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Easing nurse practitioner laws may save money at clinics

By Andrew M. Seaman

NEW YORK (Reuters Health) - Relaxing restrictions on what services nurse practitioners can and can't provide may lead to cost savings at retail health clinics, suggests a new study.

Researchers found care related to retail health clinic visits cost $34 less in states that allowed nurse practitioners to prescribe and practice independently than in states that required them to be supervised by a doctor.

"It appears there are cost savings when those nurse practitioners are allowed to operate autonomously in the retail clinic settings," Joanne Spetz told Reuters Health.

Spetz is the study's lead author and a professor at the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco.

While $34 may not seem like much, the researchers estimate there could be cost savings of $472 million by 2015 if nurse practitioners are allowed to independently practice at retail health clinics.

Those clinics are found in chain pharmacies or so-called big box stores. The clinics offer walk-in care for minor health problems, such as sore throats and ear infections, and are often staffed by nurse practitioners.

The ability of nurse practitioners to practice independently and prescribe medication varies by state, however.

In some states, nurse practitioners are allowed to practice on their own and prescribe certain medications. In others, they must be supervised by doctors.

There are expected to be more than 6,000 retail health clinics in the U.S. by the end of 2013, according to one study (see Reuters Health story of July 22, 2013 here: http://reut.rs/140T1fu).

Some researchers have raised concerns over conflicts of interest when retail clinics located in pharmacies write prescriptions.

Others have questioned whether visits to retail clinics disrupt the continuity of care between patients and their primary care doctors (see Reuters Health story of November 2, 2012 here: http://reut.rs/18EBKJb).

For the new study, the researchers used insurance claims from 2004 through 2007 to compare the costs of retail health clinic visits between states that allowed nurse practitioners to practice independently and states where they needed to be supervised.

Overall, they found visits to retail clinics were cheaper than traditional doctors' visits.

The average cost of treatment in the 14 days after a traditional doctor's office visit was $704. That includes the cost of the original appointment, plus any prescriptions and follow-up care.

In states where nurse practitioners had no independence and could not prescribe medication, the average cost of care during and after a retail clinic visit was $543.

The compared to $484 per visit in states where nurse practitioners were allowed to practice without the supervision of a doctor.

The cost savings shrank, however, in states where nurse practitioners were allowed to practice without supervision and prescribe medication. In those states, the average cost of a visit was $509.

The researchers write in Health Affairs that people were more likely to fill a prescription after visiting a retail health clinic than after visiting a doctor's office. For clinic visits, they were more likely to fill a prescription when nurse practitioners at the clinic could prescribe medication.

That doesn't mean nurse practitioners write more prescriptions than doctors, Spetz said. It could mean people are more likely to fill their prescription before they leave the store.

Future research could examine the relationship between prescribing powers and the cost of retail clinic visits, she said.

The researchers found no difference in a patient's chance of being hospitalized after a retail clinic visit based on whether states allowed nurse practitioners to independently practice.

"There is also no evidence that the states that have more restrictive scope of practice laws have better patient outcomes," Spetz said.

"I think there is a broader piece of literature and this is another little piece of that literature that there is no good reason to have those restrictions (on nurse practitioners)," she said.

SOURCE: http://bit.ly/1c73F5s Health Affairs, November 2013.

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