Massachusetts Association of Physician Assistants
P.O. Box 473 Ludlow, MA 01056 1-866-548-4415
Fax: 1-413-748-3595
An Act Relative to “Physician Services” Provided by
Licensed Physician Assistants
House Bill 948
Sponsored by Rep. Peter Koutoujian and Senator Fred Berry
Intent of this Bill
This bill prevents individual or group accident and health insurance policies and health service contracts from imposing a practice or supervision restriction which is inconsistent with state and law.
More specifically, H. 948 would prevent individual or group accident and health insurance policies and health service contracts from refusing to reimburse a physician or hospital at the full rate for necessary medical or surgical services provided by a physician assistant practicing under the supervision of a physician, if the policy or contract would have paid for the same services when provided by a physician (such as physical exams, ordering and interpreting tests, treating patients, and assisting in surgery) alone.
As it stands now, some insurers place additional restrictions or requirements for reimbursement that are not aligned with current state and federal regulations of the PA practice. For example, PAs at a primary care office in Carver owned by Beth Israel Hospital were recently told that they can no longer work on the weekends because “a physician is not there to supervise them.” This practice was providing urgent care visits for their patients in place of sending them to an emergency room. The Beth Israel took that action because Blue Cross was denying hospital claims based on this reasoning. Current law and regulations, however, do not require a physician to be physically present to supervise a PA.
These needless restrictions prevent patients from receiving needed health services and potentially delay or deny access for new patients or existing patients with acute medical problems. This is all the more problematic given the dire shortage of physicians in Massachusetts. A recent report commissioned by the Blue Cross Blue Shield Foundation suggests that one in five Massachusetts adults has unmet health needs because they have difficulty finding providers. This figure increases to one in four for residents of Western Massachusetts.
Additional points of information:
Ø This bill does not increase any cost to the plans nor does it add any new services. In fact, there is every reason to believe that this bill could potentially provide cost savings to the state by removing artificial obstacles for care to be provided by physician assistants. According to the Medical Group Management Association Physician Compensation and Production Survey (MGMA): 2008 Report Based on 2007 data,, “for services a PA or NP can handle just as effectively as a physician, a mid-level provider is a less costly investment for a group practice.” Similarly, data in a study published in Health Services Research in 2004, suggests that PAs could see 50-70% of all primary care visits, and that primary care practices that used more PAs in care delivery realized lower practitioner labor costs per visit than practices that used less.
Ø This bill is NOT a move for independent practice by physician assistants nor is it an effort to secure direct reimbursement to physician assistants. This bill is simply intended to allow consumers to continue to receive services from a physician assistant who is providing “Physician services” under the supervision of a physician in compliance with state and federal regulations
Ø This bill will allow the physician-physician assistant team to provide comprehensive cost-effective medical treatment to an increased number of patients without compromising the quality or time in which it is received.
Ø This bill would also serve to modernize our statutes by simply adding physician assistants to the list of providers who currently have similar requirements to be reimbursed for the services they provide, including nurse practitioners, nurse anesthetists, and nurse midwives.
Please contact feel free to contact Heather Trafton, Legislative Chair, MAPA with questions at hat_trafton@yahoo.com.
Massachusetts Association of Physician Assistants
P.O. Box 473 Ludlow, MA 01056 1-866-548-4415
Fax: 1-413-748-3595
Physician Assistants: An Increasingly Important Part of
Health Care Delivery in Massachusetts
PAs are increasingly becoming an indispensable component of affordable health care in Massachusetts and around the country. Today, there are over 71,000 PAs currently in clinical practice in the United States, up from 10,000 ten years ago, and approximately 1,700 licensed to practice in Massachusetts. In 2008, Massachusetts’ PAs handled just over 2.5 million internal medicine out-patient visits and 2 million in-patient encounters. Approximately 70% of all PAs are employed by physicians, group practices, HMOs or outpatient clinics. Many hospitals faced with a shortage of physician residents employ PAs to help meet their clinical service needs, and PAs work in virtually every type of medical and surgical specialty
The Cost Containment Committee formed in Massachusetts is making great efforts at reducing health care costs in the Commonwealth. The March 27, 2009 report to the Council by Balit Health titled Substitute Less Expensive for More Expensive Providers recognizes the growing use of PAs nationwide to increase access to health care. In Massachusetts alone, the number of practicing PAs increased from fewer than one thousand in 2003 to 1,725 by the end of 2008. The latest available data from the Bureau of Labor Statistics indicates that the number of PAs nationwide is expected to increase between 23% - 27% between 2006 and 2016, which is twice the growth rate expected for physicians.
As the report to the Council notes, patients and other health care providers recognize PAs’ ability to provide quality primary care. PAs expand patient access to care, decrease wait times, and reduce costs. However, the report also states that even with the expected increase in the number of practicing PAs in Massachusetts, the demand for PAs could still outweigh supply if additional efforts are not made.
PA Profession History
The PA profession was designed and developed by physicians in the mid-1960’s to address the need for health care professionals to assist professionals in the delivery of quality health care. The first group of PAs consisted of military corpsmen and medics who came back from the Vietnam War having performed highly skilled medical tasks under extraordinary circumstances, and were trained on the same medical model used to educate physicians. The PA education continues to be based on the same medical model used to educate physicians, and requires between 25 to 27 months of intensive academics and comprehensive clinical rotations from an accredited program. A typical PA student has four years of college and over four years of health care experience prior to the start of their formal training. All licensed PAs have passed the National Certifying Examination administered by the NCCPA (National Commission of Certification of PA.)
It is important to understand that physician assistants are health care professionals trained to practice medicine as part of a Physician-Physician Assistant team. Under the supervision of a physician, a PA performs duties that are within the physician’s scope of practice and allowed under Massachusetts law. This includes but is not limited to: performing physical examinations, diagnosing and treating illnesses, providing preventive medicine, counseling and providing patient education, ordering and interpreting lab tests, suturing wounds, assisting in surgery, and making rounds in nursing homes and hospitals.
Please contact feel free to contact Heather Trafton, Legislative Chair, MAPA with questions at hat_trafton@yahoo.com.
