December 6, 2023
Determine the Value You Provide and Quantify It
October 19, 2021
By Sondra DePalma, DHSc, PA-C, DFAAPA
Decades of research and experience prove that PAs are valuable, but can you demonstrate your worth?
PAs provide care that is comparable to physicians in quality and outcomes; they do so with high levels of patient satisfaction and increase profits for their employers. The Medical Group Management Association finds that practices that employed PAs had increased profit after operating costs regardless of the medical specialty, and the Medicare Payment Advisory Commission, a nonpartisan agency that provides the U.S. Congress with analysis and policy advice, states that “PAs nearly always lower costs (and increase profits) for their employers.” Despite these facts, certain billing mechanisms and limitations in metrics may undervalue PAs.
When measuring productivity, it is important to 1) ensure the most accurate data is used, and 2) understand limitations in attribution that may skew measurement. Measuring Relative Value Units (RVUs), a resource-based relative value scale, or revenue alone may provide an incomplete depiction of a PA’s productivity. This is particularly the case when billing mechanism (such as “incident to” or bundled payments) are used, or when PAs provide healthcare services that are not directly reimbursable (such as triage, care coordination, and on-call services).
What is value?
There is a traditional value equation in healthcare that defines value as quality divided by costs. In this model, value can be increased by either improving quality or reducing costs. However, a patient receiving high-quality, low-cost care would not likely consider it valuable if it were not accessible (e.g., offered at a convenient location or time) or if the practitioner did not spend time with them, answer their questions, or provide culturally competent care.
A better value equation in healthcare would factor all favorable aspects of a service, including quality, outcomes, convenience, and satisfaction, against all financial, resource, and other costs.
How to demonstrate value
Identify the value you provide and quantify it. Do you see high medical complexity patients, provide high levels of patient satisfaction, contribute to the overall efficiency of a practice, or ensure that value-based payment metrics are met?
Electronic health records, quality reporting requirements, and health information technology (IT) generate enormous amounts of data. PAs can work with practice managers, billers, IT professionals, patient experience personnel, and others to access information that is already being collected. Individual and practice metrics can both be used to show your worth.
PAs can also calculate their own value with a relatively minimal amount of work. All medical and surgical services can be looked-up on the Centers for Medicare and Medicaid Services Physician Fee Schedule (PFS) to determine their payment rate and assigned work RVUs (which represents the provider-work involved in performing a service or procedure). For example, a level 3 established office visit (CPT® 99213) has a national average payment rate of $92.47 and is assigned 1.30 work RVUs. If seeing an average of 12 level 3 established patients in an office 5 days per week, and paid at 85% of the PFS, a PA is generating, on average, $4,715.97 and 78 work RVUs each week. Using the PFS and other methods of calculation, the contribution PAs make to global surgical care can also be determined.
Sondra DePalma, DHSc, PA-C, DFAAPA, is director, Regulatory and Professional Practice at AAPA. Contact her at [email protected].
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