Physician assistants push for legislation supporting off-site supervision

Kathleen O’Dell
Springfield News-Leader

Members of the Missouri Academy of Physician Assistants from across the state gathered at the Capitol today to urge lawmakers to protect patient access to quality health care by supporting legislation that establishes new guidelines for the supervision of physician assistants.

Barring guidance from the legislature, the state Board of Healing Arts plans to enforce changes in August that would require 100 percent on-site supervision of all physician assistants, as well as eliminate an exception for physician assistants who practice in federally designated Health Professional Shortage Areas, or HPSAs.

Sen. Brad Lager has introduced SB 537 to allow physician assistants to care for patients as long as their supervising doctor is on site 66 percent of the time. When off site, the doctor must be readily available for consultation through various communication methods — including phone, fax and telemedicine equipment — and remain within 30 miles of the facility where the physician assistant is caring for patients.

The bill also includes an exception for designated shortage areas. The Board of Healing Arts would be directed to establish a waiver process for physician assistants working in designated HPSAs. To qualify for a waiver, the doctor-physician assistant team would have to show that adequate supervision would be provided and that there would be reduced access to health care for the community without the waiver.

Identical language is included in SB 308, which is pending in the House. It replaces HB 497, sponsored by Rep. David Sater.

Keely Cook, legislative coordinator for MAPA and an assistant professor at Saint Louis University, accompanied about 35 students who are enrolled in the university’s physician assistant program to Jefferson City. They were joined by 16 students from Missouri State University.

“In order to make Missouri attractive for potential employment as a physician assistant, we are encouraging all students to actively participate in the legislative effort to improve the physician assistant supervision guidelines in the state,� Cook said. “The two physician assistant education programs in the state are dedicated to serving the health care needs of Missourians. We want our graduates to stay here to care for Missouri patients.�

Physician assistants help to improve patient access to care in areas affected by a shortage of providers, said Paul Winter, president of Missouri Academy of Physician Assistants. Physician assistants always work under the supervision of primary care physicians, specialists and surgeons.

“This is an issue that is vitally important to Missouri patients and to our profession,” said Winter, who was joined by about 80 physician assistants and students. “Medical clinics in rural and inner-city communities would be forced to close or reduce operating hours, leaving the sick and injured to drive greater distances or go without care. We have licensed physician assistants, as well as students studying to become physician assistants, in Jefferson City today to respectfully ask lawmakers for their support.â€?

MAPA supports both bills, Winter said. The new supervisory requirements are part of a compromise that has gained the support of the Missouri State Medical Association, representing more than 6,500 Missouri physician. The Missouri Farm Bureau, Missouri Hospital Association and Missouri Rural Health Association also support the bills.

The state organization of doctors of osteopathy want tighter restrictions on the ability of PAs to practice when the supervising physician is not on site. Officials say individuals should not be allowed to practice medicine without a medical license. They also say they are concerned about the quality of care people get from PAs who practice off site from a supervising physician.

Winter said a doctor in rural practice would be able to see patients in the hospital while the physician assistant cares for patients with common problems and within his or her current scope of practice in the office. In inner-city clinics, it means that a health department’s medical director can more efficiently staff well-child clinics.
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