NURSE PRACTITIONERS: HMOs Curb Hospital Utilization
A managed care approach to nursing home care can trim patient hospitalizations and treatment in emergency rooms, while simultaneously increasing monthly medical visits, according to a study published in the February issue of the Journal of the American Geriatrics Society. Dr. David Reuben and his colleagues at the University of California-Los Angeles examined the impact of three HMOs on the care of nursing home residents at 20 community-based facilities over the course of one year. The researchers found that nursing home residents in all three HMOs were seen nearly twice as often as their fee-for-service counterparts -- an increase associated with a greater number of nurse practitioner visits, not more visits from physicians. Further, the HMO that provided the most monthly visits -- an average of 2.0 visits per month compared to 1.1 per month for fee-for service members in the same region -- shuttled fewer residents to the emergency department: only 6% of that HMO's nursing home residents received treatment in hospital emergency rooms, compared to 16% of fee-for-service patients. The HMO that offered the most visits also had the fewest number of hospitalizations per resident -- 0.1 per year compared to 0.5 per year for fee-for-service members. Reuben and his colleagues also examined the health systems' response to "two acute problems, falls and fever." They found that "responses to these acute problems were more prompt and better documented for HMO residents."
Saving $800 Per Patient Per Year
The authors found that the "most successful HMO achieved [its] success by providing the same number of physician visits that non-HMO residents received and supplementing these with an equal number of nurse practitioner or physician's assistant visits." Thanks to the cost effectiveness of such visits, the HMOs were able to shave 1.9 hospital days per patient. Taking into account the average cost of treatment provided by the nurse practitioner, the authors projected that considering hospital days approach $1,000, "this would mean a saving of $844 per nursing home resident per year." The authors conclude that "within risk- contract HMOs, the financial incentives correctly bring together the costs of development and implementation and the benefits from reduced hospitalization. Future Medicare planning will have to create similar financial incentives if such models are to be implemented under fee-for-service reimbursement" (Reuben et al., February issue).