Updating Wisconsin’s PA laws is crucial to maintaining a quality, cost-effective medical workforce to care for patients in all areas of the state. Please visit the action center at WisCARES.org -- do not wait!
The Problem: There are practice barriers for PAs in Wisconsin
According to the US Bureau of Labor Statistics, employment of PAs is projected to grow 37 percent from 2016 to 2026, much faster than the average for all occupations. Wisconsin is projected to face a major statewide primary care physician shortfall by 2035. Advanced practice clinicians like physician assistants (PAs) are crucial in maintaining and increasing access to primary care, especially in underserved rural areas of the state.
According to the NCCPA, the PA workforce is also in high demand due to: growing interest outside primary care; new technology like telehealth and virtual visits; increasing needs in mental health care, hospice care and palliative care; and, increasing leadership opportunities for PAs in hospital ranks.
But Wisconsin is falling behind. Nearby, Minnesota, Michigan, Illinois, and Indiana have recently enacted modernized PA laws and over a dozen states will consider bills in 2019.
About the CARES Act
We are working with lawmakers to introduce the CARES Act to maintain and increase access to high quality medical care for Wisconsin patients by reducing workforce barriers for physician assistants (PAs). The CARES Act provides necessary updates to Wisconsin’s PA laws to allow PAs to work to the full potential of their education, experience and training and to provide quality care to those who need it.
In drafting this bill, we have worked closely with other stakeholders, like the American Academy of PAs and the Wisconsin Hospital Association, both which support the legislation.
Update, September 19, 2019: Currently, the bill has been received by the Wisconsin Legislative Reference Bureau and we are collecting bipartisan co-sponsors through October 4. Full bill text for the CARES Act (LRB-0196 and LRB 4354 ) can be found here with the accompanying memo for lawmakers.
The CARES Act would change the following things:
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
Stop: Fact check!
PAs practice on healthcare teams and value their relationship with physicians. Wisconsin PAs are not seeking independent practice. WAPA believes that Wisconsin will be in a better position to attract the physicians it needs if its advanced practice workforce is working to the top of their licenses' 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.
What are PAs in Wisconsin 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.
The Wisconsin Council on Medical Education and Workforce warns that there is a projected shortfall of 745 FTE Primary Care Physicians, or 14% compared to overall supply. However, some regions will see shortages of up to 93.7%. 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.
What can I do to help?
This is one of the largest modernization efforts of a state PA law in Wisconsin. Building an effective coalition will be critical. PAs should:
Looking for more information? Please check out our resources page.