Nurse practitioners provide quality primary care at a lower cost than physicians.

The growing need for primary care providers has opened the door for nurse practitioners to fill the void. Nursing students are rushing to get nurse practitioner degrees, and researchers are working to keep pace with studies. Most of the results provide evidence for expanded use of nurse practitioners in a variety of settings.

Return on investment of advanced practice medical degrees: NPs vs. PAs.

As the United States faces a predicted physician shortage over the next 2 decades, physician assistants (PAs) and NPs are expected to fill the void. At the same time, because education is expensive, student loan and tuition increases have many potential applicants assessing differences in reimbursement and wondering about their return on investment (ROI). An analysis compared PA and NP salaries by incorporating national salary data, federal income tax, and student loans for a comparative analysis of each career pathway. METHODS: Salaries were abstracted from the 2012 Bureau of Labor Statistics database. The net present value (NPV) of PA and NP salaries was calculated with a 5% discount rate. Principal and interest for student loans was calculated at a 6% interest fixed-rate loan over 30 years. NPVs were then compared with projected ROI at retirement age. Relative career values were also given to each career choice, based on a retirement age of 65 years, which translates to about 41 years of employment for both PAs and NPs. RESULTS: PAs' and NPs' educational loans both equalled $129,484 on total repayment. The median annual salary of a PA was $90,930 and $89,960 for an NP. PA data yielded a 5% NPV of $781,323 compared with $764,348 for NPs. Of note, the 5% NPV of a 4-year nursing degree is $728,436. CONCLUSION: PAs have a slightly higher ROI compared with NPs. These findings may change due to adjustments in nursing training models. Many PA programs allow matriculation immediately after obtaining a bachelor's degree. NP schools often require nursing experience before entering their program. Some schools are considering an accelerated NP program, allowing immediate matriculation after obtaining a bachelor's degree. Because many NP programs have become doctoral degrees, the increased duration of training, higher tuition, and fewer years worked before retirement lower the overall NP ROI. A similar reduction in ROI was considered marginal in PAs who attend residency programs-though these programs are not required for PAs to practice. Comparison of an RN with a 4-year degree to an NP shows little increase in ROI. If interest rates rise, it will become fiscally preferable to remain in a nursing position. Other intangible qualities exist and need further research (for example, weighing the financial aspects with lifestyle or professional satisfaction).

The economic effect of a physician assistant or nurse practitioner in rural America.

Revenues generated by physician assistants (PAs) and NPs in clinics and hospitals create employment opportunities and wages, salaries, and benefits for staff, which in turn are circulated throughout the local economy. An input-output model was used to estimate the direct and secondary effects of a rural primary care PA or NP on the community and surrounding area. This type of model explains how input/output from one sector of industry can be the output/input for another sector. Given two example scenarios, a rural PA or NP can have an employment effect of 4.4 local jobs and labor income of $280,476 from the clinic. The total effect to a community with a hospital increases to 18.5 local jobs and $940,892 of labor income.

Modifying State Laws for Nurse Practitioners and Physician Assistants Can Reduce Cost Of Medical Services.

"Bending the cost curve" for health care services in the United States challenges policymakers. A cost analysis was undertaken based on what would occur if more physician assistants (PAs) and nurse practitioners (NPs) per capita were deployed over a 10-year period. The State of Alabama was used as a case study because it is one of a handful of U.S. states with restrictive legislation impacting the scope of practice of PAs and NPs. Changing PA and NP scope of practice legislation in Alabama to match states in the upper quartile of collaborative legislation such as Washington and Arizona would increase the employment and distribution of PAs and NPs. Even modest changes in legislation will result in a net savings of $729 million over the 10-year period. Underutilization of PAs and NPs by restrictive licensure inhibits the cost benefits of increasing the supply of PAs and NPs and reducing the reliance on a stagnant supply of primary care physicians in meeting the needs of its citizens.

Closing the primary care gap.

Millions of new patients soon will flood health care systems, exacerbating a nationwide shortage of primary care physicians. This gatefold explores how nurse practitioners and physician assistants can help to fill the void.

Physician supervision and insurance reimbursement: policy implications for nurse practitioner practice in North Carolina.

The presence of regulatory requirements that physicians supervise nurse practitioner (NP) practice and of policies that affect insurance reimbursement policies create barriers that limit North Carolina NPs from practicing to the full extent of their licensure, education, and certification. This article reviews these barriers and offers policy recommendations to ensure that NPs are equal partners in health reform innovations.

How to add a new midlevel provider to your practice.

The ever-changing environment of healthcare leads many practices to consider how they will control the cost of overhead, give access to their patients, and maintain or increase practice income. The solution may be to add a midlevel provider (MLP)--a Physician Assistant (PA) or Nurse Practitioner (NP)--to the staff. Both of these specialties train to see patients independently. The difference between a PA and an NP is the type of training and level of supervision required. The addition of an MLP can address many of the impending changes in healthcare, while increasing the quality and profitability of the practice. This article outlines the initial steps to take when adding an MLP to your practice.

