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(HealthNewsDigest.com) – In my decades of experience treating patients, one thing has always been clear: Our country needs a better health care system. Too often, patient care suffers as a result of overcrowded waiting rooms and cutthroat insurance practices. Right now, leaders of our country are debating how best to bring high-quality, affordable health care to patients and they’ve presented some viable solutions. But as the future of health care reform is volleyed between its champions and critics, one question lingers: Who will provide all of this promised care?
If we truly wish to get serious about reforming a broken health care system, we must address the provider shortage that is plaguing doctors’ offices, hospitals and clinics across the country. According to projections by the American Academy of Family Physicians, the U.S. will face a shortfall of 40,000 family physicians in 2020, just as the number of older and underserved patients — and demand for care — is expected to be at its highest.
Efforts to bridge the provider gap have been under way for decades. Forty years ago, the physician assistant (PA) profession was created to ease at least some of the burden on medical doctors and offer access to care to sparsely populated areas where physicians were few and far between. Today, I stand alongside 75,000 PAs nationwide who work in all general practice settings and many specialty areas, ready to provide the care that America needs. Unfortunately, outdated and inconsistent legislative barriers stand in our way.
For example, though I may have worked with a patient for most of his or her life, as a PA I am not allowed to order home health, nursing home or provide hospice care for that patient under current Medicare rules. In Iowa, PAs are not allowed to order pain management medications for Medicare hospice patients at the end of their lives, though they may do so for those who are on Medicaid. In California, much-needed home health physical therapy services are often delayed because only physicians — frequently off site in satellite offices, and not the PAs who are available on a daily basis — may fill out the necessary paperwork.
Whatever shape health care reform takes, PAs need to be included in the patient-care equation. PA education programs graduate more than 6,000 providers each year — five times more than family medicine programs. In fact, the American Academy of Physician Assistants predicts that the PA workforce will grow to 100,000 strong in the next five years. These programs can quickly fortify a qualified medical workforce that will help to fill critical gaps in care and ensure that patients come first.
The current Senate version of health care reform legislation contains provisions that would allow our health care system to make full use of all medical professionals, including PAs.
America’s Healthy Future Act of 2009 fully integrates PAs into new team-based models of care that are designed to promote primary care and the coordination of care for patients with chronic medical conditions. The bill contains provisions to allow PAs to order skilled nursing facility care and to provide hospice care for Medicare beneficiaries, eliminating two key treatment barriers for Medicare patients whose primary health care professional is a PA.
Lawmakers should retain these provisions so that we can stop underutilizing valuable assets that are already available, willing and able to help relieve the pressures of a system in which demand exceeds the supply of medical professionals.
In every medical setting, PAs practice and foster a team-based, coordinated approach to health care that has been shown to improve outcomes and reduce costs. We can execute more than 80 percent of the responsibilities of a physician with no compromise in quality or patient care satisfaction. In some rural and underserved communities, we are the only health care providers for hundreds of miles, increasing the urgency with which we advocate to be integrated into new models of care, such as the primary care medical home and chronic care coordination.
If the Senate is able to hold onto these provisions, as the legislation advances, real people — Medicare patients — will be the winners. Allowing PAs to administer these services also will save money, as reimbursement rates for PAs are lower than those for physicians. And they will save physicians time that can be spent seeing greater numbers of patients or focusing on the kinds of care that only physicians can provide.
Take, for example, a recent incident in Iowa, in which the family of an elderly Medicare patient who was in the end stages of kidney cancer requested urgent pain medication late one Friday evening. Their PA, who had treated the patient for many years, was still in the office and available to speak to the family. PAs are also qualified to write prescriptions for pain medications and often do so for Medicaid patients in that state. However, current federal regulations do not allow them to do so for hospice patients covered by Medicare.
As it was late on a Friday, and the supervising physician was just leaving the main office 30 miles away and unable to see the patient, the PA was placed in the undesirable position of knowing how to help a patient but being unable to take action because of overly restrictive, and inconsistent, federal policies. Under the new provisions, the PA could have written the prescription and eased the patient’s pain — along with the family’s suffering — during a highly stressful and emotional time.
Consider, as well, the case of an elderly woman in California suffering from memory problems. Recently widowed, the woman was struggling to live independently and having difficulty staying compliant with her hypertension and other medications. The family wished to have the woman evaluated at the Rancho/USC California Alzheimer’s Disease Center, where PAs provide an important component of patient care. However, PAs are not allowed to see Medicare patients on a first visit or to provide an initial evaluation. On the day of the appointment, however, the attending physician was called away for a family emergency. Though PAs were on hand and qualified to offer at least some assistance to the family, they were unable to do so under current Medicare regulations.
The anxious family was sent home and asked to reschedule. In the meantime, the patient’s condition deteriorated and she wandered away from home. Found by police and taken to the local emergency room, she was hospitalized for several weeks before her evaluation could be rescheduled and treatment administered at the Alzheimer’s Center.
President Obama is right: The time to act on health care is now. But we need to act with our patients’ needs in mind. We need legislation that makes the best use of all medical professionals and ensures that we all receive the best care possible when we’re sick. The forward-thinking health care reform that has been promised by the administration will require many more medical professionals, including PAs, to deliver the primary care services we all need.
With PAs on the team, we can provide world-class care to all Americans.
Stephen H. Hanson, MPA, PA-C, is president of the American Academy of Physician Assistants.
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