Funding Barriers for Canadian PAs in Ontario - How does billing work in the US?

Question: How does billing work for PAs in the US? Do PAs generate money for practices? Is the funding model for PAs financially sustainable in specialty practices?

Elaborating on the issue:

Physician Assistants are brand new in Canada, especially in Ontario. There is no formal funding model for MDs to have PAs. At present, the only way a practice may be compensated for the work a PA does is if the physician is in the room, actively participating in the patient’s care. If a surgeon was operating in the OR, and the PA was running a clinic, neither the MD/PA or clinic may bill for the services rendered by the PA because the MD is not physically present to see each patient the PA has seen.

We are currently either cost-neutral with the assistance of funding from the government (Ministry of Health and Long Term Care, in most cases $46000 CDN of a $75,000 starting salary is covered for only two years, then the supervising physician is expected to pay for full afterwards). In areas of medicine OUTSIDE of family med (e.g. Orthopaedics, Physiatry, etc.), it actually costs MDs money to ahve PAs, and there is no sustainable way for PAs to generate any kind of money out of the practice unless the MD is physically present seeing the patient.

I have uploaded the document outlining how MDs can bill for the work PAs do here:

http://anneccpa.files.wordpress.com/2013/05/ohip-guidelines-letter-for-pa-2011-04-04.pdf as well as a screen shot (see below):

Right now, I’m working with a few of my fellow PAs on a grassroots level to determine what steps to take next, how we can remove the barriers for PAs to practice to their fullest potential, and to understand what groundwork American PAs have laid and what funding models have worked for them. Any help would be appreciated

How MDs may bill for work PAs do in Ontario:

So my understanding of this is that PA's don't bill for their work? The supervising MD must bill? In which case the MD must actually "see" the patient? If my supervising MD is physically on site, whether or not they actually "see " the patient, I can bill the patient visit as "incident to" provided I haven't done anything other than follow the existing treatment plan. I bill for my own visits which means my supervising MD can be seeing other patients at the same time which = increased income for the practice. From the article you've posted it looks like things are hung up on the physician actually seeing the patient and that billing for the visit is entirely contingent on what the MD does, which will really limit things.