Policy Statement Promotes PA Practice

— New approach targets regulations that call for doc supervision

MedpageToday

LAS VEGAS -- Members of the American Academy of Physician Assistants' House of Delegates unanimously approved a new policy that aims to improve healthcare access for patients in hard-to-reach areas, lessen the burden on physicians, and help to protect the future of the profession at the organization's annual meeting on Thursday.

The new policy, known as "Optimal Team Practice," is based on a March report on the Future of PA Practice Authority, drafted by the group's Joint Task Force, which formed in July of last year.

A goal of the policy statement is to enable state legislators to expand patient access to PAs, said Joseanne Pagel, MPAS, PA-C, president and chair of the board for the AAPA.

"Our patients are always first, this legislation truly is committed to giving them the access to quality care they deserve, said Pagel.

It also gives legislators a springboard to take the next steps in tearing down barriers that prevent PAs from working, particularly in rural areas, while still embracing team-based care, Pagel told MedPage Today in a phone call.

States can tailor the policy to their "unique political and healthcare climate," the report states.

The House of Delegates' definition of optimal team practice encompasses the following components:

  • Committing to team-based care
  • Eliminating state laws and regulations that require PAs to have or to report a "supervisory" or "collaborating" physician in order to practice
  • Forming autonomous state boards where the majority of voting members are PAs
  • Alternatively, ensuring PAs are full voting members of medical boards
  • Urging direct reimbursement from public and private insurance for the care PAs provide

An amendment delivered on the House floor expanded the policy's scope to include an affirmation that the "degree of collaboration between PAs and physicians should be determined at the practice level."

Primary care, internal medicine, psychiatry, and women's health are all areas where Pagel believes the new approach will be adopted quickly: "This will be phenomenal for expansion of access to patients in the mental health realm," she said.

These guidelines will also make a big difference in Medicaid expansion states, Pagel added.

"In Ohio, we have over 275,000 additional patients with Medicaid expansion, and who's going to take care of those patients?" she asked.

Asked whether "red" or "blue" states would take the lead on these changes, Pagel said she didn't see a divide occurring on political lines.

"It's really based on the need of the states and the demographics of the state."

However, she expects the quickest adoption in rural Western states with hard-to-reach communities, and that these changes will start happening in the next 6-12 months.

Asked whether less experienced PAs would be treated differently than veterans under this new approach, Pagel said, "not at all."

A new PA graduate would be treated the same as a 20-year veteran, she stressed, yet they "will be on-boarded appropriately to how their employers feel that they meet with their assessment and their skill level at that time."

In total, 71% of PAs surveyed in January 2017 supported the proposal with 13% opposed and 16% undecided.

Support for the resolution was strongest among late-career PAs, who were more likely than students and all other PAs to endorse eliminating supervisory agreements, according to the report.

It's also worth noting that more than 40% of respondents reported personally being passed over for a position because of "preferential [Nurse Practitioner] hiring." Of those, 78% agreed that scrapping supervisory agreements was a good idea.