Healthcare Reform and PAs

What Impact Will Healthcare Reform Have on Physician Assistant Jobs?  – 9/13/2012

September 13, 2012
By Joyce Routson, HEALTHeCAREERS.com 

Physician assistants can look forward to more jobs, pay with accountable care organizations. Under healthcare reform, team work, primary care emphasized. 

Experts who study healthcare workforce issues believe that midlevel practitioners are becoming more common because the medical system is looking for more efficient ways to use physicians, who can be in short supply. 

The new U.S. healthcare reform act is applying even more emphasis on the use of nurse practitioners and physician assistants. Two types of organizations the government is promoting under the act will impact the physician assistant marketplace and their compensation. 

One of the new team work models under the Patient Protection and Affordable Care Act is the patient-centered medical home. The second – known as accountable care organizations (ACOs) – is designed to trim spending for Medicare patients by tying reimbursements to quality standards and efficient care. 

An ACO is a group of providers and suppliers of services (for example, hospitals, nurses, physicians, and others involved in patient care) that work together to coordinate care for the Medicare beneficiaries they serve. To be eligible, the ACO must serve at least 5,000 Medicare patients and agree to participate in the program for three years. 

The goal of an ACO is to deliver seamless, high quality, patient-centered care for Medicare beneficiaries instead of the fragmented care that has so often been part of fee-for-service health care. The Affordable Care Act specifies the groups of providers and suppliers that can form an ACO. That list includes “ACO professionals,” who are defined as physicians, nurse practitioners (NPs), clinical nurse specialists (CNSs), and physician assistants. 

The Centers for Medicaid and Medicare Services (CMS) announced in July that more than 100 ACOs are up and running. 

“ACOs will require physicians and hospitals to be more deliberate about coordinating the total care of the patient in and out of the hospital with an emphasis on keeping them out of the hospital,” says Susan O’Hare, NP, a senior vice president with Integrated Healthcare Strategiescompensation consulting firm. “Primary care physicians and advanced practice clinicians (PAs, NPs, and midwives) will provide the absolute foundation of this model.” 

Employment

With the emphasis on primary care – not just in ACOs – more providers will be needed. Since there already is a shortage of primary care physicians – midlevel providers – who typically spend about six years in training compared to the more than 10 for MDs – will be in greater demand to fill that primary care gap. 

“We certainly think any time an organization decides to move an innovative model of care where there will be an increased need for efficiency this will benefit because PAs provide many of the same duties as physicians with lower salaries,” says Michael Powe, AAPA vice president of reimbursement and professional advocacy. 

The U.S. Bureau of Labor statistics predicts physician assistants will be the second-fastest growing health profession in the next decade (after home health aides). There are 84,000 certified PAs, according to the American Academy of Physician Assistants (AAPA). 

Today, slightly more physician assistants work in hospitals rather than with physician practices or in primary care, but that ratio could change. 

According to the AAPA, close to 30 percent work in family medicine and general internal medicine, with the remainder in surgery or surgical subspecialties, emergency medicine or other internal subspecialties. About 40 percent work in hospitals. 

There remains some reluctance among physicians to employ nurse practitioners or physician assistants. According to one survey, from healthcare staffing company Jackson Healthcare, only 36 percent of the physicians it asked used NPs and 25 percent used physician assistants. The AAPA reports that 29 percent of PAs nationwide work in group practices; only 11 percent work in solo practices. 

O’Hare believes this ratio will change over time, although nurse practitioners, who may have more varied and less technical training than PAs, “will be probably see greater utilization in the primary care setting. But that will shift over the next couple of years and you will see both of them grow.” 

Data released this year from the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics, found that 49% of office-based physicians worked with physician assistants, nurse practitioners and/or certified nurse midwives. 

However Powe said because many hospitals own physician practices or have ACOs in their network, there will be a more jobs offered by those employers as well. 

Compensation

The law of supply and demand would suggest that all midlevel provider salaries will rise in the coming years. Primary care PAs make about $75,000 a year, less than those in surgical subspecialties or emergency medicine, where the median is $90,000. Increases likely will be greater for those at the lower end of the scale than those at the higher, O’Hare says. 

“Midlevel providers are cost-effective in primary care settings, where they can relieve physicians of the necessity of providing routine care,” O’Hare wrote in an article in Becker’s Hospital Review in 2010. “Midlevel providers are also cost-effective in specialty practice settings, providing much of the medical care patients need while allowing physicians to focus more attention on the complex issues that make the best use of their knowledge and experience.” 

O’Hare also wrote that as PAs and nurse practitioners take on roles similar to physicians, they could expect incentive plans to become a standard component of reimbursement, in terms of awards for productivity, patient satisfaction, adherence to quality standards and achievement of other goals. 

Scope of practice

As to whether their duties will change under ACOs, Powe says that PAs likely will enjoy an expanded role. “I think that we’ll see added incentive for all healthcare systems utilize PAs to full extent of their education and expertise – it will be an all-hands-on-board mentality and they’ll be asked to do as much as possibly can,” he said. Organizations will utilize them to the full extent of their license to gain those cost-savings, he says. 

Both O’Hare and Powe said that PAs may likely also play an important role in transition care –caring for the patient after he or she leaves the hospital. ACOs have incentives to ensure patients follow instructions and improve at home and don’t end up back in the hospital for a visit that Medicare doesn’t pay for. 

“They are well-suited to be a care coordinator; there is great need to help transition care more efficiently,” says Powe. In the traditional model, PAs are used in a “billable by encounter” way where they get paid for certain treatments – not for advising patients to take their prescriptions. “I believe that they can play a key role in educating, phone triage and treatment, and even home visits that can hugely impact keeping a patient on a prescribed therapy and healthy enough to stay out of hospitals,” says O’Hare. 

“The use of NPs and PAs by primary care doctors can bridge that gap between the hospital and the next outpatient encounter.” 

obtained from: http://www.healthecareers.com/physician-assistant/article/what-impact-will-healthcare-reform-have-on-physician-assistant-jobs/171066?type=email&source=pa-091812