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«Comparing the Cost of Care Provided to Medicare Beneficiaries Assigned to Primary Care Nurse Practitioners and Physicians Jennifer Perloff, ...»

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14 HSR: Health Services Research To our knowledge, this is the first national-level analysis of the cost of NPs providing primary care to Medicare beneficiaries. Because Medicare enrollments will expand rapidly as the baby boom generation ages, total spending on the program is likely to increase substantially. Further, as policy makers attempt to increase the capacity of the primary care workforce, in part by increasing the numbers of NPs, our results suggest that having more NPs providing primary care services to Medicare beneficiaries is unlikely to cost Medicare more than if the program relied solely on primary care physicians, and it may actually reduce costs. The $207 per beneficiary annual difference between primary care physicians and NPs on E&M services suggests that the Medicare program could obtain significant cost savings if more NPs were providing primary care services to beneficiaries. Indeed, our results are consistent with a recent estimate from the CMS Office of the Actuary that Medicare could save $60 million over 10 years by allowing CMS to assign beneficiaries to accountable care organizations based on services provided by NPs, physician assistants, and clinical nurse specialists (HHS FY2016). While the Office of the Actuary’s study is not directly comparable to ours due to differences in methods, both studies suggest that expanding the role of NPs as primary care clinicians could result in savings to the Medicare program.


Joint Acknowledgment/Disclosure Statement: This work was generously supported by a grant jointly provided by the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation, and Johnson and Johnson’s Campaign for Nursing’s Future. We also acknowledge the tremendous statistical and programming contributions of Galina Zolotusky. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript. Dr. Perloff had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Disclosures: None.

Disclaimers: None.

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Comparing the Costs of NP and PCMD Care 17


Additional supporting information may be found in the online version of this


Appendix SA1: Author Matrix.

Appendix SA2: Sensitivity of Results to Attribution Threshold.

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