A Profession on the Move

© American Academy of PAs. All rights reserved. These materials may not be duplicated without the express written permission of AAPA.

A Profession on the Move

© Copyright 2019, American Academy of PAs

Jonathan E. Sobel, DMSc, MBA, PA-C, DFAAPA, FAPACVS President and Chair of the Board, AAPA

Presented to APACVS, April 5, 2019


The Profession Has Tremendous Momentum

Demand for PAs increased more than

300% from 2011 to 2014

Employment of PAs is projected to increase 37%

by 2026

Multiple job offers are received by

76% of PAs upon graduation

# 3Best 100 Jobs ListUS News & World Report, 2019

# 5Fastest Growing Jobs In AmericaBureau of Labor Statistics, 2018

Best Healthcare Jobs ListUS News & World Report, 2019

2

#3

#1

#5


Patients

Aging boomer population

Increasing rates of disease (i.e. obesity & diabetes)

National epidemics(i.e. opioid & mental health crises)

Healthcare Environment

Changing consumer expectations & demand for

better access

Critical shortage of providers

More consolidation & alignment among existing healthcare organizations

© American Academy of PAs. All rights reserved. These materials may not be duplicated without the express written permission of AAPA.© American Academy of PAs. All rights reserved. These materials may not be duplicated without the express written permission of AAPA.

PAs are Well-Positioned for the Changing Healthcare Environment

3


C-Suites Recognize PA Value

MAXIMIZATION

OF ADVANCED

PRACTICE PROVIDERS

for CFOs Becker’s ReviewAnnual Conference

listed as one of the

top priorities

EMPLOY

ADVANCED PRACTICE

PROVIDERS

78% ofbetter-performing practices

4

(PAs and NPs)


PAs are a Critical Part of Front-line Clinician Workforce

-51,300

-90,700

-121,300

Predicted Physician Shortage

2020 2025 2030

Source: Association of American Medical Colleges, March 2018 The Complexities of Physician Supply and Demand: Projections from 2016 to 2030

PAPhysicianSource: Bureau of Labor Statistics 2016-26 Projections

5

Predicted Growth by Profession (by 2026)

37%

13%


Investigating the PA Title

and Identifying

Alternatives

Modernizing PA

Legislation

Raising Awareness &

Visibility of the PA

Profession

AAPA Priorities are Driven by Patient Needs and the Healthcare Marketplace

6

Raising Awareness &


Profession

Empowering PAs with

Leadership Opportunities


AAPA Empowers PAs with Leadership Opportunities

7

© American Academy of PAs. All rights reserved. These materials may not be duplicated without the express written permission of AAPA.8



and Identifying

Alternatives

Modernizing PA

Legislation

Raising Awareness &


Profession

Empowering PAs with


Raising Awareness & Visibility of

the PA Profession


AAPA Raises Awareness and Visibility of the PA Profession

9


AAPA Positions PAs in the Media

10




and Identifying

Alternatives

Working to Modernize

PALegislation

Raising Awareness &


Profession

Empowering PAs with


Modernizing PA Legislation


2018 Legislative Update Wins: States

All 50 states and the District of Columbia made more than 70 statutory and nearly 80 regulatory improvements to laws and regulations that govern PA practice.


2018 State Legislative Wins

Included PAs in key definitions like “prescriber,” “healthcare provider,” or “practitioner.”

27States

Either eliminated or improved outdated restrictions on PA practice like PA-to-physician ratio mandates, proximity requirements, scope of practice limitations, or face-to-face physician meeting directives.

12States

Enacted laws or regulations allowing PAs to certify health status or sign forms.

12States

Expanded PA ability to provide mental healthcare.10States

Enhanced PA ability to treat individuals with addiction (including 3 that either improved or granted PAs the ability to prescribe buprenorphine)

6States

13


AAPA Federal Advocacy Leads to Significant Victories for Profession in 2018

New Laws Enacted Waiver for buprenorphine prescribing Managing and providing hospice care Supervising cardiac and pulmonary rehabilitation Implementing competitive pay for PAs in VA

New Regulations Adopted CMS modification to QPP low-volume threshold Ease in ACO assignment of PAs

Inclusion of PAs as Accepted Medical Sources for disability claims

Acknowledgment that PAs should have authority to record progress notes of psychiatric patients

Appointment of 6 PAs to CMS advisory panels

14


Full prescriptive authority

Adaptable collaboration requirements

“Licensure” as the regulatory term

Number of PAs a physician may practice with determined at the practice level

Scope of practice determined at the practice level

Cosignature requirements determined at the practice level

AAPA’s Six Key Elements of a Modern PA Practice Act

15


Modernizing PA Laws and Regulations

6 Key Elements in State PA Law

One Key ElementTwo Key ElementsThree Key ElementsFour Key ElementsFive Key ElementsSix Key Elements

RI

DED.C.


