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To qualify to work in the emergency department, a physician assistant must have:
Emergency medicine physician assistants may provide emergency care for patients in various settings such as:
PAs practice medicine with the supervision of licensed physician and, although by law PAs are dependent practitioners, they typically exercise considerable autonomy in clinical decision-making. Supervision may be provided by varied methods such as physical presence or reasonable access by telephone or electronic media. Each state will have its own supervisory requirements and it is mandatory that the physician/EMPA team follows state law where they are practicing.
There are several types of documents that are used to describe how a physician and PA will work together. These documents are often referred to as "supervision agreements", "delegation agreements", "job descriptions", "physician-PA practice agreements", or "supervision protocols." Whatever it’s called, the purpose of the document is to: describe how the supervising physician and PA will work together; outline any specific requirements the physician has for the PA; how supervision will be documented; and general expectations for the physician and the PA. Some state laws require specific information be included in the practice agreement. The best supervision agreements are general one- or two-page documents that allow flexibility and do not have to be modified every time the PA learns a new procedure or takes on a new task.
There are four parameters that determine the scope of practice for an emergency medicine physician assistant:
PAs are utilized in all areas of the ED and in all settings from being the solo provider in a rural ED to providing patient care at a Level I Trauma Center. When staffing the ED, a PA typically sees the same patient acuity mix as the physician(s) with whom they work in the physician/PA team.
In emergency medicine, the ED medical director, other supervising physicians and the EMPA typically reaches decisions about delegation jointly. Because medical practice and physician/PA practice are dynamic, specific lists of approved tasks that can be applied to all facilities and to all physician PA teams are not practical. There are not any "typical" restrictions on what a PA does in the ED. The physician/PA team and the hospital should be aware of any restrictions on the PA's scope found within state law or hospital policy.
Examples of scope of practice include, but are not limited to the following:
There are three factors that can determine whether a PAs chart requires as co-signature:
The Medicare program does not require a PAs chart to have a co-signature. However, Medicare will defer to state law and require chart co-signature if that is a requirement of state law.
Many of the issues concerning the utilization PAs in the ED are the same issues that confront emergency department physicians including:
Some issues that are unique to PA utilization in the ED include:
Each payer determines credentialing and enrollment policies for PAs. In fact, the same national payer may have different rules regarding PA credentialing and enrollment in different states. And, some private payers or Medicaid departments may enroll PAs while others will not.
It’s important to understand that enrollment and credentialing are not synonymous with coverage or payment for services. Many payers who do not separately credential PAs will cover their services when billed under the supervising physician's name or the group practice.
The term "incident to" is occasionally used to describe coverage of services performed by a PA, when those services are billed under the name of the supervising physician. That is not correct. "Incident to" is a Medicare term used to describe services billed in the office or clinic setting. The "incident to" billing concept is not utilized in the hospital (inpatient or outpatient).
Non-Medicare payer enrollment policies are made on the local payer level. The policies followed by Medicaid and Blue Cross/Blue Shield programs vary considerably by state. For example, the Medicaid program in one state may enroll PAs, while the Medicaid program in a neighboring state may only recognize physician services.
The best way to determine credentialing and enrollment policies is to contact the payers in your specific area to ascertain their policies.
Utilizing PAs in the ED has proven to be both cost effective and efficient.
PAs provide similar, and in most cases identical, medical services that are being provided by their supervising physician but at a much lower cost. By adding a PA program to the ED, more patients can be seen faster, reducing patients waiting times and improving patient satisfaction. PAs can be utilized to treat lower acuity patients and those patients most likely to be discharged home from the ED, giving the physician more time to care for critical patients.
When recruiting PAs, an emergency department should consider its needs, and it’s important to match the expectations of the ED and the PA.
Another aspect to consider is the level of experience. Any organization hiring a new graduate should be mindful that newly trained PAs require more mentoring and closer supervision than experienced PAs. A seasoned PA with emergency medicine experience will be more likely to hit the ground running, may work at a more rapid pace than a new graduate and be able to handle a higher volume of patients.
Providing rotations for PA students in an ED is an excellent way to recruit new graduates – the physicians have a chance to work with the PA student before making a hiring decision.
When looking for ED candidates, employers might wish to consider individuals with previous ED experience, either as a PA or in a previous career as a technician, paramedic, or nurse, for example. Very often, PAs who are drawn to emergency medicine have worked in emergency medicine in some capacity before they became PAs.
SEMPA has a robust Career Center designed for PAs and employers alike.