1 PAs and Provisions of Health Reform What does it Mean to You? Presentation to the South Dakota Academy of Physician Assistants March 7, 2013 Liz Roe, Director, Constituent t Organization Outreach and Advocacy
2 Agenda Overview of the federal Affordable Care Act Implications for the PA Profession How this impacts state laws pertaining to PA practice What do we do next? And a few more items...
3 AAPA s Principles for Health Care Reform Use of evidence-based medicine Physician-directed teams Optimal utilization of primary care Health promotion and disease prevention Quality, affordable cost-effective health care Comparative-effectiveness information
5 Patient Protection and Affordable Care Act Public Law Signed into law March 23, W-111publ148/pdf/PLAW- p 111publ148.pdf
6 The Congressional Budget Office estimates that the combined legislation will cost $938 billion and will reduce the deficit by $143 billion over 10 years. The new law is expected to reduce the number of uninsured Americans by 32 million by 2019.
7 The new law requires that most uninsured individuals purchase health insurance coverage by 2014 through a health benefit exchange established by each state.
8 Implications for PA Practice Order SNF under Medicare 10% Bonus for Primary Care Codes Increased Support through h the National Health Service Corps Increased Funding for PA Education Loan Repayment for PA Faculty Full Integration of PAs in New Models of Care
9 For Patients Team-Based Primary Care Disease Prevention & Health Promotion Care Coordination
10 For Patients effective now Coverage of Adult Children up to 26 Rx Coverage for Seniors High h Risk Pool for Individuals id with Pre- Existing Conditions Cost-free Preventive Services Choice of Primary Care Provider, OB/GYN, pediatrician Use of nearest ER without penalty
11 For patients effective now Insurers can no longer Deny Coverage to Children with Pre- Existing Conditions Impose Lifetime Benefits Cancel a Policy without Proving Fraud Deny Claims without Appeal
12 In 2014 The plan is to be fully operational State Insurance Exchange Programs offering affordable health insurance coverage Tax penalty imposed on uninsured adults without coverage Fee imposed on large employers who do not offer health insurance coverage.
13 Special implications for rural communities Incentives to Attract Health Care Professionals to Rural Communities Increased Opportunities for PAs in Rural Areas.
14 Accountable Care Organizations Local or regional organizations consisting of health care professionals, typically one or more hospitals and related health care entities that have a formal or informal relationship Jointly responsible (or accountable) for achieving measurable improvements in the quality and cost of health h care delivered d within a given community.
15 Accountable Care Organizations Health care professionals and organizations financial success will be based on patient care outcomes instead of number of services delivered ACOs will have a strong base of primary care professionals, but may also provide a wide range of specialty & ancillary care services.
16 Accountable Care Organizations Expectation is that ACO participants will share information and better coordinate patient t care activities PAs must work to assure that t ACOs use appropriate interdisciplinary models, that recognize the efficiencies of the team approach For the first time, many health care professionals will have to understand and deal with the managing financial risk.
17 Insurance Exchanges Goal is to establish insurance plan options for uninsured individuals Provide a competitive (cost-effective) effective), simplified array of insurance plans for purchase for those who lack health insurance.
18 Insurance Exchanges Fully operational by 2014 Federal government is granting up to $1 million in seed money to each state to start/implement insurance exchanges.
19 Insurance Exchanges What Will Be Covered? US Department of Health & Human Services (HHS) have defined an essential benefit package Released in December 2011 (regs released in 2012) Includes the following services: Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management, and Pediatric services, including oral and vision care
20 Electric Health Record Incentive - Medicare Only physicians qualify for the Medicare EHR incentive $44,000 over 5 years to implement EHR system Must meet meaningful use criteria.
21 EHR Incentive - Medicaid Maximum payment is $63,750 over 6 years (max. of $21,250 in the first year) Special concerns in states where Medicaid does not enroll PAs Office of the National Coordinator will issue a list O ce o t e at o a Coo d ato ssue a st of certified EHR systems.
22 EHR Incentive - Medicaid NPs qualify in all practice settings under Medicaid PAs qualify under Medicaid only in Rural Health Clinics and FQHCs AAPA has had legislation introduced (Rep. Karen Bass, D-CA) in an attempt broaden PA eligibility under Medicaid 30% f ti t i t b M di id b fi i i t 30% of patient mix must be Medicaid beneficiaries to qualify for Medicaid incentive
23 Implications for the PA Profession Recognition Incentive and Momentum to Remove Federal and State Barriers to the Quality Care Provided by PAs Success Generates Success on Capitol Hill
24 It All Starts and Ends with Advocacy If You re Not at the Table, You re on the Menu!
25 PAs are key to implementation, But Only If Increase Support for PA Education to Grow the PA Workforce Eliminate Barriers to Care Existing in Federal Law and Regulations Fully Integrate t PAs in New Models of Care State Laws allow full utilization of PAs Reimbursement systems cover PAs
26 Some PA Fast Facts There are 81,000 PAs currently in clinical practice with nearly 6,000 entering the workforce each year PAs account for: more than 307+ million patient visits per year more than 264+ million prescriptions i per year hundreds of millions of recommendations for OTC products Source: AAPA 2010 Annual Conference Survey & 2008 Census
27 Health Care Reform Implication for the PAP Profession As more and more health care consumers or patients enter our health care system, there will be an even greater acknowledgement of the role of PAs and a greater incentive to remove current barriers to care provided by PAs in federal and state legislation. This creates real opportunity.
