Appendix
D. Professional Practice Index Calculations
for PAs
This
appendix contains a table that documents
the detailed calculations used to compute
the new professional practice index for
PAs for each of the 50 States plus the
District of Columbia. The criteria used
in the new index include:
Legal
Authority (Maximum = 35)
Title
protection prevents those not qualified
or certified by the State from practicing
as a professional. Title protection provides
safeguards to the public and to the professional.
Licensure
implies approval of credentials and granting
of professional status. Licensing of PAs
occurs in many States, but certification
and registration is used in other States.
States vary on the qualifications for
licensure which may include the passing
of a national certification examination
and in some States, an employment agreement
with a physician.
Although
having a supervising physician is fundamental
to PA practice, the professional association
for PAs suggests that employment agreements
should be independent of licensure. PAs
should not be required to have an employment
contract to remain licensed [PAs 8th edition,
p. v].
Professional
Practice should be “dependent
on what the supervising Physician wishes
to delegate” [PAs 8th edition, p.
xi] and not be finely detailed in law.
Supervision
should be the least restrictive mode that
permits appropriately supervised practice.
“Continuous” [PAs, 8th edition,
p. xvi] supervision which may be indirect,
but which permits contact with the supervising
physician as needed is most desirable.
Regulation
by a PA Committee of the Board of
Medicine is the optimal regulatory mechanism.
Input by PAs is important to the profession.
Fees
for supervisory agreements can create
disincentives for association with a professional.
High costs may limit the number of agreements
between a physician and PAs.
The
conditions and timing of review of
records, although an implicit part
of practice between a physician and a
PA, is best determined by the agreement
between the two professionals rather than
by specific delineation in legislation.
Limiting
the number of PAs with whom a physician
may associate through legislated ratios
may be unduly restrictive. Leaving that
number to the discretion of the physician
and PAs suggests confidence in the abilities
of both professions to adequately provide
care within the skill and competencies
of each and “according to the tenets
of good patient care, adequate supervision,
and legal responsibility.” [PAs,
8th edition, p. vi]
Locum
Tenens means “the temporary
provision of services by a substitute
provider.” [PAs, 8th edition, p
xx]. Allowance for substitution in law
provides legal means for a physician or
a PA to continue to practice in the temporary
absence or inaccessibility of the other.
Temporary
License permits a PA to practice prior
to taking the certification examination.
Supervising
Physician Liability in law reinforces
the legal relationship that exists between
a physician and PA.
The
ability to act independently in a declared
emergency allows a PA to respond appropriately
to emergency needs in a disaster. It provides
legal protection for services provided
by the PA in those circumstances.
Reimbursement
(Maximum = 25)
Any
mandated payment reflects the evolution
of payment over the decade. Payment to
PAs was changed after passage of the Balanced
Budget Act in 1997 which extended payment
for services rendered by PAs to all locations
where they are employed.
Medicaid
payment percentage varies by State
and this category reflects that fluctuation.
Any
language that permits reimbursement to
“any qualified provider”
is intended to describe the legal obligation
to pay for services supplied by a PA.
PAs are generally in employment situations
in which the physician or the facility
is billing for and receiving reimbursement
for health services. Legislation that
protects the right to payment is enabling
to care.
Prescriptive
Authority (Maximum = 40)
Prescriptive
authority as delegated to PAs “can
improve patient access to comprehensive
care and provide for increased efficiency
and cost effectiveness.” [PAs, 8th
edition, p. vii]. It may be defined
in law or by the supervisory agreement.
The more extensive privilege allows the
PA more latitude in patient care. DEA
numbers are required when prescribing
scheduled drugs. Points are allotted for
a DEA number to emphasize the importance
of the prescriptive privilege.
Accepting
and distributing samples, having the
PA name on the prescription pad
and signing prescriptions are indicative
of latitude in practice provided to the
PA in law.
