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CSBME PROPOSED RULE ON PA "OWNERSHIP" OF A PRACTICE

(PA PAYMENT TO A PHYSICIAN FOR SUPERVISION)

On December 8, 2006 the Composite State Board of Medical Examiners (CSBME) held a hearing on a proposed rule to make it unprofessional conduct for a physician "to be employed by an individual whom the physician supervises in the performance of medical tasks or providing patients' services and/or to whom the physician delegates authority."

After hearing testimony from GAPA, AAPA, and PAs and physicians representing three different administrative and financial arrangements the Board postponed the proposed rule for further consideration. It is important that PAs who own their practices or who are in minority ownership with physicians contact the Board to express their concerns. There are bullet points at the end of this section to assist in talking to Board members and others (e.g. state legislators).

GAPA has made it clear to the CSBME that it is unaware of any pervasive problem that is attributable to the relatively few instances in which a PA remunerates a physician for supervising him or her. Some members of the Medical Board apparently believe that a PA paying a physician for supervision might be able to exercise some leverage on his or her supervisor to approve services rendered to a patient. However, a PA cannot see patients without the Board's approval of a job description which contains various duties and medical tasks delegated by the supervising physician.

The proposed rule is not only out of step with the rest of the states concerning this issue; it would prevent PAs from owning a practice and literally put some PAs out of a job. It is also so broad that it could preclude PAs from serving in administrative, quality control capacity or as a minority owner.

In addition, the proposed rule focuses on the wrong point: The real issue is not the "payment trail", but whether the patient is receiving quality care and the physician is providing appropriate supervision.

If you are a PA who is affected by this proposed rule, or if you know persons who could be affected, please contact Peter Hairston (pjhairston@comcast.net) or Tom Bauer (Tbauer23@aol.com).

Summary of Unintended Consequences of the CSBME's Proposed Rule 360-3-.02(21),
PA Payment for Supervision

1. The proposed rule will restrict access to health care.

   • Some rural areas now and in the future will be deprived of a major source of primary health care; and

   • Current medical practices and clinics will be forced to close.

2. The proposed rule does not emphasize physician supervision of PAs and quality of care provided to patients.

   • Focus is on "payment trail", rather than health care; and

   • The Board has abandoned a past (February of 2005) Rules Committee proposal which emphasized physician supervision and patient care.

3. The proposed rule is "out of touch" with the current organizational status of health care.

   • Only two states prohibit PA payment to physicians for supervision;

   • The rule precludes PA ownership of a practice or clinic where the PA sees patients and in most instances precludes a PA or physician from a minority ownership; and

   • In Georgia other health care professionals in private practice (e.g. social workers) can pay "higher" professionals for supervision.

4. The proposed rule conflicts with the stated intent of the PA Act "to alleviate the growing shortage and geographic misdistribution of health care services in the state."

5. At best the proposed rule is unclear in that may well:

   • Preclude a PA from a minority ownership of a practice or clinic when a non-partner physician works at the practice or clinic; and

   • Prevent a PA from exercising administrative duties in various settings if he or she is a part owner of the business.

6. There do not appear to be any large number of significant disciplinary or supervisory issues attributable to PA ownership of a practice or payment to physicians for supervisory services.

7. The proposed rule is unfair in that it will:

   • Deprive some areas of access to health care;

   • Put some persons out of business; and

   • Treat PAs differently from other health care personnel or professionals in general.

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