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.