PAs transforming health through
patient-centered, team-based
medical practice
Agenda
2
1
Healthcare Landscape
2
Physician Assistant Overview
3
AAPA & PA Foundation Overview
Changing U.S. Healthcare Landscape
3
Accelerating reforms at the
national & state levels.
Shift from fee-for-service to
fee-for-value healthcare
delivery model.
Consumer-centric healthcare
markets.
New competitive structures –
industry consolidation,
vertical integration & new
entrants.
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
Market & Government Driving Reform
GDP
Spending
Uninsured
How We Stack Up
On the Rise
Disturbing Trend
A 2011 World Health Organization
study indicates the U.S. spends a
higher proportion of its GDP on
health care than any other country,
but ranks 37th out of 191 countries
based on 5 KPIs.
Medicare and Medicaid spending is
now at 21% of the federal budget.
48 million uninsured today…
projected to grow to 55 million.
Expectations are it will rise to 25%
in the next few years.
Of the 48 million, 80% are citizens
of the U.S.; approximately 8 million
are currently covered by Medicaid.
Current healthcare expenditures
are 18% of GDP and are expected
to rise to 20%.
Source: World Health Organization
4
Uninsured are twice as likely to be
unhealthy and over 30% have a
chronic condition.
Source: Kaiser Family Foundation
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
Source: Kaiser Family Foundation
The Solution: Patient Protection & Affordable Care Act
Guaranteed Coverage & Individual Mandate
Requirement that everyone must purchase health insurance
(unless otherwise covered) & they have to be issued a policy
regardless of rating, pre-existing conditions, or age.
Lifetime/Annual Caps Banned
Health insurance providers will no longer be allowed to set
financial limits on payouts.
Health Insurance Exchange
States have the option to create their own or adopt the
federally-run exchange. The HIE is an alternative
marketplace for individuals & small business to purchase
insurance.
Business Health Insurance Tax
Companies with 50 or more employees with at least 1 fulltime employee must provide health insurance or pay fines.
Medicaid Expansion
States that chose to participate will change eligibility for
individuals within 133% - 400% of the federal poverty level.
5
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
Preventative Services
Certain preventative services will be considered
“essential” and will be offered free of co-pays or
deductibles.
Value-Based Healthcare
Today: Fee-for-Service
Transactional
Models
• Dermatologists
• Ophthalmologists
• Dentists
• Etc.
Future: Fee-for-Value
Episodic Care
Models
• Orthopaedics
• CV Surgery
• General/specialty
surgery
Condition Care
Models
Population Care
Models
• Partial Population
• Oncology
• Frail elder
• Diabetes
• High risk
• Asthma
• Poly-chronic
• Chronic/end-stage • Full Population
renal
• Globally capitated
models
• Medicare shared
savings ACO
Source: Oliver Wyman
6
Example Model Types
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
Accountable Care Organizations – Responsible for the Whole Patient
Healthy
Independent
Health Risk Factors Early Stage Chronic
Complex
Conditions
Late State or Polychronic
End of Life
… and for managing clinical risk for all healthcare consumption across
ambulatory, acute, post-acute, and other settings.
Primary
care
Urgent
care
Behavioral
health
Hospital
emergency
services
Specialist
care
OT/PT
Hospital
OR/ICU
Source: Oliver Wyman
7
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
Diagnostic
imaging/lab
Ambulatory
surgical
center
Skilled
nursing
Home
care
Hospice &
palliative
The Trillion Dollar Question
Accountable Care . .
•
•
•
•
•
High quality care
Efficient delivery
Coordination of activities
Measurable results
Patient-centric
. . Organizations
• Whose “Home” / “Organization”
– Hospital?
– Doctor?
– Payer?
– Government?
– Third party?
