New Report: Nurses Practicing Independently in Retail Clinics Deliver Significant Cost Savings for Many Common Conditions

November 25, 2013
  • Broadening nurses’ ability to practice at “top of license” expands access to care and improves cost performance

A new study co-led1 by UnitedHealth Group’s (NYSE: UNH) Center for Nursing Advancement shows that nurse practitioners (NPs) practicing in retail clinics have the potential to deliver significant cost savings when treating a range of common conditions, with the greatest savings occurring in states that allow NPs to practice independently.

In addition, the research did not show any erosion in quality, as measured through excess ER visits or hospitalizations following use of the retail clinic, meaning cost savings can be realized without lowering the quality of care.

The study, “Scope-Of-Practice Laws For Nurse Practitioners Limit Cost Savings That Can Be Achieved In Retail Clinics,” published in the November issue of Health Affairs, examines the impact of scope-of-practice regulations for NPs on health care use and costs in retail clinics. Scope-of-practice laws – which regulate how practitioners deliver health care – vary from state to state for NPs. Some states allow NPs to practice independently, and others require direct supervision by or collaboration with physicians.

The research sheds light on an opportunity to increase consumer access to care for a range of common conditions and promote broad cost savings as a result. The study also underscores the importance of care providers being able to practice at the top end of their training and licensure, or “top of license,” in order to meet the nation’s evolving health care needs – particularly as millions of people are poised to enter the health system as a result of health reform.

The data also reveal the clear cost benefits of NPs practicing at the top end of their training and licensure:

  • NP visits in retail clinics were associated with lower costs per visit for common conditions, including upper respiratory, ear, urinary tract and eye infections, allergies and influenza;
  • the costs associated with treating these conditions were consistently lower when NPs practiced independently; and
  • the rate of emergency room and urgent care visits, and hospitalizations associated with retail clinic visits was lower than with nonretail visits for these conditions.

The evidence suggests that eliminating restrictions on NPs’ scope of practice could potentially increase the overall savings achieved by retail clinics. The researchers project that if all states nationwide allowed NPs to practice independently, cost savings in 2015 could increase by as much as $472 million if NPs were allowed to both practice and prescribe medication independently.

“This study helps confirm a new reality in today’s health system: all care providers must be allowed to fully use their skills and education to meet our nation’s increasingly complex health care needs,” said Dawn Bazarko, D.N.P., M.P.H., R.N., senior vice president of the UnitedHealth Group Center for Nursing Advancement and co-author of the study. “As one of the nation’s largest employers of nurses, UnitedHealth Group understands that this is especially important for nurse practitioners, who will continue to play a vital role in increasing access to affordable, high-quality care for everyone.”

Cost and Health Benefits of NPs Practicing at “Top of License”

Retail clinics provide a convenient and low-cost option for consumers needing to access care for common health concerns, particularly during the evenings and weekends when other cost-efficient care may not be available. These clinics often are staffed by NPs; however, the scope of nurses’ services varies from state to state due to state scope-of-practice regulations.

Using multistate insurance claims data for more than 9,000 patients over two-week periods between 2004 and 2007, researchers analyzed the costs associated with visits to retail clinics in states where NPs are allowed to practice independently vs. in states that require physician supervision. The report also examines the relationship between NP scope of practice, retail clinic use, and the rate of hospitalizations and emergency room visits.

To read the full report, go to:

About UnitedHealth Group
UnitedHealth Group (NYSE: UNH) is a diversified health and well-being company dedicated to helping people live healthier lives and making health care work better. With headquarters in Minnetonka, Minn., UnitedHealth Group offers a broad spectrum of products and services through two distinct platforms: UnitedHealthcare, which provides health care coverage and benefits services; and Optum, which provides information and technology-enabled health services. Through its businesses, UnitedHealth Group serves more than 85 million people worldwide. For more information, visit UnitedHealth Group at

1 Researchers conducting the study were: Joanne Spetz, PhD, professor at the Institute for Health Policy Studies and Associate Director for Research Strategy at the Center for the Health Professions at the University of California, San Francisco; Stephen T. Parente, director of the Medical Industry Leadership Institute at the Carlson School of Business, University of Minnesota; Robert J. Town, associate professor of health care management at the Wharton School, University of Pennsylvania; and Dawn Bazarko, D.N.P., M.P.H., R.N., senior vice president for the UnitedHealth Group Center for Nursing Advancement. Funding for the research was provided by the Robert Wood Johnson Foundation




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