This is a landmark year in the physician assistant profession, with key legislation in effect beginning Jan. 1, 2008. These changes will increase access to health care, speed up health care delivery, and help PAs work more efficiently, according to those in the profession.
The most significant piece of legislation that went into effect Jan. 1 was Assembly Bill 3, which consists of four parts. Under AB 3, a physician can now supervise four PAs at a time rather than two. AB 3 lessens the restrictions for PAs when writing a drug order for controlled substances, lessens the amount of charts a physician would need to sign for a PA working under protocols and allows PAs to bill Medi-Cal for patient procedures that were previously not covered.
The changes allow more patients to have access to health care in a timely manner, said Roy Guizado, MS, PA-C, chair of the Department of Physician Assistant Education, which is part of the College of Allied Health Professions at Western University of Health Sciences in Pomona, Calif.
“It’s a mechanism to decrease barriers to health care,” he said.
PAs are dependent practitioners but they can have a little more autonomy under these new guidelines, Guizado said. A physician assistant is part of a team, along with the physician, office manager, nurse and other professionals in the office.
“When you have a good team working together, you see more patients and meet their needs,” Guizado said.
Previously, Medi-Cal only reimbursed a specific list of procedures when performed by a PA. With AB 3, all Medi-Cal services covered when performed by a physician are also covered when performed by a PA when it’s within the PA’s scope of practice.
“This helps our office get compensated for all we do,” said Miguel A. Medina, PA-C, instructor in WesternU’s Department of Physician Assistant Education and president-elect of the California Academy of Physician Assistants (CAPA).
Reimbursement issues are important, especially in underserved areas, said Tina Meyer, MS, PA-C, chair of the Department of Health Sciences, part of WesternU’s College of Allied Health Professions, and board member of the Physician Assistant Committee’s AB 3 Task Force, a subcommittee of the California Medical Board.
With PAs receiving Medi-Cal compensation for the work they perform, it helps a physician extend their practice, Meyer said.
The AB 3 Task Force is determining the education standards needed to comply with the portion of the law that deals with drug orders for controlled substances.
AB 3 reduces from 10 percent to 5 percent the minimum number of charts that must be reviewed and signed by the supervising physician within 30 days. The chart co-signature change is an improvement, said Ann Davis, PA-C, director of state government affairs for the American Academy of Physician Assistants.
“More and more states are getting away from chart co-signature requirements,” she said. “The idea is that should be determined at the practice level.”
A physician-PA team just starting to work together or a team in high-acuity health care may want the physician to sign certain charts, Davis said.
All states except 10 have a ratio requirement. But the number is not fixed. Some situations call for a 1-to-1 ratio – such as a PA assisting in surgery – while others can have a larger PA to physician ratio – such as an immunization clinic, Davis said.
Physicians also support AB 3. The California Medical Association’s policy statement on AB 3 reads in part: “This bill makes PA supervision requirements equivalent to those of nurse practitioners and preserves the physician role in health care. This bill provides access while maintaining adequate supervision.”
Other laws in effect Jan. 1, 2008 affecting PAs include Assembly Bill 139 and state Senate Bill 102. AB 139 clarifies an inconsistency in existing law and allows PAs to conduct medical examinations on applicants seeking a license to drive a school bus, youth activity bus, farm labor vehicle and paratransit vehicles. SB 102 allows PAs to inform the potential recipient of a blood transfusion about the positive and negative aspects of receiving autologous blood and directed and nondirected homologous blood from volunteers, according to CAPA.
California is a good place for PAs, Davis said.
“California PA programs have seen it as a mission to put PAs into underserved areas, so legislative initiatives have always been in concert with that mission,” Davis said. “It’s really helped legislators see PAs as part of the solution in reaching out to underserved populations.”
All of these provisions touch on issues that the physician and the PA work out as a team, Medina said. These rules are not moving the profession toward a break from physicians.
“Both the state and national organizations never advocated for independence,” Medina said. “We’re trying to make the working environment more efficient and increase access.”
A supervising physician will still sit down with their PA to determine what tasks to delegate to that PA, Meyer said.
“Supervision has not gone away,” she said. “It’s changed in the day-to-day timing.”