Source: Oliver Wyman
8
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
Shift to Consumer-centric Healthcare Markets
Healthcare today
“Complex, fragmented and under performing”
Source: Oliver Wyman
9
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
Patient-Centered Care
“Team-Based, guided, and coordinated”
New Delivery Models
Payer
Models
Provider
Models
Open
Heart
ED
Intervention
Radiation
Oncology
Orthopedics
Cardiology
Cancer
Crowd
sourced
tools
Provider
Transparency
Monitors/
Sensors
Social
Media
Ancillary
products
Risk
Assessment
Diabetes
Wellness
Payer-Led
Model
Risk
Financing
Biometrics
Information
Goods
Wellness
Lifestyle
Retail-Led
Manager
Coaching
Retail/New-Co
Models
Network
Minute
Clinics
Retail/
Shopping
Coaches
Convenience
Minute
Clinics
Apps
Source: Oliver Wyman
10
Provider-Led
Manager
CKD
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
Financial
Mgmt.
Wellness
Frail Elder
Surgical
Oncology
Experience
Expertise
Partners
Physician Assistant Overview
11
What is a PA?
A physician assistant (PA) is nationally certified and state
licensed to practice medicine as part of a physician-led
team. PAs are educated at the graduate level and practice
in nearly every medical specialty and setting.
What do PAs do?
•
•
•
•
•
•
•
•
Conduct physical exams
Diagnose and treat illnesses
Order and interpret tests
Counsel on preventive healthcare
Assist in surgery
Write prescriptions
Make rounds in nursing homes and hospitals
Obtain medical histories
* PAs’ responsibilities correspond to their supervising physicians’
practice.
12
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
PA Vital Statistics
50
Number of states authorizing
PA prescribing privileges
94,507
Number of certified PAs in 2013,
according to the National Commission on
Certification of Physician Assistants
1967
Year the first three PAs graduated
from Duke University
$90,873
Median annual income from primary employer
for full-time clinically practicing PAs* in 2010.
Projected Growth of PAs in
Clinical Practice
With a projected growth of 39 percent, the
Bureau of Labor Statistics predicts physician
assistants will be the second-fastest-growing
health profession in the next decade (after
home health aides).
83,600
Employment in 2010
108,300
Projected employment in 2020
*Excludes self-employed and part-time PAs
Source: Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2012-13 Edition,
Physician Assistants,
on the Internet at http://www.bls.gov/ooh/healthcare/physician-assistants.htm (visited Dec.20, 2012).
13
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
Growth of the PA Profession
Number of Practicing PAs
The PA profession has doubled
every decade since the 1980s.
Number of Accredited PA programs
180
160
Number of
accredited PA
programs
140
120
Linear
(Number of
accredited PA
programs)
100
80
14
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
60
40
20
0
1967
1969
1971
1973
1976
1981
1986
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
The Association of American
Medical Colleges estimates that
there could be as many as
135,000 PAs by the year 2020.
PA Profession Ranks High in Today’s Economy
Forbes.com ranked physician assistant in its list of best
master’s degrees for jobs three years in a row.
CNNMoney.com ranked PA as number two on its Best Jobs in
America list in 2009 and 2010. The profession continues to
rank high.
U.S. News & World Report ranked the PA profession as one
of the 50 best careers of 2011.
Kiplinger’s named PAs one of the “great careers for your
future.”
“HHS continues to invest in the PA workforce through various
programs, many spearheaded by the Health Resources and
Services Administration. The Affordable Care Act builds on
these efforts through … payment increases to primary care
PAs.” – HHS Secretary Kathleen Sebelius, Oct. 5, 2012
15
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
Clinical Profile
Percent Female: 65%
Median Age: 39.6 years
Percent in Clinical Practice: 91.6%
Percent Who Work More Than One Clinical Job Concurrently: 19.0%
Median Number of Years in Clinical Practice: 7.0 years
Median Number of Years in Current Primary Specialty: 4.0 years
Primary Clinical
Specialty Unknown
Pediatric
specialties
2%
Internal
medicine
specialties
11%
Emergency
medicine
11%
Other
specialties
17%
16
Most Common Practice
SingleSettings
specialty
4%
Primary care
29%
Surgical
specialties
26%
Other setting
28%
Hospital
operating
room
6%
Outpatient unit
of hospital
8% Multispecialty
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
physician
group practice
8%
physician
group practice
17%
Inpatient
unit of
hospital
11%
Solo practice
physician
Hospital office
emergency 11%
room
11%
Addressing Health Disparities & Underserved Populations
17
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
17
Practice Profile
94,000 Practicing PAs
18
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
Multiple settings, multiple population segments,
multiple team members
Frail
Hospital
Drug Abuse
MD
PA
Nurse
Private Practice
ACO
Urgent Care Clinics
Complex
Disease
Children
Preventive Services
NP
Pharm
High Risk
Rural Practice
Retail
Integrated Health Care
System
MT
PT
Psych
Tele-health
Healthy
Acute
Chronic
19
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
Wellness Programs
How One Becomes a PA
• There are 176 accredited PA
educational programs in the United
States.
