Legislation Update: An Act Relative to Physician Services Provided by Licensed Physician Assistants

SD1090/HD2635 An Relative to Physician Services Provided by Physician Assistants
Sen. Berry & Rep. Haddad

Section 1. Chapter 175 of the General Laws is hereby amended by inserting after section 47U, inserted by section 8 of chapter 141 of the acts of 2000, the following section:-

Section 47V. No individual or group accident and health insurance policies and health service contracts can refuse to reimburse a physician 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.  Individual or group accident and health insurance policies and health service contracts cannot impose a practice or supervision restriction which is inconsistent or more restrictive than state law. Provided, however, that the following conditions are met:(1) the service rendered is within the scope of practice of physician assistants pursuant to section 9E of said chapter 112; (2) such service is provided in compliance with all other requirements of law, including a formal supervisory arrangement with a physician as provided for by said section 9E (3) the policy or contract provides benefits for such service if rendered by a registered physician in the commonwealth

SECTION 2. Chapter 176A of the General Laws is hereby amended by inserting after section 8Z, the following section:-

Section 8V. No contract or subscription certificate between an insured and the corporation can refuse to reimburse a physician at the full rate for necessary medical or surgical services provided by a physician assistant, certified by the board of registration of physician assistants pursuant to the provisions of section 9F of chapter 112, practicing under the supervision of a physician if the contract or subscription certificate would have paid for the same services when provided by a physician.  A contract or subscription certificate between an insured and the corporation cannot impose a practice or supervision restriction which is inconsistent or more restrictive than state law; provided, however, that the following conditions are met: (1) the service rendered is within the scope of practice of physician assistants pursuant to section 9E of said chapter112; (2) such service is provided in compliance with all other requirements of law, including a formal supervisory arrangement with a physician as provided for by said section 9E; and (3) the contract or subscription certificate provided benefits for such service if rendered by a registered physician in the commonwealth.

SECTION 3. Chapter 176B of the General Laws is hereby amended by inserting after section 4U, the following section:-
Section 4V. No contract or subscription certificate between an insured and the corporation can refuse to reimburse a physician at the full rate for necessary medical or surgical services provided by a physician assistant, certified by the board of registration of physician assistants pursuant to the provisions of section 9F of chapter 112, practicing under the supervision of a physician if the contract or subscription certificate would have paid for the same services when provided by a physician.  A contract or subscription certificate between an insured and the corporation cannot impose a practice or supervision restriction which is inconsistent or more restrictive than state law; provided, however, that the following conditions are met: (1) the service rendered is within the scope of practice of physician assistants pursuant to section 9E of said chapter112; (2) such service is provided in compliance with all other requirements of law, including a formal supervisory arrangement with a physician as provided for by said section 9E; and (3) the contract or subscription certificate provides benefits for such service if rendered by a registered physician in the commonwealth. No such contract of subscription certificate shall deny payment for such services solely on the basis that the service was provided by a physician assistant.

SECTION 4.  The first paragraph of section 4 of chapter 176G of the General Laws is hereby amended by adding the following sentence:- Such health maintenance contract shall also provide coverage for the services rendered by a certified registered physician assistant, as set forth in section 47V of chapter 175, subject to the provisions of said section.

Talking Points

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 federal law.

More specifically, this legislation 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 (such as physical exams, ordering and interpreting tests, treating patients, and assisting in surgery) when provided by a physician 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 Beth Israel Hospital were recently told that they can no longer work on the weekends because “a physician is not there to supervise them.” The hospital 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 vital health services and potentially delay or deny access for new 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:

  • 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, the median ratio of compensation to gross charges of a PA is 0.23. The report states, “for those 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.”
  • 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
  • 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
  • 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.

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 1,000 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.

Data in a study published in Health Services Research in 2004 suggests PAs could see 50-70% of all primary care visits, and primary care practices that used more PAs in care delivery realized lower practitioner labor costs per visit than practices that used less.

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.

Posted in Legislation.