Guest Post by Dr. Courtney H. Lyder
Dr. Lyder is dean and professor of the University of California Los Angeles (UCLA) School of Nursing, professor of Medicine and Public Health, as well as executive director of the UCLA Health System Patient Safety Institute and assistant director of the UCLA Health System.
As hospitals continue to search for ways to control rising healthcare costs and improve their bottom line, they need look no further than nurse practitioners.
For more than 45 years, evidence has shown that nurse practitioners are cost-effective 
high-quality providers in the primary care setting. In fact, nurse practitioner care resulted in significant savings with a benefit-to-cost ratio of up to 15 to 1.
In light of healthcare reform and a continued consumer spotlight on cost-effectiveness, hospitals should be looking to nurse practitioners as a critical key to their solutions
Nurse practitioners not only have the academic credentials, but on average have already worked 10-plus years as registered nurses, so they have practical, bedside experience to complement what they’ve learned in the classroom. And studies have shown no difference in outcomes when a nurse practitioner or a physician treats patients.
In a study completed here at UCLA, it was found that nurse practitioner-led care was associated with lower overall drug costs for inpatients. In another study comparing nurse practitioner to physician management of high cholesterol following coronary bypass, they found patients in the group managed by nurse practitioners had lower drug costs, while being more likely to achieve their goals and comply with prescribed regimens.
These types of results bode well for the changes coming to the reimbursement for 30-day readmissions in 2013 as part of the healthcare reform act. A growing body of evidence shows that nurse practitioners and other advanced practice nurses can be highly effective when used to coordinate and implement complex evidence-based care programs.
At the University of Virginia Health System, a nurse practitioner model introduced in the neurosciences area in 1999 cut about 2,000 inpatient days on a similar volume and case mix of patients, resulting in a $2.4 million savings the first year.
Other hospitals also have begun including nurse practitioners in their teams. When Loyola University Health System in Maywood, Illinois, revamped its cardiovascular surgery care in the late 1990s, they transferred surgery patients’ care to specially trained nurse practitioners. It was their job it was to ensure that advanced protocols were followed by constantly monitoring patients’ conditions and adjusting their care to keep them progressing towards discharge. They also served as primary contacts for patients’ families and took responsibility for discharge and follow-up care. Results showed a dramatic drop in mortality and cost savings per case of 9 percent. And while the hospital emphasized that gains resulted from the complete cardiovascular redesign, having the highly skilled nurse practitioners dedicated to patient management and coordinating the complex care process, was essential to the program’s success.
Utilizing nurse practitioners outside the hospital setting also can control unnecessary hospitalizations. Nurse practitioners in nursing homes reduce the total costs of caring for patients with Alzheimer’s disease and related dementias by treating a broad array of their medical problems, such s gastrointestinal and genitourinary considerations that can lead to expensive hospital stays. Under the care of nurse practitioners and other caregivers while in the hospital and post-discharge, per-patient costs decreased by nearly $1,000.
The bottom line is that using nurse practitioners is one of the most cost-effective and feasible actions to solve the problems of cost, quality and access to healthcare. That, in turn, makes them the answer to improving your bottom line.
