Demonstration of the cost-effectiveness of a nurse practitioner/physician team in long-term care facilities

To an HMO with a Medicare risk contract, providing high-quality medical care to a nursing home resident may generate considerable costs. To address this issue, Fallon initially assigned each primary care physician to just one nursing home. The program was successful in that coverage of all Fallon patients admitted to nursing homes was assured. In a pilot project 5 years ago, a geriatric nurse practitioner (GNP) was hired to provide primary and episodic visits to nursing home residents in three area nursing homes. Research was conducted to determine the effectiveness of a GNP-MD team. Based on positive outcomes, additional GNPs were recruited. In the current follow-up study, a review of the 1992 fiscal and utilization data for nursing home patients revealed significantly lower rates of emergency room transfers, hospital lengths of stay and specialty visits for patients covered by GNP-MD teams, as compared to patients covered by physician only. Nursing home drug costs, skilled nursing days and primary care visits were higher for patients covered by the teams, but the differences were not statistically significant. Overall costs were 42% lower for the aggregate pool (skilled nursing plus intermediate care) and 26% lower for those with long-term stays.