What is CARES?
CARES stands for Collaboration And Rural Expansion of Services. The CARES Act has been drafted by the Wisconsin Academy of PAs (WAPA) and includes input from Wisconsin physician assistants (PAs), physicians, health care administrators and other stakeholders. It serves as a comprehensive update to PA legislation, which has seen little change since 1976.
What is WAPA trying to accomplish?
WAPA's goal is to ensure that the PA profession is prepared to meet Wisconsin's ongoing healthcare access needs and to protect our collaborative relationship with our physician partners in today's changing healthcare market. We are looking to do what is right for Wisconsin's healthcare needs by proposing common sense solutions to struggles that administrators, PAs, and our physician partners face daily due to outdated practice laws that don't match today's clinical reality. We want to see decisions about how healthcare is provided moved back to the practice level so that PA and physician teams can remain flexible enough to respond to local health care needs.
What are some of the practice barriers PAs are considering and why?
The changes that Wisconsin PAs are considering have already been enacted in other states or have been adopted by the Veterans Administration and the Uniformed Services. Specifically, in the Midwest, North Dakota, Illinois, Minnesota, Michigan and Indiana have recently enacted similar laws to remove barriers to PA practice. Within Wisconsin, nurse practitioners (NPs), who fill a similar health care role as PAs, do not face any of these same barriers.
Below is a summary of the goals of the CARES Act:
Update Physician/PA relationship from “supervision” to “collaboration”
· Serves as a more accurate description of current practice and would not change daily practice
· Eliminates many current administrative burdens that do not increase patient safety
Eliminate language that implies physician liability for PA care
· Ensures that the physician/PA relationship is sustainable into the future
· Has been cited as reason NPs are hired preferentially over PAs in many areas
Scope of practice determined by PA’s individual education, training, and experience
· Ensures PAs can continue to provide the care they are trained to give despite changes in coworkers
· Continues to use established practices such as credentialing and privileging in determining scope
Eliminate ratio requirements to increase flexibility at practice level
· Allows more PAs to move into traditionally underserved areas of WI
· As an arbitrary number, the ratio has not been demonstrated to improve patient safety
· Allows these decisions to be made by those who know their staff best
Authorize PAs to participate in disaster/volunteer activities without specific physician collaboration but within a PA’s scope
· Allows WI to maximize its use of highly trained health professions in these settings
· Removes delays in care due to paperwork so PAs can help when it’s needed most
Allow PAs to self-govern their profession
· Update the relationship with WI Medical Examining Board
· Ensures that those most knowledgeable about the profession are involved in its regulation
· Prevents ongoing stagnation of laws/regulations of the profession
· Parity with other health care professions including NPs, PT/OT, pharmacists, others
Allow PAs to be self-employed
· Self-employment is not synonymous with independence
· A collaborative relationship would be maintained
Allow recognition of federal supremacy for PAs employed by the VA and Uniformed Services
· Eliminates conflict between State law and Federal prescribing authority
Direct reimbursement by third party payors (except Medicare*)
· PAs are the only health care profession not uniformly reimbursed by third party payors
· Cited as reason for PAs not being allowed to manage their own panel of patients
· Cited as reason for preferentially hiring NPs
*AAPA is currently working towards direct reimbursement for PAs under Medicare
What are PAs not considering?
PAs practice on a healthcare team and value their relationship with physicians. Wisconsin PAs are not seeking independent practice. We value our physician partners and want to be part of the solution to the provider shortage. WAPA believes that WI will be in a better position to attract the physicians it needs if its advanced practice workforce is working to the top of license and creating an environment where physicians have the partners in care that they need.
Wisconsin PAs are not pursuing mandates on providers, plans or healthcare organizations (like hospitals). In fact, PAs believe that decision-making should be made at the practice setting.
How are PAs looking to solve the provider shortage problem?
An August 2016 report from the Wisconsin Council on Medical Education and Workforce (WCMEW) warns that Wisconsin may face a shortage of more than 2,000 physicians by 2030. PAs like other healthcare professionals are concerned with this and other healthcare provider shortages - especially in rural areas of the state.
PAs believe that laws governing PAs should be evidenced-based, allow PAs to practice up to the appropriate limits of their training and educations, and don’t undermine the ability of PAs to provide the services they are qualified to provide, particularly in rural Wisconsin.
Enacting best practices and updating Wisconsin law has the potential to:
- Increase patient access to care;
- Decrease costs and burdens on Wisconsin’s healthcare system; and
- Eliminate barriers for PAs to provide service in rural and other underserved areas.
Many current PA laws were created in the 1960s and 1970s when the PA profession was created to address healthcare shortages - especially in rural areas. Many studies demonstrate that PAs provide high-quality care and that PAs are a safe provider. PAs have an extremely low medical malpractice rate and discipline rate.
Where are PAs in the process?
WAPA began this journey by surveying PAs across the state. We asked what challenges they face and what changes they support. The response was overwhelming: Wisconsin PAs are facing barriers to providing care and need our laws to change!
Since then, WAPA has been reaching out to stakeholder groups including the Wisconsin Medical Society, Wisconsin Hospital Association, and healthcare systems as well as public policymakers for feedback and advice on solutions to meet the healthcare shortage - especially in the rural areas of the state.
Based on that feedback, WAPA has developed CARES. We believe this legislation will immediately remove costly regulatory burdens, increase the health care provider pool, and, most importantly, allow PAs to more easily provide medical services to Wisconsin patients.
What can PAs do?
This is one of the largest modernization efforts of a state PA law in Wisconsin. Building an effective coalition will be critical. PAs should:
- Introduce themselves to their legislators and invite them to tour their practice setting.
- Ask their physician colleagues for feedback and advice on the barriers and solutions PAs are considering - encourage them to contact their professional organizations to express their concerns.
- Encourage their employer to support eliminating practice barriers by contacting their professional organization and encouraging active support.
WAPA is dedicated to a collaborative process for PA law modernization and we welcome any and all feedback! Please contact us today at: info@WAPA.org.
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