Employment of Advanced Practice Clinicians in Vertically Integrated Health Systems Reflects Larger Trends Toward Consolidation
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Associated Project
Coordinating Center for Comparative Health System Performance
Prepared for:
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality
Key Findings
- 4 in 10 NPs and PAs were employed in practice settings affiliated with systems.
- Employment in systems was higher in hospitals, multispecialty practice sites, and specialty practices associated with lucrative hospital services and lower in primary care practice sites.
- Systems offering a health plan and participating in a Medicare accountable care organization employed more NPs and PAs on average.
We examined the intersection of two important recent trends in health care delivery: rapid growth in employment of nurse practitioners (NP) and physician assistants (PA) and consolidation of providers and hospitals into vertically integrated health systems. Using the Agency for Healthcare Research and Quality (AHRQ) Compendium of U.S. Health Systems and IQVIA OneKey database, we examined employment of NPs and PAs in health systems in 2018. We found that 4 in 10 NPs and PAs were employed in practice settings affiliated with systems. Employment in systems was higher in hospitals, multispecialty practice sites, and specialty practices associated with lucrative hospital services and lower in primary care practice sites. Systems offering a health plan and participating in a Medicare accountable care organization employed more NPs and PAs on average. Future research should examine further the intersection of these two trends to examine how employment in systems affects cost, access, and quality of care.
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