Increasing Hospital Efficiency - The Growing Value of Mid-Level Providers

By James Ellis and Aaron Razavi
08:52 AM

Mid-level providers, commonly called registered nurses (RNs) or physicians’ assistants (PAs) are a beacon of hope for struggling hospitals as the physician attrition rate and the number of aging Americans continues to spiral upwards. RNs and PAs may help lower costs as well as increase patient care for hospitals in several ways. Two of them are: Medicare reimbursements and reduced readmissions.


Medicare reimbursements are favorable for mid level providers. According to Tricia Marriott, director of reimbursement for the AAPA, NPs and PAs are reimbursed at 85% of the physician rate. However, since they are not paid the same as a physician, less than half of the average physicians’ salary actually, about $88,000, the hospital comes out ahead.

Lowering Readmissions:

With enough NPs and PAs on staff, they can delegate admission checks and facilitate a clear communication pathway, while physicians take care of the more pressing and life threatening cases. As Ruth Kleinpell, R.N., director of the Center for Clinical Research and Scholarship at Rush University Medical Center says, “Mid-levels are improving quality and safety with quality-improvement projects by teaching colleagues and by making sure evidence-based best practice protocols are being used.” Similarly, by informing patients and patients’ families about what is to happen and future treatment steps to take, patient satisfaction is increased and avoidable readmissions reduced.

In a previous post I mention several studies as of late, on readmissions and staff nursing levels. One such was published in Circulation: Cardiovascular Quality and Outcomes found evidence supporting that discharged patients from hospitals with a low nurse staff count had higher readmission rates than hospitals with a higher nurse staff count. By cutting back the number of nurses or having nurses work over time, hospitals are increasing the risk of costlier patient care expenses as well as government sanctioned readmission penalties.

Though they do have restrictions on their ability to provide treatment, NPs and PAs are progressively growing with over 14,000 combined graduating each year. That’s doubled what it was 15 years ago. And while not the only solution, they can substantially help an overburdened health system.


James Ellis, CEO, Health Care Realty Development Company, is a nationally recognized successful real estate investor and developer of medical office properties with a comprehensive knowledge of sophisticated real estate transactions, cost effective designs, and efficient property management.

Aaron Razavi is Associate Marketing Director at Health Care Realty Development.



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