Appropriate Billing and PA Utilization
I suggest that if a Physician's Assistant sees a patient independently in Fast Track or anywhere else, they should only be able to bill a maximum of 50% of the normal physician fee for that service. (UPDATE: this refers to insurance reimbursement and government programs; in a free market system, I of course believe they should be able to charge whatever the market will bear).
If a PA is directly supervised by a physician and the physician personally evaluates the patient or is physically present during the key portion of a procedure (and documents that fact) then they should be able to bill the full price. Just signing the chart is not sufficient. That is how we are required to supervise residents (some of whom already have their medical licenses and can therefore supervise PAs themselves). The requirements for supervision and documentation should not be less restrictive for PAs than for residents.
If a patient is not receiving the full service of a physician, then they (or their third-party payer) should not have to pay the full charge of a physician service. Because of the difference in training and experience, a physician's assistant does not provide the same level of care that a physician provides, even if the interaction appears to be superficially identical. So they shouldn't command the same fee.
In order to encourage physicians to still utilize and supervise PAs, I suggest reducing the liability of physicians who "supervise" essentially unsupervised PAs. After all, if the doc didn't see the patient, they shouldn't be liable (or only minimally so) for the PA's error. But PAs hardly ever make errors anyway, according to their supporters. When they are responsible for their own errors, I wager they will make even fewer.
If the theoretical numbers presented by Ten/Ten and Shadowfax are correct, a PA who was bringing in $160/hour would still bring in at least $80/hour under my system and still only cost $50/hour, so the physician groups would still make money pimping out their PAs with even less liability. Patients will have cheaper healthcare options, the costs of insurance will decrease, and the failure of the Medicare system will be delayed a bit longer.
Win/win/win. Everybody wins.
If a PA is directly supervised by a physician and the physician personally evaluates the patient or is physically present during the key portion of a procedure (and documents that fact) then they should be able to bill the full price. Just signing the chart is not sufficient. That is how we are required to supervise residents (some of whom already have their medical licenses and can therefore supervise PAs themselves). The requirements for supervision and documentation should not be less restrictive for PAs than for residents.
If a patient is not receiving the full service of a physician, then they (or their third-party payer) should not have to pay the full charge of a physician service. Because of the difference in training and experience, a physician's assistant does not provide the same level of care that a physician provides, even if the interaction appears to be superficially identical. So they shouldn't command the same fee.
In order to encourage physicians to still utilize and supervise PAs, I suggest reducing the liability of physicians who "supervise" essentially unsupervised PAs. After all, if the doc didn't see the patient, they shouldn't be liable (or only minimally so) for the PA's error. But PAs hardly ever make errors anyway, according to their supporters. When they are responsible for their own errors, I wager they will make even fewer.
If the theoretical numbers presented by Ten/Ten and Shadowfax are correct, a PA who was bringing in $160/hour would still bring in at least $80/hour under my system and still only cost $50/hour, so the physician groups would still make money pimping out their PAs with even less liability. Patients will have cheaper healthcare options, the costs of insurance will decrease, and the failure of the Medicare system will be delayed a bit longer.
Win/win/win. Everybody wins.
Labels: health care crisis, physician assistants
posted by scalpel at 7:23 AM
14 Comments:
Actually that is a great idea and probably part of the solution to this universal health care rubbish. I would be willing to be seen by a PA for some things if that meant I would be able to pay less. If I am sick and I need to go to my doc I have no problem with the PA, but recently I was having some bad upper GI pain and I insisted on seeing my doctor, not the PA who worked at the practice, because quite frankly I knew it whatever the problem it was not normal and I wanted to experience and education of the doctor.
You make very good points, thanks for provoking thoughts.
Anthony
Perhaps PA's should bill less, it seems logical and practical. Maybe third-party payers should then require patients to first see a mid-level for all non-emergent care? I'm concerned if we establish a precedent that mid-levels are capable of the independent practice of medicine through cost effectiveness all we do in the long run is lower the standard of care for the patient.
Pretty soon insurance companies are going to re-define medicine. I guess they already have. I guess in a purely Darwinian approach those who can't afford excellent medical care shouldn't survive anyway.
PA services are currently billed fully, but when seeing a patient indepedently, most isurance companies who follow medicare's model, are only reimbursing at 85%, I would like to see this extended to ALL insurance companies. SO, this is already happening. 50% is too little, and does not accurately reflect the care the patient is recieving, however, I would have no problem with all billing being at 85%.
I'd compromise on 60%, but 85% is too high.
"85% is too high"
Based on what data. I mean, I look at these studies regarding MLP utilization, practice patterns, outcomes, etc. every day. If you have real data that suggests that PA's are being overpaid, or over re-imbursed, please present it.
BTW, CMS, Congress, and many other groups would completely disagree with your assertion.
The current rates aren't set by empirical data on their validity, they are set based upon what the insurance companies and federal government are willing and able to pay. I'm suggesting that they (and the public at large) should pay less money for services provided by nonphysicians.
And if they think they can get away with it, they will probably do so. You'll get paid about the same, hopefully, so you should have no reason to complain.
Scalpel! La Belle et Bonne Bianca Castafiore to the rescue. Step back... I will explain by this perspicacious citation of authority -- from Voltaire's Candide:
'Work then without disputing,'said Martin; it is the only way to render life supportable.''
The little society, one and all, entered into this laudable design and set themselves to exert their different talents. The little piece of ground yielded them a plentiful crop. Cunegund indeed was very ugly, but she became an excellent hand at pastrywork: Pacquette embroidered; the old woman had the care of the linen. There was none, down to Brother Giroflee, but did some service; he was a very good carpenter, and became an honest man. Pangloss used now and then to say to Candide:
'There is a concatenation of all events in the best of possible worlds; for, in short, had you not been kicked out of a fine castle for the love of Miss Cunegund; had you not been put into the Inquisition; had you not traveled over America on foot; had you not run the Baron through the body; and had you not lost all your sheep, which you brought from the good country of El Dorado, you would not have been here to eat preserved citrons and pistachio nuts.'
'Excellently observed,' answered Candide; 'but let us cultivate our garden.'
I'll have the Bœuf bourguignon and the Cabernet.
Well, the fact is that regardless - the fact remains that even when you bill for less when your PA sees the patient without your supervision, you will still come out on top since the increased volume and lower cost to employ a PA makes up for it.
True, but scalpel, many free standing urgent cares and clinics that are staffed solely by "MLP's". Reducing reimbursement rates to those suggested will make it harder to cover overhead expenses such as facility costs, nursing, secretarial support, and ancillary personnel, as well as supplies. In a fully staffed and functional ED, the differences would be nominal, but in a free standing clinic, they may be much more pronounced.
BTW, for more data, including ED physician supply, and salary information.....please see.
http://physasst.blogspot.com
Quit spamming, you already gave your URL. Your Urgent Care will make up for the decreased reimbursement with increased volume because you can offer a lower-priced service than a facility that does not employ PAs.
With liability shifted to the midlevels, ER docs would put them in charge of running the entire ER, not just fast tracks. Giant national ER groups would follow suit. Since midlevels work for so much less ER docs would be fired en masse, just a few would be kept on to serve as salaried medical directors to "supervise" multiple ER's from afar. Care delivered in ER's would obviously plummet.
Minor quibble, I know, but, when referring to the professional title, it is "Physician Assistant".
"Physician's Assistant" implies ownership.
Lower case, physician's assistant, of course is fine, but would refer to anyone that helps the physician provide their excellent care rather than the entire profession of PAs as you are referring to in your post.
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