The nurse practitioner will see you now.

A host of factors are pushing mid-level providers into more prominent roles in hospitals, and the results are quality care, reduced costs and physicians freed up to handle tougher cases.

Establishing nurse practitioner clinical practicums: Addressing fiscal realities.

As demand expands for nurse practitioner clinical practicum sites, the supply of preceptors is decreasing. The traditional model of in-kind clinical training is losing its foothold for a variety of reasons. A looming question is how quickly a "pay to precept" norm will grow and what will be the costs. The pay for precepting movement is discussed including current trends, costs, and emerging compensation models. To adapt to this trend, alternative ways of drawing the precepting value proposition are suggested, particularly decreasing preceptor and site demands while increasing students' readiness to enter clinical practicum and tapping into faculty expertise to add value to the partnership. The authors provide suggestions on building a strategy for rethinking the structure of student precepting arrangements and compensation models.

Systematic review addressing nurse practitioner reimbursement policy: Part one of a four-part series on critical topics identified by the 2015 nurse practitioner research agenda.

BACKGROUND AND PURPOSE: The growth and sustainability of nurse practitioners (NPs) requires transparent, fair and equitable reimbursement policies. Complicating this issue is variation in reimbursement policy within and across federal, state, and other payers. Even with explicit regulations, there remain questions on how reimbursement policies are covertly operationalized in practice. This systematic review aims to identify knowledge gaps related to reimbursement policy issues and outlines recommendations for further research. METHODS: Eight major databases were searched using terms including "nurse practitioner," "reimbursement," "policy," and "research," limited to the United States and inclusive of December 2006-September 2017. Articles meeting the inclusion criteria were analyzed for themes and gaps. CONCLUSION: The final review includes 17 articles identifying themes including state-determined Medicaid reimbursement and scope of practice legislation shapes NP clinical practice; NPs as identified primary care providers: credentialing and contracting; reimbursement parity; and "incident to" billing. Moreover, there is evidence of discriminatory policies that disadvantage NPs and limit their access to patients, direct billing, and direct reimbursement. IMPLICATIONS FOR PRACTICE: Future research needs to focus on outcomes of discriminatory, as well as supportive, reimbursement policies in organizations, and their influence on patient access and quality care.

The Extraregulatory Effect of Nurse Practitioner Scope-of-Practice Laws on Physician Malpractice Rates.

Patients can hold physicians directly or vicariously liable for the malpractice of nurse practitioners under their supervision. Restrictive scope-of-practice laws governing nurse practitioners can ease patients' legal burdens in establishing physician liability. We analyze the effect of restrictive scope-of-practice laws on the number of malpractice payments made on behalf of physicians between 1999 and 2012. Enacting less restrictive scope-of-practice laws decreases the number of payments made by physicians by as much as 31%, suggesting that restrictive scope-of-practice laws have a salient extraregulatory effect on physician malpractice rates. The effect of enacting less restrictive laws varies depending on the medical malpractice reforms that are in place, with the largest decrease in physician malpractice rates occurring in states that have enacted fewer malpractice reforms. Relaxing scope-of-practice laws could mitigate the adverse extraregulatory effect on physicians identified in this study and could also lead to improvements in access to care.

Salaries for Nurses Decrease, While NP Salaries Rise.

Nurses say salaries aren't commensurate with experience.

Making "cents" of the business side of nurse practitioner practice.

Nurse practitioners produce excellent patient outcomes and should be allowed to practice to the full extent of their education and training. In addition to clinical skills, nurse practitioners need to understand the business side of practice in order to ensure fair and equitable compensation.

Preparing the next generation of health care providers: A description and comparison of nurse practitioner and medical student tuition in 2015.

BACKGROUND AND PURPOSE: The purpose of this study was twofold: to describe the average cost of nurse practitioner (NP) tuition based on degree program, program type, and geography; and to compare the cost of NP tuition to medical school tuition. METHODS: A listing of all NP degree granting universities was obtained from the American Association of Colleges of Nursing during the fall of 2014, and tuition data were obtained from university websites. Medical school tuition data were obtained online during the fall of 2014 from the American Association of Medical Colleges. Average 1-year tuition rates were calculated for NP programs and medical schools and compared across private and public institutions. CONCLUSIONS: Average 1-year resident tuition for public university NP programs ranges between $8671 and $11,077 based on type of program. The cost of 1-year NP program tuition at the master's and the doctoral level is much lower than the cost of 1-year medical school tuition at both private and public universities. IMPLICATIONS FOR PRACTICE: NPs can perform many of the same services as physicians in the primary care setting with comparable outcomes, yet the cost of educating NPs is much lower. NPs are a cost-effective solution to the healthcare workforce shortage.