In the Journals

Increased use of physician assistants can reduce costs without significant impact on patient outcomes

A staffing model employing a higher ratio of physician assistants to hospitalists led to similar clinical outcomes at a lower cost at a community hospital, according to recent study results.

“Hospitalist program staffing models must optimize efficiency while maintaining clinical outcomes in order to increase value and decrease costs,” Timothy M. Capstack, MD, from Physicians Inpatient Care Specialists (MDICS), Hanover, Md., and colleagues wrote. “Significant savings could be achieved if less costly physician assistants could be incorporated into clinical teams to provide similar care without sacrificing quality.

The researchers from MDICS implemented a staffing model in which physician assistants (PAs) see a large proportion of patients collaboratively with physicians to evaluate whether a higher PA-to-physician hospitalist staffing ratio can accomplish similar clinical outcomes to a low PA-to-physician ratio.

The investigators conducted a retrospective cohort study to compare two hospitalist groups at a 384-bed community hospital: expanded PA (a high PA-to-physician ratio model) with three physicians, and three PAs visiting 14 patients daily (35.73% of all visits) and conventional (a low PA-to-physician ratio model), with nine physicians, and two PAs visiting nine patients daily (5.89% of all visits).

“The expanded PA model could free up physicians’ time to focus on more complex cases or allow hospitalists to provide additional or different services,” Henry Michtalik, MD, MPH, MHS, an assistant professor of medicine at the Johns Hopkins University School of Medicine, and the study’s senior author, said in a press release.

The study included 16,964 adult patients discharged by the hospitalist groups with a medical principal APR-DRG code between January 2012 and June 2013. The researchers analyzed in-hospital mortality, cost of care, readmissions, length of stay, and consultant use adjusted for age, insurance status, severity of illness and mortality risk using logistic regression.

They found no statistically significant differences between the two groups for in-hospital mortality (OR = 0.89; 95% CI, 0.66-1.19), readmissions (OR = 0.95; 95% CI, 0.87-1.04], length of stay (effect size, 0.99 days shorter in expanded PA group; 95% CI, 0.97-1.01) or consultant use (OR = 1; 95% CI, 0.94-1.07).

In addition, they found cost of care in the expanded PA group was less (effect size, 3.52% less; estimated cost $2,644 vs. $2,724; 95% CI, 2.66-4.39).

“This study’s expanded PA group’s PAs rounded on 14 patients per day, close to the ‘magic 15’ that is considered by many a good compromise for hospitalist physicians between productivity and quality,” Capstack and colleagues wrote. “Our results show that expanded use of well-educated PAs functioning within a formal collaboration arrangement with physicians provides similar clinical quality to a conventional PA staffing model with no excess patient care costs.”– by Savannah Demko

Disclosure: The researchers report no relevant financial disclosures.

A staffing model employing a higher ratio of physician assistants to hospitalists led to similar clinical outcomes at a lower cost at a community hospital, according to recent study results.

“Hospitalist program staffing models must optimize efficiency while maintaining clinical outcomes in order to increase value and decrease costs,” Timothy M. Capstack, MD, from Physicians Inpatient Care Specialists (MDICS), Hanover, Md., and colleagues wrote. “Significant savings could be achieved if less costly physician assistants could be incorporated into clinical teams to provide similar care without sacrificing quality.

The researchers from MDICS implemented a staffing model in which physician assistants (PAs) see a large proportion of patients collaboratively with physicians to evaluate whether a higher PA-to-physician hospitalist staffing ratio can accomplish similar clinical outcomes to a low PA-to-physician ratio.

The investigators conducted a retrospective cohort study to compare two hospitalist groups at a 384-bed community hospital: expanded PA (a high PA-to-physician ratio model) with three physicians, and three PAs visiting 14 patients daily (35.73% of all visits) and conventional (a low PA-to-physician ratio model), with nine physicians, and two PAs visiting nine patients daily (5.89% of all visits).

“The expanded PA model could free up physicians’ time to focus on more complex cases or allow hospitalists to provide additional or different services,” Henry Michtalik, MD, MPH, MHS, an assistant professor of medicine at the Johns Hopkins University School of Medicine, and the study’s senior author, said in a press release.

The study included 16,964 adult patients discharged by the hospitalist groups with a medical principal APR-DRG code between January 2012 and June 2013. The researchers analyzed in-hospital mortality, cost of care, readmissions, length of stay, and consultant use adjusted for age, insurance status, severity of illness and mortality risk using logistic regression.

They found no statistically significant differences between the two groups for in-hospital mortality (OR = 0.89; 95% CI, 0.66-1.19), readmissions (OR = 0.95; 95% CI, 0.87-1.04], length of stay (effect size, 0.99 days shorter in expanded PA group; 95% CI, 0.97-1.01) or consultant use (OR = 1; 95% CI, 0.94-1.07).

In addition, they found cost of care in the expanded PA group was less (effect size, 3.52% less; estimated cost $2,644 vs. $2,724; 95% CI, 2.66-4.39).

“This study’s expanded PA group’s PAs rounded on 14 patients per day, close to the ‘magic 15’ that is considered by many a good compromise for hospitalist physicians between productivity and quality,” Capstack and colleagues wrote. “Our results show that expanded use of well-educated PAs functioning within a formal collaboration arrangement with physicians provides similar clinical quality to a conventional PA staffing model with no excess patient care costs.”– by Savannah Demko

Disclosure: The researchers report no relevant financial disclosures.