A benefit-cost analysis of a worksite nurse practitioner program: first impressions.
ABSTRACT This study aimed to assess the initial impact of an on-site nurse practitioner (NP) initiative on the health care costs (HCC) among 4,284 employees and their dependents.
The authors analyzed HCC by two methods. First, they compared annualized actual values for the first 6 months of the startup year (2004) with those projected for 2004 on the basis of claims paid in 2002 and 2003. Both aggregate and per-individual HCC were used as the basis for comparison. The difference in HCC between projected and observed values for 2004 was defined as the benefit of the NP program. In a second analysis, HCC were calculated using 2003 paid claims for major diagnostic categories (MDC). These HCC were compared with those that would have been incurred had off-site care been used for the (annualized) number of such patients cared for by the NP in 2004 with the same MDC. The cost of the NP program was used as the denominator in calculating the benefit-to-cost ratio using the savings in HCC estimated by the two previously mentioned methods.
Annualized cost of the NP program was 82,716 dollars. Savings in HCC using the first method were 1,313,756 dollars per year, yielding a benefit-to-cost ratio of 15 to 1. Using the MDC analysis, the ratio was 2.4 to 1. This difference in ratios between the two estimates may partly be attributable to effects of other initiatives such as the wellness program and the Nurse Health Line. The latter was begun 10 weeks before the NP program, is available at all times, and is intended to minimize the need for workers and families to seek high-cost care at hospital emergency departments.
The first 6 months of a new NP initiative yielded substantial reductions in HCC that warrant further analysis over longer periods of observation. However, the initial estimates may understate the aggregate value of the program because it may also reduce on-site injury and illness patterns and improve productivity, end points that were not assessed in this initial snapshot.
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ABSTRACT: The purpose of this study was to use cost-benefit analysis of activity to clarify the economic effect of prepared nurses versus atmospheric environment managing engineers as healthcare managers. For the study 111 workplaces were surveyed, workplaces in which nurses or atmospheric environment managing engineers were employed as healthcare managers. The survey content included annual gross salaries, participation in external job training, costs in joining association covered by the company, location and year of construction of the healthcare office, various kinds of healthcare expenditures, costs in operating healthcare office, health education, and activity performance in the work of environment management. In the case of the healthcare manager being a nurse, benefit was larger than input costs at a ratio of 2.31. On the other hand, in the case of healthcare manager being an atmospheric environment managing engineer, input costs were larger than benefits (benefit-cost ratio 0.88). Results indicate that nurses are an effective healthcare human resource and can offer good quality healthcare service. Therefore companies should hire nurses and actively promote the economic efficiency of nurses in workplace.Journal of Korean Academy of Nursing 08/2013; 43(4):507-16. · 0.29 Impact Factor
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ABSTRACT: On March 23, 2010, the Affordable Care Act became law. The need for healthcare reform was prompted by an imperative to reduce the relentless increase in spending on medical care in the United States. One approach to examining and solving the problem of escalating costs is to focus on applying proven principles of evidence-based practice and cost-effectiveness practices to find the least-expensive way to ensure clinical services of acceptable quality without sacrificing patient satisfaction. Advanced practice registered nurses (APRNs) have positioned themselves to serve an integral role in national health care reform. A successful transformation of the nation's health system will require utilization of all clinicians, including highly qualified APRNs, to provide cost-effective, accessible, patient-centered care. There is extensive, consistent evidence that nurse practitioners (NPs) provide care of equal or better quality at lower cost than comparable services provided by other qualified health professionals. However, current policies in many states prevent NPs from practicing within their full, legally defined scopes of practice. The Office of Technology Assessment's conclusions noted in 1981 that APRNs can be substituted for physicians in a significant portion of medical services with at least similar outcomes. Since then, numerous studies have supported that the care provided is equal to those provided by physicians for services within the overlapping scopes of licensed practice. This paper combines economic analysis with review of literature on health care reform initiatives to explore how the goals of healthcare reform can be accomplished by advanced nurse practitioners to provide their wide range of services directly to patients in a variety of clinical settings.
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ABSTRACT: This study assessed the impact and cost-effectiveness of an on-site health clinic at a self-insured university. Health care costs and number of claims filed to primary care providers were trended before and after the clinic was established to determine savings. A retrospective chart review of all full-time, insured employees treated for upper respiratory tract infections (URIs) during a 1-year study period was conducted. On-site clinic costs for the treatment of URIs were compared to costs at outside community providers for similar care. Community cost norms for the treatment of URIs were provided by Primary Physicians Care, the administrator of insurance claims for the University. A cost-benefit analysis compared the cost of services on-site versus similar services at an outside community provider. Based on the results of this study, the University's on-site health care services were determined to be more cost-effective than similar off-site health care services for the treatment of URIs. [Workplace Health Saf 2014;62(4):162-169.].Workplace health & safety. 04/2014; 62(4):162-9.
A Benefit-Cost Analysis of a Worksite Nurse Practitioner
Program: First Impressions
David Chenoweth, PhD, FAWHP
Nanette Martin, RN, FNP
Jared Pankowski, MSEd
Lawrence W. Raymond, MD, ScM
From Chenoweth & Associates, Inc. and the Department of Health Education and
Promotion, East Carolina University, Greenville, NC 27858 and the Division of
Corporate Health and Department of Family Medicine, Carolinas HealthCare System, PO
Box 32861, Charlotte, NC 28232 and the University of North Carolina at Chapel Hill,
Address Correspondence to:
David Chenoweth, Ph.D.
Chenoweth & Associates, Inc.
