Transforming Communication in Leadership and Teamwork: Person-Centered Innovations
PAs transforming health through patient-centered, team-based medical practice
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Transcript of PAs transforming health through patient-centered, team-based medical practice
PAs transforming health throughpatient-centered, team-basedmedical practice
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1 Healthcare Landscape
3 AAPA & PA Foundation Overview
Agenda
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Physician Assistant Overview
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Changing U.S. Healthcare Landscape
New competitive structures – industry consolidation, vertical integration & new entrants.
Accelerating reforms at the national & state levels.
Consumer-centric healthcare markets.
Shift from fee-for-service to fee-for-value healthcare delivery model.
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Market & Government Driving Reform
On the Rise
Medicare and Medicaid spending is now at 21% of the federal budget.
Expectations are it will rise to 25% in the next few years.
Disturbing Trend
48 million uninsured today… projected to grow to 55 million.
Of the 48 million, 80% are citizens of the U.S.; approximately 8 million are currently covered by Medicaid.
Uninsured are twice as likely to be unhealthy and over 30% have a chronic condition.
How We Stack Up
A 2011 World Health Organization study indicates the U.S. spends a higher proportion of its GDP on health care than any other country, but ranks 37th out of 191 countries based on 5 KPIs.
Current healthcare expenditures are 18% of GDP and are expected to rise to 20%.
Spending UninsuredGDP
Source: World Health Organization Source: Kaiser Family Foundation Source: Kaiser Family Foundation
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The Solution: Patient Protection & Affordable Care Act
Medicaid ExpansionStates that chose to participate will change eligibility for individuals within 133% - 400% of the federal poverty level.
Preventative ServicesCertain preventative services will be considered “essential” and will be offered free of co-pays or deductibles.
Guaranteed Coverage & Individual MandateRequirement that everyone must purchase health insurance (unless otherwise covered) & they have to be issued a policy regardless of rating, pre-existing conditions, or age.
Health Insurance ExchangeStates have the option to create their own or adopt the federally-run exchange. The HIE is an alternative marketplace for individuals & small business to purchase insurance.
Lifetime/Annual Caps BannedHealth insurance providers will no longer be allowed to set financial limits on payouts.
Business Health Insurance TaxCompanies with 50 or more employees with at least 1 full-time employee must provide health insurance or pay fines.
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Value-Based Healthcare
Today: Fee-for-Service Future: Fee-for-Value
Transactional Models
Episodic Care Models
Population Care Models
Condition Care Models
Example Model Types
• Dermatologists• Ophthalmologists• Dentists• Etc.
• Orthopaedics• CV Surgery• General/specialty
surgery
• Oncology• Diabetes• Asthma• Chronic/end-
stage renal
• Partial Population• Frail elder• High risk• Poly-chronic
• Full Population• Globally capitated
models• Medicare shared
savings ACO
Source: Oliver Wyman
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Accountable Care Organizations – Responsible for the Whole Patient
Healthy Independent Health Risk Factors Early Stage Chronic Complex
ConditionsLate State or Poly-
chronic End of Life
… and for managing clinical risk for all healthcare consumption across ambulatory, acute, post-acute, and other settings.
Hospital OR/ICU
Urgent care
Primary care
Hospital emergency
services
Specialist care
Behavioral health OT/PT
Diagnostic imaging/lab
Skilled nursing
Ambulatory surgical center
Home care
Hospice & palliative
Source: Oliver Wyman
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The Trillion Dollar Question
Accountable Care . .
• High quality care• Efficient delivery• Coordination of activities• Measurable results• Patient-centric
. . Organizations
• Whose “Home” / “Organization”– Hospital?– Doctor?– Payer?– Government?– Third party?
Source: Oliver Wyman
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Shift to Consumer-centric Healthcare Markets
Healthcare today“Complex, fragmented and under performing”
Patient-Centered Care“Team-Based, guided, and coordinated”
Source: Oliver Wyman
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CardiologyOrthopedics
CKD
Diabetes Wellness
Frail Elder
Surgical Oncology
Radiation Oncology
Intervention
Open Heart
ED
Cancer
Biometrics
Lifestyle
Coaching Convenience
Retail/ Shopping
Wellness
Minute Clinics
Monitors/ Sensors
Apps
Social Media
Information
Provider Models
Retail/New-Co Models
Payer Models
Risk Assessment
Ancillary products
Goods Network
Risk Financing
Wellness
Minute Clinics
Financial Mgmt.
Coaches
Crowd sourced
tools
Provider Transparency
Provider-Led Manager
Payer-Led Model
Retail-Led Manager
New Delivery Models
Source: Oliver Wyman
Experience
Expertise
Partners
Physician Assistant Overview
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What is a PA?
A physician assistant (PA) is nationally certified and state licensed to practice medicine as part of a physician-led team. PAs are educated at the graduate level and practice in nearly every medical specialty and setting.
What do PAs do?• Conduct physical exams• Diagnose and treat illnesses• Order and interpret tests• Counsel on preventive healthcare• Assist in surgery• Write prescriptions• Make rounds in nursing homes and hospitals• Obtain medical histories
* PAs’ responsibilities correspond to their supervising physicians’ practice.
