Adding physicians’ assistants cuts hospital costs

As health care expenditures rise, policy makers and administrators are scrambling to find ways to cut costs. The results of a recently published study indicate that it’s possible for hospitals to decrease expenditures without compromising the quality of patient care by adding more physicians’ assistants (PAs).

With the rising costs of health care, hospitalists and dedicated in-patient medical practitioners (including but not limited to doctors, nurses and physicians’ assistants) who work exclusively at hospitals are becoming more and more important in big medical centers.

Over 18 months, researchers at the Anne Arundel Medical Center in Annapolis compared two hospital groups: one with more physicians’ assistants than doctors (referred to as “expanded”) and one with fewer physicians’ assistants than doctors (called “conventional”).

The expanded PA group had three doctors and three PAs. The PA conventional group consisted of nine doctors and two PAs.

When admitted to the hospital, patients were assigned to one group or the other based on prior arrangements with the patient’s primary care doctor.

In the expanded PA group, the PAs cared for 14 patients a day, while in the conventional PA group, the PAs cared for nine patients each day. Each physician, regardless of the group, cared for around 13 patients each day.

Each morning, the research team examined the patients and assigned them to either a doctor or a PA. To maintain continuity, patients were seen by the same hospitalist as the previous day. In both groups, each PA was paired with a physician who oversaw care.

While PAs were responsible for independent rounding and clinical decision-making, doctors in both groups took primary rounding responsibility for patients with more complex cases. Both groups required an in-person doctor visit at least every third hospital day.

In the expanded PA group almost 36 percent of visits were conducted by a PA, compared to less than six percent in the conventional group.

The researchers also found that the expanded PA group had slightly higher readmissions and inpatient mortality rate compared to the conventional PA group. These differences, however, were not statistically significant. Rates of consultant use and length of inpatient stay were also found to be similar.

The average cost for each patient was $2,644 in the expanded PA group and $2,724 in the conventional group.

“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,” Henry Michtalik, the paper’s senior author, said according to a press release. “The expanded PA model could free up physicians’ time to focus on more complex cases or allow hospitalists to provide additional or different services.”

However, since the experiment was only conducted in a single medical center, the researchers urge the scientific community to study the role of PAs in patient care.

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