The expansion of scope of practice for nurse practitioners (NPs) and physician assistants (PAs) in some states, changes in the way health plan benefit packages are structured, and a shortage of primary care physicians (PCPs) helped to drive more visits to NPs and PAs, and fewer to PCPs, according to a report by the Health Care Cost Institute (HCCI). PCP office visits dropped 18% from 2012 to 2016; they rose 129% to NPs and PAs in the same time period. The rise in visits to NPs and PAs accounted for 42% of the drop in PCP visits, the report states.
The HCCI report also notes that there was an overall 2% drop in total primary care office visits and that, on a state-to-state basis, the decline in visits to PCP offices ranged from 6% in Washington, D.C., to 31% in North Dakota.
Scope of practice is defined by states and have changed a lot in the last decade. One of the major issues is whether NPs and PAs can practice independently or require doctor supervision. Point of service and preferred provider structured health plans often allow referrals to specialists to be granted by NPs and PAs, and not solely by PCPs. And some areas just don’t have enough PCPs to handle all the patients, and that’s where NPs and PAs come in handy.
Where patients got their care did not seem to influence how much they had to pay. “While the utilization of office visits to NPs and PAs increased dramatically over the study period, the substitution did not result in cost savings,” the report states. “Since 2012, the average cost of an office visit to a primary care physician remained closely aligned with the cost of a NP and PA visit. In 2016, the average cost per visit to a primary care physician was $106 compared to $103 for an office visit to a NP or PA.”