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Nurse Practitioners Gain Steam as Cost Cutting Continues

Dec. 27, 2018, 11:23 AM

“Nurse practitioner” is one of the fastest expanding professions in health care, and the growth is expected to outpace doctors by more than two to one over the next 10 years.

As nurse practitioners become more integral to patient care, they also are influencing health-care policymakers by backing a potential change in Medicare billing that would use their own names.

In January, a Medicare advisory board is expected to throw its weight behind the proposed change, which would bar physician clinics from billing the government for services provided by nurse practitioners and physician assistants under a doctor’s billing code. The change, which could then be adopted by Congress, would mean practices would get paid less for the services not provided by a doctor.

Some doctors groups, including the American Academy of Family Physicians and the American Osteopathic Association, are opposed to the change.

Billing practices are one example of potential tension between doctors and other health-care practitioners when it comes to authority over patient care. However, as doctors increasingly step away from primary care and policy leaders look for ways to lower costs, the reach and autonomy of nurse practitioners will continue to grow.

The Bureau of Labor Statistics expects the number of nurse practitioners and physician assistants to grow 31 percent and 37 percent, respectively, by 2026. The number of doctors in the U.S. still vastly overshadows that of nurse practitioners, but that ratio will change as the physician/surgeon profession is expected to grow by just 13 percent in the same time period.

Here are a few things you might not know about nurse practitioners:

Care Can Be Cheaper

Some research shows nurse practitioners are cheaper than physicians for patients seeking primary care. One 2015 study found there is a “lower cost of care for beneficiaries managed by [nurse practitioners], as compared to those managed by [primary care doctors] across inpatient and office‐based settings. Patients who use nurse practitioners “achieve clinical outcomes and patient satisfaction comparable to primary care physicians across a variety of settings and diagnoses,” the study said.

However, the research isn’t conclusive. An older study from 2000 showed “clinical care and health service costs of nurse practitioners and general practitioners were similar.”

Nurse practitioner Wendy Wright says “there is a place for every single one of us in this system.”

Wright owns her own practice in New Hampshire."I am not pulling patients from [physicians]. I know what I know and what I don’t know. If you’re having a heart attack, you don’t belong with me or often a family physician. You belong with a specialist,” she said.

Prescribing Rights in 24 States

In states that allow it, nurse practitioners can prescribe medication without physician or Board of Medicine involvement. The spread of “solo-prescription” rights is slightly controversial in the medical community.

Carolyn Zaumeyer, a nurse practitioner in Florida, overheard a primary care doctor say nurse practitioners were “ruining” his practice at a cocktail party.

She lives in a state that requires her nurse practice to partner with a physician to prescribe medicine. She told Bloomberg Law that her doctor partner and the surrounding medical community are generally supportive, even though she occasionally hears “mumblings” about taking business away from traditional doctors.

The American Medical Association, the leading lobbying group for doctors, has opposed expanding independent prescribing for nurses in the past. The group didn’t provide a comment for Bloomberg Law on its current stance.

Low Malpractice Rates

Malpractice rates are low, according to statistics from the American Association of Nurse Practitioners, with just 1.9 percent of nurse practitioners saying they’ve been named as a primary defendant in a malpractice case. That compares with 13 percent of doctors.

Doctors typically handle more complicated cases than nurse practitioners, which could partly explain why they’re sued at higher rates. But 11 percent of primary care doctors, who offer similar services to nurse practitioners, say they’ve been sued.

The lower rate of malpractice suits might be because nurse practitioners generally have more face time with patients than doctors. A 1997 study concluded primary care doctors who spent more time with patients were less likely to be sued. Other research suggests communication makes a big difference in the likelihood of being sued.

“I do not have time constraints on patients,” said Irene Bean, a nurse practitioner with her own practice in Nashville. “Many patients have expressed their desire to receive care from nurse practitioner because they feel they are heard before treated.”

“Research has shown that the best defense about being named in a malpractice suit is a positive relationship with your patient,” Wright said.

But she expects nurse practitioners will get sued more frequently as they become more popular and open more independent practices. “When you introduce more into the system, there is always the potential for things to happen,” she said.

—With assistance from Mindy Yochelson

To contact the reporter on this story: Jacquie Lee in Washington at jlee1@bloomberglaw.com