On a larger health care system scale, PAs can help to save the health care system money while at the same time improving patient access to health care services. This can theoretically free up health care dollars to be spent on other necessary services.
At a family practice for example, a PA can see their own list of patients, while the physician is seeing their own list of patients. A family practice that adds a PA to their practice can expand the number of patients seen, increase number of appoints available while simultaneously decrease wait times to see a primary care provider.
At a specialty practice, a PA can help a specialist physician increase the number of patients seen, decrease the wait times to be seen by a specialist, while simultaneously increase the fee-for-service billing that comes to the practice **
**In Canada, a physician must have “meaningful participation” in order to bill for the patient encounter at 100% of the physician code (Source: OHIP Schedule of Benefits). An example of how this can work:
- Step 1: This means the PA can start the encounter (history, physical, review of investigations)
- Step 2: PA leaves the room & case presents with provisional diagnosis & management plan (or MD reads PAs note on EMR or paper file). The physician then confirms or modifies the plan (or the clinic note)
- Step 3: Physician enters the room to finish off the encounter, (primary assessment and plan, although there may be a quick check of specific history or physical exam points). During this time the PA has started another patient encounter (Step 1).
This model in a fee-for-service setting allows the physician to bill for 100%, with the PA having done 85% of the work in the patient encounter. PAs in Canada cannot independently bill provincial health insurance plans. The above model allowed my supervising physician to triple the number of patients seen, while simultaneously reducing the length of the clinic (6 hours instead of 8), and the physician subsequently did no medical dictation for the clinic afterward as the PAs completed the dictations between the next patient.
In the United States, PAs have billing numbers and do not require physician participation to bill third party insurers. They bill at 85% of the physician fee. The “Incident to” billing is when the physician steps in and participates in the patient encounter, the practice can then bill at 100% of the physician fee. The steps outlined above may occur for PAs that are fresh out of school, but as PA builds competency, it may transition into a more indirect supervision method (MD available in building or by phone if PA needs to consult).