PA and NP productivity in the Veterans Health Administration

Moran, Eileen; Basa, Edesha; Gao, Jian; Woodmansee, Denni; Almenoff, Peter L.; Hooker, Roderick S.

doi:10.1097/01.jaa.0000484311.96684.0c

Cited by 14 publications

(16 citation statements)

References 14 publications

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“…Other than some minimal regional associations, state-level factors were not associated with PCP provider type. Our finding that the type of PCP assigned to a patient was not affected by state SOP is consistent with recent findings that SOP regulations were not associated with productivity in the VHA 58 or with practice patterns and care quality in Community Health Centers. 59 …”

Section: Discussionsupporting

confidence: 92%

Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus

Morgan

Everett

Smith

et al. 2017

INQUIRY

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Expanded use of nurse practitioners (NPs) and physician assistants (PAs) is a potential solution to workforce issues, but little is known about how NPs and PAs can best be used. Our study examines whether medical and social complexity of patients is associated with whether their primary care provider (PCP) type is a physician, NP, or PA. In this national retrospective cohort study, we use 2012-2013 national Veterans Administration (VA) electronic health record data from 374 223 veterans to examine whether PCP type is associated with patient, clinic, and state-level factors representing medical and social complexity, adjusting for all variables simultaneously using a generalized logit model. Results indicate that patients with physician PCPs are modestly more medically complex than those with NP or PA PCPs. For the group having a Diagnostic Cost Group (DCG) score >2.0 compared with the group having DCG <0.5, odds of having an NP or a PA were lower than for having a physician PCP (NP odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.79-0.88; PA OR = 0.85, CI: 0.80-0.89). Social complexity is not consistently associated with PCP type. Overall, we found minor differences in provider type assignment. This study improves on previous work by using a large national dataset that accurately ascribes the work of NPs and PAs, analyzing at the patient level, analyzing NPs and PAs separately, and addressing social as well as medical complexity. This is a requisite step toward studies that compare patient outcomes by provider type.

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Section: Discussionsupporting

confidence: 92%

Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus

Morgan

Everett

Smith

et al. 2017

INQUIRY

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“…What PAs and NPs do, how well they do it, and what impact this has on patient-centered results are a needed piece of health service research [11, 19, 20, 24, 31]. One finding in this study revealed that a great number of tasks performed by a PA and NP in Dutch hospitals were not visible to administrators due to lack of documentation or registration.…”

Section: Discussionmentioning

confidence: 94%

An activity analysis of Dutch hospital-based physician assistants and nurse practitioners

Brink

Kouwen

Hooker³

et al. 2019

Hum Resour Health

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BackgroundThe physician assistant (PA) and the nurse practitioner (NP) were introduced into The Netherlands in 2001 and 1997 respectively. By the second decade, national policies had accelerated the acceptance and development of these professions. Since 2015, the PA and NP have full practice authority as independent health professionals. The aim of this research was to gain a better understanding of the tasks and responsibilities that are being shifted from Medical Doctors (MD) to PAs and NPs in hospitals. More specifically in what context and visibility are these tasks undertaken by hospital-based PAs and NPs in patient care. This will enable them to communicate their worth to the hospital management.Study designA descriptive, non-experimental research method design was used to collect and analyze both quantitative and qualitative data about the type of tasks performed by a PA or NP. Fifteen medical departments across four hospitals participated.MethodsThe patient scheduling system and hospital information system were probed to identify and characterize a wide variety of clinical tasks. The array of tasks was further verified by 108 interviews. All tasks were divided into direct and indirect patient care. Once the tasks were cataloged, then MDs and hospital managers graded the PA- or NP-performed tasks and assessed their contributions to the hospital management system.FindingsIn total, 2883 tasks were assessed. Overall, PAs and NPs performed a wide variety of clinical and administrative tasks, which differed across hospitals and medical specialties. Data from interviews and the hospital management systems revealed that over a third of the tasks were not properly registered or attributed to the PA or NP. After correction, it was found that the NP and PA spent more than two thirds of their working time on direct patient care.ConclusionsNPs and PAs performed a wide variety of clinical tasks, and the consistency of these tasks differed per medical specialty. Despite the fact that a large part of the tasks was not visible due to incorrect administration, the interviews with MDs and managers revealed that the use of an NP or PA was considered to have an added value at the quality of care as well to the production for hospital-based medical care in The Netherlands.

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“…Studies also show that there is wide variation across different types of organizations in their productivity (Xue & Tuttle, 2017), CHCs in particular (Park et al, 2020). Others include primary and specialty care at the Veteran Health Administration (Moran et al, 2016) and oncology settings (Moote et al, 2012). The purpose of this study is to explore why this variation occurs in the context of CHCs.…”

Section: Introductionmentioning

confidence: 99%

“…This average, however, may be obscuring the potential to enhance NP’s and PA’s productivity by modifying policies and practices, be they at the federal, state, or organizational levels. Moran et al (2016) examined factors influencing NP and PA productivity in the context of primary and specialty care at the Veterans Health Administration (VHA), where the use of both professions has also grown dramatically. While their approach differed from ours (they measured productivity using RVUs and at the individual level), they found that practice settings were key explanatory factors associated with productivity.…”

Section: Introductionmentioning

confidence: 99%

Understanding Why Nurse Practitioner (NP) and Physician Assistant (PA) Productivity Varies Across Community Health Centers (CHCs): A Comparative Qualitative Analysis

et al. 2020

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This study asks how much and why the productivity of advanced practice clinicians (APCs; nurse practitioners and physician assistants) varies across community health centers (CHCs), as measured in their marginal contribution to overall patient visits. We found APCs in the 90th percentile CHCs provide about 1,840 adjusted-visits per year, whereas APCs in the 10th percentile CHCs provide about 978 adjusted-visits per year. We interviewed leadership at 14 high APC and 16 low APC productivity CHCs to elicit organizational conditions that could explain the difference. Using content analysis and then qualitative comparative analysis, we found several important conditions were more common among high productivity CHCs, including scheduling APCs and physicians for the same number of visits, parity in terms of any financial incentives, and formal education programs for new APCs during onboarding/transition to practice.

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PA and NP productivity in the Veterans Health Administration

Cited by 14 publications

References 14 publications

Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus

Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus

An activity analysis of Dutch hospital-based physician assistants and nurse practitioners

Understanding Why Nurse Practitioner (NP) and Physician Assistant (PA) Productivity Varies Across Community Health Centers (CHCs): A Comparative Qualitative Analysis

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