4 ms·

The AMA obviously has an agenda, but that doesn't that change the fact that non-physicians cost patients and taxpayers more money, hard to argue with the cms da

The AMA obviously has an agenda, but that doesn't that change the fact that non-physicians cost patients and taxpayers more money, hard to argue with the cms data. Who cares if your doctor gets paid more if he is saving you and the taxpayers money. I guess it might make business sense from a hospital perspective, because physicians are more expensive to employee than NPs and hospitals don't have a business reason to save taxpayers or patients money.

mikeyouse 4y ago
Claiming as a fact that non-physicians cost more money based on the back of one random study from a Mississippi health system might be a bit rash. Especially since almost every other bit of research has shown the opposite; "Overall, the average PCMD cost of care is 34% higher than PCNP care in the low-risk stratum, and 28% and 21% higher in the medium-risk and high-risk stratum" - https://journals.lww.com/lww-medicalcare/Fulltext/2021/02000/Drivers_of_Cost_Differences_Between_Nurse.13.aspx https://journals.lww.com/lww-medicalcare/Fulltext/2021/02000... "Most of the studies were of good methodological quality, and the results point in the same direction; PAs delivered the same or better care outcomes as physicians with the same or less cost of care." - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559935/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559935/ For a few examples from the past couple years.
- seattle_spring 4y ago
  It is a bit rash, but it’s the exact same study trotted out literally thousands of times by disgruntled residents on Reddit, fuming that there exists a profession that can practice medicine without years of humiliating residency. Whenever someone uses that study as a citation, it’s immediate reason to discredit anything else they’re going to say. Just spend a few minutes looking at that “Noctor” subreddit the guy shared. It makes me disguised with MDs in general just reading it, until I remind myself that most of the posters there are just inexperienced students or residents. I do feel bad for the suckers that take its content at face value though.
  - oaktrout 4y ago
    Truly reddit is a place full of idiots on all sides, do you have specific criticisms of the study I posted though? Or specific criticisms of the study in the NPR article?
    - seattle_spring 4y ago
      https://xkcd.com/882/ https://xkcd.com/882/
- oaktrout 4y ago
  Truly it's a nuanced topic and you cannot say that across the board NPs cost more than physicians. I have no doubt that NPs and PAs can be cost saving when employed appropriately. An issue with your first study is that some NP care was attributed to physicians (as a result of NPs billing under a physicians NPI), hence decision making that was done by an NP is being analyzed as if it was done by a physician. In the study I linked that wasn't have been an issue as they could see which patients were on which providers panel. The study you linked on PAs is interesting, although it's an international one and ~24% of included studies were of PAs who did only one procedure (not really applicable to the discussion here). If you bring a PA into your practice to do only one procedure it's hard to envision that being much of an issue. The NPR article itself links to a study that shows NPs cost more than physicians (in the emergency department), so it's not just one random study that shows they can cost more. I think we could both post studies back and forth all day, maybe it makes more sense to look at things from first principles. If your ED visit is billed the same whether you are seen by an MD or NP, how would an NP go about saving you money? I hope that we can agree they will have less medical knowledge, so I don't see how they could order fewer studies / tests safely.
  - mikeyouse 4y ago
    Trying to apply "first principles" approaches to something as complicated as medical billing and reimbursement is a fools' errand. As a quick example before I move onto more pressing things, you ask, "If your ED visit is billed the same whether you're seen by an MD or NP, how would an NP go about saving you money?" It'd be helpful to know that they aren't billed the same! From CMS: > When an emergency department E/M is shared between a physician and a PA or NP from the same group practice and the physician provides the substantive portion of the E/M encounter with the patient, then the service may be billed under either the physician's or the PA's or NP’s UPIN/PIN number. If the physician does not provide the substantive portion of the encounter even if the physician participated in the service by reviewing the patient’s medical record, then the service may only be billed under the PA's or NP’s UPIN/PIN. In this scenario payment will be made at 85 percent of the Medicare physician fee schedule.
    - 4y ago

mikeyouse 4y ago

Claiming as a fact that non-physicians cost more money based on the back of one random study from a Mississippi health system might be a bit rash. Especially since almost every other bit of research has shown the opposite; "Overall, the average PCMD cost of care is 34% higher than PCNP care in the low-risk stratum, and 28% and 21% higher in the medium-risk and high-risk stratum" - https://journals.lww.com/lww-medicalcare/Fulltext/2021/02000/Drivers_of_Cost_Differences_Between_Nurse.13.aspx https://journals.lww.com/lww-medicalcare/Fulltext/2021/02000... "Most of the studies were of good methodological quality, and the results point in the same direction; PAs delivered the same or better care outcomes as physicians with the same or less cost of care." - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559935/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559935/ For a few examples from the past couple years.

seattle_spring 4y ago
It is a bit rash, but it’s the exact same study trotted out literally thousands of times by disgruntled residents on Reddit, fuming that there exists a profession that can practice medicine without years of humiliating residency. Whenever someone uses that study as a citation, it’s immediate reason to discredit anything else they’re going to say. Just spend a few minutes looking at that “Noctor” subreddit the guy shared. It makes me disguised with MDs in general just reading it, until I remind myself that most of the posters there are just inexperienced students or residents. I do feel bad for the suckers that take its content at face value though.
- oaktrout 4y ago
  Truly reddit is a place full of idiots on all sides, do you have specific criticisms of the study I posted though? Or specific criticisms of the study in the NPR article?
  - seattle_spring 4y ago
    https://xkcd.com/882/ https://xkcd.com/882/
oaktrout 4y ago
Truly it's a nuanced topic and you cannot say that across the board NPs cost more than physicians. I have no doubt that NPs and PAs can be cost saving when employed appropriately. An issue with your first study is that some NP care was attributed to physicians (as a result of NPs billing under a physicians NPI), hence decision making that was done by an NP is being analyzed as if it was done by a physician. In the study I linked that wasn't have been an issue as they could see which patients were on which providers panel. The study you linked on PAs is interesting, although it's an international one and ~24% of included studies were of PAs who did only one procedure (not really applicable to the discussion here). If you bring a PA into your practice to do only one procedure it's hard to envision that being much of an issue. The NPR article itself links to a study that shows NPs cost more than physicians (in the emergency department), so it's not just one random study that shows they can cost more. I think we could both post studies back and forth all day, maybe it makes more sense to look at things from first principles. If your ED visit is billed the same whether you are seen by an MD or NP, how would an NP go about saving you money? I hope that we can agree they will have less medical knowledge, so I don't see how they could order fewer studies / tests safely.
- mikeyouse 4y ago
  Trying to apply "first principles" approaches to something as complicated as medical billing and reimbursement is a fools' errand. As a quick example before I move onto more pressing things, you ask, "If your ED visit is billed the same whether you're seen by an MD or NP, how would an NP go about saving you money?" It'd be helpful to know that they aren't billed the same! From CMS: > When an emergency department E/M is shared between a physician and a PA or NP from the same group practice and the physician provides the substantive portion of the E/M encounter with the patient, then the service may be billed under either the physician's or the PA's or NP’s UPIN/PIN number. If the physician does not provide the substantive portion of the encounter even if the physician participated in the service by reviewing the patient’s medical record, then the service may only be billed under the PA's or NP’s UPIN/PIN. In this scenario payment will be made at 85 percent of the Medicare physician fee schedule.
  - 4y ago