for the pa profession top 5...

10/13/2014

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Challenges and Opportunities Facing the PA Profession

Challenges and OpportunitiesFacing the PA Profession

Lawrence Herman, PA-C, MPA, DFAAPAChair of the Board / Immediate Past President

AAPA


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Challenges and Opportunitiesfor the PA Profession

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Top 5 OpportunitiesThe PA profession has the opportunity to …

1. Position PAs to capitalize on changing consumer expectations

2. Reduce PA practice barriers

3. Maximize PA employment options and pay

4. Deliver on the promise of “patient-centered, team-based care”

5. Keep up with the rapid and dramatic changes in medicine andlearning

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NEW CONSUMER EXPECTATIONS

The PA profession has the opportunity to …

1. Position PAs to capitalize on changing consumerexpectations



4. Deliver on the promise of “patient-centered,team-based care”

5. Keep up with the rapid and dramatic changes inmedicine and learning

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Patient access to health informationis changing patient/provider interaction

Consumers SeekHealthcare Information Online

• 95 million Americans are now using mobilephones as health tools or to find healthinformation, up 27% over 2012.

• 72% of U.S. adults said they looked online forhealth information last year.

• 35% said they went online specifically to figure outwhat medical condition they or someone elsemight have.

Sources: Manhattan Research, Cybercitizen Health US Survey, 2013; PewInternet and American Life Project Health Online 2013, Jan 15, 2013;http://www.pewinternet.org/fact-sheets/health-fact-sheet/


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There is a growing consumerawareness of healthcare costs

Source: Kaiser/HRET Survey of Employer-Sponsored HealthBenefits, 2001-2012

Average Annual Health Insurance Premiums andWorker Contributions for Family Coverage, 2002-2012

Share of Healthcare Spending Borne byFamilies Projected to Continue to Rise

Source: Center for American Progress, “Family Health Spendingto Rise Rapidly” September 15, 2009

Worker Contributions to Insurance PremiumsMore Than Doubled in 10 Years


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PAs/NPs are Providers of ChoiceAmong YoungerAmericans

A shift in consumer preferencesamong providers is already apparent

Most Patients PreferImmediate Care from PA or NP

Prefer to see a PA or NPPrefer to see a PA or NP

Wait for aphysicianWait for aphysician

60%

25%

0% 50% 100%

Age 18-34

Age 35-60

Age 60-75

Prefer PA/NP Prefer Physician

Sources: (left) Association of American Medical CollegesConsumer Survey; (right) The Millennial Project 2013


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Increaseawareness of

PA value

Increaseawareness of

PA value

Empowerconsumers

withinformationabout PAs

Empowerconsumers

withinformationabout PAs


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Creating Opportunities to Raise Awareness


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PA Week 2014


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12www.aapa.org/PAweek

California

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Changing the Way We Talk about PAs

• PAs practice medicine in collaborationwith physicians

• PAs are members of healthcare teams

• PAs diagnose

• PAs prescribe medication

• PAs treat patients with complex conditions

• PAs are good for patients …


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… and good for the business of healthcare!



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Showcasing PA Value: Earned Media


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Telling the PA Story


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Creating New Information to Leverage Interest

• 75% of PAs are paid a salary.

• 22% are paid an hourly wage.

• 3% are paid based on productivity.

Every year, a typical PA:

• Treats more than 3,500 patients

• Writes 2,600 to 5,200 prescriptions


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REDUCE PRACTICE BARRIERS







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Continued Progress in 2014!



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Advocacy Update: California

SB 1083 - authorizes PAs to certify claims for disabilityinsurance when practicing in compliance with the state’sPA practice act and rules and adds PAs to the definitionof “practitioner.”

AB 2102 - requires the PA board (and other boards) tocollect and report demographic data.



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U.S. CongressionalCommittees took steps

toward PA-positivechanges in federal law

Next step inMedicare payment reform:

Treat PAs the sameas physicians!



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Important changes in federal regulations

CMS• No on-site physician supervision required in rural health clinics

and hospitals• Delayed a burdensome CMS durable medical equipment

(DME) policy that would have required a physician’s signatureon DME orders

• Convinced CMS to reverse its policy that hindered the ability ofPAs to perform hospital admissions

SAMHSA• Drafted guidelines to authorize PAs to diagnose/admit to opioid

treatment programs.

• PAs authorized providers in community mental health centers.

VA• Updated utilization guidelines for PAs, moving away from

“supervision” to “collaboration”

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Business/industry practices are asimportant as federal and state laws

New MarketEntrants are

EstablishingTheirOwn Rules!



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Continue towork at

federal andstate level to

reducebarriers

Continue towork at

federal andstate level to

reducebarriers

Educateemployers

about how tomaximize PA

value

Educateemployers

about how tomaximize PA

value



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AAPA is pursuing legislative and regulatorychange at the state and federal level

Build on momentum at federal level to:

• Advocate for Medicare modernization• Advocate for PAs to receive direct payment from Medicare consistent

with all other healthcare professions

• Actively pursue opportunities to remove/prevent barriers to PA practicein EHRs, home health and hospice laws and regulations



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AAPA is pursuing legislative and regulatorychange at the state and federal level

Work with AAPA Constituent Organizations instates to:

• Adopt the six key elements of Modern PAPractice Act

• Add PAs to all relevant sections of health law

• Recognize PAs in ACAregulations/implementation at state level

• Expand PA authority in mental health

• Streamline the state licensure process

• Add PAs to all state workforce enhancementplans – scholarships, tax incentives, etc.

