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Adding PAs may be safe way to cut hospital costs

Hiring more physician assistants in hospitals alongside doctors can reduce the cost of hospital care without sacrificing safety or quality, a study suggests.

The 18-month study comparing a high PA/physician ratio with a conventional lower ratio found no significant differences in key clinical outcomes: patient mortality, hospital readmissions within 30 days, length of stay, or specialty consultant use.

More and more medical centers rely on hospitalists, hospital-based internal medicine specialists who coordinate inpatient care.

The study indicates “expanded use of well-trained PAs within a formal PA-physician collaboration arrangement can provide similar clinical outcomes with lower costs,” says Henry Michtalik, assistant professor of medicine at the Johns Hopkins University School of Medicine.

“The expanded PA model could free up physicians’ time to focus on more complex cases or allow hospitalists to provide additional or different services,” says Michtalik, senior author of a paper published in the Journal of Clinical Outcomes Management.

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The study took place at Anne Arundel Medical Center, a community hospital in Annapolis, Maryland. In one group of three physicians and three PAs, the PAs cared for 14 adult patients a day. In a conventional hospitalist group of nine physicians and two PAs, the PAs cared for nine patients. Physicians in both groups cared for about 13 patients.

In both groups, each PA was formally paired with an overseeing physician. PAs were responsible for independent clinical decision-making, but physicians in both groups took primary responsibility for more complex cases. Both groups mandated an in-person physician visit at least every third hospital day.

Each morning, patients were reassessed and designated a provider; patients would be seen by the same provider as the previous day whenever possible. In the expanded PA group, 35.73 percent of visits were conducted by a PA, compared to 5.89 percent in the conventional group.

In the expanded PA group, 14.05 percent of patients were readmitted within 30 days, while 13.69 percent in the conventional staffing model were readmitted. The expanded PA group recorded a 1.3 percent inpatient mortality rate, while the conventional group had a 0.99 percent rate. These differences were statistically insignificant, as were differences in consultant use and length of stay.

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For the study’s “standard” patient—one between 80 and 89 with Medicare and a major illness—the average patient charge was $2,644 in the expanded PA group and $2,724 in the conventional group.

Michtalik cautions that the study focused only on a single medical center, and that the role of PAs in patient care needs much more attention.

“As we address the challenges of an expanding older and more complex patient population in the setting of health care reforms and financial pressures, optimizing the patient care team and outcomes are high priorities,” he says. “Support, education, and teamwork are essential for any staffing model to be successful.”

The federal Agency for Healthcare Research and Quality funded Michtalik’s role in the study.

Source: Johns Hopkins University

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