Opinion: Three ways to maximize the benefits of physician assistants

August 10, 2017

How Phoenix Children’s improved access, value and outcomes through a dedicated focus on advanced practice providers.

While the future of our nation's healthcare system remains uncertain, it is clear value and efficiency will take top priority now and in years ahead. Meanwhile, improving access to care is another critical goal, but continues to be a struggle for healthcare organizations-especially for providers in rural settings and specialists treating highly complex patient populations.

A new solution has emerged in recent years, and it may be the silver bullet for organizations straining to meet cost, quality and access objectives.

Over the last 20 years, legistation in many states has enabled healthcare organizations to leverage the experience and know-how of licensed physician assistants (PAs). Recognizing the potential of PAs to ease workforce burdens and improve access to care, states that once tightly controlled PAs’ scope of practice have since broadened their regulations. Today, PAs can diagnose, treat, prescribe and manage a broad range of medical conditions with a much higher degree of autonomy, and research has repeatedly demonstrated the quality and safety of their care.

In Jan. 2016, Phoenix Children’s set out to fully leverage the skills and expertise of our PAs and other advanced practice professionals (APPs). Like many other health systems, we were faced with heavy patient loads, a highly diverse pediatric patient population, and long wait times in some of our specialized service areas. Meanwhile, our enterprise was transitioning to a value-based care model with rigorous benchmarks for efficiency and quality. It was a demanding healthcare environment, to say the least.

The opportunity to maximize our PAs in addressing these challenges bubbled up as a clear solution.

Today, our PAs operate at the top of their license-with astounding success. We have made significant strides in enhancing access to care. Moreover, outcomes for PA-provided care have been overwhelmingly positive, patients report high satisfaction, and our costs have decreased.

Of course, this shift didn’t happen overnight. Over the past 18 months, we took deliberate steps to refine healthcare delivery at Phoenix Children’s, which also meant redefining the role of the PA on our care teams.

Like many healthcare organizations, Phoenix Children’s physicians preciously worked with PAs in the same way they worked with medical residents or fellows. PAs served in a support capacity to the doctor, spending a majority of their days shadowing, charting, putting in orders, and engaging in other tasks that did not fully harness their expertise or alleviate the workload for physicians in a meaningful way.

Next: Three ways

 

 

Here’s 3 ways to maximize the benefit of PAs:

  • Create an optimal care delivery approach. Recognizing their untapped potential, Phoenix Children’s created a more optimal care delivery approach. Now, PAs see their own patients, make diagnoses, prescribe medications, and create and manage care plans within the area covered by their training and legal scope of practice.

In fact, our PAs manage patient care in divisions across our hospital system, including orthopedics, oncology, urology, cardiovascular surgery and the emergency department. In cases when the patient’s needs are highly complex or will require surgical intervention, physicians conduct the initial consult and use their specialized knowledge to create an appropriate care plan. From there, our PAs may handle post-operative care, manage the care plan, monitor the patient’s condition, and consult with the doctor as needed.

This division of labor has drastically reduced physicians’ workload, freeing them to see other patients that require their level of expertise. In a busy hospital where patient acuity and demand for services is high, this benefit cannot be overstated.

Phoenix Children’s Center for Pediatric Orthopedics offers a prime example of the benefits of our new care delivery approach. Here, our surgeons and PAs provide team-based care, yet PAs maintain a high level of autonomy and address specific patient needs. For example, young children with bone abnormalities like club foot and bow legs typically heal on their own without surgery, braces, or other medical intervention, but their parents face significant anxiety; our PAs can manage this group by spending “high-touch” time with parents, answering questions and addressing their concerns.

  • Don’t shortchange the patients. It’s important to note that a PA visit does not shortchange our patients; it signifies our focus on providing the right level of service with the right provider type. Today, our orthopedic PAs hold their own clinics, which has helped Phoenix Children’s ease access issues, increase patient volumes, and provide high-value, cost-effective care. Notably, this structure has also enhanced overall quality of care and raised patient satisfaction scores. Morale among our APPs has improved as well.
  • Don’t limit PAs’ skillset to a particular setting. PAs have proven to be highly effective in a hospital setting, but their skills and training are also ideal for primary practice. For example, children with cough and cold, conjunctivitis, respiratory issues, simple fever and other routine symptoms are ideal candidates for a PA consult.

Giving PAs the opportunity to practice at the top of their license has been an organizational homerun for Phoenix Children’-but it’s not just a win for our enterprise. Improving access for patients, bringing down the cost of care, and delivering quality outcomes is a win-win for everyone.

 

 

Heather Healy, RN, MSN, FNP-BC, NEA-BC, is vice president, Advanced Practice Providers & Ambulatory at Phoenix Children's Hospital.