Top 5 Opportunities. Challenges and Opportunities Facing the PA Profession 10/13/2014. Challenges and Opportunities for the PA Profession

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1 Challenges and Opportunities Facing the PA Profession Lawrence Herman, PA-C, MPA, DFAAPA Chair of the Board / Immediate Past President AAPA 2 2 Challenges and Opportunities for the PA Profession Top 5 Opportunities The PA profession has the opportunityto 1. Position PAs to capitalize on changing consumer expectations 4. Deliver on the promise of patient-centered, team-based care 5. Keep up with the rapid and dramatic changes in medicine and learning 3 4 The PA profession has the opportunity to Patient access to health information is changing patient/provider interaction 1 1. Position PAs to capitalize on changing consumer expectations 4. Deliver on the promise of patient-centered, team-based care 5. Keep up with the rapid and dramatic changes in medicine and learning Consumers Seek Healthcare InformationOnline 95 million Americans are now using mobile phones as health tools or to find health information, up 27% over % ofu.s. adults saidthey looked online for health informationlast year. 35% saidthey went online specifically to figure out what medical conditionthey or someone else might have. Sources: ManhattanResearch, CybercitizenHealthUS Survey, 2013; Pew Internet and AmericanLifeProject HealthOnline2013, Jan 15, 2013;

2 There is a growing consumer awareness of healthcare costs A shift in consumer preferences among providers is already apparent Worker Contributions to Insurance Premiums More Than Doubled in 10 Years Share of Healthcare Spending Borne by Families Projected to Continue to Rise Most Patients Prefer Immediate Care from PAor NP Prefer to see a PA or NP 60% PAs/NPs are ProvidersofChoice Among YoungerAmericans Prefer PA/NP Age Prefer Physician Wait for a physician 25% Age AverageAnnual Health InsurancePremiums and Worker Contributions for Family Coverage, Source: Center for American Progress, Family Health Spending to Rise Rapidly September 15, 2009 Sources: (left) Association of American Medical Colleges Consumer Survey; (right) The Millennial Project 2013 Age Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, % 50% 100% 7 8 Creating Opportunities to Raise Awareness Increase awareness of PA value Empower consumers with information about PAs 9 10 PA Week 2014 California

3 Changing the Way We Talk about PAs PAs practice medicine in collaboration with physicians PAs are members of healthcare teams PAs diagnose PAs prescribe medication PAs treat patients with complex conditions PAs are good forpatients and good for the business of healthcare! Showcasing PA Value: Earned Media Telling the PA Story Creating New Information to Leverage Interest The PA profession has the opportunity to 2 1. Position PAs to capitalize on changing consumer expectations Every year, a typicalpa: Treats more than 3,500 patients Writes 2,600to 5,200 prescriptions 75% of PAs are paid a salary. 22% are paid an hourly wage. 3% are paid basedon productivity. 4. Deliver on the promise of patient-centered, team-based care 5. Keep up with the rapid and dramatic changes in medicine and learning J

4 19 20 Continued Progress in 2014! Advocacy Update: California SB authorizes PAs to certify claims for disability insurance when practicing in compliance with the state s PA practice act and rules and adds PAs to the definition of practitioner. AB requires the PA board (and other boards) to collect and report demographic data Important changes in federal regulations U.S. Congressional Committees took steps toward PA-positive changes in federal law Next step in Medicare payment reform: Treat PAs the same as physicians! CMS No on-site physiciansupervision required in rural health clinics and hospitals Delayed a burdensome CMS durable medical equipment (DME) policy that would have required a physician ssignature on DME orders Convinced CMS to reverse its policy that hindered the ability of PAs to perform hospital admissions SAMHSA Drafted guidelines to authorize PAs to diagnose/admit to opioid treatment programs. PAs authorized providers in community mental health centers. VA Updated utilization guidelines for PAs, moving away from supervision to collaboration

