Team-based care can improve outcomes, lower costs
by Stephen J. Grindel, DO —
We as physicians are always looking at ways to improve quality and efficiency in the practice of medicine. Data over the past several years show the team-based approach to medicine gaining traction.
Multiple studies of team-based medicine have indicated improved patient outcomes and the highest quality of care provided with the lowest cost.
Studies performed by Blue Cross Blue Shield of Michigan noted that a physician-led medical home results in significant cost savings along with a decrease in hospital admissions, readmissions and emergency department visits. Insurance companies and physicians both benefit financially. There also is improved quality and patient satisfaction.
Members of the team include nurse practitioners, physician assistants, nurses, medical assistants, dietitians, physical therapists and pharmacists all working together to improve the quality of patient care. Staff members need to be working at the top of their licenses to allow for employee satisfaction along with efficiency in patient care. This leads to less physician burnout.
In specifically looking at nurse practitioners in independent practice, the state of Oregon has allowed unrestricted practice for many years. In retrospective studies, this has not expanded access in rural and underserved areas. Meanwhile, states that require supervision of nurse practitioners have had the opposite effect, with more NPs in rural and underserved areas.
Another factor in looking at nurse practitioners is the increased cost of care. Non-physicians order far more diagnostic tests and have a 400% increase in skeletal X-ray exams, according to studies looking at Medicare claims data. In addition, they prescribed 20% more opioids and antibiotics. None of these factors improves quality or cost of care.
Another concern regarding nurse practitioners working without supervision is the safety of patients. The time required for training a nurse practitioner is 500-750 hours, in contrast to a physician’s training of approximately 16,000 hours. We want the best-trained individuals to lead our health care teams.
For many years APRNs have been lobbying the Kansas Legislature for independent practice. This year’s bills failed to pass either the House or Senate health committees. However, the House bill was “blessed” by House leadership, which kept it alive until the end of this month.
The team approach to health care can allow for improved access to care, enhanced quality and greater continuity of care with improved patient satisfaction. As a medical society, we need to advocate for the best health care for our patients, which includes a physician-led, team-based approach to medicine.