating the cost of NP-led vs. GP-led primary care in British Columbia (2024) · cites this paper as [40]
The Abstract (page not provided) reports lower Medicare payments for beneficiaries assigned to nurse practitioners: 29% less for evaluation and management, 11% less for inpatient care, and 18% less for office visits. This supports the cited claim of lower costs, but “marginally” understates at least the 29% difference. (LLM, conf=0.85)
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Comorbidity measures for use with administrative data.
Elixhauser, A., Steiner, C., Harris, D. R., & Coffey, R. M. (1998) · Medical Care · doi:10.1097/00005650-199801000-00004 · Cited by 9,921 · see citing works
SOME PRACTICAL GUIDANCE FOR THE IMPLEMENTATION OF PROPENSITY SCORE MATCHING
Caliendo, M., & Kopeinig, S. (2008) · Journal of Economic Surveys · doi:10.1111/j.1467-6419.2007.00527.x · Cited by 6,238 · see citing works
Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized, Controlled Trial
Naylor, M. D., Brooten, D. A., Campbell, R. L., Maislin, G., McCauley, K. M., & Schwartz, J. S. (2004) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52202.x · Cited by 1,365 · see citing works
Hirano, K., & Imbens, G. W. (2001) · Health Services and Outcomes Research Methodology · doi:10.1023/a:1020371312283 · Cited by 1,039 · see citing works
Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians: A Randomized Trial
Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W.-Y., Cleary, P. D., Friedewald, W. T., Siu, A. L., & Shelanski, M. L. (2000) · JAMA · doi:10.1001/jama.283.1.59 · Cited by 955 · see citing works
Methods for Constructing and Assessing Propensity Scores
Garrido, M. M., Kelley, A. S., Paris, J., Roza, K. A., Meier, D. E., Morrison, R. S., & Aldridge, M. D. (2014) · Health Services Research · doi:10.1111/1475-6773.12182 · Cited by 882 · see citing works
Comparative Effectiveness of Revascularization Strategies
Weintraub, W. S., Grau‐Sepulveda, M. V., Weiss, J. M., O’Brien, S. M., Peterson, E. D., Kolm, P., Zhang, Z., Klein, L. W., Shaw, R. E., McKay, C. R., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1110717 · Cited by 608 · see citing works
Venning, P. (2000) · BMJ · doi:10.1136/bmj.320.7241.1048 · Cited by 494 · see citing works
Primary Care: Proposed Solutions To The Physician Shortage Without Training More Physicians
Bodenheimer, T. S., & Smith, M. D. (2013) · Health Affairs · doi:10.1377/hlthaff.2013.0234 · Cited by 302 · see citing works
Primary Care Outcomes in Patients treated by Nurse Practitioners or Physicians: Two-Year Follow-Up
Lenz, E. R., Mundinger, M. O., Kane, R. L., Hopkins, S. C., & Lin, S. X. (2004) · Medical Care Research and Review · doi:10.1177/1077558704266821 · Cited by 278 · see citing works
Variation in health care spending: target decision making, not geography
(2014) · Choice Reviews Online · doi:10.5860/choice.51-4556 · Cited by 180 · see citing works
The Impact of Nonphysician Clinicians
Laurant, M., Harmsen, M., Wollersheim, H., Grol, R., Faber, M., & Sibbald, B. (2009) · Medical Care Research and Review · doi:10.1177/1077558709346277 · Cited by 166 · see citing works
Hofer, A., Abraham, J. M., & Moscovice, I. (2011) · Milbank Quarterly · doi:10.1111/j.1468-0009.2011.00620.x · Cited by 162 · see citing works
Quality of HIV Care Provided by Nurse Practitioners, Physician Assistants, and Physicians
Wilson, I. B., Landon, B. E., Hirschhorn, L. R., McInnes, D. K., Ding, L., Marsden, P. V., & Cleary, P. D. (2005) · Annals of Internal Medicine · doi:10.7326/0003-4819-143-10-200511150-00010 · Cited by 155 · see citing works
Brooten, D. A., Naylor, M. D., York, R., Brown, L. P., Munro, B. H., Hollingsworth, A. O., Cohen, S. M., Finkler, S. A., Deatrick, J. A., & Youngblut, J. M. (2002) · Journal of Nursing Scholarship · doi:10.1111/j.1547-5069.2002.00369.x · Cited by 130 · see citing works
