Ten ways certified PAs improve quality, reduce costs

Morton-RiasHealthcare organizations are being asked to do more and more these days: cut costs, expand access, improve quality and increase patient engagement. How exactly do we do more without spending more?

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For a growing number of organizations, the answer lies in expanded and effective utilization of certified physician assistants (PAs).

That goes well beyond just using PAs in medical office settings to obtain patient histories and to perform physical exams. Today’s PAs are highly educated-taught in the medical model and often learning alongside medical students-and the majority are experienced in specialty areas ranging from hospital and emergency medicine to nephrology and psychiatry.

The bottom line is it’s time for organizations to expand the way they think about and employ PAs by looking at how the profession can impact areas where there are real needs, such as expanding access, decreasing infection rates and reducing hospital readmissions.

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Here are 10 ways PAs help healthcare organizations tackle some of their most difficult healthcare delivery challenges.

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1. Expand the clinical team. In this era of physician shortages, certified PAs provide a staffing solution that maximizes the delivery of quality care. PAs have the clinical expertise to handle most acute and chronic cases while freeing up overscheduled physicians to treat the most complex or critically ill patients.

2. Serve as the primary care provider. PAs practice medicine from diagnosis to treatment, from performing physicals to ordering and interpreting labs and procedures and prescribing medication. This means PAs offer increased access for many newly insured Americans. According to a 2014 consumer survey by the National Commission on Certification of Physician Assistants (NCCPA), over 94% of patients are willing to be seen by a PA. This acceptance combined with increased access means people don’t delay care, which can translate into reduced emergency room visits and even hospitalizations.

3. Reduce wait times. The same survey showed patients are concerned about not being able to get appointments when they need them and about long waits once they get to a doctor’s office. The availability of PAs means that many physicians can offer same-day appointments and reduce waiting room anxiety.

4. Provide coordination and continuity of care. PAs are educated in communications and how to engage patients in their own health. They are focused on the patient care across the continuum, not just the individual appointment or acute illness. Hospitalist PAs act as inpatient advocates, handling daily patient management, speaking with the patient and family and playing a key role in discharge planning to ensure patient compliance and reduced readmission rates.

5. Specialize in any area, including surgery. PAs on surgical teams are handling pre-operative and post-operative care, freeing physicians to focus on the actual surgical procedure. In addition, PAs regularly serve as the first assistant to the physician during surgery. PAs can earn a Certificate of Added Qualifications (CAQ) in seven specialties including orthopaedic surgery and cardiovascular/thoracic surgery. The CAQ requires certified PAs to earn additional specialty experience and continuing education on top of their generalist medical degree. In addition they must have a physician attest to their knowledge and skills in that specialty and pass a national specialty exam. PAs with this credential are sending a message to employers, physicians and the public that they have the specialty expertise along with the generalist medical education to deliver quality specialty care.

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6. Manage the health of populations. Certified PAs are often the “go to” clinical resource for patient management of complex, multisystemic illnesses like diabetes or hypertension. They may use protocols and checklists to manage patients with specific conditions and/or hold group appointments both for educational and management purposes. Through education and support, patients with chronic disease are able to self-manage and reduce the need for emergency visits or hospitalization.

7. Reduce hospital rates of infections. Hospitals are developing care teams with PAs to reduce sepsis, central-line infections and ICU pneumonias. PAs are involved in setting up protocols, following high risk patients and measuring results.

8. Build patient satisfaction. PAs improve patient satisfaction by reducing wait times and communicating with patients and their families, including educating them about their condition and how to maintain and improve health. A well-managed patient, whose needs and concerns have been addressed, is also a satisfied patient, and this improves quality and compliance.  Both the Medical Group Management Association's report NPP Utilization in the Future of U.S. Healthcare and the Kaiser Commission on Medicaid and the Uninsured give PAs high marks for patient satisfaction.

9. Help earn financial incentives. Value-based medicine affects the bottom line. The Centers for Medicare and Medicaid Services now rewards quality through financial incentives based on the Physician Quality Reporting System (PQRS). Hospitals are being measured on the patient experience through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey of discharged patients, and those results also affect reimbursement. A Health Affairs article studying Medicare patients with diabetes concluded that PAs were effective members of the healthcare team and had similar outcomes as physicians. Quality outcomes lead to satisfied patients and increased reimbursements.

10. Increase patient volume and revenue. As PAs are added to the healthcare team, more patients can be effectively seen. According to NCCPA’s 2014 Statistical Survey, PAs who work full time see 76 patients on average per week in their principal clinical position. This can generate significant revenue for the organization. PAs earn about 40% to 60% of a physician’s salary yet generate revenue per patient similar to that of a physician.

Dawn Morton-Rias, EdD, PA-C, is president and CEO of the National Commission on Certification of Physician Assistants. Previously, she served as Dean of the College of Health Related Professions and professor at SUNY Downstate Medical Center in New York. Morton-Rias has been a certified PA for more than 30 years.