Association between physician practice Medicaid acceptance and employing nurse practitioners and physician assistants: A longitudinal analysis

Abstract

Background: Access to care is often a challenge for Medicaid beneficiaries due to low practice participation. As demand increases, practices will likely look for ways to see Medicaid patients while keeping costs low. Employing nurse practitioners (NPs) and physician assistants (PAs) is one low-cost and effective means to achieve this. However, there are no longitudinal studies examining the relationship between practice Medicaid acceptance and NP/PA employment.

Purpose: The purpose of this study was to examine the association of practice Medicaid acceptance with NP/PA employment over time.

Methods: Using SK&A data (2009-2015), we constructed a panel of 102,453 unique physician practices to assess for changes in Medicaid acceptance after newly employing NPs and PAs. We employed practice-level fixed effects linear regressions.

Results: Our results showed that, among practices employing both NPs and PAs, there was a roughly 2% increase in the likelihood of Medicaid participation over time. When stratifying our sample by practice size and specialty, the positive correlation localized to small primary care and medical practices. When both NPs and PAs were present, small primary care practices had a 3.3% increase and small medical practices had a 6.9% increase in the likelihood of accepting Medicaid.

Conclusion: NP and PA employment was positively associated with increases in Medicaid participation.

Practice implications: As more individuals gain coverage under Medicaid, organizations will need to decide how to adapt to greater patient demand. Our results suggest that hiring NPs and PAs may be a potential lower cost strategy to accommodate new Medicaid patients.

Figure 1.

Medicaid acceptance in physician practices with and without nurse practitioners (NPs) and physician assistants (PAs) by practice size. Calculations based on pooled observations of Medicaid acceptance in 102,453 physician practices present in all 4 years of data: 2009, 2011, 2013, 2015. Small practice = 1–3 physicians; not-small practices = 4+ physicians