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PA Vital Statistics
83,600Employment in 2010
108,300Projected employment in 2020
Projected Growth of PAs in Clinical Practice
With a projected growth of 39 percent, the Bureau of Labor Statistics predicts physician assistants will be the second-fastest-growing health profession in the next decade (after home health aides).
50Number of states authorizing
PA prescribing privileges
94,507Number of certified PAs in 2013,
according to the National Commission on
Certification of Physician Assistants
1967Year the first three PAs graduated
from Duke University
$90,873Median annual income from primary
employer for full-time clinically practicing PAs* in 2010.
*Excludes self-employed and part-time PAsSource: Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2012-13 Edition, Physician Assistants, on the Internet at http://www.bls.gov/ooh/healthcare/physician-assistants.htm (visited Dec.20, 2012).
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Growth of the PA Profession
1967
1970
1973
1980
1986
1990
1993
1996
1999
2002
2005
2008
2011
020406080
100120140160180
Number of Accredited PA programs
Number of accredited PA programsLinear (Num-ber of accred-ited PA pro-grams)
The PA profession has doubled every decade since the 1980s.
Number of Practicing PAs
The Association of American Medical Colleges estimates that
there could be as many as 135,000 PAs by the year 2020.
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PA Profession Ranks High in Today’s Economy
Forbes.com ranked physician assistant in its list of best master’s degrees for jobs three years in a row.
CNNMoney.com ranked PA as number two on its Best Jobs in America list in 2009 and 2010. The profession continues to rank high.
U.S. News & World Report ranked the PA profession as one of the 50 best careers of 2011.
Kiplinger’s named PAs one of the “great careers for your future.”
“HHS continues to invest in the PA workforce through various programs, many spearheaded by the Health Resources and Services Administration. The Affordable Care Act builds on these efforts through … payment increases to primary care PAs.” – HHS Secretary Kathleen Sebelius, Oct. 5, 2012
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Clinical ProfilePercent Female: 65%Median Age: 39.6 yearsPercent in Clinical Practice: 91.6%Percent Who Work More Than One Clinical Job Concurrently: 19.0%Median Number of Years in Clinical Practice: 7.0 yearsMedian Number of Years in Current Primary Specialty: 4.0 years
Primary care29%
Surgical specialties26%
Other specialties17%
Emergency medicine11%
Internal medicine specialties
11%
Pediatric specialties2%
Unknown4%
Primary Clinical Specialty
Single-specialty physician group practice
17%Inpatient unit of hospital
11%Solo practice physician of-
fice11%
Hospital emergency room11%
Multispecialty physician group practice
9%
Outpatient unit of hospital8%
Hospital operating room6%
Other setting28%
Most Common Practice Settings
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Addressing Health Disparities & Underserved Populations
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Practice Profile94,000 Practicing PAs
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Urgent Care Clinics
Preventive Services
Rural Practice
Retail
Wellness Programs
Hospital
Private Practice
ACO
Integrated Health Care System
Tele-health
Frail
Drug Abuse
High Risk
Acute
Chronic
Healthy
Children
Complex Disease
Multiple settings, multiple population segments, multiple team members
MD
PA
NP
PT
Psych
MT
Pharm
Nurse
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How One Becomes a PA• There are 176 accredited PA
educational programs in the United States.
• Most PA programs award a master’s degree.
• PAs are required to complete:• More than 400 hours in basic
sciences• 75 hours in pharmacology• 175 hours in behavioral sciences• Nearly 580 hours of clinical medicine• The average length of a PA program
is 27 months long.
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After Graduation
• PAs are required to pass a national certifying examination administered by the National Commission on Certification of Physician Assistants.
• PAs must earn and log 100 hours of continuing medical education every two years.
• PAs must take a recertification examination every six years (every 10 years starting in 2014).
• To be able to practice, PAs must have a state license and work with a physician.
• The current six-year time period between recertification exams will be extended to 10 years to better reflect PA competence in practice.
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PA Utilization
Ongoing research & data analysis continue to prove the economic & clinical outcome value of PAs.
Demand is high for PAs, but not all health systems use them efficiently.
True integration calls for all healthcare professionals being able to function at the top of their license.
Shifting to a value-based, outcomes-centric health delivery model is more than using terms such as integrated delivery model or forming an ACO.
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PAs Positioned Well for the Future
The landmark Patient Protection and Affordable Care Act, which has implications across every health delivery setting, includes specific provisions for PAs.
U.S. faces an insufficient number of physicians, with projections indicating that supply will be unable to keep pace with demand; by 2025, a shortage of 124,000 primary care physicians is anticipated.
A component of the law identifies PAs as necessary to help mitigate the expected doctor shortage.
The language specifies support for PA education in primary care, and fully integrates PAs in the new Independence at Home demonstration project.
Cost bonus incentives for PA use in the primary care setting with certain Medicare codes from 2011-2015.
