Nursing home facilities that employ nursing practitioners (NPs) and physician assistants (PAs) make a significant investment in quality of care for their residents. In 2001, there were approximately 65,000 NPs in the United States but only 10 percent were employed in nursing homes and hospitals. Similarly, there were 57,000 practicing PAs but only 0.4 percent were employed in a nursing home. The purpose of this study was to determine whether Medicaid reimbursement rates and market competition made a difference to the employment of PAs and NPs in nursing homes.
Data were gathered from the Online Survey Certification and Reporting System (OSCAR) database, Area Resource File, and from surveys of state policies from 1993 to 2002. The study found that throughout the 1990s, NPs and PAs were increasingly included in care teams in nursing homes, with their presence rising from 10 percent to over 25 percent by the end of the century. Facilities in states with higher Medicaid reimbursement rates were more likely to employ NPs and PAs, as were facilities in more competitive markets and those in markets with a higher managed care penetration. Expectations about quality of care and service capabilities were probably higher in these markets.