28 State Advocacy Agenda The Six Key Elements of a Modern PA Law Full prescriptive authority Licensure as the regulatory term Scope of practice determined d at the practice No ratio restriction No co-signature requirement in law Adaptable supervision requirements
29 Number of Key Elements Included in State PA Law January 2013 RI DE DC One Key Element Two Key Elements Three Key Elements Four Key Elements Five Key Elements Six Key Elements
30 States Making Improvements in the Six Key Elements Since May 2009 RI DE DC No Improvements to 6KEs since May 2009 Made a definitive improvement to at least one 9/11 of the Six Key Elements since May 2009
31 States Making Improvements to PA Laws & Regulations Since May 2009 RI DE DC No legislative or regulatory improvement since May 2009 Made one or more definitive improvements to PA laws or 9/11 regulations since May 2009
32 Where does SD Stack Up? South Dakota meets 5 of the six key elements: Key not met: Licensure Scope of Practice Distance Limitations Co-Signature Supervision Ratio
33 Ratio Law 36-4A Modification of method and frequency of supervision-- Number of physician assistants--application. A supervising physician may apply ppy to the board for permission to supervise more than one physician assistant. The board shall establish the number of physician assistants, up to four FTE, to be supervised by a supervising physician based upon its finding that adequate supervision will exist under the arrangement proposed by the supervising physician.
34 How is South Dakota Doing? In 2010, a study was conducted which reviewed the number of the Six Key Elements of a Modern PA Practice Law in comparison to the number of practicing i PAs in a state SD was ranked #2 in the number of PAs per 10, individuals (by population) 4.9 PAs per 10,000 Ranked 20 th in the nation of the percentage of counties lacking a PA (15.2%) *source: JAAPA September 2010
35 What does this tell us? PAs educated in South Dakota stay here While laws and regulations governing PA practice are good to great, SD PAs must remain vigilant, il looking outside the practice act to assure laws are allowing PAs to fully participate i t in care.
36 In addition Nominate PAs to State Health Commission, State Health Workforce Commission Look for opportunities to support PA Education Review legislation for opportunities to promote PAs Remove state law practice barriers Review the exchange products for inclusion of PAs and reimbursement of care provided by PAs Ensure full integration of PAs in new models of care.
37 It All Starts and Ends with Advocacy Our professional organizations are the voice, but we are the megaphone. Stephane VanderMeulan, MPAS, PA-C
38 Federal Advocacy Update
39 112 th Congress Approx. 220 laws were passed by the 112 th Congress vs. over 700 laws passed by the 100 th Congress. Must-pass legislation, (farm bill, postal reform, hurricane relief, cyber security protections) failed to make it out of the 112 th Congress.
40 PA Issues in 112 th Congress Stalled : bipartisan bills designed to increase access to and continuity of the quality medical care provided by PAs - PA Hospice, Ordering Home Health Care, Federal Workers Compensation, Medicaid Coverage, and EHR Incentive Payments, etc. Passed: one year patch to Medicare s SGR, averting a 27.5 percent decrease in Medicare reimbursements.
41 AAPA Priorities: 113 th Congress Reintroduction of PA bills from 112 th: - Allowing PAs to provide care to patients who elect to receive Hospice through Medicare. - Allowing PAs to order home health care for Medicare patients - Including PAs in the Medicaid financial incentive program for Electronic Health Records. - Including PAs as providers in the Federal Employees Compensation Act. Appropriations: Preserve funding for PA Programs through Title VII Health Professions Grants
42 Increasing Medicare Transparency Through legislative and regulatory efforts, AAPA aims to: Fully enroll PAs in Medicare and Medicaid Change the current culture of billing PA care through physician Improve ability to track and compare the effectiveness, quality, and value of PA practice and prescriptive patterns Update Medicare payment policy to treat PA reimbursement the same as other medical providers, allowing PA-owned clinics to be assigned an NPI number.
43 Improving Care in Rural Communities AAPA supports the Strengthening Rural Access to Emergency Services Act (S. 328), introduced by Sen. John Thune (R- SD), to improve access to emergency services in rural and medically underserved areas.
44 We re From the Academy and dw We re Here to Help
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