Healthcare Reform & the Role of the Physician Assistant

1. Healthcare Reform & the Role of the Physician Assistant National Credentialing Forum 2014 Tricia Marriott, PA-C, MPAS AAPA Director, Regulatory and Professional Advisory Services tmarriott@aapa.org

2. PA Trends Over Time Data sources include AAPA, PAEA, NCCPA, and ARC-PA The PA Profession has experienced double digit growth since its inception in 1967 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.

3. 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.

4. 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

5. PAs PRACTICE MEDICINE On 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 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

6. 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. Procedures Performed by PAs in the ICU

7. 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

8. Opportunities, Progress & challenges

9. 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.

10. Key Areas Credentialing & Privileging PAs Reimbursement & Billing Policy • Regulatory Compliance and Scope of Practice Maximizing PA Utilization

11. 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

12. 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.

13. States that enroll PAs in their Medicaid Program RI DE DC States where PAs are enrolled in the Medicaid program (35) January 2014

14. CMS Challenges Conditions of Payment Conditions of Participation Restraints 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. • Hospice • Home Health • DME • Diabetic Shoes • Medical Nutrition Therapy • Hospital Admission Order & Certification (IPPS) • Supervision of Diagnostic Tests

15. 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.

16. 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. 39% of Physicians Report that they are satisfied or very satisfied with their job*** • 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

17. “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