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cation. Physician assistants are trained as generalists in a medical model and have the same CME licensing requirement as physicians. Nurse practitioners receive their training in the nursing model but with more specialization opportunities. The nursing model for the undergraduate degree may be less demanding. Nurse practitioners also have a greater variety of non-clinical practice options; the nursing model was initially thought to provide a slight advantage due to their nursing patient care experiences. Both training programs are already moving toward additional postgraduate training.
For some reason the state legislature in Kentucky has been somewhat more nurse practitioner friendly both in terms of initial practice and in 2 / 2N prescription writing. Kentucky is presently the only state that allows nurse practitioners 2 / 2N narcotic prescription writing capability, but denies physician assistants that ability. It is estimated that over half of the patients seen in practice by either of them in Kentucky are on 2 / 2N drugs. This issue surely must be corrected because it may have a negative impact on the employment and the retention of physician assistant graduates in Kentucky.
The delivery of health care in the future will utilize PAs in a central role; the type of health care funding will determine the care model if the past is prologue to the future. The delivery model will be social. Physicians and their extenders will comprise about 20 percent of a health care delivery team designed to improve health outcomes. The other 80 percent will be comprised of a great variety of persons with different backgrounds, training and experience. The combined team’ s effort will be directed toward keeping well people well, improving the quality of life of persons with chronic illness, and training patients to accept personal responsibility for their health. Considerable effort will be focused on both affecting and responding to the patient’ s perception of the care received, and their evaluations of their experiences. Medical practices that involve physician assistants should allow more time for the patient to spend with both the assistant and their sponsoring physician. Patient complaints may represent process issues, and patient grievances may represent structural issues. Carefully obtained metrics will be used to analyze, evaluate and remediate. However, metrics are not yet in common use that will serve to guide physicians and their physician assistants in the evaluation of health as a state of well-being or that can provide the direction required to determine the quality of life for patients.
Physician assistants will play a critical role in value-added health care, population-based health care, and those best practices in view of the Medicare Access and CHIP Reauthorization Act of 2015. The Affordable Care Act of 2010 will likely be altered and adjusted in a meaningful way by a new president and remade congress. I think that the ACA will however continue to transform the system from one that is activity based to one that is dependent on the total value assigned by the insurer. CMS predicts that 50 percent of Medicare payments in 2018 will be value-based; therefore provider – based integrated delivery networks and systems will be required.
Value added health care is yet another paradigm shift in that it depends on results and not on inputs. It also requires a better use of capacity by the elimination of non-value added services. Value-based health care is projected to produce measurably lower health care costs and improved outcomes. Future PAs should be well trained to be helpful to their responsible sponsoring physicians in achieving the desired results in both of these areas.
What is population-based health care and what does it mean to a practicing physician? Population-based health care indicates the changing reality in the organization and delivery of health care in the United States. It signifies a dramatic departure from the essential role of physicians as providers to individual patients. To health care planners, the concept encompasses valuable new tools and techniques to improve the health of all people. Population-based health care can be described in terms of panels of patients associated with a physician, practice or delivery system. This is distinct from the public health perspective of the population as all residents of a geographic community or region. A population-based health perspective encompasses the ability to assess the health needs of a specific population, which then allows the required implementation to improve the health of that population. It should also include the provision of care to individual patients in terms of their culture, health status, and the health care needs of the“ population” to which the patient belongs. When caring for a population, the physician should measure outcomes for all patients with the targeted condition, will not just the patients seen in the office. This may be what largely differentiates population-based care from traditional individual centered care.
Population-based health care delivery has arrived at a time when medical care has been moving toward a more individualized science-based treatment for each person( the influence of genetic information and its use, for instance). Treatment might then be provided to patients based on the person’ s current response to their present illness or disease.
Population-based health care does not extend to an individual but to an entire health community or panel of enrolled members. Therefore, the structural relationship between the physician and the individual patient could be severely strained. This approach to health care delivery draws from the marketing concept of assessing the health care needs of a specific population that can be delivered in a quality and cost-effective manner. Evidence based guidelines on how to practice population-based health care are not yet available and will need to be developed. The responsible sponsoring physicians of physician assistants will need to be life-long learners who are willing to embrace change. They will need to mentor, teach and to provide continuing education for all of their team members. Multiple physician assistants will need to be well positioned in order to become good associates for their sponsoring responsible physician related to the design, provision, and delivery of health care in this very complicated environment. Physician assistants are trained in general medicine and surgery for all age groups of patients and may become their primary caregivers in this new paradigm. This should free up the required time needed for their sponsoring responsible physicians to become more involved as medical care consultants and health care delivery planners.
In 2015, MACRA, for the first time surely and absolutely puts physicians and their physician assistants at financial risk. It is not
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