Ohman‐Strickland, P., Orzano, A. J., Hudson, S. V., Solberg, L. I., DiCicco‐Bloom, B., O’Malley, D. M., Tallia, A. F., Balasubramanian, B. A., & Crabtree, B. F. (2008) · The Annals of Family Medicine · doi:10.1370/afm.758 · Cited by 121 · see citing works
Use of Midlevel Practitioners to Achieve Labor Cost Savings in the Primary Care Practice of an MCO
Roblin, D. W., Howard, D. H., Becker, E. R., Kathleen Adams, E., & Roberts, M. H. (2004) · Health Services Research · doi:10.1111/j.1475-6773.2004.00247.x · Cited by 114 · see citing works
Emergency nurse practitioners: a three part study in clinical and cost effectiveness
Sakr, M. (2003) · Emergency Medicine Journal · doi:10.1136/emj.20.2.158 · Cited by 85 · see citing works
The Effect of Different Attribution Rules on Individual Physician Cost Profiles
Mehrotra, A., Adams, J. L., Thomas, J. W., et al. (2010) · Annals of Internal Medicine · doi:10.7326/0003-4819-152-10-201005180-00005 · Cited by 76 · see citing works
Grading a Physician's Value — The Misapplication of Performance Measurement
Berenson, R. A., & Kaye, D. R. (2013) · New England Journal of Medicine · doi:10.1056/nejmp1312287 · Cited by 57 · see citing works
Medicare's Physician Value-Based Payment Modifier — Will the Tectonic Shift Create Waves?
Chien, A. T., & Rosenthal, M. B. (2013) · New England Journal of Medicine · doi:10.1056/nejmp1311957 · Cited by 37 · see citing works
Nurse Practitioners as Attending Providers for Injured Workers
Sears, J. M., Wickizer, T. M., Franklin, G. M., Cheadle, A. D., & Berkowitz, B. (2007) · Medical Care · doi:10.1097/mlr.0b013e3181468e8c · Cited by 17 · see citing works
Sears, J. M., Wickizer, T. M., Franklin, G. M., et al. (2007) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0b013e318124a90e · Cited by 15 · see citing works
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Research works printed but not linked: 1
- Institute of Medicine. 2010. The Future of Nursing. Washington, DC: The National Aca- demies Press [accessed on August 15, 2015]. Available at http://www.thefuture- ofnursing.org/IOM-Report
Cited by
Sorted by citations
Nurses as substitutes for doctors in primary care
Laurant, M., van der Biezen, M., Wijers, N., Watananirun, K., Kontopantelis, E., & van Vught, A. J. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001271.pub3 · Cited by 614 · see citing works
Evaluating the cost of NP-led vs. GP-led primary care in British Columbia
Contandriopoulos, D., Bertoni, K., McCracken, R., Hedden, L., Lavergne, R., & Randhawa, G. K. (2024) · Healthcare Management Forum · doi:10.1177/08404704241229075 · Cited by 5 · see citing works
- Authors
- Perloff, J., DesRoches, C. M., & Buerhaus, P.
- Affiliations
- Brandeis University (US)
- Mathematica Policy Research (US)
- Montana State University (US)
- Corresponding author
- Perloff, Jennifer
- Venue
- Health Services Research
- Publisher
- Wiley
- Published
- 2015-12-27
- Volume
- 51
- Issue
- 4
- Pages
- 1407-1423
- ISSN
- 0017-9124 (ISSN-L)
- 1475-6773
- PMC
- PMC4946030
- OpenAlex
- W2209421517
- Cited by
- 118
- References
- 23
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 9 · 2023: 6 · 2022: 9 · 2021: 16 · 2020: 20 · 2019: 12 · 2018: 15 · 2017: 10 · 2016: 5 · 2014: 1
- FWCI
- 18.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Health Services Research (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Montana State University ScholarWorks (Montana State University) (submittedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- Robert Wood Johnson Foundation
- Gordon and Betty Moore Foundation
- Topics
- Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- nurse practitioners, primary care physicians, Medicare, cost of care, relative value units, hospital costs, office visits, primary care access, cost reduction
- MeSH terms
- Medicare, Humans, Nurse Practitioners, Primary Health Care, Reimbursement Mechanisms, Retrospective Studies, United States, Physicians, Primary Care
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