More Physician Assistants Slash Health Care Costs


New findings revealed that PA-to-physician ratio model can significantly reduce health care costs without having an effect on quality of care.

A reduction of healthcare costs can be achieved through higher physician assistant-to-physician ratios, a recentstudypublished in theJournal of Clinical Outcomes Managementfound.

The retrospective cohort study compared 2 hospitalist groups at a community hospital. The first group had a high PA-to-physician ratio model (expanded PA), which included 3 physicians/3 PAs and the PAs rounding on 14 patients a day, while the other had a low PA-to-physician ratio model (conventional) with 9 physicians/2 PAs rounding on 9 patients a day.

Researchers analyzed 16,964 adult patients who had been discharged by the groups with a medical principal APR-DRG code in hospital mortality, readmissions, length of stay (LOS), cost of care, and consultant use.

The data was collected between January 2012 and June 2013, and was analyzed using logistic regression. The researchers adjusted for age, severity of illness, risk of mortality, and insurance status.

The results of the study found no statistically significant differences between the 2 groups for in-hospital mortality (OR, 0.89 [95% CI, 0.66-1.19;P= 0.42); readmissions (OR, 0.59 [95% CI, 0.87-1.04;P= 0.27); length of stay (effect size 0.99 days shorter LOS in expanded PA group, 95% CI, 0.97-1.01 days;P= 0.34); or consultant use (OR, 1.00, 95% CI, 0.94-1.07;P= 0.90).

Additionally, cost of care was found to be less in the expanded PA group (effect size 3.52% less; estimated cost $2644 vs $2724; 95% CI 2.66-4.39%,P< 0.001).

The study is believed to be the first of its kind, according toHealth System Management, and the findings suggest that hospitals can safely lower the cost of hospitalist programs without having to sacrifice quality of care.

“We believe this is the first study of its kind to directly compare outcomes and costs between different staffing models using hospitalist PAs and hospitalist physicians,” said senior study author Henry Michtalik, MD, MPH, MHS, as reported byHSM. “It shows that the expanded use of well-trained PAs within a formal PA-physician collaboration agreement can provide similar outcomes with lower costs, potentially allowing hospitalists to provide additional or different services.”

Although the findings are promising, the authors noted that their study only focused on a single medical center, and that research into the role of PAs in patient care requires more attention, according to theHSMreport.

“This study shows that the expanded use of well-trained PAs within a formal PA-physician collaboration arrangement can provide similar clinical outcomes with lower costs,” Michtalik said, as reported byHSM. “The expanded PA model could free up physicians’ time to focus on more complex cases or allow hospitalists to provide additional or different services.

“As we address the challenges of an expanding older and more complex patient population in the setting of healthcare reforms and financial pressures, optimizing the patient care team and outcomes are high priorities. Support, education, and teamwork are essential for any staffing model to be successful.”

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