A newly released decade-long study by the Workers’ Compensation Research Institute indicates that claims initiated by nurse practitioners (NPs) and physician assistants (PAs) didn’t lead to negative outcomes and suggested some benefits when compared to those led by primary care physicians (PCPs).
The WCRI report, “Advanced Practitioners and Workers’ Compensation Claim Outcomes,” tracked claims from 29 states between 2013 and 2022 and explored how the initial treating provider affects a claim’s medical and indemnity trajectory.
The data highlights how workers’ compensation insurers are navigating limited provider availability in rural settings and the impact of using advanced practitioners, demonstrating improved time to treatment.
“The question isn’t whether NPs or PAs can manage injured workers effectively. The data shows they already are—and have been for years,” said WCRI economist and study co-author Dr. Bogdan Savych.
The percentage of claims with the first non-emergency E&M visit (evaluation and monitoring/office visit) with an advanced practitioner varied from less than 20% in Delaware, Kentucky, New Jersey and Virginia to more than 40% in Indiana, Nevada, New Mexico and North Carolina.
The report found that in the typical study state, 33% of claims with more than seven days of lost time had the first non-emergency office visit with either a nurse practitioner or a physician assistant.
Data shows the changing dynamics of emergency room treatment over the years, with more claimants being examined by advanced practitioners rather than PCPs.
Injured workers treated first by NPs received non-emergency care 2.3% faster on average than those whose care was initiated by a physician. The effect was even more in rural regions, where limited provider availability often delays treatment for days, in some cases.
In rural areas, advanced practitioners are already the most prevalent provider, the report found.
More importantly, “the first provider strongly predicts subsequent care,” according to the researchers.
The data showed PAs helped expedite access to specialty services, such as diagnostic imaging, pain injections, and neurology consults.
Compared to PCP-led claims, PA-led cases had 2.4 percent faster access to radiology, 3.2% faster access to pain injections, and 3.9% faster access to neurology consultations.
Most notably, claims outcomes remained stable no matter whether the initial treating provider was an NP, PA or PCP.
In addition, there was no significant difference in temporary disability duration, no change in the number of evaluation and management visits, no shift in timing or likelihood of specialty referrals, and no variation in early MRI usage.
The findings show utilization patterns were nearly identical.
There was a notable difference in claims led by PAs, which revealed a slight divergence in payment structure with 4 percent higher medical payments and 5.2% lower indemnity payments.
Researchers indicated that earlier diagnostic and specialty access could reduce the overall duration of wage loss.
Shortage rates for advanced practitioners were also analyzed, which showed that higher per-capita availability of NPs was associated with a slightly longer disability duration, while a larger PA workforce correlated with shorter durations.
This factor in particular highlights the need for carriers to monitor provider-type availability, to maintain positive outcomes, and reduce claim costs.
WCRI points to several suggestions for carriers when reviewing provider type availability. These include:
- Increasing the number of advanced practitioners in provider panels, particularly in rural and underserved markets.
- Updating claim models to account for the measurable differences in utilization and payment structure by provider type.
- Ensuring clinical oversight protocols are in place to maintain treatment quality and guideline compliance as NP/PA utilization rises.
- Monitoring whether early specialty access via PAs might offset reductions in wage-replacement exposure.
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