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New Primary Care Provider, Same or Better Outcomes

Blog | 
Outcomes | 
Policy | 
System Dynamics | 

Expanding the scope of practice for nurse practitioners and physician assistants may be a cost-effective way to manage the health of patients with chronic illnesses.

That’s the market-based reform takeaway from a new study that found that patients with diabetes who saw NPs and PAs enjoyed the same—and sometimes better—clinical outcomes as patients who saw physicians for the same chronic illness.

Researchers from the Veterans Health Administration conducted the study and published their results in the Annals of Internal Medicine. They wanted to know who—primary care physicians, NPs or PAs—did a better job controlling the blood sugar, blood pressure and cholesterol levels of diabetic patients who are on prescription medications to manage their illness.

The patient pool consisted of 368,481 adults who regularly saw either a PCP, NP or PA at a VA primary-care facility in 2012. PCPs treated 74.9 percent of the patients; NPs treated 18.2 percent of the patients; and PAs treated 6.9 percent of the patients.

The researchers looked at whether the patients’ blood sugar, blood pressure and cholesterol levels were under control a year later in 2013. Here’s what they found:

  • 38.7 percent of the patients who saw a doctor had their blood sugar under control compared with 40 percent who saw an NP and 38.4 percent who saw a PA
  • 35.8 percent of the patients who saw a doctor had their blood pressure under control compared with 36.1 percent who saw an NP and 36.3 percent who saw a PA
  • 75.2 percent of the patients who saw a doctor had their cholesterol under control compared with 74.1 percent who saw an NP and 73.2 percent who saw a PA and

“We did not observe clinically significant differences in intermediate diabetes outcomes or the control of those outcomes among patients with NP, PA, or physician PCPs,” the researchers said.

So, NPs and PAs were just as good as physicians in helping patients with diabetes control the things that come with diabetes that can make them sicker, use more medical resources and raise healthcare costs.

“This study provides further evidence that using NPs and PAs as PCPs may represent a mechanism for expanding access to primary care while maintaining quality standards,” the researchers said.

In a previous blog post, we commented on a separate study by the Health Care Cost Institute that found that the rate of office visits by patients to NPs and PAs went up while the rate of office visits by patients to primary-care physicians went down. But, the cost of an office visit was about the same no matter who patients went to see.

The two studies combined suggest that patients can get better outcomes for the same price from NPs and PAs as they can from doctors. What patients desire are better outcomes for less regardless of who provides the care.

The way to do that is through market competition. The way to spark market competition is by revising state laws that artificially limit what services trained and qualified NPs and PAs can provide to patients.


David Burda is a columnist for 4sight Health and news editor of 4sight Friday, our weekly newsletter. Follow Burda on Twitter @DavidRBurda and on LinkedIn. Read his bio here

About the 4sight Health Author
David W. Johnson
David Johnson CEO 4sightHealth

David Johnson is the CEO of 4sight Health, a boutique healthcare advisory and investment firm. Dave wakes up every morning trying to fix America’s broken healthcare system. He is a frequent writer and speaker on market-driven healthcare reform. His expertise encompasses health policy, academic medicine, economics, statistics, behavioral finance, disruptive innovation, organizational change and complexity theory. Dave’s book, Market vs. Medicine: America’s Epic Fight for Better, Affordable Healthcare, is available on