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MAXIMIZING EMPLOYMENT / PAY







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PAs are the biggest value in medicine

$0 $100,000 $200,000 $300,000 $400,000 $500,000 $600,000

Cardiology (cath lab)

Cardiac/thoracic surgery

Orthopedic surgery

Diagnostic radiology (interventional)

Gastroenterology

Urology

Cardiology

Dermatology

Anesthesiology

Otolaryngology

General surgery

Hematology/medical oncology

OB/GYN (general)

Emergency medicine

Pulmonary disease (without critical care)

Hypertension/nephrology

Allergy/immunology

Neurology

Infectious disease

Hospitalist (internal medicine)

Rheumatologic disease

Urgent care

Endocrinology

Internal medicine

Psychiatry

Family medicine

Pediatrics/adolescent (general)

PA Compensation (2012)

Physician Compensation (2012)


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16 Need new photo here--maybe from Dropbox?Ashley Kent, 9/12/2014

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PA flexibility to change specialtiesprovides advantages to PAs and employers


PAs in practice morethan 10 years have

changed specialties anaverage of 2 times.

Source: AAPA 2013 Annual Survey

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ACA is driving new opportunities invalue-based healthcare

Source: Oliver Wyman


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PAYERS MOVING INTO CARE

++ + +

+

NEW NATIONAL PLAYERS?

+

New business models are focusedon the bottom line


PROVIDERS MOVING INTO RISK

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40%

42%

44%

46%

48%

50%

52%

54%

56%

58%

60%

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Number of Hospitals % of Hospitals in Health Systems

Hospitals are increasingly affiliatingwith health systems


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Source: Accenture

2000 – 2012, Number of Physicians in Thousands

Physicians in Private Practice

Total Number of Physicians

57%2000 49%

200543%2009

39%2012

Physicians are leaving private practice


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Quantify anddocument PAcontributionsto improved

patientoutcomes

Quantify anddocument PAcontributionsto improved

patientoutcomes

Quantify anddocument PA

economicvalue to

employers

Quantify anddocument PA

economicvalue to

employers

Provide PAswith tools/infothey need toadvance their

careers

Provide PAswith tools/infothey need toadvance their

careers


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AAPA research: Non-economic value ofPAs may be as important as economic value

Non-Economic Value

Higher patient satisfaction

More team communicationand access to information

Better quality of life forMDs/DOs

More MD/DO time for criticaland complex cases

EconomicValue

Higher billing andreimbursement

Increased patient load

More accurate coding

Lower overall salary costs

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Providing PAs the information they needto advance their careers

Did you know?

• Employers pay license fees for 62% of PAs.

• Professional development allowance covers all CME for 71% of PAs.

• Nearly half of PAs earn a bonus; PAs who get a bonus earn an averageof $10,000 more per year.

• On average, PAs earn more at hospitals than in physician practices.

• On average, PAs earn more in multi-specialty and group practices thanin solo practices.

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PATIENT-CENTERED, TEAM-BASED CARE







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Patient-centered, team-based carehas positive effects

Positive impacts on:

• Patient care

• Practice workflows

• Patient satisfaction

• Provider satisfaction

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Hurdles to building effective healthcare teams

• Conflict

• Lack of coordination

• Distractions

• Fatigue

• Workload

• Misinterpretation of cues

• Lack of clarity

• Hierarchy

• Lack of information sharing

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PAs can help lead this effort

• PAs have a strong foundationin general medicine

• On average, PAs work with 4physicians, 3 to 4 other PAs,and 1 to 2 NPs

Source: AAPA 2013 National PA Survey

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Promote team-based care

andinstitutionalize

the PA role

Focuseducation and

CME onpatient-

centered,team-based

care

Differentiateroles amongPAs, NPs,MDs/DOs



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KEEP PA KNOWLEDGE RELEVANT






5. Keep up with the rapid and dramatic changes inmedicine and learning5

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Technology is driving andchanging healthcare as we know it

TODAYReactive, Transactional

Healthcare

FUTUREPreventive,

Interventionist HealthManagement

Source: National Human Genome Research Institute

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AAPA is helping to promote andimplement new standards for education and CME

• Inter-professional education

• Evidence and outcome-basededucation

• Performance Improvement (PI)– CME

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Evidence-based medicine will bedriven by EHR and big data

Source: Oliver Wyman

Electronic HealthRecords and the

Big Data Revolution

Electronic HealthRecords and the

Big Data Revolution

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Providers and patients are carryingdiagnostic apps in their pockets


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CME must betimely,

accessible andpersonalized

CME must betimely,

accessible andpersonalized

Create newtools andlearning

opportunitiesfor PAs

Create newtools andlearning

opportunitiesfor PAs

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New and Improved Learning Tools

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Top 5 Opportunities for YOU

1. Tell the PA story at every opportunity.

2. Advocate on behalf of PAs with your employer, your stateofficials and your federal representatives.

3. Help your employer understand the value PAs bring to thehealthcare workplace.

4. Continue to be a team player.

5. Adapt and adopt new technology.

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This Is Our Moment

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