Physician Assistants Poised, Ready to Accept Reform Responsibilities

As the political bickering over the Affordable Care Act (ACA) continues, those of us in the trenches will continue to provide excellent care for our patients who rely on us, regardless of how this debate shakes out. I just hope that we all take a deep breath, and work together with the American Academy of Physician Assistants (AAPA) to improve the healthcare system with the needs of the patient as our highest priority.

Each day, I see people who benefit from provisions of the reform law like coverage until age 26 under a parent’s plan, no exclusions of pre-existing conditions, and expanded coverage. As a physician assistant (PA), I just want the means and the ability to care for the patients who present themselves to our facility with healthcare problems and injuries. I am sure that we all desire a healthcare system that is efficient, safe, accessible, and affordable for all patients.

We are already delivering healthcare to unfunded patients in the most expensive way possible. I spend a lot of time in our ER's burn unit caring for uninsured patients who receive the best care possible once they cross the threshold of our emergency department.

What I don’t understand is how we, as a nation, can "afford" to deliver care in this model, but can’t afford to fund expansion of outpatient healthcare delivery in a manner that focuses on prevention and disease maintenance, which ultimately reduces reliance on hospital-based care?

We are spending the money now in a very inefficient way. This is a large reason why the United State’s quality measures and health status indicators are so poor in comparison to the rest of the industrialized world. This is simply unacceptable.

A smart way to spend money, in my opinion, is to embrace a team-based approach to delivering healthcare that could drive costs down. The law bolsters a number of ongoing market trends that are likely to continue regardless of future intervention by federal and state lawmakers. These include a shift from fee-for-service to payment for value and outcomes, additional focus on prevention and coordination of care, and the increased use of information technology.

We all know that PAs are critical members of healthcare teams, and the reform law emphasized this by including PAs as one of three primary-care providers along with doctors and nurse practitioners. In the coming months and years, PAs will continue to play a pivotal part in an changing healthcare landscape which is seeking to do something that we as PAs have been doing since we began practicing more than 45 years ago - placing the emphasis on the patient where it belongs.

In addition to being listed as primary-care providers under the ACA there are many other provisions that highlight the increasingly significant part PAs play. Under the law, PAs are eligible for a 10 percent bonus for primary-care codes through Medicare and allowed to order skilled nursing facility care for Medicare beneficiaries. PAs are also embraced as healthcare professionals in Patient-Centered Medical Homes, accountable care organizations, Independence at Home models of care, chronic care management, and other new models of care designed to better coordinate care through team-based practice and to promote value to the healthcare delivery system.

I have a hard time understanding political hindering of healthcare reform in this day and age of escalating costs, millions of under-served and underserved Americans in the healthcare system, and the highest per-capita spending on healthcare in the world, with embarrassing results in health quality indicators to show for it.

Open enrollment for health insurance exchanges begins October 1 in various states. It may be time to start embracing the new future of healthcare and the important role of PAs in that future, rather than using this method of modernizing healthcare as a political football. Through educational materials for you and your patients on various aspects of the reform law, the AAPA is committed to helping PAs navigate the intricacies of the new healthcare landscape. Our patients’ health is at stake.

This blog was provided in partnership with the American Academy of Physician Assistants.