December 6, 2023
Advancing the PA Profession at the Federal Level
February 1, 2019
As a new Congress begins and we enter the second half of President Trump’s current term in office, now is a good time to reflect on AAPA’s federal advocacy accomplishments over the past two years. During this time, there were many significant victories for the profession.
Congress passed and the President signed into law several bills favorable to PAs.
Obtaining the waiver for buprenorphine prescribing
The ability of PAs to obtain federal waivers to prescribe buprenorphine—a leading Medication Assisted Treatment (MAT)for the treatment of opioid use disorder (OUD)—was made permanent. This change went into effect in 2018 and updated a program that was initially authorized for only five years. Of the more than 131,000 practicing PAs in the United States, approximately 30,000 practice in addiction medicine or primary care, where they commonly work with patients who struggle with OUD. PAs’ ability to prescribe MAT expands access to care for those suffering from OUD and allows PAs to continue to play a vital role in the fight against the opioid crisis.
Managing and providing hospice care
After many years of advocacy, PAs are authorized to manage and provide hospice care to terminally-ill Medicare patients. Medicare beneficiaries throughout the nation, especially those living in rural and other medically underserved communities where PAs may be the sole healthcare professional, will benefit from this important legislation. This legislation went into effect on January 1, 2019.
Supervising cardiac and pulmonary rehabilitation
PAs will gain authorization to supervise cardiac and pulmonary rehabilitation programs under the Medicare program. Cardiac and pulmonary rehabilitation is proven to improve health outcomes for patients who have survived a heart attack or have chronic obstructive pulmonary disease (COPD), but it remains underutilized, especially in rural or medically underserved areas. This provision goes into effect on January 1, 2024.
Implementing competitive pay for PAs in VA
Legislation is now in effect that implements competitive pay for PAs serving at the Department of Veterans Affairs (VA). The VA is the largest single employer of PAs in the country, with more than 2,200 PAs serving at the VA on a full-time basis. Unfortunately, PAs face compensation levels that do not come close to matching what they could earn in the private sector, and are also significantly lower than other healthcare professions performing the same role within the VA. While this improvement for PAs serving at the VA has not yet been fully implemented by the VA, that process is ongoing and AAPA continues to monitor developments as they occur. In addition, AAPA worked with congressional champions to introduce bills on issues such as direct payment, home health, diabetic shoes and ACO assignment. While none of these bills were signed into law in the 115th Congress, AAPA laid crucial groundwork to continue to press forward on them in the 116th Congress. Congress also heard from individual PAs during Hill day at the 2017 and 2018 AAPA Leadership and Advocacy Summits, through letter-writing campaigns and other events.
CMS modification to QPP low-volume threshold
The past two years have also seen significant advancement for the PA profession in the federal regulatory arena. PA leaders and AAPA staff met with officials from multiple federal agencies, and submitted over thirty comment letters, to educate and advocate for changes to benefit the PA profession. As a result, regulatory changes are reflecting greater inclusion of PAs, such as CMS’ modification to the Quality Payment Program low-volume threshold, that previously may have restricted some PAs from participating, but now permits most to voluntarily opt-in.
Ease in ACO assignment of PAs
In addition, CMS will remove requirements for a physician visit in order for patients to be assigned to an Accountable Care Organization if a beneficiary voluntarily identifies a PA as the clinician they want to coordinate their care.
Other noteworthy changes occurring over the past two years include the inclusion of PAs as Acceptable Medical Sources for disability claims under Social Security, acknowledgement by CMS that PAs should have the authority to record progress notes of psychiatric patients, and receipt of a favorable interpretation directly from CMS that PAs do not require a physician co-signature on hospital discharge summaries. Finally, AAPA secured the appointment of six PAs to CMS advisory panels.
After numerous meetings between CMS, the Federal Trade Commission, Office of Management and Budget, and the National Economic Council and AAPA on the topic of policies to increase efficiency, access, and transparency of care, the Administration recently released a report on Reforming America’s Healthcare System Through Choice and Competition. The report explicitly called for the elimination of unnecessary supervisory/collaborative requirements placed on PAs, the changing of scope-of-practice statutes to allow PAs to practice to the top of their license and training, and the adoption of direct reimbursement.
These are just a few of the accomplishments that the PA profession has achieved over the past two years at the federal level, and AAPA is confident the next two years will continue to be a productive period for the profession.