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The ACA is the most visible acceptance and recognition of physician assistants as a full member of the healthcare team, reflecting years of work.
The Affordable Care Act (ACA), passed by Congress in 2010 and upheld by the Supreme Court this summer, is one of the most sweeping pieces of healthcare legislation passed in the history of the United States
As a profession, the American Academy of Physician Assistants (AAPA) specifically stayed away from advocating for any specific structure of healthcare reform or financing for reform efforts, unlike other major professional associations. AAPA talked with legislators about supporting access to quality, affordable, cost-effective care for all Americans, with the expanded use of primary medical care; an emphasis on health promotion and disease prevention; the use of comparative-effectiveness research; and a payment mechanism that is portable and sustainable for individuals, families and society.
As then-president of the AAPA, I stood on the stage with President Obama on March 3, 2010, and listened to the first president in history talk about the importance of PAs in healthcare in a major speech. It was an important moment in our professional history to be recognized and valued. Regardless of what direction healthcare reform took from that day, we were confident that it would include and value the PA profession.
But what does it mean for the physician assistants in your practice? First and foremost, it means the formal recognition of PAs as providers of patient-centered, team-based primary medical care.
As a veteran of legislative affairs over three decades, I know that words have meaning. Compared with doctors and nurses, the PA profession is a relatively new one, yet PAs have at times been an afterthought in legislation and regulation and without direct recognition, it is easy for system to ignore the profession when it comes to scope of practice and reimbursement issues.
PAs are now one of three primary healthcare professionals in the U.S. today, according to the law. The demand for primary-care providers will be overwhelming into the foreseeable future and has been made much more critical by full implementation of the ACA. The ACA supports the educational preparation of PAs who intend to provide primary-care services in rural and underserved communities. Thirty-two million dollars was allocated for the direct training of 600 new PAs. The ACA provides $1.5 billion over five years to expand the National Health Service Corps. Plus, I discussed the emphasis on training veterans to become PAs in a previous blog. This builds on a $300 million investment in the NHSC in the American Recovery and Reinvestment Act. The combined more than $2 billion investment is expected to result in an increase of more than 12,000 additional primary-care physicians, nurse practitioners, and physician assistants by 2016.
The ACA creates a five-year, 10 percent Medicare bonus for select primary-care codes furnished by PAs, as well as other primary-care providers, for whom at least 60 percent of services are in primary care. I have always believed that if you want to change how medical care is deployed, change how it is funded. By valuing primary care with bonuses, we will help to ensure the expansion of primary care to Americans.
Also, the ACA fully integrates PAs into newly established models of coordinated care. PAs play an important role in patient-centered, primary-care medical homes, Independence at Home models of care, chronic care management, and other new models of care designed to better coordinate care through team-based practice and to promote value to the healthcare delivery system.
Yet, the most important effect of the ACA on the PA profession is the recognition of PAs’ contribution to the healthcare system in the United States. Again, PAs are now one of three primary healthcare providers in the country, according to the law. While the ACA represents the most visible acceptance and recognition of PAs as a full member of the healthcare team, it reflects years of work by the profession in achieving legislative and regulatory change that better integrates PAs into healthcare teams across this country.
There is much more to do to ensure that all Americans have access to affordable, quality healthcare. As far as the healthcare workforce is concerned, the ACA provides for the expansion in the supply of physicians, PAs, and nurse practitioners. The only thing that we can really be sure of is that the direction of healthcare reform in the United States will continue to be debated into the foreseeable future, regardless of the results of the coming election.