128 St. Andrews Circle
New Bern, NC 28562-2907
* Title Page (include all author information)
A nurse practitioner at the worksite can provide valuable health care services to enhance
the health status of employees; in addition such an initiative also enhances the overall
effectiveness of clinic-based health care services.
A Benefit-Cost Analysis of a Worksite Nurse Practitioner Program: First
Objective: This study aimed to assess the initial impact of an on-site Nurse Practitioner (NP) initiative upon the health
care costs (HCC) among 4,284 employees and their dependents. Methods: The authors analyzed HCC by two methods.
First, they compared annualized actual values for the first six months of the start-up year (2004) with those projected for
2004 on the basis of claims paid in 2002 and 2003. Both aggregate and per-individual HCC were used as the basis for
comparison. The difference in HCC between projected and observed values for 2004 was defined as the benefit of the NP
program. In a second analysis, HCC were calculated using 2003 paid claims for Major Diagnostic Categories (MDC).
These HCC were compared with those which would have been incurred, had off-site care been utilized for the
(annualized) number of such patients cared for by the NP in 2004, with the same MDC. The cost of the NP program was
used as the denominator in calculating the benefit-to-cost ratio, using the savings in HCC estimated by the two above
methods. Results: Annualized cost of the NP program was $82, 716. Savings in HCC using the first method were
$1,313,756 per year, yielding a benefit-to-cost ratio of 15 to 1. Using the MDC analysis, the ratio was 2.4 to 1. This
difference in ratios between the two estimates may partly be attributable to effects of other initiatives, such as the wellness
program and the Nurse Health Line. The latter was begun 10 weeks prior to the NP program, is available at all times,
and is intended to minimize the need for workers and families to seek high-cost care at hospital emergency departments.
Conclusions: The first six months of a new NP initiative yielded substantial reductions in HCC which warrant further
analysis over longer periods of observation. However, the initial estimates may understate the aggregate value of the
program since it may also reduce on-site injury and illness patterns and improve productivity, end-points which were not
assessed in this initial snapshot (J Occup Environ Med 2005; 47:000-000)
BP: arterial blood pressure
C&A: Chenoweth & Associates
CHS: Carolinas HealthCare System
MDC: Major Diagnostic Category
NP: Nurse Practitioner
Health care costs; Nurse practitioners; Mid-level providers; worksite clinics
* Manuscript (All Manuscript Text Pages, including, References a
Worksite Nurse Practitioner
With the advent of higher medical care costs and productivity concerns increasing at more worksites in
the past decade, a growing number of companies have developed in-house medical clinics with occupational
health nurses, nurse practitioners, and other allied health professionals. These clinics exist in both mid-sized and
large organizations. According to some of these companies, on-site medical clinics make sense to them in terms
of both cost-containment and quality of health care provided to their employees.1 For example, an external audit
of one company’s on-site clinics found that employees used fewer outpatient and inpatient services when
adjusted by age, gender, and other demographics, than their peers in the community. Moreover, the company’s
database showed the costs to run the clinic are significantly less than what the health plan would have been
paying if employees were to have used community health care providers.2 Similarly, other organizations report
their health care costs have risen just 6% annually over the past four years, translating into corporate health care
spending that is 17% less than industry-related averages; another organization reported its on-site clinics saves
the company more than one million dollars per year.3
In early 2004, officials of a southeastern US industrial metal/plastics manufacturing firm and Carolinas
Healthcare System (CHS) engaged in a contract to offer nurse practitioner (NP) services at the firm’s (1)
administrative, (2) plastics, and (3) foundry locations. On June 17, 2004, a nurse practitioner was hired by CHS
and placed at the firm to begin her official duties. The NP’s official workload was distributed as follows:
• 18 hours per week devoted to plastics division employees
• 18 hours per week devoted to foundry division employees
• 4 hours per week devoted to administrative division employees
The primary goal of the NP is to provide primary care services to employees in a timely and cost-
efficient manner. The scope of her services includes writing prescriptions, administering medications, and
establishing treatment modalities for chronic conditions. Currently, only employees are eligible to receive on-
site medical care services from the NP at no out-of-pocket expense.
Prior to the NP placement, employees and dependents with health plan coverage obtained all medical
care from off-site medical care providers. However, since April 1, 2004, a 24/7 nurse advice line provided by
CHS has been available to employees and dependents. The nurse advice line is primarily designed to (1) assist
employees in selecting appropriate on-site and off-site medical care and (2) eliminate unnecessary emergency
In order to determine the impact on the new NP placement on the firm’s medical care expenses, CHS
retained the services of Chenoweth & Associates, Inc. (C&A).
Based on the primary purpose of the NP initiative and the type of pre- and post-initiative data available
to C&A, a benefit-cost analysis framework was used to evaluate the initial impact of the NP intervention. The
primary purpose of benefit-cost analysis (BCA) is to determine whether a program is worth its cost.4 In essence,
BCA is an economic tool with an emphasis on estimating the monetary value of everything. The monetary value
of a project rests on two fundamental postulates:
Making value judgments about the desirability of economic states is the thrust of welfare economics and the
The social value of an intervention is the sum of the values
of the project to the individual members of society [workplace]
The value of an intervention to an individual is equal to his
(fully informed) willingness to pay for the intervention.
choice of a decision criterion is critical. A guiding rule in formulating criteria, at least in Western society, is that
each individual’s preferences must (somehow) count in the evaluation of alternative economic states. While
there are four popular decision criteria (Unanimity, Pareto Superiority, Majority Rule, Potential Pareto
Superiority), the criterion used in benefit-cost analysis is the Potential Pareto Superiority criterion. It states that