Utah PA Shares Experience Facing Outdated Laws and Red Tape
Death of Supervising Physician Supports Urgency for Passage of Bill Pending in Utah Legislature
February 26, 2021
By Wade Anderson, PA-C
When I decided to go into medicine more than two decades ago, a childhood experience was one of my main reasons.
I was eight years old, and my father had recently built a zip line out of our treehouse. Believing I was as big as my brothers and could go down without harm, I didn’t hesitate to try it out.
I fell – of course – and ended up with a displaced fracture of my left distal radius and ulna. To make matters worse, my parents happened to be out of town. Thankfully, a neighbor took me to the most trusted person in our town they knew next to my parents – Dr. Dwight Inouye.
Dr. Inouye dismissed his busy schedule and carried me – a young, frightened boy – in his arms over to the hospital. I don’t remember much after that except waking up to find that my arm was straight; I was in less pain; and Dr. Inouye had made it all better.
And so began my interest in medicine.
As I plotted my course toward medicine, my path led to PA school. After I graduated from Midwestern University in Phoenix, my old friend Dr. Inouye offered me a job at his independent practice, and we began our partnership in medicine.
For the past 13 years while working alongside Dr. Inouye, I aspired to follow his example and be a caring and skilled provider to the underserved area of Central Utah. I learned that practicing medicine is more than performing medical exams and treatment; it’s service. I learned the importance of helping people after hours, even when it isn’t convenient.
After more than a decade of practicing together, we began to plan a transition that would involve bringing in another physician to the practice so that Dr. Inouye could retire.
But COVID put a stop to our planning when Dr. Inouye contracted the virus and passed away.
All the years we worked side by side, we never fully understood the other side of medicine involving outdated laws, inappropriate bureaucracy, and too much red tape. We just wanted to make our patients’ lives a little better.
Utah law currently requires PAs to have an on-paper relationship with a specific physician in order to practice. This means that without a supervising physician, I was no longer legally permitted to care for my patients following Dr. Inouye’s death – despite my scope of practice, my training, and my experience.
As any PA can imagine, the past several weeks have been a nightmare for me – and my patients.
While scrambling to find another supervising physician to join the practice, I also quickly realized that until I secured a supervising physician, I could no longer sign orders for the medical care of our patients on hospice and home health. Additionally, I learned that my orders for our hospital patients had to be changed to the supervising physician as my signature was not accepted, again delaying patient care.
Yet, these issues were nothing compared to what I learned a few weeks after Dr. Inouye’s death.
As a PA I am not allowed to bill insurance companies directly in the state of Utah. Though the recent passing of the Coronavirus Relief and Omnibus Agreement gave PAs the right to bill Medicare independently, Utah law still requires physicians to submit the claim for reimbursement. While the new supervising physician is taking the steps to get credentialed, this can take up to 150 days. And current insurances will not allow us retro bill as the current supervising physician is not yet credentialed. While we wait, hundreds of patients still need to be seen; but without the ability to bill insurance, we will not have the necessary revenue to keep the practice open.
Our office manager recommended we close for the time being. But how do you tell your patients, “Sorry, I can’t help you until we get the financial side of our business figured out”? But there is hope for our community and other underserved areas in our state experiencing similar roadblocks to patient care.
As a Utah PA, I am asking our state lawmakers to support SB 27, the Physician Assistant Act Amendments bill sponsored by Senator Curtis Bramble. This bill will allow PAs to treat patients consistent with their training, experience, and competency – without being held back by outdated state law requirements for a relationship with a specific physician in order to practice.
SB 27 will also give PA employers in Utah the flexibility to establish healthcare teams that are tailored to best meet the needs of patients and the facility or practice and make decisions based on the skill and expertise of the team members.
My experience following the unexpected passing of a supervising physician underscores just how important advocacy is – and why more PAs like myself must get involved. The only way lawmakers will ever understand why PA laws must be updated is for them to hear from us how patients are being affected by outdated laws.
In underserved areas like central Utah where I practice, we don’t have a moment to wait. Our patients need updated PA laws now.
Wade Anderson is family medicine PA, practicing in Gunnison, Utah.