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“We’re running into a brick wall on telemedicine,” says Desmond Watt, PA-C, co-founder and executive board president of the Maryland-based group. “There’s more that PAs can do … than they’re (being allowed) to do.”
The problem highlights a persistent barrier to the widespread adoption of telehealth and mHealth programs: a hodgepodge of federal and state laws and policies that recognize PAs as providers of telehealth, but restricts how, where and under whose supervision they practice.
“For a lot of healthcare providers, it’s a matter of convenience in hiring a PA vs. hiring another provider type, but the paperwork is too much,” Watt says.
Defined in the early 1960s as a new class of care provider, PAs are defined by the American Academy of Physician Assistants (AAPA) as “medical professionals who diagnose illness, develop and manage treatment plans, prescribe medications, and often serve as a patient’s principal healthcare provider.“ They number roughly 140,000 in the US – and their ranks are expected to grow by 30 percent over the next decade.
With an emphasis on collaboration and flexibility, PAs are poised to fill in the gaps in care created by a national shortage of providers. And telehealth and mHealth programs would offer an ideal platform to address those gaps, Watt says.
“Telemedicine is a collaborative endeavor, focused on taking down walls rather than building them,” he says. “We’re aiming for a continuum of care.”
The biggest barrier lies in supervisory guidelines, particularly in direct-to-consumer telehealth programs. While some of those restrictions have been eased in light of the COVID-19 emergency, PAs are still very much defined in care delivery by who and where their supervisors are, and that can be a challenge when PAs are located in rural clinics, federally qualified health centers, community health centers and other distant sites or states.
In addition, Watt says, PA services are reimbursed by the Centers for Medicare & Medicaid Services, but it's done indirectly, obscuring the value of the caregiver.
On the flip side, he points out that cost of care is much lower when provided by a PA instead of a doctor, particularly in primary care settings. In addition, with the current pandemic causing provider shortages or furloughs, PAs can be flexed to fill in where they’re needed.
“We’re not seeking completely full unrestricted practice,” Watt says. Just, he says, recognition for the work that PAs can do through telehealth.
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