HCCI Report Shows Visits to Nurse Practitioners, Physician Assistants Soaring

Workers younger than 65 with employer-sponsored health insurance dramatically shifted to nurse practitioners (NPs) and physician assistants (PAs) between 2012 and 2016 as visits to primary care physicians (PCPs) decreased, according to a new report from the Health Care Cost Institute (HCCI).

Primary care visits to NPs and PAs soared 129%, while office visits to PCPs dropped 18%, and all office visits dropped 2%. Office visits to specialists and other nonphysician providers remained relatively unchanged over the period.

However, the total increase in NP and PA visits accounted for just 42% of the total decline in PCP visits between 2012 and 2016. The rate of decline in PCP visits slowed, whereas the rate of increase in NP and PA office visits stayed relatively constant. Because some visits to NPs and PAs may not have been for primary care, “the 42% offset may be an upper bound,” the report said.

“The decline in primary care visits comes at a time when awareness has grown of the role of primary care in prevention and in containing overall medical spending,” said Niall Brennan, president and chief executive officer of HCCI, in a statement. “We saw these trends in our annual report and wanted to explore them more fully to shed light on this aspect of rising health care costs.”

A study published earlier this year in Health Affairs noted the increased role of NPs in primary care between 2008 and 2016, especially in rural areas. Thursday's report also noted that the use of NPs and PAs has been rising, although the laws governing their scope of practice vary from state to state.

The HCCI report said there were 273 fewer office visits per 1000 insured individuals to PCPs in 2016 compared with 2012, whereas visits to NPs and PAs rose from 88 to 201 visits per 1000 insured members.

Primary care is important for keeping healthcare costs low, the report noted, because specialist or emergency department care costs more. However, the shift in visits did not result in cost savings. In 2016, the average cost per visit to a PCP was $106, versus $103 for an office visit to an NP or PA.

Every state saw declines in PCP visits, with North Dakota seeing the largest overall decline of 31%. Likewise, each state saw an increase in NP and PA office visits, the largest increase of 285% happening in Massachusetts.

HCCI, an independent nonpartisan research organization that analyzes the causes of the rise in health spending, is funded partly by 4 insurers that contribute claims data.