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Ten ways NPs reduce costs, improve quality


Cindy Cooke, president of the American Association of Nurse Practitioners, shares 10 ways nurse practitioners reduce healthcare costs while improving quality.

Cooke, DNP, FNP-C, FAANPDecades of independent research show patients treated by nurse practitioners (NPs) experience equivalent outcomes to patients treated by physicians. Beyond that, studies demonstrate that nurse practitioners are extremely cost-effective providers-a much-needed combination as healthcare costs continue to inflate. In fact, a study by the RAND Corporation in 2009 projects that the improved use of nurse practitioners could save Massachusetts between $4 billion and $8 billion dollars over 10 years; additional studies in California and North Carolina show comparable savings.

Here are 10 ways nurse practitioners reduce healthcare costs while improving quality:

1. Nurse practitioners reduce the cost of patient visits across healthcare settings. Numerous studies show extensive savings for myriad practice settings that employ nurse practitioners. A 2009 study in Nursing Economics found nurse practitioner-led care was associated with lower drug costs for inpatients in acute-care settings. Nursing Management has also published findings that show nurse practitioners in managed care deliver care at 23% below the average cost associated with other primary-care providers.

2. Nurse practitioners keep patients out of the hospital. While chronic conditions take a toll on patients' physical and emotional well-being, they also result in added costs. Nurse practitioners are proven to decrease patient hospitalizations, ER visits and lengths of stay at various facilities, keeping healthcare costs down for patients, institutions and taxpayers, and reducing time and income lost from work. This has been confirmed by recent research in Nursing Management.

3. Nurse practitioners are the fastest growing primary-care provider profession. With more than 85%of nurse practitioners prepared in primary care-the field most needed in today’s healthcare climate, and the one that keeps patients as healthy as possible-nurse practitioners are increasingly providing preventive care that is equally essential for budget health.

4. Nurse practitioners treat the whole patient, not just the disease. Nurse practitioners go beyond diagnosing and treating the condition afflicting the patient. They also address holistic healthcare needs. This could encompass prescribing medicine while counseling about diet and exercise, and troubleshooting how to best address other issues that have the potential to reverse a patient’s progress. To illustrate, a 2012 report appearing in Health Affairs states that “the patient-centered nature of nurse practitioner training, which often includes care coordination and sensitivity to the impact on health of social and cultural factors, such as environment and family situation, makes nurse practitioners particularly well prepared for and interested in providing primary care.”


NEXT: Nurse practitioners excel at managing complex health conditions


5. Nurse practitioners excel at managing complex health conditions. A growing number of Americans today suffer from multiple, complex chronic illnesses like diabetes and heart disease, which are major cost drivers in healthcare. Nurse practitioners see such patients in growing numbers and are shown to help them get these conditions in check.

6. Nurse practitioners are well-liked and trusted by their patients. Nurse practitioners routinely outscore other healthcare providers when it comes to patient satisfaction, namely their ability to listen and understand patients’ concerns. In fact, a 2011 study showed only 50% of patients felt their physician providers “always” listened carefully, compared to more than 80%of patients with nurse practitioner providers. The trust this fosters between patient and provider is critical for ensuring patients are engaged in their own healthcare. It also encourages patient adherence to treatment plans and scheduled follow up and wellness visits- appointments that are critical for cost efficiency and healthcare quality.

7. Nurse practitioners spend more time with patients overall. Among the reasons that nurse practitioners are able to treat patients holistically, manage complex conditions and maintain patient trust is that they spend more time with patients. This simple patient-centered act of carving out longer appointments to accommodate more patient questions, education and counseling has proven invaluable to improving health and reducing unnecessary costs in today’s healthcare climate.

8. Nurse practitioners receive cost-efficient education and training. Nurse practitioners provide advanced nursing care that builds on the professional license of a registered nurse and graduate education that focuses on one specialty area, such as pediatrics, from “day one” of their graduate academic programming. This is in direct contrast to medical school, where students begin their graduate education without prior healthcare education or patient care, and spend time in rotations that are often unrelated to the care they ultimately deliver. The result is that competency-based nurse practitioner education costs 20% to 25% less than that of time-based physicians for similar patient-care services with equitable patient-care outcomes.


NEXT: Nurse practitioners are educated and trained to provide care without physician supervision


9. Nurse practitioners are educated and trained to provide care without physician supervision. Not only are nurse practitioners high-quality, dedicated, cost-effective clinicians in the ways illustrated above, they are prepared to practice without the supervision of physicians, meaning they can advance patient care without the need for chart reviews, collaborative agreements and other mandates that create redundancies and bottlenecks in care delivery. For this reason, a growing number of states-currently 21 and Washington, D.C.-have granted nurse practitioners full-practice authority, meaning patients have full and direct access to the full scope of services they’re educated and trained to deliver.

10. Reducing barriers to nurse practitioner practice improves patient access to quality, cost-effective healthcare. Research in publications ranging from Nursing Management to The New England Journal of Medicinereaches the conclusion that full-practice authority for nurse practitioners promotes healthcare quality and savings. Such regulatory reform also prompts greater numbers of nurse practitioners to practice in medically underserved rural communities, as verified in 2012 by the WWAMI Rural Health Research Center, which has joined the growing list of proponents for full-practice authority for nurse practitioners nationwide.


Cindy Cooke is president of the American Association of Nurse Practitioners. She lives and works in Brownsboro, Alabama, where she has long provided primary-care services to active duty and retired military personnel and their families, and worked with victims of sexual assault.

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