Retail clinics can reduce costs when nurse practitioners are allowed to practice independently, potentially by nearly $472 million or more in 2015, according to a new study.
Retail clinics, found in settings including pharmacies, grocery stores and big box stores, are increasingly popular for people who need diagnosis and treatment for common, non-life-threatening conditions. NPs are the primary care providers in these clinics, which first were established in 2000 and now number more than 1,200 nationwide. Past research has shown the clinics provide quality healthcare and reduce healthcare costs.
In the study, researchers compared insurance claims data for a two-week period for 9,503 patients who visited retail and nonretail clinics from 2004-07. They compared costs in states that require NPs to be supervised by or collaborate with physicians, states that allow NPs to practice independently but not prescribe, and states in which NPs are allowed to practice and prescribe independently.
The research led by Joanne Spetz, PhD, professor, Institute for Health Policy Studies and associate director of research strategy, Center for the Health Professions, University of California, San Francisco; and Stephen T. Parente, PhD, MPH, MS, director of the Medical Industry Leadership Institute, Carlson School of Business, University of Minnesota was funded by the Robert Wood Johnson Foundations Interdisciplinary Nursing Quality Research Initiative. The findings appear in the November issue of Health Affairs.
The researchers found insurance claims for a two-week period were lower after retail clinic patient visits than after visits to other settings, such as doctors offices and EDs, for the same conditions. Insurance expenditures for retail patient visits were even lower in states that allow NPs to practice independently. Payments for prescriptions were slightly higher in states where NPs are allowed to prescribe, according to the findings, but that increase in cost was mitigated by the lower cost of an NP practicing independently.
Adjusted to 2013 dollars, the average two-week cost was $704 for nonretail clinic visits, $543 for retail clinic visits in states with no NP independence and $484 for retail clinic visits in states where NPs have independence in practice. The average two-week cost for retail clinic visits in states where NPs had independence in practice and prescribing was $509.
Retail clinics are projected to account for about 10% of outpatient primary care visits by 2015. The studys authors projected the cost savings from using retail clinics at that level would be $2.2 billion. The savings would be increased by $810 million if all states allowed NPs to practice independently, and by $472 million if NPs were allowed to practice and prescribe independently.
Our findings underscore earlier research findings indicating that when NPs practice to the full extent of their training, they can deliver highly efficient high-quality primary care, Spetz said in a news release. We believe that primary care practices should leverage NPs knowledge and skills and the increased availability of convenient care delivery settings to expand access to healthcare. They also need to work to improve care coordination, as continuity of care can be an issue with retail clinics as compared with hospitals.
This study is one of a series funded by INQRI to examine issues related to recommendations of the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health, which include removing scope-of-practice barriers, expanding opportunities for nurses, and increasing the numbers of nurses with BSNs and advanced degrees.
Study abstract: http://bit.ly/17DxD1H
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