Adding PAs to Hospitalist Program Saves Money: Study

Integrating more physician assistants (PAs) into a conventional hospitalist practice in a community hospital saved money without sacrificing quality of care, a recent study found.

The study in the October issue of the Journal of Clinical Outcomes Management compared two hospitalist groups practicing in a 384-bed community hospital, Anne Arundel Medical Center in Annapolis, Md. One group staffed at a higher PA-to-physician ratio model, employing three physician and three PAs who rounded with 14 patients a day (nearly 36 percent of all visits), while the other staffed a lower PA-to-physician ratio model of nine hospitalist physicians using two PAs. In that group, the PAs were rounding with nine patients a day (6 percent of all visits).

The study looked at 16,964 adult patients discharged by the hospitalist groups between January 2012 and June 2013 and adjusted for age, acuity, and mortality risk for statistical evaluation.

Timothy Capstack, MD, the study’s lead author and medical director of a hospitalist staffing firm, Adfinitas Health, cautioned that while it was a single study at a single location, the results should be replicable in other hospital environments.

The study found no statistically significant differences between the two hospitalist groups in patient mortality, readmissions or length of stay, but learned that the cost of care per patient was $80 less in the expanded PA group, $2,644 versus $2,724.

Hospitalists earn $250,000 annually, compared to $110,000 for PAs, he said.

“So you’re getting more bang for your buck,” Capstack said. “The big win is in the comparative salary department.”

Capstack said that the medical community has debated the roles NPs and PAs should play within hospitalist settings.

“We are not advocating they should practice independently outside of this collaborative role,” said Capstack. “But in a market with not enough physician hospitalists, this model offers another potential way to have hospitalist roles covered in these institutions.”

“The need for hospitalists is expanding and the number of physicians entering the field has not kept pace,” Capstack said.

Capstack said it’s important to know that in the study, it wasn’t the number of PAs in the two groups that accounted for the difference, but how they were used.

“In our group, the PAs accounted for 36 percent of patient encounters, versus 6 percent in the other group,” he said. “We’re not implying superiority, just non-inferiority. There’s an impression in some parts of the medical community that these patients are too sick for PAs and NPs and would prefer physicians alone. We’re saying that’s not necessarily the case.”

A similar case study examines tax-exempt hospital compliance with IRS 501(r) under the new regulations established by the Affordable Care Act in 2010.

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