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PAs in Value-Based Healthcare
More than four decades of research are available:
• PAs substitute for doctors at approximately 85% of the range of primary care tasks
• PAs produce approximately 2.4 times their salary in revenue
• PAs are equally productive in outpatient visits
• Opportunity cost of producing a PA is approximately 20% of a doctor
• PA produces approximately 5 years of healthcare services to society before a doctor is functioning independently from postgraduate training
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PAs in Consumer-Centric Care
Outlook for traditional players in a value-based population management ecosystem
Inpatient
Outpatient
Emergency Department
Retail
Primary care offices
Diagnostics
Specialty care offices
Ambulatory center
LTC facilities
Behavioral health
Home healthcare
Source: Oliver Wyman
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PAs Expanding Access to Care• . . . “with an aging population and more chronic disease, the medical
profession needs all the help it can get,” says Dr. J. Lloyd Michener, professor and chairman of the department of community and family medicine at Duke. “PAs are a critical member of the health team.
2011http://www.foxbusiness.com/personal-finance/2011/01/21/pas-play-pivotal-role-health-care-reform/#ixzz2YfM6Y6CZ
• Approximately 10 percent of physicians practice in rural areas, where approximately 20 percent of the U.S. population lives. Rural residents are also limited by lack of transportation, extreme weather, social isolation and poverty. Therefore, access to care is a major concern in most rural areas. Fortunately, PAs are helping to extend care to areas most in need: About 17 percent of PAs practice in rural areas.
AAPA 2011
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Coordinating Care and Saving Health Care Dollars
PA Home Visit Program Reduces Hospital Readmissions
• PAs made house calls on days 2 and 5 following hospital discharge
• Study followed 26 months of readmissions
• 30-day readmissions were reduced by 25% for patients receiving PA home visits
• Most common intervention: medication adjustments – diuretic agents, meds for hypoglycemia, and antibiotics.
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PAs in New Health Delivery ModelsTake Care Clinics Expand Scope of Health Care Services to Include Chronic Condition Management and Additional Preventive Health OfferingsDEERFIELD, Ill., April 4, 2013 - Access to health care services is an ongoing challenge to the U.S. health care system. With a physician shortage, aging population, a growing prevalence of chronic diseases and up to 30 million people projected to gain insurance coverage in 2014 through the Affordable Care Act, the issue will become even more critical – and may further impact both patients and the health care system at large…. Take Care’s board-certified nurse practitioners and physician assistants deliver patient-centric care, driving patient satisfaction rates that are consistently greater than 90 percent.
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About AAPAFounded in 1968, AAPA is the national professional society for physician assistants.
AAPA represents a profession of more than 94,000 certified PAs. Approximately 47,000 PAs are members of AAPA, including 10,400 students.
The Academy educates the general public about the PA profession, ensures competency of PAs through active involvement in the accreditation of PA programs, provides continuing education & conducts PA-related research.
AAPA works in cooperation with its sister organizations:NCCPA – certifying body for PAsPAEA – PA academic educational programsARC-PA – educational accrediting body
VisionPAs transforming health
through patient-centered, team-based
care.
MissionProviding innovative
solutions that empower our members to
connect, enhance their careers and improve
patient health.
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About the Physician Assistant Foundation
The Physician Assistant Foundation is the philanthropic arm of the American Academy of Physician Assistants.
Foundation Initiatives• Student Scholarships• Caring for Communities Award• Innovations in Health Care• Community-based Project Grants• Research Fellowship• Leadership Development• Health Policy Fellowships• Global Outreach• Matching Grants• Pre-PA Minority Student Scholarships
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Effective and Productive Partnerships
25 Specialty Organizations
50 State Chapters & DC Chapter
17 Special Interest Groups & 8 Caucuses
5 Federal Service Chapters
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Collaborative Relationships
Professional organizations (AMGA, NGA) as well as patient & disease groups
Physician organizations: AAFP,ACP, AAP, AMA, SHM, AAOS, AAO-HNS, AOA, ACS
Government agencies: HHS, CMS, CDC, DOL, VA, OIG
Nursing: advanced practice nurses, ANA, ACNP-AANP
Health Systems & Payers: Johns Hopkins, Cleveland Clinic, Geisinger, United, Aetna
Retail: CVS MinuteClinic, Walgreens Take Care Clinic, RiteAid NowClinic
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.
State made PA-positive changes to law in last 12 months
No positive change in State law in last 12 months
2012 - Unprecedented Year:40 States Made PA-Positive Changes to State Law
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AAPA & PAF Strategic Commitments
Create & Deliver Value
Offer an Essential Digital “Home”
Be Fiscally Responsible & Transparent
Provide Meaningful Volunteer Opportunities
Make AAPA a Great Place to Work
Foster PA Excellence – through integrated professional development & coordinated advocacy
Optimize PA Practice – identify, evaluate & promote best practice models that increase PA impact on health, maximize PA value & enhance PA satisfaction
Grow the PA Profession – elevate PA roles, recognition & respect and support increasing the number & diversity of PAs
To Members To Staff & VolunteersTo the Profession
Lisa GablesExecutive Director – PA FoundationChief Development Officer - AAPA
Phone: 571.319.4502Email: [email protected]
Or visit our website at www.aapa.org
For more information please contact: