As health care delivery continues to transform, the implementation of the Patient Centered Medical Home (PCMH) as a vehicle for patient care is rapidly expanding. Physician Assistants (PAs) are becoming increasingly recognized as important players on the patient care team. Recent studies from the American College of Physicians and the American College of Family Physicians state that PAs should be recognized as primary care providers in the PCMH model. Accrediting bodies such as (NCQA) and the Utilization Review Accreditation Commission (URAC) support the PCMH as a proven model for delivering high quality, cost-effective patient care and encourage the inclusion of Physician Assistants.
Nationally, the American Academy of Physician Assistants (AAPA) supports the fundamental premise that standards used to define PCHM and care delivery models are not limited to physicians. Approximately 30,000 PAs practice in primary care of the nearly 80,000 PAs nationwide. Many PAs will practice in health care PCMHs; lead patient care teams and will participate in and be an integral component of quality performance reporting.
Utilization of PAs in the PCMH model may exist in several ways. In some settings, PAs may be focused on acute care or on management of chronic conditions, while in other communities, PAs may maintain their own panels of patients alongside physicians, and in rural communities, PAs may practice alone with a physician located off site. Optimal utilization supports the patient to choose a PA as a primary care provider, ensuring and increasing access to care while the physician maintains oversight of the PA scope of practice. This utilization model allows for continuity of care, fosters patient/provider relationships, and underscores chronic disease management efforts for challenging care conditions including diabetes and asthma. Ultimately, the role of the PA within the PCMH will depend on the clinical setting, patient population, clinical competency and experience, and the professional relationship between the PA and the physician(s).
Using broad legislative language to describe the primary providers of health care encourages flexibility and innovation as practices shift toward developing systems of care that focus on value and quality rather than volumes of patients. Population management of chronic diseases will meet the needs of patients and community through models like PCMH and utilization of PAs will be an essential part of the successful solution.