5 Business/industry practices are as important as federal and state laws New Market Entrants are EstablishingTheir Own Rules! Continue to work at federal and state level to reduce barriers Educate employers about how to maximize PA value AAPA is pursuing legislative and regulatory change at the state and federal level REDUCE PRACTICE16 BARRIERS AAPA is pursuing legislative and regulatory change at the state and federal level Buildon momentum at federal level to: Advocate for Medicare modernization Advocate for PAs to receive direct payment from Medicare consistent with all other healthcare professions Actively pursue opportunities to remove/prevent barriers to PA practice in EHRs, home health and hospice laws and regulations Work withaapa Constituent Organizations in states to: Adopt the six key elements of Modern PA Practice Act Add PAs to all relevant sections of health law Recognize PAs in ACA regulations/implementation at state level Expand PA authority in mental health Streamline the state licensure process Add PAs to all state workforce enhancement plans scholarships, tax incentives, etc The PA profession has the opportunity to 3 1. Position PAs to capitalize on changing consumer expectations 4. Deliver on the promise of patient-centered, team-based care 5. Keep up with the rapid and dramatic changes in medicine and learning 29 L PAs are the biggest value in medicine Pediatrics/adolescent (general) Family medicine Psychiatry Internal medicine Endocrinology PA Compensation (2012) Physician Compensation (2012) Urgent care Rheumatologic disease Hospitalist (internal medicine) Infectious disease Neurology Allergy/immunology Hypertension/nephrology Pulmonary disease (without critical care) Emergency medicine OB/GYN (general) Hematology/medical oncology General surgery Otolaryngology Anesthesiology Dermatology Cardiology Urology Gastroenterology Diagnostic radiology (interventional) Orthopedic surgery Cardiac/thoracic surgery Cardiology (cath lab) $0 $100,000 $200,000 $300,000 $400,000 $500,000 $600,

6 Slide Need new photo here--maybe from Dropbox? Ashley Kent, 9/12/2014

7 PA flexibility to change specialties provides advantages to PAs and employers ACA is driving new opportunities in value-based healthcare Source: Oliver Wyman PAs in practice more than 10 years have changedspecialties an average of 2 times. Source: AAPA 2013AnnualSurvey New business models are focused on the bottom line 7,000 Hospitals are increasingly affiliating with health systems 60% PAYERS MOVING INTO CARE PROVIDERS MOVING INTO RISK 6,000 58% 56% ,000 4,000 54% 52% 50% 3,000 48% + NEW NATIONALPLAYERS? 2,000 1, % 44% 42% 40% Number of Hospitals % of Hospitals in Health Systems Physicians are leaving private practice Total Number of Physicians Quantify and document PA contributions to improved patient outcomes 57% % 2005 Physicians in Private Practice 43% 39% Quantify and document PA economic value to employers , NumberofPhysicians in Thousands Provide PAs with tools/info they need to advance their careers Source: Accenture

8 AAPA research: Non-economic value of PAs may be as important as economic value Providing PAs the information they need to advance their careers Non-Economic Value Higher patient satisfaction More team communication and access to information Better quality of life for MDs/DOs More MD/DO time for critical and complex cases EconomicValue Higher billing and reimbursement Increased patient load More accurate coding Lower overall salary costs Did you know? Employers pay license fees for62% ofpas. Professionaldevelopmentallowance coversall CME for 71% ofpas. Nearly half of PAs earn a bonus; PAs who get a bonus earn an average of $10,000 more per year. On average, PAs earn more at hospitals than in physicianpractices. On average, PAs earn more in multi-specialty andgroup practicesthan in solo practices The PA profession has the opportunity to Patient-centered, team-based care has positive effects 1. Position PAs to capitalize on changing consumer expectations Positive impacts on: Patient care 4 4. Deliver on the promise of patient-centered, team-based care 5. Keep up with the rapid and dramatic changes in medicine and learning J Practice workflows Patient satisfaction Provider satisfaction Hurdles to building effective healthcare teams PAs can help lead this effort Conflict Lack of coordination Distractions Fatigue Workload Misinterpretation of cues Lack of clarity Hierarchy Lack of information sharing PAs have a strong foundation in general medicine On average, PAs work with 4 physicians, 3 to 4 other PAs, and 1 to 2 NPs Source: AAPA2013NationalPA Survey

9 Promote teambased care and institutionalize the PArole The PA profession has the opportunity to Differentiate roles among PAs, NPs, MDs/DOs 1. Position PAs to capitalize on changing consumer expectations Focus education and CME on patientcentered, team-based care 5 4. Deliver on the promise of patient-centered, team-based care 5. Keep up with the rapid and dramatic changes in medicine and learning L Technology is driving and changing healthcare as we know it AAPA is helping to promote and implement new standards for education and CME TODAY Reactive, Transactional Healthcare FUTURE Preventive, Interventionist Health Management Inter-professional education Evidence and outcome-based education Performance Improvement (PI) CME Source: National Human Genome Research Institute Evidence-based medicine will be driven by EHR and big data Providers and patients are carrying diagnostic apps in their pockets Electronic Health Records andthe Big Data Revolution Source: Oliver Wyman

10 10/13/2014 CME must be timely, accessible and personalized Create new tools and learning opportunities for PAs New and Improved Learning Tools Top 5 Opportunities for YOU Tell the PA story at every opportunity. 2. Advocate on behalf of PAs with your employer, your state officials and your federal representatives. 3. Help your employer understand the value PAs bring to the healthcare workplace. 4. Continue to be a team player. 5. Adapt and adopt new technology. 52 This Is Our Moment 53 9