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Physician assistants look to expand EHR incentive eligibility

Despite their insight on clinical workflow, EHR use and implementation, physician assistants are on the outside looking in for the EHR incentive programs. Some want to change that.

Physician assistants (PAs), like a handful of other non-primary care specialties, are not considered eligible professionals (EPs) under the Medicare EHR Incentive Program. However, under the Medicaid EHR Incentive Program, they are eligible in limited circumstances, such as a PA-led rural health clinic (RHC) or federally qualified health centers (FQHC).

The Centers for Medicare and Medicaid Services (CMS) has clarified what a PA-led organization entails, even though the number of physician assistant-led RHCs and FQHCs are few and far between.

  • When a physician assistant is the primary provider in a clinic. For example, an RHC with a part-time physician and a full-time PA would be considered "PA-led."
  • When a PA is a clinical or medical director at a clinical site of practice.
  • When a PA owns an RHC.

PAs are frustrated with the decision to bar them from monetary incentives in the majority of cases. To that end, Tricia Marriott, a PA and the director of reimbursement advocacy for the American Academy of Physician Assistants (AAPA), is one of many leading the push for EHR incentives for PAs.

Part of the reason, Marriott wrote in an email to earlier this year, is that "they are well-suited to shepherd the EHR implementation," adding, "their clinical knowledge and knowledge of the physician and practice styles are invaluable for creating [EHR] templates."

EHR use a common responsibility for PAs

Although the HITECH Act put incentives in motion to encourage EHR adoption among physicians, they are not always the ones using EHR systems. Physician assistants often undertake that responsibility.

"It's very rare to find a teaching surgeon or physician putting in their order," said Jenn Wall, a PA in the burn and trauma unit at Brigham and Women's Hospital in Boston. Wall said that fewer senior physicians, or “head honchos” as she puts it, are using the electronic system at all.

Wall uses the hospital's EHR system for viewing clinic notes, checking a patient’s past medications, looking up where a patient's primary care doctor is located, completing computerized physician order entry, viewing admission notes and discharge summaries, and paging physicians in the hospital, among other tasks. She said some like to call this "grunt work," but these tasks are listed among the meaningful use requirements for receiving EHR incentives.

PAs are a viable option in EHR implementation for a hospital or practice. "They are seeing patients and intimately involved in practice workflow,” Marriott said. “Their insights can be a huge asset to the EHR adoption team, and must be included as part of the implementation process on the road to meaningful use."

Patient volume plays no role

It is ultimately an uphill climb for PAs. The push to be included in the Medicare EHR Incentive Program is not only limited to clinical insight and regular EHR use, either. Over the last several years, Wall said, PAs have been getting well versed on billing codes in an effort to show their worth when it comes to numbers of patients.

PAs often see a higher patient volume than physicians, she said. If 30% or more of a physician's patients are on Medicaid, then the physician qualifies for EHR incentives. PAs generally see more than 30%, Wall said, which she believes is more than enough include them in the incentive program.

The answer to that provides the backbone to the AAPA's mission. The organization believes CMS assumed, incorrectly, that payments to PAs would be covered under EHR incentives given to EPs. That has not been the case so far.

For that reason the AAPA is urging physician assistants to lobby for a HITECH Act amendment that would extend the Medicaid EHR Incentive Program to PAs. This would not be without precedent. The act was amended in 2010 to make hospital-based physicians eligible for meaningful use, and a movement is also underfoot to add behavioral health care providers as well.

Let us know what you think about the story; email Craig Byer, Assistant Editor.

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