A recent study concluded that just two home visits by a physician assistant (PA) during the week after hospital discharge significantly reduces the chance a heart surgery patient will be readmitted. The reduced readmissions also reduce overall costs associated with the heart surgery — a $39 savings for each dollar spent on PAs.
In a presentation recently at the 52nd Annual Meeting of The Society of Thoracic Surgeons, John P. Nabagiez, MD, from Staten Island University Hospital in New York City, noted that adult cardiac surgery has one of the highest readmission rates for all hospitalized patients.
Nabagiez and colleagues analyzed hospital readmission rates of 1,185 patients who underwent cardiac surgery from September 2008 through August 2012 at Staten Island University Hospital.
Patients who received visits from PAs on days 2 and 5 following hospital discharge had a significantly lower rate of readmission (10%) compared with those who did not receive home visits (17%), Nabagiez reported. This represents a 41% reduction in the rate of readmission within the first 30 days following cardiac surgery.
“The physician assistants who made the house calls in our study were fully trained cardiac surgery PAs who were actively involved in the preoperative, intraoperative, and postoperative care of our patients,” Nabagiez said in his presentation, which was provided to Hospital Peer Review by the society.
“Unlike standard visiting nurses, our PAs knew each patient personally and understood all of the pertinent issues of the patient’s medical history. They also knew the patient’s individual postoperative course prior to discharge, so they entered the patient’s home already knowing the concerns, if any, of the surgeon and the patient.”
Healthcare expenditures fell in conjunction with the reduced readmissions, even when the additional cost of PA visits was included. It cost $23,500 to make house calls to 363 patients, which saved $977,500 in readmission costs, Nabagiez said, which translated to $39 in healthcare savings for every dollar spent.
Nabagiez attributed the lowered readmissions partly to the PAs helping patients comply with all prescribed medications and physical rehabilitation after heart surgery.
“Complications can arise in the first week after surgery, and these initial home visits can help diagnose problems earlier, which can keep patients out of the emergency department,” Nabagiez said. “We found that making these two visits is cost effective and keeps patients on the road to recovery, while also reducing hospital readmissions.”
PAs Rapidly Growing in Number and Influence
Physician assistants (PAs) are rapidly increasing their presence in healthcare, according to a recent report from the National Commission on Certification of Physician Assistants (NCCPA) in Johns Creek, GA.
The 2015 Statistical Profile of Certified Physician Assistants indicates rapid growth in the profession, which currently has almost 109,000 certified PAs practicing across every state, specialty, and clinical setting. The following are some findings in the report:
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More than 70% of certified PAs work in specialties outside of primary care, including 18% percent in surgical subspecialties and 13% in emergency medicine.
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The states with the largest number of PAs per capita are Alaska, South Dakota, Pennsylvania, Maine, and New York, suggesting they are in high demand in both populous and rural areas.
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The median age of certified PAs is 38.
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More than 22% of PAs communicate with patients in a second language. Of those PAs, 81% are speaking to patients in Spanish.
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Full-time PAs treat an average of 75 patients a week in their principal clinical position. All PAs cumulatively care for more than 7 million patients weekly.
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More than 13% of certified PAs work in a second clinical position, averaging 10 hours a week and treating 22 patients in that position.
The report is available online at http://bit.ly/292XOnI.
