Insufficient physician attention to nursing home patients and the need for higher quality of care within these homes are problems that have been extensively documented. One solution may lie in the introduction into nursing homes of new midlevel providers known as geriatric nurse practitioners (GNPs). This report presents findings on the cost implications of nursing-home-based GNPs trained through the Mountain States Health Corporation program. The authors found no evidence that GNPs significantly increased or decreased per diem operating costs in nursing homes, nor did they find evidence that GNPs significantly affected per diem profits. GNPs had no effect on per diem imputed expenditures for medical services for patients who were residents at the beginning of the study; but for patients who were admitted during the course of the study, the authors found some evidence that GNPs could in fact reduce costs. Analysis of the composition of medical services used provided good evidence that GNPs reduced hospital use.