TESTIMONY
House Healthcare Efficiencies Study Committee
Wednesday, September 16, 2015
Josanne K. Pagel MPAS, PA-C, DFAAPA
Director of Governmental Affairs, Ohio Association of Physician Assistants
Chairman Huffman and members of the House Healthcare Efficiencies Study Committee,
thank you for the opportunity to present testimony about the work of physician assistants,
especially as it relates to serving our Medicaid and aging populations.
My name is Josanne Pagel and I am the Director of Governmental Affairs for the Ohio
Association of Physician Assistants (PAs). I am also the Executive Director of PA Services at
Cleveland Clinic, Clinical Associate Professor in the Division of General Medical Sciences for
Medical Education and Clinical Director of Professional Development at Case Western
Reserves’ Inaugural PA Program.
By the end of this year, Cleveland Clinic will employ almost 500 PAs within its Health
System. We are the largest employer of PAs within Ohio and one of the largest in the U.S. I
also represent PAs nationally as President Elect on the Board of Directors for the American
Academy of PAs. Nationally, there are approximately 104,000 certified PAs. Employment of
PAs is projected to increase 38.4% between 2012 and 2022 much faster than the average for all
occupations, according to the U.S. Bureau of Labor Statistics. PAs write 50-100 prescriptions
per week and see on average, 60 patients per week dependent upon the setting. Almost 30% of
PAs practice in primary care settings.
Background
Physician Assistants work throughout the State of Ohio as important members of
healthcare teams with physicians and other providers, such as APRNs, RNs, LPNs, and Medical
Assistants. PAs provide critical front-line healthcare services by assessing, diagnosing, treating,
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prescribing and educating patients. PAs work in diverse setting across Ohio including hospitals,
emergency and critical care departments, surgical specialty practices, cancer centers, family
medicine practices, osteopathic practices, rural clinics and large integrated health systems.
Recently, the legislature passed SB 110 which greatly enhances PA practice within Ohio.
On Oct. 15, 2015, this bill becomes law. PAs will be able to apply for a license to practice and
prescribe in one application. Physician will no longer have a restrictive 60 minute clause for
supervising a PA due to the vast availability of media networking. And the required supervision
agreement between a physician and PA will now be filed with the State Medical Board instead of
approved which expedites the working start date of the PA with the physician or group practice.
This supervision agreement outlines what the PA may do (by law) and any controls the
supervising physician wishes to place on the PAs practice.
Ohio law identifies PAs as team-
based providers, who are supervised and controlled by the physician. This supervision may be
direct, as in first assisting in the OR, indirect as in another room or area of the practice, or offsite. Under current law, a physician may supervise 2 PAs at one time. This number will increase
to 3 in October. Furthermore, the PA’s scope of practice is directly tied to the scope of his or her
supervising physician.
Presently, Ohio has 11 accredited PA programs, all accredited by one body, the ARC-PA.
By 2017 there may be two additional accredited PA programs in Ohio, Case Western Reserve,
(opening in 2016) and St. Josephs (opening 2017) bringing our total to 13 programs. In Ohio, by
law, all PA programs must be Master Degree programs. A number of these PA programs are
situated within underserved areas: Mt. Union in Alliance, Marietta University on the Ohio River,
Findlay Univ. in the Northwestern part of the state and Ohio University in Athens (Campus in
Dublin). Other Ohio PA programs include: Tri-C/CSU in Cleveland, Lake Erie College in
Painsville, Baldwin Wallace in Berea, Ohio Dominican Univ. in Columbus, Univ. of Toledo,
Dayton Univ., and Kettering College. Upon graduation, PAs must sit for a national certification
test and recertify every 10 years and are subject to a rigorous set of continuing education
requirements of any profession. The PA CME format is almost identical to that of boardcertified physicians. There are 196 PA programs throughout the U.S., graduating about 8,900
new PAs each year.
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PA programs are full time study with an average of 27 months of rigorous curriculum.
They all provide advanced coursework in pharmacology equal to or greater than that which is
offered in medical schools. And the students complete a full year of clinical site rotations
including but not limited to: family medicine, internal medicine, emergency medicine,
psychiatry, women’s health, surgery and pediatrics. Competition to get a seat within a PA
program is as fierce as getting into medical school. Every program receives over 800 applicants
each year for about 30-50 seats.
