Ever visited the ER in a hospital? Chances are high that you might not have met a health care provider and as an alternative checked by a nurse. The rationale why there is no such thing as a guarantee that one will see a health care provider on their visit to ER is the little-known ‘blended model.’

Many hospitals outsource their emergency rooms to medical staffing firms similar to American Physician Partners (APP). APP, an organization owned by private equity investors, employs fewer doctors in its ERs as a way of cost-saving to extend revenue, in line with a confidential company document.

Doctors at the moment are being sidelined by nurse practitioners and physician assistants, collectively often known as “midlevel practitioners.” These professionals are able to performing most of the duties and generate almost the identical revenue, but have lower than half of a health care provider’s pay.

“It’s a comparatively easy equation,” Dr. Robert McNamara, a founding father of the American Academy of Emergency Medicine and chair of emergency medicine at Temple University, said, in line with CNN. ”Their No. 1 expense is the board-certified emergency physician. So, they will wish to keep that expense as little as possible.”

Calling it a “blended model,” APP said that it’s a way of creating sure all ERs stay fully staffed. In this manner, doctors, nurse practitioners, and physician assistants can “provide care to their fullest potential,” it further said.

Besides the apparent fear that an individual may not receive adequate care, critics posit that the model increases the likelihood of misdiagnoses and better medical bills. 

In a study, published in October by the National Bureau of Economic Research, about 1.1 million visits to 44 ERs throughout the Veterans Health Administration were analyzed. Here, nurse practitioners are allowed to treat patients without oversight from doctors.

Treatment by a nurse practitioner led to a 7% increase in the price of care and an 11% increase in length of stay, the study found. 

“It’s not only a straightforward query of if we are able to substitute physicians with nurse practitioners or not,” Yiqun Chen, co-author and an assistant professor of economics on the University of Illinois-Chicago said. “It relies on how we use them. If we just use them as independent providers, especially … for relatively complicated patients, it doesn’t appear to be a excellent use.”

Resulting from a scarcity of definite evidence on the negative impact of substituting doctors with nonphysicians, the blended model is more likely to proceed, Dr. Cameron Gettel, an assistant professor of emergency medicine at Yale, said.

“Worse patient outcomes haven’t really been shown across the board,” he said. “And I feel until that’s shown, then they may proceed to play an increasing role.”