Healthcare Reform & the Role of the Physician Assistant

National Credentialing Forum 2014Tricia Marriott, PA-C, MPAS

AAPA Director, Regulatory and Professional Advisory Servicestmarriott@aapa.org

PA Trends Over Time

YEAR1969

19721976

19851989

19921995

19982001

20042007

20102013

020000400006000080000

100000 93,000

Number of Practicing PAs1967 through 2013

Currently there are 181 accredited PA Programs. Another 60 are in the accreditation process.

There are an average of 42.5 students in each graduating class producing over 7,000 newly certified PAs.

There are 95,587 NCCPA certified PAs in the US as of December 2013.

The PA Profession has experienced double digit growth since its inception in 1967

Data sources include AAPA, PAEA, NCCPA, and ARC-PA

PAs ARE SKILLED HEALTHCARE PROVIDERS AND A GROWING FORCE

On average, PAs are 40 years old, and female, have ten years experience practicing medicine – with 7 years in their current specialty.

PAs are trained as generalists, enabling them to more easily change specialties

With a strong foundation in general medicine, PAs are able to adapt to changing healthcare needs.

PAs ARE SKILLED HEALTHCARE PROVIDERS AND A GROWING FORCE

The number of physicians grew 15% from 2005 to 2012*

* Source: JOURNAL of MEDICAL REGULATION, Federation of State Medical Boards, 2013, 2011

PAs can be found in virtually every medical specialty – in clinical and surgical medicine. PAs usually change specialty areas 2 to 3 times during their careers.

Since 2006, the PA profession has grown 34% and is expected to continue growing.

PAs PRACTICE MEDICINEOn average,

physicians see ~4,700 patients a

year*

Every year, a typical PA treats 3,500 patients.• 80% of PAs provide acute care management• 64% of PAs provide chronic disease management

*Source: The Physicians Foundation, A survey of America’s Physicians: Practice Patterns and Perspectives, Merritt Hawkins, 2012

PAs perform a variety of medical and surgical procedures

Arterial line 81%Central line 79%

Endotracheal intubation 59%Chest tube 61%

Thoracentesis 50%Spinal tap 43%Swan ganz 33%

Paracentesis 28%Balloon pump removal 25%

Intracranial drain 15%

Tracheostomy 11%

PEG 9%

Procedures Performed by PAs in the ICU

PA Profile:AAPA Survey 2013

PAs play a significant role as a member of the health care team in the practice of medicine by performing a variety of medical procedures.

PAs INCREASE AMERICA’S ACCESS TO HEALTHCARE

*Note: Family with/Without Urgent, General, Peds

Nearly one third (32%) of PAs practice in primary care*

… the largest segment of which is family medicine (23% of PAs overall).

A small but growing number of PAs are practicing in new models of care:

• 10% practice in patient centered medical homes.• 3% practice in retail or freestanding urgent care facilities.

OPPORTUNITIES, PROGRESS & CHALLENGES

2014 • Health marketplace changes favor PAs• Affordable Care Act encourages team-

based care• Physicians embracing PAs as partners• PA flexibility contributes to mobility and

innovative models of care.• Old (and new) laws and regulations continue to

confound.

Key Areas

Regulatory Compliance and Scope of Practice

Credentialing & Privileging PAs

Maximizing PA Utilization

Reimbursement & Billing Policy

Barriers to PA practice are falling

Legislative Goals• Full prescriptive authority• Licensure as the regulatory

term• Scope of practice determined

at the practice level• No ratio restriction• No co-signature requirement in

law• Adaptable supervision

requirements

42 States & DC Made Positive Changes to State Law in 2013

State made PA-positive changes to law in 2013

RIDE

DC

Veteran’s Health Administration 2013

• VHA moved from “supervision” to collaboration

• PAs and their collaborating physician(s) determine the degree of autonomy the PA should have.

States where PAs are enrolled in the Medicaid program (35)

States that enroll PAs in their Medicaid Program

RIDE

DC

January 2014

CMS ChallengesConditions of Payment• Hospice• Home Health• DME• Diabetic Shoes• Medical Nutrition Therapy• Hospital Admission Order &

Certification (IPPS)• Supervision of Diagnostic

Tests

Conditions of ParticipationRestraints Standard -use of “LIP”. • Defined in Interpretive Guidelines only.• Definition does not align with the Joint

Commission glossary definition which allows

for delegation.

Licensed Independent Practitioner (LIP) For the purpose of ordering restraint or seclusion, an LIP is any practitioner permitted by State law and hospital policy as having the authority to independently order restraints or

seclusion for patients.

Licensed Independent Practitioner

• Term continues to create barriers, despite the Joint Commission glossary disclaimer.

• “Licensed Practitioner, as allowed by state law and facility policy” would be an appropriate substitute.

• In areas of the country where facilities have not yet utilized PAs, the “LIP” terminology leads them to believe PAs cannot provide care without physician present. The glossary disclaimer has not changed this.

PAs DELIVER PATIENT-CENTERED CARE IN A TEAM ENVIRONMENT

39% of Physicians Report that they are satisfied or

very satisfied with their job***

***Source: The Physicians Foundation, A Survey of America’s Physicians: Practice Patterns and Perspectives, Merritt Hawkins, 2012

PAs work with an average of four physicians, three other PAs, and one NP.

• PAs report practicing on their own 70 – 80% of the time. • PAs spend 20-30% of their time consulting with

physicians.

86% of PAs report that they are satisfied or very satisfied with their job.

“The way a team plays as a whole

determines its success. You may have

the greatest bunch of individual stars

in the world, but if they don’t play

together, the club won’t be worth a

dime.” Babe Ruth