PAs in nephrology weigh in on FPAR
Nephrology best describes the conundrum present for PAs. We are integrated into a community of nephrology practitioners (PAs, NPs, and physicians) who care for a very fragile and sick population where one small misstep can cause grievous harm. Yet, we are very independent practitioners; often traveling miles (or hours) by ourselves between dialysis units to manage our patients with kidney failure. To say that we must depend on the kindness of others is to undersell the interlinkage of the work of nursing, social work, dialysis technicians, and dietitians in the Medicare star-rating published data of each nephrology practitioner. If the dietitian does not adjust binders, if social work does not arrange transportation, if the tech does not convince the patient to stay on the machine, if the nurse does not watch/adjust medications like a hawk, our published ratings for quality measures will show deficiencies. We are all a part of a larger microorganism.
However, we also have seen NPs hired in place of PAs: especially in Colorado, Arizona, Ohio, and Pennsylvania. As nephrology practices have grown larger and are managed by professional managers, they look at the requirement for supervision of PAs, and hire NPs instead. This also is true for the VA or university settings. Although we all understand we are a community, we also understand the difficulty of supervision when we are sometimes in a different county or state than our nephrologists. This is even more evident in the seasoned PA in nephrology, who may have been managing patients with kidney disease while the nephrologist was in grade school. Nephrology is a small community and many of our physicians (including Alan Kliger, MD, past president of the RPA) will admit that PAs helped train them. Yet, we all admit that the nephrologist is the captain of the ship, who acknowledges that without all the moving parts, the ship will run aground and/or sink.
Thus, we are gratified to see the wording of the task force to reiterate that PAs will continue to be part of the community while removing the supervisory requirement. We wholeheartedly sign on to that concept. As we are a national organization, we cannot give opinions on state matters and as 90% of our reimbursements are Medicare-based, it would take an act of Congress to change billing and collections for nephrology. We, as a community, do not think Congress is going to be taking on Medicare billing because healthcare has been so divisive this year.
We do want to point out one small item. AAPA and the National Commission on Certification of Physician Assistants (NCCPA) have recently been in a disagreement about certification and recertification. This disagreement comes at an awkward time. If the physician community does not feel that it can depend on a third-party, independent, outside certifying body to qualify PAs, asking for more autotomy is impossible. The nephrology community strongly recommends that AAPA follow through with the task force's recommendations and let NCCPA exist as the central PA certifying body.