• Most PA programs award a master’s
degree.
• PAs are required to complete:
• More than 400 hours in basic
sciences
• 75 hours in pharmacology
• 175 hours in behavioral sciences
• Nearly 580 hours of clinical
medicine
• The average length of a PA program
is 27 months long.
20
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
After Graduation
21
•
PAs are required to pass a national certifying
examination administered by the National
Commission on Certification of Physician
Assistants.
•
PAs must earn and log 100 hours of
continuing medical education every two years.
•
PAs must take a recertification examination
every six years (every 10 years starting in
2014).
•
To be able to practice, PAs must have a state
license and work with a physician.
•
The current six-year time period between
recertification exams will be extended to 10
years to better reflect PA competence in
practice.
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
PA Utilization
22
Demand is high for PAs, but not all health
systems use them efficiently.
Shifting to a value-based, outcomescentric health delivery model is more
than using terms such as integrated
delivery model or forming an ACO.
True integration calls for all healthcare
professionals being able to function at the
top of their license.
Ongoing research & data analysis
continue to prove the economic &
clinical outcome value of PAs.
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
PAs
Positioned
Well for the
Future
The landmark Patient Protection and Affordable Care Act, which
has implications across every health delivery setting, includes
specific provisions for PAs.
U.S. faces an insufficient number of physicians, with projections
indicating that supply will be unable to keep pace with demand; by
2025, a shortage of 124,000 primary care physicians is
anticipated.
A component of the law identifies PAs as necessary to help
mitigate the expected doctor shortage.
The language specifies support for PA education in primary care,
and fully integrates PAs in the new Independence at Home
demonstration project.
Cost bonus incentives for PA use in the primary care setting with
certain Medicare codes from 2011-2015.
23
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
PAs in
Value-Based
Healthcare
24
More than four decades of research are
available:
• PAs substitute for doctors at approximately
85% of the range of primary care tasks
• PAs produce approximately 2.4 times their
salary in revenue
• PAs are equally productive in outpatient
visits
• Opportunity cost of producing a PA is
approximately 20% of a doctor
• PA produces approximately 5 years of
healthcare services to society before a
doctor is functioning independently from
postgraduate training
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
PAs in Consumer-Centric Care
Outlook for traditional players in a valuebased population management ecosystem
Inpatient
Outpatient
Emergency Department
Retail
Primary care offices
Diagnostics
Specialty care offices
Ambulatory center
LTC facilities
Behavioral health
Home healthcare
Source: Oliver Wyman
25
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
PAs Expanding Access to Care
• . . . “with an aging population and more chronic disease, the medical
profession needs all the help it can get,” says Dr. J. Lloyd Michener,
professor and chairman of the department of community and family
medicine at Duke. “PAs are a critical member of the health team.
2011
http://www.foxbusiness.com/personal-finance/2011/01/21/pas-play-pivotal-role-health-carereform/#ixzz2YfM6Y6CZ
• Approximately 10 percent of physicians practice in rural areas, where
approximately 20 percent of the U.S. population lives. Rural residents
are also limited by lack of transportation, extreme weather, social
isolation and poverty. Therefore, access to care is a major concern in
most rural areas. Fortunately, PAs are helping to extend care to areas
most in need: About 17 percent of PAs practice in rural areas.
