How PAs Factor Into Improved CMS Patient Satisfaction Scores

"PAs have been on the health care scene for 48 years. Today's PAs are highly educated at the Master's degree level and graduate with 2,000 or more hours of clinical training. We are also educated to practice collaboratively with physicians and other members of the health care team. However, we do practice autonomously, which means a physician is not looking over our shoulder but is available for consultation if needed. As we are now 100,000 strong and work in every specialty and clinical setting, we need to be included in any provider discussion, since we provide direct patient care and counsel both the patient and family members.

Even the Kaiser Commission on Medicaid states: 'A substantial body of research examining the quality of NP and PA primary care shows that these clinicians perform as well as physicians on important clinical outcome measures...and patients report high levels of satisfaction' with their care. Since we all have been and will again be patients in this health care system, it's time we:

• recognize the pervasive presence of PAs in health care and the roles PAs play in keeping Americans healthy, working, and contributing to society;
• include certified PAs in leadership positions where policies and clinical roles are being defined;
• understand that the PA profession is founded on team care and certified PAs are educated and trained to work with physicians and other medical staff in a patient-centered environment; and
• review state laws that restrict PAs in unnecessary ways.

We should enable PAs scope of practice to be determined at the practice level, including full prescriptive authority and chart co-signature requirements tailored to the particular treatment setting. The supervising physician is in the best position to evaluate the PA's experience and abilities. State laws that list specific services that PAs can provide, or those that require the scope of practice of each individual PA to be approved by the state medical board, restrict the ability of medical facilities and supervising physicians to optimize physician-PA teams. These restrictions limit access to care.

PAs have many opportunities to influence the patient experience, whether at an initial office encounter or handling post-op care. For example:

• Increasing Access to Care and Reducing Wait times: Many physician offices are able to offer walk-in appointments because they have PAs on staff who will see patients sooner than a physician, resulting in faster treatment and relief of symptoms. PAs may also have a full schedule of their own panel of patients, who will probably not even see a physician on this visit, unless their overall health is compromised by a highly complex issue.
• Implementing Preventive Health/Wellness Programs: Prevention and wellness programs can be costly and time-consuming, but they also have the potential to improve long-term health. Since CMS is paying for wellness programs, they are now a "must have" in medical practice. PAs are highly qualified to develop and run these programs.
• Managing At-Risk Populations: PAs are perfectly suited to address the needs of chronically ill patient populations. They play a vital role in determining and following protocols and managing patients in accordance with evidence-based medicine. By focusing on those most at risk, PAs help prevent emergency room visits and hospitalizations, so patients can follow a treatment plan in the comfort of their own home.
• Helping with Care Coordination: PAs participate in health promotion and coordination of care across transitions including the ER, hospital, and long-term care facilities.
• Performing Home Visits: Particularly for patients who need special attention or monitoring, as part of the implementation of Patient Centered Medical Homes, PAs have the opportunity to provide primary care where it is most convenient. In the surgical area, a New York hospital developed a program for patients who underwent cardiac surgery. Physician assistants made house calls on days two and five following hospital discharge, reducing the 30-day readmission rate by 25 percent.
• Providing Care in Remote and Underserved Areas: PAs make economic sense for a health care system that cannot afford a physician in these areas. PAs allow patients to be cared for in their own communities, avoiding the hardships and cost of travel to major medical centers.
• Delivering Specialty Care: Two-thirds of PAs now work outside of primary care, with over 19 percent of certified PAs working in surgical specialties, almost 14 percent in emergency medicine and almost 3 percent in the growing field of hospital medicine."

bit.ly/APPex187