Paper 37: Cost Effectiveness of Incorporating a Clinical Nurse Practitioner in a Urogynecology Practice in the United States

Abstract

OBJECTIVE: To determine the cost-effectiveness of a clinical nurse practioner in a urogyecology practice. METHODS: A financial model to identify all incremental revenues and costs associated with incorporating a clinical nurse practitioner into a urogynecology practice was developed. Baseline assumptions included a 40-hour work week, office visit: procedure session ratio of 6:4, time spent per patient twice that of a physician and a 6-month time period to achieve full capacity. A detailed analysis based on this model was performed including calculation of net present value of incremental cash flow over a 5-year period and payback period. Sensitivity analysis was performed for effect of the number of office visits and procedures performed, time taken to reach capacity, nurse practitioner compensation, discount rate, and reimbursement rate. RESULTS: Based on our financial model, incorporation of a clinical nurse practitioner into a busy urogynecology practice is profitable in less than 6 months under conservative assumptions. Net present value is significantly dependent on the level of procedures performed and the number of office visits scheduled for the nurse practitioner. Sensitivity analysis showed that under the assumption of no procedures and moderate office visit schedule, net present value was decreased by 58%. Net present value is moderately affected by nurse practitioner salary and benefits; a 50% increase in total compensation resulted in a 22% decrease in net present value. Net present value is minimally affected by length of time to achieve full clinical capacity, the discount rate, and the Medicare Geographic Adjustment Factor. Extending time to full capacity to 1 year and doubling the discount rate each resulted in a 9% decrease in net present value. Using the most unfavorable Medicare Geographic Adjustment Factor to weight Relative Value Units in calculating reimbursement rates resulted in a 4% decrease in net present value. Under all tested scenarios, net present value remained positive. Payback period calculations were relatively similar under all scenarios, achieving profitability within 1 year (range 5–10 months). CONCLUSIONS: A robust model to determine the cost-effectiveness of a nurse practitioner in a urogynecology practice can be developed. Incorporation of a clinical nurse practitioner into a urogynecology practice is cost effective and financially favorable in most geographic areas of the country.