PAs, Physicians, and Other Medical Professionals

Achieving Optimal Team PracticeOptimal Team Practice occurs when

work together to provideQuality Care

without burdensome

Administrative Constraints

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Achieving Optimal Team Practice

Eliminate the requirement for PAs to have an

agreement with a specific physician.

Create a separate majority-PA board to

regulate PAs, or add PAs and physicians who work

with PAs to medical or healing arts board.

Authorize PAs to be directly reimbursed

by all public and private insurers.

18


What’s Driving the Need for Change?

19

When PAs Were CreatedPAs and physicians worked together in solo practices

Today…PAs and physicians work on teams in group practice or hospital settings

Fewer than Half of Physicians Own Practices

76.1%

47.1%

- 38%

Decrease in Physicians who own practices from 1983

to 2016

1983 2016


NPs Don’t Require an Agreement with a Specific Physician

20

1990

4

1998

8+ D.C.

2012

16+ D.C.

2014

19+ D.C.

2017-Today

22+ D.C.

Number of States where NPs Have Full

Practice Authority


Removing the Legal Agreement Requirement

Reduce Healthcare Spending

Expand Access to

Care

Strengthen Healthcare

Teams

Eliminate the requirement for PAs to havean agreement with a specific physician.


Creating a Separate, Majority-PA Board

Create a separate, majority-PA board to regulate PAs, or add PAs and physicians who work with PAs to

medical or healing arts board.


Authorizing Direct Reimbursement

Authorize PAs to be directly reimbursed by all public and private insurers.


INCREASING RURAL ACCESS TO CARE

15.8% of PAs work in rural settings

77.4% increase in PAs working in rural settings since 2012(2018 AAPA Salary Report)

Why OTP Matters to Our Stakeholders

will have greater access to high-quality healthcare.

PATIENTSwill have more flexibility in arranging healthcare teams.

EMPLOYERS

will see lower Medicaid costs in their states.

LEGISLATORSwill be relieved of unnecessary administrative and legal burdens.

PHYSICIANS

24


State Activity on OTP Sweeping the Nation

■ Chapter taking action on OTP

■ Chapter not yet taking action


Nationwide Look at OTP Activity

More than half of states are active on OTP.

Engaging with state medical boards and medical societies about OTP

Talking with primary care associations, hospital associations, and other stakeholders

Holding town halls or conducting surveys with their constituents to get feedback and develop their plans

Actively planning legislation

Some states have introduced or plan to introduce legislation.

26


Significant Support for Optimal Team Practice

27

The changes PAs are seeking represent

a natural evolution of the PA profession.

Patients, especially in rural and

underserved areas, will benefit from

greater access to the high-quality care

that PAs provide.” Bill Finerfrock, Executive DirectorNational Association of Rural Health Clinics

Removing unnecessary restrictions on PA practice,

such as eliminating the requirement for PAs to have

an agreement with a specific physician in order to

practice, would help alleviate healthcare shortages

and improve efficiency with no adverse effects on

patient outcomes.” E. Kathleen Adams and Sara MarkowitzThe Brooking’s Institution’s Hamilton Project


Federal Government Report Supports Elimination of PA Practice Barriers

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, U.S. DEPARTMENT OF THE TREASURY, U.S. DEPARTMENT OF LABOR

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AGREEMENT REQUIREMENT[R]igid ‘collaborative practice agreement’ requirements can impede collaborative care rather than foster it because they limit the ability of healthcare professionals to adapt to varied healthcare demands, thereby constraining provider innovation in team-based care.”

DIRECT REIMBURSEMENTThe federal government and states should consider accompanying legislative and administrative proposals to allow non-physician […] providers to be paid directly for their services where evidence supports that the provider can safely and effectively provide that care.”


Federal Advocacy Priorities 2019

The Physician Assistant Direct

Payment Act

The Home Health Care Planning

Improvement Act of 2019

The Promoting Access to

Diabetic Shoes Act

The ACO Assignment

Improvement Act of 2019

Modernizing PA Practice at the Department of

Veterans Affairs

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and Identifying

Alternatives

Modernizing PA

Legislation

Raising Awareness &


Profession

Empowering PAs with



and Identifying

Alternatives


Investigating the PA Title and Identifying Alternatives

31

July 2018, AAPA’sBoard of Directors:

- Approved preliminary project plan - Designated initial investment of up to $1 million - Approved the establishment of an Advisory Council

Identified the expert firm to deliver an extensively researched and unbiased report


AAPA Connects with PAs on Multiple Channels

z


Keynote: Allison Massari


Questions and Discussion

Documents

A Profession on the Move