pas transforming health through patient-centered, team-based medical practice

PAs transforming health throughpatient-centered, team-basedmedical practice

2

1 Healthcare Landscape

3 AAPA & PA Foundation Overview

Agenda

2

Physician Assistant Overview

This document is the property of AAPA & PAF. Do not reproduce or disseminate without expressed permission from AAPA & PAF.3

Changing U.S. Healthcare Landscape

New competitive structures – industry consolidation, vertical integration & new entrants.

Accelerating reforms at the national & state levels.

Consumer-centric healthcare markets.

Shift from fee-for-service to fee-for-value healthcare delivery model.


Market & Government Driving Reform

On the Rise

Medicare and Medicaid spending is now at 21% of the federal budget.

Expectations are it will rise to 25% in the next few years.

Disturbing Trend

48 million uninsured today… projected to grow to 55 million.

Of the 48 million, 80% are citizens of the U.S.; approximately 8 million are currently covered by Medicaid.

Uninsured are twice as likely to be unhealthy and over 30% have a chronic condition.

How We Stack Up

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.

Current healthcare expenditures are 18% of GDP and are expected to rise to 20%.

Spending UninsuredGDP

Source: World Health Organization Source: Kaiser Family Foundation Source: Kaiser Family Foundation


The Solution: Patient Protection & Affordable Care Act

Medicaid ExpansionStates that chose to participate will change eligibility for individuals within 133% - 400% of the federal poverty level.

Preventative ServicesCertain preventative services will be considered “essential” and will be offered free of co-pays or deductibles.

Guaranteed Coverage & Individual MandateRequirement that everyone must purchase health insurance (unless otherwise covered) & they have to be issued a policy regardless of rating, pre-existing conditions, or age.

Health Insurance ExchangeStates 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.

Lifetime/Annual Caps BannedHealth insurance providers will no longer be allowed to set financial limits on payouts.

Business Health Insurance TaxCompanies with 50 or more employees with at least 1 full-time employee must provide health insurance or pay fines.


Value-Based Healthcare

Today: Fee-for-Service Future: Fee-for-Value

Transactional Models

Episodic Care Models

Population Care Models

Condition Care Models

Example Model Types

• Dermatologists• Ophthalmologists• Dentists• Etc.

• Orthopaedics• CV Surgery• General/specialty

surgery

• Oncology• Diabetes• Asthma• Chronic/end-

stage renal

• Partial Population• Frail elder• High risk• Poly-chronic

• Full Population• Globally capitated

models• Medicare shared

savings ACO

Source: Oliver Wyman


Accountable Care Organizations – Responsible for the Whole Patient

Healthy Independent Health Risk Factors Early Stage Chronic Complex

ConditionsLate State or Poly-

chronic End of Life

… and for managing clinical risk for all healthcare consumption across ambulatory, acute, post-acute, and other settings.

Hospital OR/ICU

Urgent care

Primary care

Hospital emergency

services

Specialist care

Behavioral health OT/PT

Diagnostic imaging/lab

Skilled nursing

Ambulatory surgical center

Home care

Hospice & palliative


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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?



Shift to Consumer-centric Healthcare Markets

Healthcare today“Complex, fragmented and under performing”

Patient-Centered Care“Team-Based, guided, and coordinated”



CardiologyOrthopedics

CKD

Diabetes Wellness

Frail Elder

Surgical Oncology

Radiation Oncology

Intervention

Open Heart

ED

Cancer

Biometrics

Lifestyle

Coaching Convenience

Retail/ Shopping

Wellness

Minute Clinics

Monitors/ Sensors

Apps

Social Media

Information

Provider Models

Retail/New-Co Models

Payer Models

Risk Assessment

Ancillary products

Goods Network

Risk Financing

Wellness

Minute Clinics

Financial Mgmt.

Coaches

Crowd sourced

tools

Provider Transparency

Provider-Led Manager

Payer-Led Model

Retail-Led Manager

New Delivery Models


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.


PA Vital Statistics

83,600Employment in 2010

108,300Projected employment in 2020

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).

50Number of states authorizing

PA prescribing privileges

94,507Number of certified PAs in 2013,

according to the National Commission on

Certification of Physician Assistants

1967Year the first three PAs graduated

from Duke University

$90,873Median annual income from primary

employer for full-time clinically practicing PAs* in 2010.

