Today's employers want two things when it comes to their health care benefit programs: value and quality. To support this quest, leading brokers, employers and employer coalitions continue to push for reform in our health care system, aimed toward quality-based payment over volume.

A growing body of evidence shows that the nation's 123,000 certified physician assistants (PA-Cs) lower costs while improving health care quality. As a result, they can play a crucial role in helping health care organizations implement value-based reforms.

The road to value-based care is not an easy one

Employers and health care systems are working on the transformation to a value-based care system at the same time several other health care trends are presenting fresh obstacles. As the U.S. population ages, more patients suffer from chronic diseases and complex medical conditions, spurring a greater need for specialty care and imposing more demands on our nation's hospitals.

What is more, the American Association of Medical Colleges predicts a continuing physician shortage. So, the demand for care is going up while the supply of providers is going down, as the nation works to fundamentally change the health care delivery system.

Help is available

The realities of provider shortages, increasing demand for services, and system changes are why PAs can make a significant impact. According to new data from the National Commission on Certification of Physician Assistants (NCCPA), the number of Certified PAs continues to grow. The number of PAs per 1,000 physicians has increased over 23 percent over the last three years alone.

The percentage of PAs working in high-demand and high-need specialty areas has also grown more than 13 percent over the previous three years. Some specialties have seen the number of PAs more than triple in the past decade. So why is this data good news as we work to create a value-based care system? There are three key reasons:

PAs are a cost-effective solution to the growing demand for health care services.

First, PAs are filling a provider workforce shortage at a manageable cost. Many hospitals are already experiencing a dearth of doctors. According to NCCPA's Statistical Report of Certified PAs by Specialty, over 3,200 PAs now work in hospital medicine, a 21 percent increase over three years.

PAs often manage patients throughout their hospital stay, with a physician available to see the patient for the most complex clinical issues. Hiring PAs costs a hospital less than hiring additional physicians, and is probably less challenging, given the physician shortage. Data from NCCPA's latest survey reveals the average salary for a certified PA working in Hospital Medicine is $108,797, compared to the average salary of a Physician Hospitalist of $222,363.

Specialty medicine practices are also finding it cost-effective to hire well-qualified PAs to meet their patients' needs. According to a report in JAMA Internal Medicine, about 1 in 4 specialty medical practices employs physician assistants or nurse practitioners today, and nearly half of multispecialty practices use them as well. This is good news at a time when specialty medicine is in high demand, and cost continues to rise.

PAs help health care organizations improve quality

Second, in addition to being lower cost providers of care, numerous studies also show PAs provide care at a level that meets the quality of care provided by physicians. A recent study comparing two hospitalist groups — one with a high PA-to-physician ratio (the “expanded PA” model) and one with a low PA-to-physician ratio (“conventional”) — has found no significant differences in important clinical outcomes achieved by both groups.

A study of PAs in emergency medicine shows improvements in care quality metrics and patient satisfaction scores. This means that hospitals with provider shortages can hire PAs to fill staffing needs, at a lower cost, without compromising the quality of care.

An additional role PAs play is helping hospitals reduce their readmission rates, a quality metric often tied to value-based payment. For example, one organization in New York has developed a PA home care program, in which PAs make house calls after hospital discharge. The most common home intervention has been medication adjustment, particularly for diuretic agents, hypoglycemic medications and antibiotics. Upon comparing 30-day readmission rates for the control and home care groups, the home care group rate was reduced by 25 percent, according to a study.

Many PAs are leaders of value-based care reforms

As many health care systems transition to value-based care, many PAs are playing a day-to-day role in implementing new systems and processes to handle new payment arrangements that track and report quality metrics.

As a 2017 article in Revenue Cycle Intelligence pointed out:

“Many hospital leaders and physicians face greater care delivery, administrative, and patient access demands under alternative payment models. However, the payment models also require hospitals to reduce health care costs while managing more requirements. In a seemingly impossible balancing act, some hospitals are turning to physician assistants to shoulder some of the additional responsibilities.”

Because of their broad education and comprehensive experience managing patients, many PAs are being tapped for new leadership roles either developing or leading quality improvement initiatives.

The employer role

Despite their proliferation in numbers and leadership roles, some patients still don't understand the role of the PA as a care provider. Brokers and other benefits professionals can play an essential role in helping employees understand that they can receive top quality care in any setting from a certified PA. Articles in employee newsletters can offer guidance on the rigorous certification maintenance requirements of PAs, who must complete substantial continuing education credits every two years and pass written assessments every 10 years. Benefits professionals can also highlight media articles or other sources that show the breadth of specialties and clinical settings where PAs work.

Looking ahead

Transitioning to a value-based care system is a high priority for employers who care about reducing costs and improving outcomes. However, this transition isn't easy for providers, especially in a health care system with a shortage of physicians, a proliferation of administrative and organizational tasks, and a notable growth in an aging and medically complex patient population. Fortunately, certified PAs are stepping up to help, reducing labor costs while filling workforce needs, improving care quality, and taking on new roles to strengthen quality initiatives that lead to better health outcomes. Employers can play a valuable role in educating their employees and health plans about this important trend.

About the Author: Dawn Morton-Rias, Ed.D, PA-C. is President and CEO of the National Commission on Certification of Physician Assistants (NCCPA), the nation's only certifying body for PAs. She has been certified as a PA for over 30 years and has worked in family medicine, addictive medicine, GYN, acute care for the homeless and education. For more information visit www.nccpa.net .

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A secret weapon in our march toward value-based care

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