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A limitation on PA owned practices...make your voice heard!

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From DEAPA News:



Physician Assistant Practice Ownership



Submitted by Erika Pierce, PA-C, DEAPA President-Elect



Mar 09, 2011- The DownEast Association of Physician Assistants is aware of excellent, well run, PA owned practices in the state. Over the years, Physician Assistant owned practices have served thousands of patients. Recently PA owned practices have become the center of the proposed changes to Chapter 2.


Under the Board of Licensure in Medicine (BOLIM), Chapter 2 contains the rules that govern current PA practice with a Medical Doctor (MD) in the state. The Physician Assistant Advisory Committee (PAAC) to the BOLIM was asked to review the chapter 2 rules and propose changes including limiting PA ownership of practices. The reasoning behind the concern over PA practice ownership is based on the perception that PA owned practices produce more numerous and significant complaints than from non-PA owned practices. However, when reviewing the public data on disciplined providers, it is not clear what percentage of PAs disciplined were actual practice owners. Several serious disciplinary actions against PAs did not involve PAs who owned their practices. Interested readers are invited to review disciplinary actions on the Board's website at www.docboard.org/me/discipline/dw_actions.html.


The Rules for Maine’s Osteopathic Physician Assistants

Several years ago the Maine Osteopathic Board of Licensure adopted a policy limiting PA practice ownership to 49%. This rule has been in place for several years, limiting the ability for PAs who are supervised by Osteopathic Physicians to own practices. Based on the request of BOLIM the PAAC has reviewed the Osteopathic Board’s rules on PA practice ownership and considered recommending a rule that mirrors the current Osteopathic rule.


The Potential Impact:

Although there are only a few PA owned practices in the state, if such a rule were put in place, those PA owned practices, as they currently stand, would have to restructure themselves or close, thereby impacting the community served by the practice. The real question is: Does closing or limiting PA owned practices increase public safety in the communities served by PA owned practices? If so, the BOLIM must limit PA practice ownership. At this time, DEAPA is not aware of any evidence to suggest that restriction of PA owned Practices increases public safety. This limitation will decrease access to care for patients who are currently served by a PA owned practice and prohibit any future PA owned practices from entering communities that may be served by such a clinic, at a time when access to care is limited for some populations.


An Ethical Dilemma?

There is concern that PA employment of the supervising physician renders it impossible for the physician to be impartial in their supervisory duties, suggesting that the relationship between a PA practice owner and the employed physician is unethical and should not be allowed.


In the recent March 1st PA Advisory Committee meeting the concern focused not on the PA employing the physician, or PA clinic ownership itself, but rather the need for transparency around the employment arrangement. There was consensus that all PA owned practices should disclose on Form C that the supervising physician is employed by the PA, as well as several ideas as to what else could be required disclosures. DEAPA leaders present at the meeting were encouraged that significant work is going into creating a licensing process that allows safe, competent, well-supervised PA owned practices which offer increased access to care in their communities.


A National Perspective:

The American Academy of Physician Assistants (AAPA) is very clear that the clinical relationship between a PA and their supervising physician is unrelated to employment arrangements. The supervising physician is always the clinical leader of the physician/PA team. The role of the supervising physician is defined in chapter 2 and that role remains the same whether the physician employs the PA, the PA employs the physician, or both the physician and the PA are employees (or co-owners) of the same practice.


What About Other States?

There are many examples of PA owned practices throughout the country. Many individual states have laws that clearly allow PAs to own practices. However, the majority of states do not define who can own a corporation. Silence on the issue leaves the issue up for interpretation, but according to the AAPA many of these “Silent States” have examples of PA owned practices within them. There are only three states with clear rules that prohibit PA practice ownership: Arkansas, Illinois, and Louisiana. There are four states beside Maine that allow PAs to own a practice, but restrict PAs to owning a minority share of the practice: California, Colorado, Kansas and Oregon. Sixteen states clearly allow PAs to own a practice, and do not restrict the percentage of shares that may be owned by PAs. Despite the differences at the state level, the Centers for Medicare & Medicaid Services (CMS) allow Physician Assistants to own ninety-nine percent of a practice. From a national perspective, limiting PA owned practices would leave Maine PAs in the minority when it comes to allowing PA practice ownership.


What Do The Physicians Think?

DEAPA asked the Maine Medical Association for their position on this issue. We are expecting a formal stance from them on the issue by mid-March. Gordon Smith, Esq. and Executive Vice President of the Maine Medical Association gave an informal opinion supporting PA practice ownership.


DEAPA’s Opinion:

DEAPA supports PA practice ownership.


What Can You Do?

DEAPA is interested in your opinion, and want your input on this issue. What aspects of the employment and supervisory arrangements between a supervising physician and employing PA should be required by the BOLIM?


A few suggestions:

Express your opinion to DEAPA so we can better represent our membership.


Contact the PA Advisory Committee of the BOLIM directly to express your opinion.


PAAC Committee Chair: Erich Fogg PA-C

Get your supervising physician involved by asking their opinion and encourage them to contact the MMA on the issue.

Join the DEAPA Legislative Committee.

Attend the upcoming June 7th, PA Advisory Committee Meeting in person.


DEAPA Welcomes your input!

Contact us at: bfarrell@mainemed.com or info@deapa.com

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  • 1 month later...
... The supervising physician is always the clinical leader of the physician/PA team. The role of the supervising physician is defined in chapter 2 and that role remains the same whether the physician employs the PA, the PA employs the physician, or both the physician and the PA are employees (or co-owners) of the same practice.

Is there somewhere we can read what exactly is stated in the rules (chapter 2)?

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