*Excludes self-employed and part-time PAsSource: 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).

http://www.bls.gov/ooh/healthcare/physician-assistants.htm


Growth of the PA Profession

1967

1970

1973

1980

1986

1990

1993

1996

1999

2002

2005

2008

2011

020406080

100120140160180

Number of Accredited PA programs

Number of accredited PA programsLinear (Num-ber of accred-ited PA pro-grams)

The PA profession has doubled every decade since the 1980s.

Number of Practicing PAs

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


Clinical ProfilePercent Female: 65%Median Age: 39.6 yearsPercent 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 yearsMedian Number of Years in Current Primary Specialty: 4.0 years

Primary care29%

Surgical specialties26%

Other specialties17%

Emergency medicine11%

Internal medicine specialties

11%

Pediatric specialties2%

Unknown4%

Primary Clinical Specialty

Single-specialty physician group practice

17%Inpatient unit of hospital

11%Solo practice physician of-

fice11%

Hospital emergency room11%

Multispecialty physician group practice

9%

Outpatient unit of hospital8%

Hospital operating room6%

Other setting28%

Most Common Practice Settings


Addressing Health Disparities & Underserved Populations

17


Practice Profile94,000 Practicing PAs


Urgent Care Clinics

Preventive Services

Rural Practice

Retail

Wellness Programs

Hospital

Private Practice

ACO

Integrated Health Care System

Tele-health

Frail

Drug Abuse

High Risk

Acute

Chronic

Healthy

Children

Complex Disease

Multiple settings, multiple population segments, multiple team members

MD

PA

NP

PT

Psych

MT

Pharm

Nurse


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.


After Graduation

• 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.


PA Utilization

Ongoing research & data analysis continue to prove the economic & clinical outcome value of PAs.

Demand is high for PAs, but not all health systems use them efficiently.

True integration calls for all healthcare professionals being able to function at the top of their license.

Shifting to a value-based, outcomes-centric health delivery model is more than using terms such as integrated delivery model or forming an ACO.


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.


PAs in Value-Based Healthcare

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


PAs in Consumer-Centric Care

Outlook for traditional players in a value-based population management ecosystem

Inpatient

Outpatient

Emergency Department

Retail

Primary care offices

Diagnostics

Specialty care offices

Ambulatory center

LTC facilities

Behavioral health

Home healthcare



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.

2011http://www.foxbusiness.com/personal-finance/2011/01/21/pas-play-pivotal-role-health-care-reform/#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

http://www.foxbusiness.com/personal-finance/2011/01/21/pas-play-pivotal-role-health-care-reform/

http://www.foxbusiness.com/personal-finance/2011/01/21/pas-play-pivotal-role-health-care-reform/


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.


PAs in New Health Delivery ModelsTake Care Clinics Expand Scope of Health Care Services to Include Chronic Condition Management and Additional Preventive Health OfferingsDEERFIELD, 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.


About AAPAFounded 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 PAsPAEA – PA academic educational programsARC-PA – educational accrediting body

VisionPAs transforming health

through patient-centered, team-based

care.

MissionProviding innovative

solutions that empower our members to

connect, enhance their careers and improve

patient health.


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


Effective and Productive Partnerships

25 Specialty Organizations

50 State Chapters & DC Chapter

17 Special Interest Groups & 8 Caucuses

5 Federal Service Chapters


Collaborative Relationships

Professional organizations (AMGA, NGA) as well as patient & disease groups

Physician organizations: AAFP,ACP, AAP, AMA, SHM, AAOS, AAO-HNS, AOA, ACS

Government agencies: HHS, CMS, CDC, DOL, VA, OIG

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


.

State made PA-positive changes to law in last 12 months

No positive change in State law in last 12 months

2012 - Unprecedented Year:40 States Made PA-Positive Changes to State Law


AAPA & PAF Strategic Commitments

Create & Deliver Value

Offer an Essential Digital “Home”

Be Fiscally Responsible & Transparent

Provide Meaningful Volunteer Opportunities

Make AAPA a Great Place to Work

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

Grow the PA Profession – elevate PA roles, recognition & respect and support increasing the number & diversity of PAs

To Members To Staff & VolunteersTo the Profession

Lisa GablesExecutive Director – PA FoundationChief Development Officer - AAPA

Phone: 571.319.4502Email: [email protected]

Or visit our website at www.aapa.org

For more information please contact:

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