Browsing by Author "Perloff, Jennifer"

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Comparing the Cost of Care Provided to Medicare Beneficiaries Assigned to Primary Care Nurse Practitioners and Physicians
(2016-08) Perloff, Jennifer; DesRoches, Catherine M; Buerhaus, Peter I.
Objective. This study is designed to assess the cost of services provided to Medicare beneficiaries by nurse practitioners (NPs) billing under their own National Provider Identification number as compared to primary care physicians (PCMDs). Data Source. Medicare Part A (inpatient) and Part B (office visit) claims for 2009-2010. Study Design. Retrospective cohort design using propensity score weighted regression. Data Extraction Methods. Beneficiaries cared for by a random sample of NPs and primary care physicians. Principal Findings. After adjusting for demographic characteristics, geography, comorbidities, and the propensity to see an NP, Medicare evaluation and management payments for beneficiaries assigned to an NP were $207, or 29 percent, less than PCMD assigned beneficiaries. The same pattern was observed for inpatient and total office visit paid amounts, with 11 and 18 percent less for NP assigned beneficiaries, respectively. Results are similar for the work component of relative value units as well. Conclusions. This study provides new evidence of the lower cost of care for beneficiaries managed by NPs, as compared to those managed by PCMDs across inpatient and office-based settings. Results suggest that increasing access to NP primary care will not increase costs for the Medicare program and may be cost saving.
Prescribing Practices by Nurse Practitioners and Primary Care Physicians: A Descriptive Analysis of Medicare Beneficiaries
(2017-04) Muench, Ulrike; Perloff, Jennifer; Thomas, Cindy Parks; Buerhaus, Peter I.
Introduction Nurse practitioner (NP) prescribing continues to be a contentious policy issue, and studies systematically examining NP prescribing are lacking. The aim of this study was to conduct a descriptive analysis comparing the prescribing services of NPs with those of primary care physicians (PCPs) in providing care to Medicare beneficiaries. Methods Part D drug claims of beneficiaries who saw an NP or a PCP in 2009 and 2010 were examined for differences in the types of medications prescribed, the volume of prescriptions, and the duration of prescriptions across all drug classes in Medicare Part D. Results Data for 164,681 beneficiaries were analyzed. Results showed the same top 20 types of medications and the same share of generic medications for NP and PCP prescriptions. Differences in prescribing patterns were found for the number of prescriptions and for the duration of the prescriptions (daysâ€™ supply per claim). NP beneficiaries received, on average, approximately one more 30-day prescription per year than PCP beneficiaries. The mean duration for an NP prescription claim was 3 days shorter than that for a PCP prescription claim, indicating that NP beneficiaries need refills sooner than PCP beneficiaries. This pattern existed in most drug classes and was more pronounced in behavioral drug classes, such as antidepressants, antipsychotics, psychotherapeutics, and opioids and in patients with more comorbidities. Differences in state scope of practice laws did not affect these prescribing patterns. Conclusions Key differences were observed in the number and duration of prescriptions written by NPs and PCPs. Further research is needed to understand the impact of differences in NP and PCP patient populations on provider prescribing, such as the higher number of prescriptions issued by NPs for beneficiaries in moderate and high comorbidity groups and the implications of the duration of prescriptions for clinical outcomes, patient-provider rapport, costs, and potential gaps in medication coverage