More states are lifting restrictions and regulatory hurdles to allow physician assistants to work more “collaboratively” with physicians as the team-based approach to healthcare takes hold.
Historically, states have required physicians to more closely monitor physician assistants (PAs) in what some have said led to redundant tasks or slowed the ability of patients to get the care they needed in a timely fashion.
But physician assistants — like nurse practitioners — are successfully convincing lawmakers and governors to break down regulatory hurdles to their patients for a variety of reasons, including the physician shortage and general comfort U.S. patients have with being treated by someone other than a doctor. Such changes to regulations, or scope of practice laws, are the result of state legislative sessions that are just wrapping up this spring.
In New Mexico and Tennessee, for example, new changes to regulations involve replacing the phrase “supervision” with “collaboration” to define how physicians and PAs work together, according to a legislative update from the American Academy of PAs.
And in Washington D.C., regulations now allow scope of practice to be determined in the doctor’s practice, following a general trend of the last decade when nine states changed laws or regulations to allow scope of practice to be determined at the practice. In all, 38 states and the District of Columbia allow PA scope of practice to be determined at the practice site .
PAs and lawmakers passing such legislation say they are essentially granting physician assistants the ability to do what they are trained to do. Most have a two-year master’s degree, often from a program that runs about two years and includes three years of healthcare training.
“The PA profession has really reached a pivotal moment in its history,” American Academy of PAs CEO Jenna Dorn . “As PAs continue to play an increasing role in healthcare, states across the country are recognizing that breaking down barriers to PA-practice is simply the common sense thing to do.”
Changes to scope of practice for physician assistants is also happening thanks to the move from fee-for-service medicine to value-based care, which emphasizes getting care in the right place, in the right amount and at the right time.
Under the team-based approach to healthcare delivery, physician assistants are increasingly an integral part of accountable care organizations (ACOs) and other care models that contract with insurers, Medicare and Medicaid programs. The ACO shares in money that is saved from the costs of keeping a population of patients healthy.
Major insurers including Aetna, Anthem, Cigna, Humana and UnitedHealth Group are paying the bulk of the medical care providers they work with via value-based models.
PAs work in doctor’s offices, retail clinics and other locations and their work includes diagnosing illnesses, writing prescriptions and counseling patients on preventive care. There are now more than 40 states that have implemented “full prescriptive authority” for PAs with the addition in the last year of Maine and Florida.
This year, there were “16 states that have made improvements to PA practice,” the Academy said in a statement.
In many cases, state rules date back to a time when there were few PAs and patients got their care mostly from a physician. Today there are more than 115,000 PAs compared to 20,000 in 1990. “We look forward to supporting our state chapters as they work on behalf of PAs to ensure they are prepared to meet the needs of patients across the country,” Dorn said.
For more information on healthcare, read Bruce Japsen’s book, Inside Obamacare: From Barack And Michelle To The Affordable Care Act.