Transcript Healthcare Reform & the Role of the Physician Assistant

Healthcare Reform & the Role
of the Physician Assistant
National Credentialing Forum 2014
Tricia Marriott, PA-C, MPAS
AAPA Director, Regulatory and Professional Advisory Services
[email protected]
PA Trends Over Time
Number of Practicing PAs
1967 through 2013
100000
80000
60000
40000
20000
0
Currently there are
Data sources include AAPA, PAEA,
NCCPA, and ARC-PA
93,000
The PA
Profession
has
experienced
double digit
growth since
its inception
in 1967
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.
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
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.
The number of
physicians grew 15%
from 2005 to 2012*
* Source: JOURNAL of MEDICAL REGULATION, Federation of State Medical Boards, 2013, 2011
PAs PRACTICE MEDICINE
Every year, a typical PA treats 3,500 patients.
•
•
80% of PAs provide acute care management
64% of PAs provide chronic disease management
On average,
physicians see
~4,700 patients a
year*
PAs perform a variety of medical and surgical procedures
*Source: The Physicians Foundation, A survey of America’s Physicians: Practice Patterns and Perspectives, Merritt Hawkins, 2012
PA Profile:
AAPA Survey 2013
Procedures Performed by PAs in the ICU
Arterial line
Central line
Endotracheal intubation
Chest tube
Thoracentesis
81%
79%
59%
61%
50%
Spinal tap
Swan ganz
Paracentesis
43%
33%
28%
Balloon pump removal
25%
Intracranial drain
15%
Tracheostomy
11%
PEG
9%
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
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.
*Note: Family with/Without Urgent, General, Peds
OPPORTUNITIES, PROGRESS
& CHALLENGES
2014
• Health marketplace changes favor PAs
• Affordable Care Act encourages teambased 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
Credentialing & Privileging PAs
Maximizing PA Utilization
Reimbursement & Billing Policy
Regulatory Compliance and Scope of
Practice
Barriers to PA practice are falling
42 States & DC Made Positive Changes to State Law in 2013
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
RI
DE
DC
State made
PA-positive
changes to
law in 2013
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 that enroll PAs in their Medicaid Program
RI
DE
DC
States where PAs are
enrolled in the Medicaid
program (35)
January 2014
CMS Challenges
Conditions of Payment
Conditions of Participation
•
•
•
•
•
•
Restraints Standard -use of “LIP”.
Hospice
Home Health
DME
Diabetic Shoes
Medical Nutrition Therapy
Hospital Admission Order &
Certification (IPPS)
• Supervision of Diagnostic
Tests
•
•
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
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.
***Source: The Physicians Foundation, A Survey of America’s Physicians: Practice
Patterns and Perspectives, Merritt Hawkins, 2012
39% of Physicians
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