Should physician assistants get Meaningful Use incentives?

When any government entitlement program gets underway, there will be those who feel unjustly slighted--and those who will try to remedy the situation.

So it is with physician assistants (PAs), who for the most part have been excluded from the electronic health record incentive programs. The HITECH Act allows physicians, dentists and nurse practitioners (NPs) to obtain incentive payments under the Medicaid EHR incentive program, but not PAs. And as for the Medicare EHR incentive program, only physicians need apply.

The Centers for Medicare & Medicaid Services expanded the Medicaid EHR incentive payment to "PA-led" rural health clinics and federally qualified health centers, but only 6,000 of the 81,000 PAs in the country are employed in those types of organizations, according to the American Academy of Physician Assistants (AAPA).

So why weren't PAs allowed on the playing field?

"There was a lack of understanding of the role of the PA," Tricia Marriott, a PA and the director of reimbursement advocacy for the AAPA in Alexandria, Va., said in an exclusive interview. "Congress believed that by paying physicians the incentive payment PAs would be taken care of."

That is an oversight that should be fixed," she adds. "There's no downside."

AAPA is lobbying to expand the program to all PAs.

Marriott does make a compelling argument for including PAs in the Medicaid EHR incentive program. Many physician practices and hospitals employ PAs, who use EHRs to treat Medicaid patients. PAs serve as primary care providers in many areas, especially for underserved populations. PAs are considered eligible professionals under CMS' electronic prescribing incentive program and the accountable care organization pilot program.

"If a [provider] could receive the incentive payment for the work performed by a PA, it could help defray the cost of the EHR system and perhaps another PA could be added to the staff to treat more patients and increase access to care," Marriott says.

Eligible professionals can earn up to $63,700 under the Medicaid incentive program.

Moreover, it's not unusual for physicians or hospitals to send a PA to EHR training meetings to learn the quality indicators and qualify as "super users" who can train other staffers.

Marriott herself was the designated EHR super user for her hospital department. "Physicians don't go to these meetings and don't want to be the super user to train the others," she says.

Not allowing PAs to even qualify for the incentive payments has become a disincentive for using PAs just as the need for them is rising. The ranks of Medicaid recipients are swelling, and more hospitals are bringing on PAs to give residents a break, says Marriott.

Would it drain the incentive program? I doubt it. There are 81,000 Pas nationwide. But that's dwarfed by the number of physicians in the United States, which the Wall Street Journal estimates to be 954,000. As of November 2011 only 11,270 eligible professionals successfully attested to Meaningful Use under the Medicaid incentive program, according to Health Data Management, although they have until Feb 29, 2012 to attest for 2011.

And there's movement afoot to help the PAs out. U.S. representatives Karen Bass (D-Ca.) and Lee Terry (R-Neb.) introduced legislation in August to extend the Medicaid EHR program to all PAs who meet the 30 percent Medicaid coverage threshold. The bill hasn't had much traction yet, notes Marriott.

Perhaps it should. The government is not always adverse to correcting perceived gaps or updating rules as they mature. If it could add hospital based physicians and some PAs to the program, it can tweak it a bit further. - Marla

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