AAPA 2011
26
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
Coordinating Care and Saving Health Care Dollars
PA Home Visit Program Reduces Hospital Readmissions
• PAs made house calls on days 2 and 5 following hospital discharge
• Study followed 26 months of readmissions
• 30-day readmissions were reduced by 25% for patients receiving PA
home visits
• Most common intervention: medication adjustments – diuretic agents,
meds for hypoglycemia, and antibiotics.
27
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
PAs in New Health Delivery Models
Take Care Clinics Expand Scope of Health Care Services to Include
Chronic Condition Management and Additional Preventive Health
Offerings
DEERFIELD, Ill., April 4, 2013 - Access to health care services is an
ongoing challenge to the U.S. health care system. With a physician
shortage, aging population, a growing prevalence of chronic diseases
and up to 30 million people projected to gain insurance coverage in 2014
through the Affordable Care Act, the issue will become even more critical
– and may further impact both patients and the health care system at
large…. Take Care’s board-certified nurse practitioners and physician
assistants deliver patient-centric care, driving patient satisfaction rates
that are consistently greater than 90 percent.
28
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
About AAPA
Vision
PAs transforming health
through patientcentered, team-based
care.
Mission
Providing innovative
solutions that empower
our members to
connect, enhance their
careers and improve
patient health.
29
Founded in 1968, AAPA is the national professional society
for physician assistants.
AAPA represents a profession of more than 94,000 certified
PAs. Approximately 47,000 PAs are members of AAPA,
including 10,400 students.
The Academy educates the general public about the PA
profession, ensures competency of PAs through active
involvement in the accreditation of PA programs, provides
continuing education & conducts PA-related research.
AAPA works in cooperation with its sister organizations:
NCCPA – certifying body for PAs
PAEA – PA academic educational programs
ARC-PA – educational accrediting body
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
About the Physician Assistant Foundation
The Physician Assistant Foundation is the
philanthropic arm of the American Academy of
Physician Assistants.
Foundation Initiatives
• Student Scholarships
• Caring for Communities Award
• Innovations in Health Care
• Community-based Project Grants
• Research Fellowship
• Leadership Development
• Health Policy Fellowships
• Global Outreach
• Matching Grants
• Pre-PA Minority Student Scholarships
30
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
Effective and Productive Partnerships
31
50 State Chapters & DC Chapter
5 Federal Service Chapters
17 Special Interest Groups & 8
Caucuses
25 Specialty Organizations
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
Collaborative Relationships
Physician organizations: AAFP,ACP,
AAP, AMA, SHM, AAOS, AAO-HNS, AOA,
ACS
Nursing: advanced practice nurses,
ANA, ACNP-AANP
Health Systems & Payers: Johns
Hopkins, Cleveland Clinic, Geisinger,
United, Aetna
Retail: CVS MinuteClinic, Walgreens
Take Care Clinic, RiteAid NowClinic
Government agencies: HHS, CMS,
CDC, DOL, VA, OIG
32
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
Professional organizations (AMGA,
NGA) as well as patient & disease
groups
2012 - Unprecedented Year: .
40 States Made PA-Positive Changes to State Law
State made PA-positive
changes to law in last 12
months
No positive change in
State law in last 12 months
33
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
AAPA & PAF Strategic Commitments
To the Profession
Foster PA Excellence –
through integrated professional
development & coordinated
advocacy
Optimize PA Practice –
identify, evaluate & promote
best practice models that
increase PA impact on health,
maximize PA value & enhance
PA satisfaction
To Members
Create & Deliver Value
Offer an Essential Digital
“Home”
Be Fiscally Responsible &
Transparent
Grow the PA Profession –
elevate PA roles, recognition &
respect and support increasing
the number & diversity of PAs
34
This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.
To Staff & Volunteers
Provide Meaningful
Volunteer Opportunities
Make AAPA a Great Place to
Work
For more information please contact:
Lisa Gables
Executive Director – PA Foundation
Chief Development Officer - AAPA
Phone: 571.319.4502
Email: lgables@aapa.org
Or visit our website at www.aapa.org