Updating PA Practice Laws May Improve Rural Healthcare Access

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Improving PA reimbursement and removing practice restrictions could increase rural healthcare access and fill clinical vacancies.

May 10, 2018 - Physician assistants (PAs) have the potential to help combat the shortage of physicians in rural communities and improve patient access to healthcare, the National Rural Health Association (NRHA) stated in a recent policy brief.

However, the reimbursement policies and practice restrictions that govern PA practice must change to support new care team designs.

The number of physicians practicing in rural areas has been steadily declining for decades, says the NRHA. While 20 percent of the US population is rural, only 11 percent of physicians practice in these settings.

As physicians have increasingly moved into more urban areas, the health of rural populations has only gotten worse. Rural populations are also expected to grow in both age and number in the coming years, a trend that will widen the care gap that exists in these communities.

PAs could provide a promising solution to this issue. PAs are one of three professions delivering primary care in the US, and they are a growing force in the healthcare industry. NRHA pointed out that the PA profession has doubled every decade since the 1980s, reaching 115,500 members in 2017. Fifteen percent of PAs currently practice in rural or frontier counties.

PAs also receive a broad medical education that allows them to perform numerous care services in rural practices, including nursing home and hospital visits, emergency and urgent care, and office procedures.

Despite the many capabilities of PAs, new and developing models of care don’t always fully recognize PAs, which can reduce the benefits they could bring to rural settings, NRHA wrote.

For example, PAs are the only providers who are restricted from directly receiving payment for the care they deliver to Medicare beneficiaries.

Medicare also requires physician co-signatures on certain services delivered by PAs, including inpatient hospital admissions and discharges. This requirement can obscure accountability and cause delays in patient care.

NRHA recommended that Medicare reimbursement structures treat PA-provided services the same as those delivered by other Medicare providers.

The organization also called for payers to adopt standards of accountability and transparency by identifying PAs in claims when these professionals perform services for patients.

NRHA stated that reimbursement for mental health services delivered by PAs must improve as well.

Rural communities have a great need for mental health services. NRHA said that only about 1000 PAs practice with psychiatrists nationwide, and the most significant barrier to PAs partnering with psychiatrists is lack of third-party payment.

While Medicare does include PAs among the health professionals who can provide mental health treatment, NRHA said that many private behavioral health payers do not recognize or reimburse PAs.

Recognizing or reimbursing PAs for performing mental health services may increase the number of PAs practicing with psychiatrists, which in turn may improve the availability of these services in rural settings.

In addition to payment models, NRHA stated that state and federal policies present a barrier for PAs and can prevent them from practicing to the full extent of their experience and education.

For example, Medicare does not permit PAs to certify the need for hospice care or home health services, and Medicare law requires that PAs practice under the supervision of a physician.

NRHA stated that these policies should be repealed. Allowing PAs to certify the need for hospice or home health services will eliminate the need for physician certification, which will save time and reduce costs.

Additionally, permitting PAs to practice without the supervision of a physician could encourage greater inclusion in team-based care innovations.

NRHA stressed that if changes are made to current PA practice laws, these healthcare professionals can offer even more value to rural populations.

“NRHA’s goal in the US healthcare delivery system of the future is to ensure access to quality health care for all rural residents,” the organization wrote.

“Modernizing of regulations restricting practice privileges, mental health laws and payer policies that unnecessarily restrict PA practice will enable PAs to more efficiently contribute to ending the shortage of health care professionals accessible to rural patients and communities.”

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