APRNs vs. Physicians: How Their Practice Impacts Healthcare Quality

IMPACT OF APRN PRACTICE

The role of Advanced Practice Registered Nurses (APRNs) is increasingly being recognized for its profound impact on healthcare outcomes, patient satisfaction, and healthcare system efficiency. APRNs provide high-quality care, comparable to physician practice, and often at a lower cost. This is particularly true in primary care, where APRNs have been shown to enhance access to care, improve health outcomes, and reduce unnecessary hospital admissions.

One of the most notable impacts of APRN practice is in cost-effectiveness. APRNs contribute to the overall reduction of healthcare expenses by providing preventive care, managing chronic illnesses, and reducing the need for more expensive interventions. According to the resource-based relative value (RBRV) scale methodology, which Medicare uses to determine reimbursement rates, APRNs’ work value is similar to that of physicians for specific procedures, making them a cost-effective alternative (CMS, 2021b).

Table: APRN Practice Impact – Bio Data and Professional Information

Relative Work Value of APRNs

Payment for services provided to Medicare patients is based on the resource-based relative value scale (RBRV), which estimates the work involved, practice expense, and professional liability insurance related to procedures. This system applies not only to physicians but also to APRNs, although CMS does not publish a specific fee schedule for APRNs (Sullivan-Marx, 2008). Demonstrating the financial impact of APRNs on the healthcare system remains a challenge, especially in identifying the true savings or cost avoidance achieved through APRN-led care (Kapu, Kleinpell, et al., 2014).

Despite these challenges, the work of APRNs in both billable and nonbillable activities continues to provide significant value. A survey of Nurse Practitioners (NPs) by Kippenbrock et al. (2018) found that nonbillable tasks—such as reviewing lab reports, refilling prescriptions, and communicating with patients and family members—consumed substantial time, yet these activities are essential for ensuring quality care.

Nonbillable but Essential Activities

One of the lesser-known impacts of APRN practice is the substantial amount of time they spend on nonbillable activities, which still contribute to overall patient outcomes. These include tasks such as making follow-up phone calls, refilling prescriptions, and reviewing diagnostic results. Research by Winter et al. (2021) found that APRNs dedicate up to 36.5 hours per month on these critical, but non-reimbursable, activities, which ultimately enhance the quality of care provided to patients.

APRNs are also instrumental in managing chronic diseases. In one international study conducted by Partiprajak (2012), patients with type 2 diabetes who participated in an APRN-led support group had lower systolic blood pressure and improved self-care abilities, underscoring the importance of APRN-led care in chronic disease management.

Frequently Asked Questions (FAQs)

1. How does APRN practice impact healthcare costs?
APRNs help reduce healthcare costs by focusing on preventive care, managing chronic diseases, and providing care that prevents expensive emergency room visits and hospitalizations.

2. Are APRNs capable of delivering the same quality of care as physicians?
Yes, studies show that APRNs provide care comparable to physicians, particularly in primary care and chronic disease management. Their ability to deliver high-quality care at a lower cost makes them a valuable asset to the healthcare system.

3. Why do APRNs spend time on nonbillable activities?
While not directly reimbursable, nonbillable activities like reviewing lab results or communicating with patients are essential for ensuring continuity of care and improving patient outcomes.

4. What are some of the challenges APRNs face in terms of reimbursement?
One of the biggest challenges is that APRN activities are often not fully captured in traditional billing systems, which were designed with physicians in mind. As a result, the relative work value of APRNs may not reflect their actual contribution to patient care.

5. How does APRN care impact patient outcomes?
Research consistently shows that APRNs contribute to improved health outcomes, particularly in managing chronic diseases like diabetes, hypertension, and asthma.

International Studies on APRN Practice

The global impact of APRN practice continues to grow as more countries adopt advanced practice nursing roles. In Thailand, for instance, Partiprajak’s study (2012) found that patients with type 2 diabetes who received care from APRNs in a support group setting had significantly better health outcomes compared to a control group. Similar findings have been observed in other countries, with APRNs contributing to improved patient satisfaction and better management of chronic diseases.

Tracking the Productivity and Value of APRN Care

A major focus for healthcare systems worldwide is understanding and tracking the productivity of APRNs. Steuer and Kopan (2011) emphasize the need for productivity tools to better capture the outcomes and contributions of APRNs. In the lung cancer specialty, Baxter and Leary (2011) found that restructuring the APRN role to implement national practice guidelines resulted in better case management, leading to fewer hospital admissions for non-acute issues.

The Future of APRN Practice

As healthcare systems continue to evolve, the role of APRNs will likely expand even further. Their contributions to improving patient access, reducing healthcare costs, and enhancing care quality are undeniable. However, continued research and evaluation are necessary to fully understand and optimize the impact of APRN practice on healthcare delivery.

In conclusion, APRN practice is a vital component of modern healthcare, offering a unique combination of quality care and cost savings that is transforming the healthcare landscape globally.