The
actual point allocations for PAs for the
50 States are presented below.
Table
D-1 Professional Practice Index Scoring
Criteria For Physician Assistants in 2000
New Index for AL, AK, AZ, AR, CA, and CO
| Scoring
Category |
Points |
Optimal
Score |
fn |
State |
| AL |
AL
|
AK |
AK
|
AZ |
AZ
|
AR |
AR
|
CA |
CA
|
CO |
|
Legal authority |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Title
protection |
3 |
3 |
a |
3 |
|
3 |
|
3 |
|
3 |
|
3 |
|
|
| How
Licensed |
|
|
b |
|
|
|
|
|
|
|
|
|
|
|
Licensure
language only
|
5 |
5 |
|
|
|
5 |
b |
5 |
|
|
|
5 |
|
|
Licensure
w/Registration ( i.e. reg. w/employment
papers)
|
3 |
|
|
3 |
|
|
|
|
|
3 |
|
|
|
|
Certification
or Registration language only
|
1 |
|
|
|
|
|
|
|
|
|
|
|
|
1 |
| Agreement |
|
|
c |
|
|
|
|
|
|
|
|
|
|
|
No
notification required, agreement
exists btw phys & PA
|
3 |
3 |
|
|
|
|
|
|
|
|
|
|
|
|
Notification
only of employment/agreement btw
phys & PA
|
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Written
agreement available
|
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
File
practice agreement w/board
|
1 |
|
|
|
|
|
|
|
|
|
|
|
|
1 |
File
for approval of board
|
0 |
|
|
0 |
|
0 |
c |
0 |
|
0 |
|
0 |
|
|
| Definition
of Scope |
|
|
d |
|
|
|
|
|
|
|
|
|
|
|
Scope
defined by supervising physician
& PA
|
5 |
5 |
|
|
|
5 |
|
|
|
|
|
|
|
5 |
Scope
loosely defined in law (may include
but not limited to…)
|
3 |
|
|
3 |
|
|
|
3 |
|
3 |
|
3 |
|
|
Scope
clearly delineated in law (list
of permissible tasks)
|
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
| National
certification required for initial
licensing |
1 |
1 |
e |
1 |
|
1 |
|
1 |
|
|
|
1 |
|
1 |
| Supervision: |
|
|
f |
|
|
|
|
|
|
|
|
|
|
|
Indirect-physical
presence not required
|
5 |
5 |
|
5 |
|
5 |
|
5 |
|
5 |
|
5 |
|
5 |
Limited
Indirect (limit on distance, time,
travel, etc)
|
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Direct-physical
presence required (on site)
|
0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
| Regulated
by: |
|
|
g |
|
|
|
|
|
|
|
|
|
|
|
| PA
Board or committee appt by ext agency
resp to med bd |
5 |
5 |
|
|
|
|
|
5 |
|
|
|
5 |
|
|
| Medical
Board with PA representation |
5 |
|
|
|
|
|
|
|
|
|
|
|
|
|
| PA
Committee appt by medical board |
5 |
|
|
5 |
|
|
|
|
|
|
|
|
|
|
| Medical
Board with no PA representation |
0 |
|
|
|
|
0 |
|
|
|
0 |
g |
|
|
0 |
| No
fees for supervisory agreements |
1 |
1 |
h |
|
|
|
|
|
|
|
|
|
|
1 |
| Review
of Records by Physician: |
|
|
I |
|
|
|
|
|
|
|
|
|
|
|
| >
7 days/not described/determined by
phys-PA team |
1 |
1 |
|
1 |
I |
1 |
|
1 |
I |
1 |
|
|
|
|
| <
7 days |
0 |
|
|
|
|
|
|
|
|
|
|
|
I |
0 |
| Ratios
> 2 in outpatient settings, or not
legislated |
2 |
2 |
j |
2 |
|
2 |
|
|
|
|
j |
|
|
|
| Locum
Tenens |
|
|
k |
|
|
|
|
|
|
|
|
|
|
|
| Legislated |
1 |
1 |
|
|
|
1 |
|
|
|
|
|
|
|
|
| When
no practice agreement, locum tenens
inherent |
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
| Temporary
License |
< |