Rx News

Effectively integrating physician assistants into your practice

By Gary Winchester, M.D., FAAFP

November 15, 2015

Today, physicians in Florida continue to struggle to find ways to maintain financially viable practices, provide quality care to their patients and maintain a positive work/life balance. That effort has become more challenging because of multiple factors ranging from increased patient care loads, decreases in reimbursement and escalating regulatory demands.

As the burdens on Florida physicians increase, we welcome certified physician assistants (PA-Cs) as valued providers. Certified PAs educated in the medical model and certified by a broad-based national certification exam work in every medical and surgical specialty and setting. They assist with the full scope of patient care, oft en handling patients with multiple comorbidities. PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care and prescribe medications.

According to the National Commission on Certification of Physician Assistants (NCCPA), over the past five years, the care marketplace takes more than simply hiring an individual with a credential. Physicians are encouraged to thoughtfully explore their professional and practice needs and those of their patients as well as the future goals for the practice. Here are some critical yet simple steps that can help physicians meet existing challenges and bring balance to the entire practice.

1. Explore the patient care needs of the practice One of the best ways to maximize value from PAs is to look closely at the areas in the practice that have the most need or are taking you away from your own primary duties. Do you have a high population of seniors or patients with specific health needs such as diabetes or heart disease? Consider bringing on a PA with skills and education in chronic conditions and medication management. These focused service areas can diff erentiate you from others in the area and better meet patient needs.
2. Look at the fi nancial implications of bringing on a PA PAs off er high-quality, personalized, cost-eff ective patient care. They can help grow a practice because they increase access for patients. For services that are incidental to a physician's services, the reimbursement rate is at 100 percent of the physician's rate. For other services, reimbursement is 85 percent of a physician's fees. Salary for a PA in primary care is about $90,000 per year.
3. Examine insurance requirements PAs need to carry full liability insurance coverage, just as any other provider. Physicians must examine their insurance contracts carefully to ensure all providers are fully covered. However, it's important to note that studies show PAs and their supervising physicians experience a low rate of malpractice litigation.
4. Factor in additional time you may need to spend on oversight Some physicians are concerned about the collaboration and supervisory time a PA might add to their day - a concern that is oft en unfounded. Florida requires all PAs to have direct or indirect supervision, defined as "easy availability of the supervising physician to the PA which includes the ability to communicate by telecommunications" and that the supervising physician must be within "reasonable proximity." Most medical offices today easily fi t into that regulation. And of course, as with any clinician, the more experienced he or she is, the less direct oversight is required.
5. Consider the needs and preferences of patients There was a time when some patients were skeptical about seeing PAs, but over the past several years there has been increasing acceptance. A recent survey by the NCCPA showed that more than 94 percent of patients surveyed are willing to see PAs. Today, patients' top priorities oft en center on wanting more time to talk to providers about health concerns. PAs help provide additional time to listen and answer questions. When physicians and PAs collaborate eff ectively, patients are comfortable being treated by PAs.
6. Look at ways PAs can reduce the time you spend on administrative tasks Many medical offices today rely on PAs to coordinate care between their offi ces and other providers or locations - for example specialists, physical therapists or hospitals/outpatient surgery centers. This helps improve care coordination and frees up physicians to focus their efforts in the greatest areas of need.
7. Task PAs with helping the practice to better meet CMS requirements There are many new requirements for quality outcomes, EHRs and patient engagement. For example, Medicare patients are asked to complete a Consumer Assessment of Healthcare Provider (CAHP) survey, which specifically asks about the patient experience. As a provider, a PA may be well equipped to assess knowledgegaps in the practice and provide additional knowledge, skills and time that may be needed to meet these goals.
8. Be creative PAs can provide many services busy medical offices today may want to offer but have been unable to because of cost or time. For example, some offices may want to create wellness programs for seniors or initiate group appointments for patients with similar conditions. PAs are well suited to lead these initiatives. They also can perform as the clinical interface to the business office.

Assess current strengths, determine skills needed, and consider bringing in a certified PA to help your practice meet the challenges of today's health care landscape.

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