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- Title
Use of Midlevel Practitioners to Achieve Labor Cost Savings in the Primary Care Practice of an MCO.
- Authors
Roblin, Douglas W.; Howard, David H.; Becker, Edmund R.; Kathleen Adams, E.; Roberts, Melissa H.
- Abstract
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). 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. 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. 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.
- Subjects
PRIMARY care; MANAGED care programs; MEDICAL care costs; MEDICAL care; MANAGED Care Organization (Organization); HEALTH care industry; PUBLIC health
- Publication
Health Services Research, 2004, Vol 39, Issue 3, p607
- ISSN
0017-9124
- Publication type
Article
- DOI
10.1111/j.1475-6773.2004.00247.x