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cation . Physician assistants are trained as generalists in a medical model and have the same CME licensing requirement as physicians . Nurse practitioners receive their training in the nursing model but with more specialization opportunities . The nursing model for the undergraduate degree may be less demanding . Nurse practitioners also have a greater variety of non-clinical practice options ; the nursing model was initially thought to provide a slight advantage due to their nursing patient care experiences . Both training programs are already moving toward additional postgraduate training .
For some reason the state legislature in Kentucky has been somewhat more nurse practitioner friendly both in terms of initial practice and in 2 / 2N prescription writing . Kentucky is presently the only state that allows nurse practitioners 2 / 2N narcotic prescription writing capability , but denies physician assistants that ability . It is estimated that over half of the patients seen in practice by either of them in Kentucky are on 2 / 2N drugs . This issue surely must be corrected because it may have a negative impact on the employment and the retention of physician assistant graduates in Kentucky .
The delivery of health care in the future will utilize PAs in a central role ; the type of health care funding will determine the care model if the past is prologue to the future . The delivery model will be social . Physicians and their extenders will comprise about 20 percent of a health care delivery team designed to improve health outcomes . The other 80 percent will be comprised of a great variety of persons with different backgrounds , training and experience . The combined team ’ s effort will be directed toward keeping well people well , improving the quality of life of persons with chronic illness , and training patients to accept personal responsibility for their health . Considerable effort will be focused on both affecting and responding to the patient ’ s perception of the care received , and their evaluations of their experiences . Medical practices that involve physician assistants should allow more time for the patient to spend with both the assistant and their sponsoring physician . Patient complaints may represent process issues , and patient grievances may represent structural issues . Carefully obtained metrics will be used to analyze , evaluate and remediate . However , metrics are not yet in common use that will serve to guide physicians and their physician assistants in the evaluation of health as a state of well-being or that can provide the direction required to determine the quality of life for patients .
Physician assistants will play a critical role in value-added health care , population-based health care , and those best practices in view of the Medicare Access and CHIP Reauthorization Act of 2015 . The Affordable Care Act of 2010 will likely be altered and adjusted in a meaningful way by a new president and remade congress . I think that the ACA will however continue to transform the system from one that is activity based to one that is dependent on the total value assigned by the insurer . CMS predicts that 50 percent of Medicare payments in 2018 will be value-based ; therefore provider – based integrated delivery networks and systems will be required .
Value added health care is yet another paradigm shift in that it depends on results and not on inputs . It also requires a better use of capacity by the elimination of non-value added services . Value-based health care is projected to produce measurably lower health care costs and improved outcomes . Future PAs should be well trained to be helpful to their responsible sponsoring physicians in achieving the desired results in both of these areas .
What is population-based health care and what does it mean to a practicing physician ? Population-based health care indicates the changing reality in the organization and delivery of health care in the United States . It signifies a dramatic departure from the essential role of physicians as providers to individual patients . To health care planners , the concept encompasses valuable new tools and techniques to improve the health of all people . Population-based health care can be described in terms of panels of patients associated with a physician , practice or delivery system . This is distinct from the public health perspective of the population as all residents of a geographic community or region . A population-based health perspective encompasses the ability to assess the health needs of a specific population , which then allows the required implementation to improve the health of that population . It should also include the provision of care to individual patients in terms of their culture , health status , and the health care needs of the “ population ” to which the patient belongs . When caring for a population , the physician should measure outcomes for all patients with the targeted condition , will not just the patients seen in the office . This may be what largely differentiates population-based care from traditional individual centered care .
Population-based health care delivery has arrived at a time when medical care has been moving toward a more individualized science-based treatment for each person ( the influence of genetic information and its use , for instance ). Treatment might then be provided to patients based on the person ’ s current response to their present illness or disease .
Population-based health care does not extend to an individual but to an entire health community or panel of enrolled members . Therefore , the structural relationship between the physician and the individual patient could be severely strained . This approach to health care delivery draws from the marketing concept of assessing the health care needs of a specific population that can be delivered in a quality and cost-effective manner . Evidence based guidelines on how to practice population-based health care are not yet available and will need to be developed . The responsible sponsoring physicians of physician assistants will need to be life-long learners who are willing to embrace change . They will need to mentor , teach and to provide continuing education for all of their team members . Multiple physician assistants will need to be well positioned in order to become good associates for their sponsoring responsible physician related to the design , provision , and delivery of health care in this very complicated environment . Physician assistants are trained in general medicine and surgery for all age groups of patients and may become their primary caregivers in this new paradigm . This should free up the required time needed for their sponsoring responsible physicians to become more involved as medical care consultants and health care delivery planners .
In 2015 , MACRA , for the first time surely and absolutely puts physicians and their physician assistants at financial risk . It is not
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