The Hattiesburg Clinic in Mississippi—a large, multi-specialty facility with over 300 physicians—spent 15 years hiring more physician assistants, nurse practitioners, and other advanced practice providers (APPs). The clinic’s goal was to provide the best care to patients at the best value. After analyzing years’ worth of data, they reached an important conclusion: replacing physicians with PAs and NPs leads to higher costs, not lower.
At Physicians for Patient Protection, we’ve been saying this for years. And we’ve been pointing out the dangers to patients of non-physician-led care. The Hattiesburg Clinic identified that APP-led care resulted in higher costs for patients and payers to the tune of more than $28 million annually. The bulk of the higher cost came from increased test orders, specialist referrals, and more patients being sent to emergency medicine departments. Nurse practitioners, in particular, stood out as four of the five highest-cost AAP provider categories.
The experts publishing this study disclosed that, based on “a wealth of internal data, the results are consistent and clear: By allowing APPs to function with independent panels under physician supervision, we failed to meet our goals in the primary care setting of providing patients with an equivalent value-based experience.”
Stated more simply: replacing physicians with PAs and NPs ends up costing patients more. At PPP, we would also warn that it degrades quality of care!
It’s one thing to reach the right data-driven conclusion. It’s another to act on it and do the right thing. Hattiesburg Clinic made changes based on their study so that all patients now see a physician as their primary care provider and no one sees a nonphysician exclusively.
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