Physician assistants get more responsibility

Physician assistants may gain expanded responsibilities as a result of the final 2020 Physician Fee Schedule Rule, issued in November by the Centers for Medicare and Medicaid Services (CMS).

The rule loosens Medicare’s supervision requirements for PAs by largely deferring to state law on how PAs practice with physicians and other members of the healthcare team.

“In recent years, 11 states have replaced the outdated term ‘supervision’ with other terms, such as ‘collaboration,’ to better reflect current PA practice,” says Michael Powe, vice president of reimbursement & professional advocacy for the American Academy of PAs. “Another state, North Dakota, has eliminated the legal requirement for a specific relationship between a PA, physician, or any other healthcare provider in order for a PA to practice to the full extent of their education, training, and experience.”

“Deferring to states on how PAs work with other healthcare providers ensures that Medicare policy aligns with the direction many states are already heading when it comes to how healthcare is delivered,” David E. Mittman, PA, DFAAPA, president and chair of the Board of Directors for AAPA, said in a statement.

The final rule also:

  • Authorizes PAs to prescribe medications in their role as “attending physicians,” similar to physicians and advanced practice registered nurses, under Medicare’s hospice benefit.
  • Allows physicians, physician assistants, and advanced practice registered nurses (APRNs, that is, nurse practitioners, clinical nurse specialists, certified nurse-midwives and certified registered nurse anesthetists) to review and verify (i.e., sign and date) – rather than re-document – notes made in the medical record by other physicians; residents; medical, physician assistant, and APRN students; nurses; or other members of the medical team.
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