According to Medicare and The Joint Commission, a Physician Assistant (PA) must be credentialed and privileged through the medical staff process – this speaks to individuals providing a medical level of care (or a service a physician would otherwise have to provide). This may come as a surprise to many folks. The role of the PA is one that has undergone substantial change in the past 15 years and many facilities are still learning how to fold PAs into the new order – and how to think of them as part of the medical staff!
Are PAs really considered staff members?
PAs can be members of the medical staff, but membership is different than privileging because you can grant privilege without affording them membership (the caveat to medical staff membership for PAs is that it must be allowed by state law). And medical staff membership is something that is new from the past couple of years. As it is becoming more widely understood and accepted that PAs are providing some of the same services a physician would otherwise provide (i.e.: writing orders, providing medical care), having them participate in the medical staff committee is an important contribution. Something to think about: PAs can serve as great “doers” of many of your initiatives both on a policy and quality side.
Think about the fact that the physician and the PA work together – the physician delegates through the PA what is in his or her scope of practice, then you can easily take the privileges granted to the physician and red line things that the PA would not necessarily do.
Having PAs be a part of the staff activities is now becoming an increasingly popular concept. So much so that it’s been discussed at the NAMSS Educational Conference for the past few years and at the national credentialing forum. Because of this newfound acceptance, PAs are able to get involved at all the different levels – they really should be sitting on committees like quality, ethics, pharmacy and therapeutics committees – especially since many PAs are currently being employed as ad hoc physicians on the Medical Executive Committee (MEC).
Should the infrastructure change as a result?
There is also an evolution of infrastructure for reporting because in every hospital we have a Chief Nursing Officer, a Chief Medical Officer, a Director of Respiratory, etc. Generally, your PAs (and Nurse Practitioners) are sort of tucked somewhere into that hierarchy and often not managed well. There has been a recent surge in a new position to cover this from an organizational standpoint by having Chief PAs in the department level and an overall Director of PA Services for the entire facility.
But there is another, more unspoken issue – and that is with organizational culture and perception. If the physicians aren’t familiar or comfortable with working with PAs, or if the support staff or the clinical operations people don’t understand the concept of PAs, then you’re going to have trouble with implementation. There is no good and hard “rule” here, but it’s something to look out for.
How does peer review work with PAs?
The Joint Commission defines “peer” as practitioners in the same professional discipline as the applicant who has personal knowledge of the applicant. This means that a PA should be evaluating a PA, and a Nurse Practitioner (NP) should evaluate a NP, etc. However, there may be a situation where there is no NP or PA, so it is acceptable for a physician or someone with equivalent qualifications to provide the peer reference.
In closing, there is a lot of groundwork in place to continue to make PAs an ever-important part of every healthcare facility. Make sure you stay up-to-date with what’s going on with them and don’t get left behind thinking about PAs as they were in the 20th century!