Researchers Call for Increasing Nurse Practitioners' Scope

Laird Harrison

November 14, 2013

Allowing nurse practitioners to practice independently in retail clinics starting in 2015 could save $810 million nationwide, researchers write in an article published in the November issue of Health Affairs.

Broadening the scope-of-practice laws for nurse practitioners could achieve savings in the cost of visits to retail clinics, write a team of economists led by Joanne Spetz, PhD, professor of economics at the University of California, San Francisco, and Stephen T. Parente, PhD, MPH, from the Carlson School of Management, University of Minnesota, Minneapolis.

They report that nurse practitioners provide most of the care in such clinics, which treat non–life threatening conditions in settings such as pharmacies, grocery stores, and big-box retailers.

The team compared the 2-week costs associated with a clinic visit for 9503 patients in 27 states who visited retail and nonretail clinics at some point between 2004 and 2007.

Adjusted to 2013 dollars, the average 2-week cost for a nonretail clinic visit was $704. In states where nurse practitioners required physician supervision or collaboration, the cost for a retail clinic visit was $543. In states where nurse practitioners practiced independently, the cost was $484. Finally, in states where nurse practitioners both practiced and prescribed independently, the cost was $509.

Using a projection that retail clinic visits will account for about 10% of all outpatient primary care visits in 2015, the authors estimate that the national cost savings from such a level of use will be $2.2 billion. If nurse practitioners were allowed to practice independently in all 50 states, the savings would increase by $810 million. If they were allowed to practice and prescribe independently, the savings would increase by $472 million.

"The traditional solution to a shortage of physicians has been to mint more," said Mark D. Smith, MD, MBA, president and chief executive officer of the California HealthCare Foundation in Oakland, in a news release about the retail clinics study and related articles in the same issue of Health Affairs. "But that won't close the gap, because demand is too strong and too few medical students are choosing primary care."

Health Aff. 2013;32(11):1977-1984. Abstract


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