I have a long history with family medicine as my father was an early pioneer – heading up the family medicine program at Chicago’s Cook County Hospital in the 1970s. Even back then my dad was using physician assistants (PAs) — many of them former military medics in the Vietnam War era — who were part of what was at that time a brand new profession.
Family medicine as a whole was early to recognize the value of PAs and how they could extend our ability to help people in an outstanding manner. As a family practice physician, I work with PAs on a daily basis to coordinate and deliver comprehensive care for our patients.
In the 25 years I have practiced medicine, our health care system has come full circle — back to the concept of the family doctor, as medicine moves to patient-centered medical homes (PCMH) and accountable care organizations (ACOs). That appeals to patients who want providers who know who they are and who can both help them today and care for them over a lifetime. It also benefits health care organizations that recognize they must be cost-effective to survive.
From a global perspective, the U.S. is #1 in health care spending, but we are far from #1 in outcomes. We deliver way too much care in disjointed ways and settings.
Today more than 400 ACOs care for more than 7 million patients, but the program is in its infancy. This model will surge as HHS has set a goal of tying 50% of all Medicare payments to alternative models such as ACOs by 2018.
Both the ACO and PCMH concept demand integrated and coordinated care for patients at all stages of life. We can’t be successful in these new care models without the inclusion of certified PAs and other team members working to the extent of their clinical strengths. Although our roles and scope of practice are different, our goals are the same. And if you are thinking about joining an ACO or becoming a PCMH, I maintain you can’t do it without PAs. Why?
1. Our patient base is growing. There are increasing demands for care from new patients who were previously uninsured. Many of them have chronic diseases and previously only sought medical care in emergencies. Now they are able to schedule routine visits for management of chronic conditions. With Medicaid expansion, the reimbursement is low, and we can’t sustain a system where only physicians treat these patients.
Certified PAs are qualified to treat these patients because they are medical providers who are educated at the Master’s degree level and must pass a rigorous national exam administered by the National Commission on Certification of Physician Assistants (NCCPA) in order to be initially licensed in every state. They can conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care and prescribe medications — offering value-based care at a sustainable cost.
2. We interact with multiple insurers, each with their own ground rules and formularies. PAs have the medical education and the clinical training to meet payer requirements for reimbursements. In an ACO or PCMH, we need to match clinical need with the strengths and practice scope of each team member to save costs.
3. A lot of what you do in primary care can be done as effectively and more cost effectively by a PA than a physician. If you develop a solid relationship with the PA, your patients won’t think of themselves as your patients but patients of the team.
4. The employment of PAs creates flexibility in scheduling, allowing physicians to have greater work/life balance through staggered schedules or a four-day workweek. At the same time, it allows us to have the welcome mat out for longer hours. We even have an urgent care that remains open in the evening after the office closes. PAs make it possible for us to see our patients in our offices with their current medical record, almost any time of day.
5. If you are a leader in the ACO or PCMH, much of your time will be diverted to administrative duties and may require you to be away from the office. Who will take care of your patients as you develop new organizational infrastructure and policies? Certified PAs can manage patients and use electronic means to reach you if needed.
On a personal level as a Latino physician, I am particularly interested in the genetic predisposition to diabetes as well as nutrition and preventive care. I am a board member for the local community leadership board of the ADA. After 35 years practicing medicine I want to have time to contribute to these organizations. I am confident that our patients are well cared for by certified PAs when I am out of the office.
We are still in the early days of the ACO and PCMH delivery models. The one thing that is clear is that we need good people with different skill sets to optimize the right level of care for the patient. We have to embrace the new paradigm, and PAs are a valued component of it.
Francisco Prieto is a family practice physician. This article was written in conjunction with the National Commission on Certification of Physician Assistants (NCCPA).
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