Use of Midlevel Practitioners to Achieve Labor Cost Savings in the Primary Care Practice of an MCO

Roblin, Douglas W.; Howard, David H.; Becker, Edmund R.; Kathleen Adams, E.; Roberts, Melissa H.

doi:10.1111/j.1475-6773.2004.00247.x

Cited by 114Nursing Roles and PracticesHealthcare Policy and ManagementPrimary Care and Health Outcomes

Use of Midlevel Practitioners to Achieve Labor Cost Savings in the Primary Care Practice of an MCO

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Roblin, Douglas W., Howard, David H., Becker, Edmund R., Kathleen Adams, E., Roberts, Melissa H.·2004·Health Services Research

DOI 10.1111/j.1475-6773.2004.00247.xPMC PMC1361027

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Abstract

Objective. To estimate the savings in labor costs per primary care visit that might be realized from increased use of physician assistants (PAs) and nurse practitioners (NPs) in the primary care practices of a managed care organization (MCO). Study Setting/Data Sources. Twenty‐six capitated primary care practices of a group model MCO. Data on approximately two million visits provided by 206 practitioners were extracted from computerized visit records for 1997–2000. Computerized payroll ledgers were the source of annual labor costs per practice from 1997–2000. Study Design. Likelihood of a visit attended by a PA/NP versus MD was modeled using logistic regression, with practice fixed effects, by department (adult medicine, pediatrics) and year. Parameter estimates and practice fixed effects from these regressions were used to predict the proportion of PA/NP visits per practice per year given a standard case mix. Least squares regressions, with practice fixed effects, were used to estimate the association of this standardized predicted proportion of PA/NP visits with average annual practitioner and total labor costs per visit, controlling for other practice characteristics. Results. On average, PAs/NPs attended one in three adult medicine visits and one in five pediatric medicine visits. Likelihood of a PA/NP visit was significantly higher than average among patients presenting with minor acute illness (e.g., acute pharyngitis). In adult medicine, likelihood of a PA/NP visit was lower than average among older patients. Practitioner labor costs per visit and total labor costs per visit were lower (p<.01 and p=.08, respectively) among practices with greater use of PAs/NPs, standardized for case mix. Conclusions. Primary care practices that used more PAs/NPs in care delivery realized lower practitioner labor costs per visit than practices that used less. Future research should investigate the cost savings and cost‐effectiveness potential of delivery designs that change staffing mix and division of labor among clinical disciplines.

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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 [41]

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Self-citation

Authors: Roblin, D. W., Howard, D. H., Becker, E. R., Kathleen Adams, E., & Roberts, M. H.
Affiliations: Kaiser Permanente (US)
Corresponding author: Roblin, Douglas W.
ORCID: Becker, Edmund R.
Roberts, Melissa H.
Venue: Health Services Research
Publisher: Wiley
Published: 2004-05-04
Volume: 39
Issue: 3
Pages: 607-626
ISSN: 0017-9124 (ISSN-L)
1475-6773
DOI: 10.1111/j.1475-6773.2004.00247.x
PMC: PMC1361027
OpenAlex: W1997458217
Cited by: 114
References: 33
Citations by year: 2025: 2 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 6 · 2020: 2 · 2019: 6 · 2018: 1 · 2017: 5 · 2016: 10 · 2015: 14 · 2014: 5 · 2013: 4 · 2012: 5
FWCI: 11.37
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Health Services Research (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Kaiser Permanente
Centers for Disease Control and Prevention (R01 CD000033)
Agency for Healthcare Research and Quality (R01 HS026232)
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: physician assistants, nurse practitioners, labor cost reduction, primary care, managed care organizations, cost per visit, division of labor, elderly patients
MeSH terms: Workforce, Adolescent, Adult, Aged, Child, Child, Preschool, Cost Control, Diagnosis-Related Groups, Georgia, Humans, Managed Care Programs, Middle Aged, Nurse Practitioners, Personnel Staffing and Scheduling, Physician Assistants, Primary Health Care, Likelihood Functions, Linear Models, Health Care Costs, Models, Organizational

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Use of Midlevel Practitioners to Achieve Labor Cost Savings in the Primary Care Practice of an MCO

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