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Physician Assistants and Optimal Team Practice

By Debra Wood, RN, contributor

Physician assistants have been providing care for more than 50 years, collaborating with physicians in practices or hospital settings. But now the American Academy of PAs (AAPA) House of Delegates has passed an Optimal Team Practice policy hoping to change requirements for physician agreements. 

“The PA profession recently started our advocacy efforts to adopt Optimal Team Practice, which is defined as the way PAs, physicians and other medical professionals work together to provide quality care without burdensome administrative constraints,” said Carrie Munk, AAPA vice president of communications.

Optimal Team Practice (OTP) contains four key elements:

  • It retains a commitment to team-based practice;
  • It supports doing away with laws and regulations requiring a PA to have a supervisory, collaborating or other relationship with a specific physician;
  • It recommends the establishment of autonomous state boards to regulate, license and discipline PAs;
  • It aims to obtain direct reimbursement for PAs by public and private insurance. 

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Eliminating physician agreements

“A core tenet of OTP is for states to eliminate the legal requirement for PAs to have a specific relationship with a physician in order to practice,” Munk explained. “Thus far, North Dakota is the only state to have enacted this. OTP does not represent an expansion of PA scope of practice.

“That new North Dakota law says that PAs, like all other health care professionals, will now collaborate with, consult with or refer to the appropriate member of the health care team as indicated by the condition of the patient, the education, experience and competence of the PA, and the standard of care,” Munk continued.

AAPA states on its website that “when a PA isn’t tethered to a specific physician by a rigid agreement, PA employers (health systems, hospitals, and group practices) can be more flexible in determining health care teams.” AAPA expects that changing to OTP will make it easier for PAs to practice in medically underserved communities.

The AAPA site also describes a situation in which a supervising physician in Wyoming died unexpectedly, and the PA could not continue providing services in the community for eight days until another physician was hired and approved to supervise PAs.

Under OTP, a physician or experienced PA would be able to supervise a newly licensed PA.

The Physician Assistant Education Association is in full support of OTP, according to spokesperson Steven Lane, MA, MPP, senior director of strategic communications.

“Our focus is the implication of it on new graduates and PA education,” Lane added.

The American Medical Association (AMA) House of Delegates in November 2017 passed a resolution “that our American Medical Association advocate in support of maintaining the authority of medical licensing and regulatory boards to regulate the practice of medicine through oversight of physicians, physician assistants and related medical personnel; and be it further resolved, that our AMA oppose legislative efforts to establish autonomous regulatory boards meant to license, regulate, and discipline physician assistants outside of the existing state medical licensing and regulatory bodies’ authority and purview.”

Minutes from later year meetings of the AMA’s House of Delegates do not address the issue, and an AMA spokesperson did not provide newer information.

The AAPA, on the other hand, thinks physicians will benefit from OTP, since physicians will not be responsible for PA care.

Looking ahead

AAPA President Dave Mittman, PA, DFAAPA, listed his priorities in a July 2019 post to the organization’s website, saying AAPA will support states that are considering optimal team practice. In September 2018, the APAA allocated $200,000 in its 2019 budget to support chapter projects to advance OTP in its entirety or one aspect of it.

In addition to states changing physician assistant practice authority, federal law will need to change to allow for PAs to bill Medicare, since currently the law uses the word “supervision” as it pertains to physicians working with PAs. On the other hand, nurse practitioners can bill for their services. AAPA states that not being able to be paid directly hinders PAs from fully participating in innovative value-based payment arrangements and emerging models of healthcare delivery.

Rep. Terri Sewell (D-AL) sponsored a bill (H.R.1052) in the House of Representatives that would allow Medicare to pay physician assistants directly for certain services furnished to enrollees. It remains in the House Ways and Means Subcommittee on Health.

AAPA expects OTP will strengthen teams, increase access to care, reduce health care spending and help meet patient needs.

Related:
The Benefits of Physician Assistant Travel Jobs


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