Do mid-level providers enhance hospital cost per discharge or triple aim performance efficiency? An exploratory analysis

Hospital administrators are shifting care delivery models toward an approach that uses more caregivers in the form of mid-level providers (MLPs), such as nurse practitioners, physician assistants, and clinical nurse specialists. To date, however, healthcare operations management (OM) literature remains ambiguous about longitudinal empirical associations between mid-level providers and hospital costs, quality, and other performance measures. We analyze how the extent of MLP employment used by a hospital is associated with hospital operational outcomes, as reflected by hospital cost per discharge and Triple Aim Performance (TAP) efficiency metrics. Our findings indicate percent MLP usage is positively associated with efficiency metrics for hospital clinical quality, technical efficiency, and patient experience, but not associated with hospital costs. We also find percent MLP usage is associated with the likelihood that hospitals excel on all TAP metrics simultaneously. Post-hoc exploratory analyses suggest the associations exhibit differential outcomes across hospital efficiency quantiles, while sub-sample analyses motivate boundary conditions for some hypothesized MLP associations. We contribute to healthcare OM research by providing one of the first panel data analyses of MLPs, improving insights relative to extant work. By giving key stakeholders useful findings about outcomes associated with hospital staffing trends, our managerial contribution helps hospital administrators understand empirical consequences of the increasing use of MLPs.