Improving outcomes and the bottom line
The question keeping America’s healthcare leaders up at night is a daunting one: How can we provide cost-effective, quality care to all patients in today’s value-driven environment?
A recent study by economic modeling firm IHS on “The Complexities of Physician Supply and Demand: Projections from 2013 to 2015”1estimates that by 2025 the demand for physicians will exceed the supply by 46,000 to 90,000, with a shortage of primary care physicians between 12,500 and 31,000. Compounding that shortage, the study states that the U.S. population will grow close to 10% in this period even as the 65-and-over population (patients more likely to have multiple comorbidities and complex care demands) increases by 46%.
Bridging the Gap
The encouraging news is that physicians need not bear this burden alone. The nation’s 108,500-plus certified physician assistants (PAs) have proven to be an integral part of the team-based paradigm, especially as the U.S. healthcare system evolves to a patient-centered approach to care.
PAs manage the full scope of patient care: obtain patient histories, conduct physical exams, assist in surgery, order and interpret laboratory and diagnostic tests, diagnose and treat illnesses, counsel on preventive healthcare and prescribe medications.
While PAs practice medicine in all medical and surgical specialties and in every clinical setting, according to the 2014 Statistical Profile of Certified Pas,2 published by the National Commission on Certification of Physician Assistants (NCCPA), primary care and surgical subspecialties have the greatest number of certified PAs followed by emergency medicine. PAs also fulfill an integral role in serving the rural, underserved and aging population, groups most vulnerable to the physician shortage.
Specialties with Greatest Number of PAs
A June 2013 article by Dill, Pankow, Erikson and Shipman in Health Affairs examines provider preferences based on data from the Association of American Medical Colleges’ consumer survey. It indicated that patients preferred a PA or NP for reasons of access and cost and also mentioned quality issues, “including perceptions of more personalized and compassionate care, greater comfort levels in communicating, and good experiences receiving care from one in the past.”
Certified PAs are particularly attractive to many health systems, practices and patients because they are educated in the medical model and have proven themselves through a rigorous certification exam (required for initial state licensure in all 50 states). Then, like most physicians, they maintain certification by earning substantive continuing medical education credits and by passing recertification exams throughout their career.
Commit to Patient Satisfaction
Having certified PAs as members of the healthcare team can directly contribute to improved patient satisfaction by:
- Increasing access to care. The availability of PAs ensures more available appointments to keep pace with the increasing patient population.
- Enabling same-day appointments. Often, PAs enable practices to expand hours for acute care visits. This allows patients to be seen by a familiar provider with access to their current electronic health record, which can eliminate the higher-cost option of going to an emergency room.
- Freeing up the physician to handle the most complex patients. Most patients understand that a PA can handle most office visits, which means a physician will be available when they really need one.
- Offering cultural and gender diversity. Everyone wants to be heard and understood, and successful communication enhances patient engagement. Toward that end, a physician might expand the cultural diversity and sensitivity of the practice through inclusion of PA s from diverse ethnic, racial, social and cultural backgrounds, thus facilitating the breakdown of cultural and communication barriers that sometimes impede care.
- Educating patients and their families about prevention, wellness and compliance. PA programs include education on counseling patients, and equipping patients to more effectively manage self-care can help stave off some of the growing demand.
- Improving the quality of care. According to a 2014 Harris Poll conducted by the American Academy of PAs, 91%3 of Americans agree PAs improve health outcomes for patients. For example, in hospital inpatient settings, PAs have been key contributors in implementing programs that improve surgical outcomes and reduce readmission rates. It makes sense that good outcomes are a leading factor in patient satisfaction.
Focus on Quality and Incentives Follow
Quality and satisfaction are hallmarks of the patient-centered paradigm. The Physician Quality Reporting System is a value-based program from CMS that rewards quality care through incentive payments. In 2015, the program has expanded to apply negative payment adjustments to providers who do not satisfactorily report data on quality measures. At the same time the Hospital Consumer Assessment of Healthcare Providers and Systems is another CMS initiative that surveys recently-discharged hospital patients to gauge their overall experience. Hospitals that do not have adequate patient experience scores will have a reduction in reimbursement.
Recognizing the importance of quality of care, patient satisfaction and patient loyalty, the healthcare delivery systems needs to strike a balance between the physician’s capacity to offer care and the patient’s demand for increased services through staffing diversification. That is why healthcare employers are embracing the team concept and relying on providers such as PAs to provide high quality care and improve patient satisfaction.
Dr. Peter McGough, medical director of the University of Washington Neighborhood Clinics in Seattle, says: “We have recruited certified PAs to all of our 10 primary care clinics. Working closely with physicians in care teams, they have expanded our capacity and improved our ability to effectively care for more complex patients.”
Invest in Sustainable Staffing
While patient satisfaction and quality care are the top priorities for medical providers, today more than ever, healthcare has to be cost-effective. PAs deliver on the cost front too.
- PA salaries are a fraction of their physician teammates. According to physician staffing firm Jackson & Coker, the average family medicine physician earned a salary of $183,721 in 2014. The average dermatologist’s salary was $414,880. According to NCCPA the average PA in family medicine earned $89,999 (49% of physician salary), and the average PA in dermatology earned $112,537 (27% of physician salary).
- PAs generate significant revenue. Based on their lower salary, PAs more than carry their weight in revenue. Medicare reimburses for PA services at 85% of what a physician can charge but pays 100% if the services are “incident to” the physician’s treatment plan.4
- PAs are a smart staffing solution for the PCMH. PAs are educated as generalists to be patient-centric and are well-equipped to provide care coordination and continuity. Even as the majority of PAs move into specialty practice, they all maintain their broad, generalist knowledge base as required by their ongoing certification maintenance process. Partnering with patients to maximize their health can eliminate costly emergency room visits and hospitalizations.
- PAs enable surgeons to perform more surgeries, which increases the bottom line. For example, in orthopedic surgery, PAs often handle pre-op evaluations, assist in surgery and prepare post-operative orders. They also manage non-operative fractures, removing these duties and procedures from the surgeon’s schedule.
In healthcare the customer is the patient, and nothing improves satisfaction more than great outcomes. Certified PAs are one of the cornerstones of the new healthcare paradigm, improving quality care at a sustainable cost.
- Dall, Tim; West, Terry; Chakrabarti, Ritashree; Iacobucci, Will. “The Complexities of Physician Supply and Demand: Projections from 2013 to 2015.” Available at:https://www.aamc.org/download/426242/data/ihsreportdownload.pdf
- “2014 Statistical Profile of Certified Pas.” Available at: http://www.nccpa.net/Uploads/docs/2014StatebyStateReport.pdf
- “Attitudes Toward Physician Assistants: A 2014 Survey by the American Academy of Physician Assistants.” Available at: https://www.aapa.org/uploadedFiles/Site_Content/News_and_Publications/AAPA-HarrisSurvey%20Methodology%20and%20Tables.pdf
- American College of Physicians. “Internists and Physician Assistants: Team-based Primary Care, 2010.” Available at: https://www.acponline.org/acp_policy/policies/internists_asst_teambased_primarycare_2010.pdf