Optimal Team Practice Updates to AAPA s Guidelines for State Regulation of PAs Montana Academy of PAs 2018 Annual Conference June 6, 2018 Ann Davis, MS, PA-C VP, Constituent Organization Outreach and Advocacy, AAPA Copyright 2017, American Academy of PAs
We ve Come a Long Way 1967 Three former Navy corpsmen graduate from Duke University PA program 2018 115,500 PAs practice in every medical specialty and clinical setting 2
Modernizing PA Practice Laws and Policies 6 Key Elements in State PA Law 3
PAs in Montana 727+ Number of PAs in Montana % of PAs by Specialty in Montana Number of 123,000+ PAs in the U.S. % of PAs by Setting in Montana 24.4% Family Medicine 22.2% All Other Specialties 17.8% Urgent Care 17.8% Surgical Subspecialties 13.3% Emergency Medicine 2.2% Gen Peds, Gen Internal Med Source: NCCPA 46.7% Outpatient Office or Clinic 24.4% Hospital Settings 17.8% Urgent Care 11.1% Other Settings 26.7% of PAs specialize in Primary Care (Primary Care includes Family Medicine, General Internal Medicine, and General Pediatrics) 30.2% of PAs are employed by a Physician Group or Solo Practice In Montana: A typical PA completes 70 patient visits per week A typical PA is on call 90 hours per month 4
Federal Trade Commission Engagement in State Regulation Unnecessary Restrictions FTC staff urge the PA Board, as well as the BOM, to apply a similar analytical framework as they consider regulations governing physician supervision of PAs... Even well-intentioned laws and regulations may include unnecessary or overbroad restrictions, including those that may limit competition or frustrate the development of innovative and effective models of team-based health care. 9 Source: https://www.ftc.gov/system/files/documents/advocacy_documents/ftc-staff-commentprofessional-licensure-division-iowa-department-public-health-regardingproposed/v170002_ftc_staff_comment_to_iowa_dept_of_public_health_12-21-16.pdf
6 Key Elements of a Modern Practice Act Update on state laws and regulatory environment 50 states and D.C. Licensure as Regulatory Term 43 states and D.C. Full Prescriptive Authority 37 states and D.C. Scope Determined at Practice Site 29 states and D.C. Adaptable Collaboration/Supervision Requirements 30 states and D.C. Chart Co-Signature Requirements Determined at the Practice 15 states No Ratio Restriction 10
6 Key Elements in State PA Law Licensure as Regulatory Term Full Rx Montana Scope Determined at Practice Site Physician May Practice With Unlimited Number of PAs Adaptable Supervision/ Collaboration Requirements Chart Co-signature Determined at the Practice Level 7
Modernizing PA Practice Laws and Policies Reasons to move beyond Six Key Elements of Modern PA Practice: Verdict is in: PAs provide high quality care Many early PA laws outdated Dynamic changes in healthcare marketplace 8
Changing Healthcare Marketplace Decrease in % of Physicians Who Own Practices from 1983 to 2016 Physicians accept liability of PA Practices can see more patients Financial benefit goes to the employer 9
Changing Healthcare Marketplace Laws in Many States Do Not Require NPs to Have Supervising Agreements Number of States Where NPs Have Full Practice Authority by Year 10
Changing Healthcare Marketplace 11
New Policy to Respond to Healthcare System Changes To implement new policy, AAPA is seeking to change laws and regulations to: 1 2 3 4 Emphasize PAs commitment to team practice Authorize PAs to practice without an agreement with a specific physician enabling practicelevel decisions about collaboration. Create separate majority-pa boards to regulate PAs, or give authority to healing arts or medical boards that have as members both PAs and physicians who practice with PAs Authorize PAs to be directly reimbursed by all private and public payers 12
Enabling Practice-Level Decision Making» State PA chapters decide if and when to pursue changes» Optimal Team Practice is an evolution of the direction many state laws are already heading 13
Enabling Practice-Level Decision Making» These changes do not mean that PAs want to practice independently» Optimal Team Practice is about team and includes two important points that distinguish it from independent practice: It reinforces PAs commitment to team practice Calls for collaboration decisions to be made at the practice level 14
Enabling Practice-Level Decision Making» These changes do not mean that PAs want to practice independently» Optimal Team Practice is about team and includes two important points that distinguish it from independent practice: It reinforces PAs commitment to team practice Calls for collaboration decisions to be made at the practice level 15
Benefits to Physicians Reducing administrative burdens and increased flexibility Eliminating physician liability for care provided by PA Team practice and design determined at practice level No disciplinary action for paperwork infractions Accuracy of data related to quality and value of care Informed regulation of the PA profession 16
Benefits to Patients Add value to health systems Expand access to care Physician focus on patient needs Increase volunteer medical services 17
Separate PA Boards» PAs are most commonly regulated by state medical boards.» Physicians and nurses are assured that their regulatory boards have current knowledge of their profession. PAs have no such assurance.» Medical boards are made up of majority physicians.» Physicians may not have current knowledge of PA practice. 18
Direct Reimbursement» PAs are the only health professionals who bill Medicare that are not entitled to direct reimbursement.» PAs must have the same reimbursement flexibility as other health professionals in order to maximize PA practice. 19
Working with PAs PAs are widely trusted PAs are team players PAs connect with patients PAs connect with each other 20
What would OTP look like in Montana Law?» Remove references to supervision AAPA MODEL LANGUAGE:» PAs shall collaborate with, consult with and/or refer to the appropriate member(s) of the healthcare team as indicated by the patient s condition, the education, experience and competencies of the PA and the standard of care.» The degree of collaboration should be determined by the practice which may include decisions made by the employer, group, hospital service, and the credentialing and privileging systems of licensed facilities. 21
What are states doing?» Twenty states are active on OTP Surveying members Surveying stakeholders Meeting with regulators Hosting presentations» Ten states plan for OTP legislation in 2019 session 22
What is AAPA doing?» Preparing and providing resources (See the AAPA OTP Page) Information on safety and efficacy of PA practice Issues in Brief Fact Sheets Practice Snapshots State-specific information and resources Consultation and strategy assistance» Working with stakeholder organizations» Meeting with CMS» Direct reimbursement legislation 23
Questions, ideas, feedback 24
At your service» Ann Davis, MS, PA-C adavis@aapa.org 571-319-4359» Keisha Pitts, JD kpitts@aapa.org 571-319-4357 25