As you heard from panelists last week, more than one million Ohioans live in a health
professional shortage area. To meet the growing need for care, Ohio needs to continue bringing
primary health care providers into the workforce. It is critically important that the state continue
to support graduate medical education to ensure these needs are met. Like physicians, most PA
students graduate with debt – often over $100,000 – and many gravitate to higher paying
specialty positions in order to pay off that debt. State support of medical education will help
ensure that health care professionals can not only afford to enter the medical field, but that career
choices are not limited by the need to pay off student loans.
As I have mentioned, we recently worked with the Ohio General Assembly on the
passage of S.B. 110, to modernize the PA sections of Ohio Revised Code and streamline some
administrative processes to make it easier for physicians to hire and work with physician
assistants. This bill goes into effect on October 15, and we are grateful to you and your
colleagues for your support of this legislation.
PAs and Medicaid and Aging Populations
PAs serve a vital role in providing care to aging Ohioans. With an ever-growing
percentage of our population in the 65-and-over age group and life expectancies increasing, we
will continue to need healthcare professionals to provide services to our elderly populations. PAs
are well-suited to help fill this gap as they increase provider coverage while providing high
quality and cost-efficient care.
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A 1998 study, published in the Journal of the American Geriatric Society, showed that
utilizing physician assistants to provide comprehensive medical care in a nursing home resulted
in a 68.8% decrease in hospital days and a 19.7% decrease in Medicare expenditures. In fact,
utilization of a PA led to an average Medicare savings of an average of $800 per bed per year. 1
With the passage of SB 110, PAs will be able to fill the need within nursing home settings in
Ohio which in the past have been restrictive with our old laws. This enables more providers to
work with our aging population and serve their healthcare needs.
Physician Assistant programs in Ohio are doing their part to prepare our PAs for this
work, with several programs offering opportunities for students gain clinical experience in
geriatric care facilities, nursing homes, hospice centers, and other areas where students can
interact with aging patients.
Geriatrics is becoming a CORE requirement for many PA
programs. And nursing homes are a perfect site for the early clinical experience for our first year
PA students.
Physician Assistants also provide Medicaid beneficiaries with health care services in all
50 states and the District of Columbia. PAs provide quality medical care to these individuals, and
studies have shown that there is little difference in the level of patient satisfaction when care is
provided by a PA as opposed to a physician and that quality of care is equivalent to that provided
by physicians when PAs are practicing within the scope of their education and training.
In addition to providing high quality care, PAs also provide cost-effective care for
Medicaid patients. All 50 states cover medical services provided by PAs under their Medicaid
fee-for-service or Medicaid managed care programs. These rates are generally either the same as
or slightly lower than that paid to physicians.
In Ohio, PAs help expand the reach of our healthcare system, by providing access to care
for patients in underserved areas. This ability was enhanced in S.B. 110, which removed a
1
Ackermann RJ, Kemle KA. The effect of a physician assistant on the hospitalization of nursing home residents. J
Am Geriatr Soc. 1998;46(5):610-614.
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restrictive 60-minute limitation that required a physician to be within 60 minutes of a practicing
PA. With the enhancement of technology, this requirement was obsolete, and will be replaced in
law with a reasonable distance requirement. Today, PAs and physicians can stay in touch
through telemedicine, video conferencing, face time, Skype and other modalities to ensure
constant clear communication that complies with HIPAA guidelines. I myself facilitate clinics at
the Lorain County Free Clinic on a monthly basis. For those folks who have no insurance this is
their “healthcare lifeline”.
In addition, the bill increased the number of PAs that can be supervised by a physician at
one time from two to three. Allowing a physician to supervise up to three PAs at one time,
enables the physician to expand access to patients, decrease wait times for appointments and
allow more patients to be seen rapidly. With Medicaid expansion and an estimated 275,000
additional patients coming through our offices, this increase in number of supervised PAs is
critical.
We believe these changes will create increased opportunity for PAs to help meet the
growing health care need in Ohio, while still maintaining important safeguards and controls. We
continue to identify barriers within our laws which would impact our ability to give care to our
patients. PAs are critical to creating and sustaining access to quality care for our residents.
Thank you for the opportunity to speak with you today. I would be happy to answer any
questions the Committee may have.
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