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HOSPITAL BASEDPA’SARE THEY COST EFFECTIVE ?TIMOTHY J. BRAY M.D.

CONFLICTS NOTHING OF BENEFIT

J Orthop Trauma. 2013 Apr;27(4):e87-91. doi:10.1097/BOT.0b013e3182647f29.Impact of hospital-employedphysician assistants on a level IIcommunity-based orthopaedictrauma system.Althausen PL1, Shannon S, Owens B, Coll D, Cvitash M, LuM, Omara TJ, Bray TJ

HISTORY OF PA PROFESSIONThe PA profession was created to improve and expand healthcare.In the mid-1960s, physicians and educators recognized there was ashortage of primary care physicians.Duke University Medical Center, four Navy Hospital Corpsmenwho had received considerable medical training during their militaryservice.The PA concept was lauded early on and gained federal acceptance andbacking as early as the 1970s as a creative solution to physicianshortages.The medical community helped support the new profession and spurredthe setting of accreditation standards, establishment of a nationalcertification process and standardized examination, and development ofcontinuing medical education requirements

GROWING PROFESSIONAccording to the National Commission onCertification of Physician Assistants (NCCPA)more than 8,500 certified PAs working inorthopedic surgery9 percent of the total number of the nation's96,000 certified PAs.

PAOSPhysician Assistants in Orthopaedic Surgery(PAOS)specialty organization of the American Academy ofPhysician Assistants (AAPA) for PAs who are NCCPAcertified and practice in orthopaedicsPAOS is dedicated to providing a common direction for PAsquality educational programs , provides a forum fornetworking and information dissemination and jobplacement for PAs in orthopaedics.

PAOSPhysician Assistants in Orthopaedic Surgery(PAOS) is a specialty organization of the AmericanAcademy of Physician Assistants (AAPA) for PAs who areNCCPA certified and practice in orthopaedics, 1600members who practice orthopaedics in collaboration withorthopaedic surgeons.PAOS is dedicated to providing a common direction for PAsin orthopaedics, quality educational programs , provides aforum for networking and information dissemination andjob placement for PAs in orthopaedics.

OTA/AAOS TRAUMA GUIDELINES STIPENDS, REIMBURSEMENTDESIGNATED OPERATING ROOMS,ANCILLARY STAFFADEQUATE INSTRUMENTATIONPROGRAMS FOR PERFORMANMCEIMPROVEMENT, PAIN MANAGEMENT,GERIATRIC TRAUMA HOSPITAL BASED PHYSICIANASSISTANTS

WHY EXTENDERS ? LOSS RESIDENTS POSITIONS OR NO RESIDENTSERVICE AVAILABLE 80 HOUR WORK WEEK RESTRICTIONS HOSPITAL FINANCIAL PRESSURES 1/3 MAJOR TRAUMA CENTERS USEEXTENDERS ‘TEAM WORK’ FREES SURGEONS TOPERFORM OTHER DUTIES

CONTRACTING FOR YOUR PAMDs NEED TO ADVOCATE FORYOUR PAsGET INVOLVED, BE OUTSPOKEN,FAMILIARIZE YOURSELF WITH HOSPITAL &STATE REGULATIONS REGARDING PRACTICE

HOSPITAL ADMINISTRATION “always lose money” Tough negotiators PA contracts shouldnot depend onrevenue generation QUALITY OF LIFE,INDIRECT REVENUEGENERATION

“SPEAK THEIR LANGUAGE”

2012 FY Orthopaedic Trauma ProspectusOverviewAverage wRVUsScientific Papers Published in Peer Review Journals2010 - 2012Althausen, Bray, O'Mara - J of Orthop Trauma 20122500020000Althausen, Bray, O'Mara - J Shoulder Elbow Surg 201215000Average wRVUs1000050000201020112012Althausen, Bray, O'Mara - J of Orthop Trauma 2011Althausen, Bray, O'Mara - J of Orthop Trauma 2010Althausen - J of Orthop Trauma 2013Althausen - J of Orthop Trauma 2012Althausen - J of Orthop Trauma 2012Althausen - J of Orthop Trauma 2011Bray - J of Orthop Trauma 2012Bray - J of Orthop Trauma 2011Bray - J of Orthop Trauma 2011Bray - J of Orthop Trauma 2010New IRB Applications (2012) - 4Presentations at National Meetings (2010 - 2012) - 8Instructor at Educational Course (2010 - 2012) – 88days/yearStudents Rotating on Service (2010-2012) - 60Fellows Graduated (2010 - 2012) - 2Implant and Orthobiologic Cost Containment 3,000,000Total Cost Bone Graft &Bioloics Used 2,000,000Total Nail Costs 1,000,000 -Total Hemiarthroplasty Cost201020112012

HCAHPSHOSPITAL CONSUMER ASSESSMENT OFHELATHCARE PROVIDERS AND SYSTEMS

HOSPITAL ADMINISTRATION

HCAHPSHOSPITAL CONSUMER ASSESSMENT OF HELATHCAREPROVIDERS AND SYSTEMSSATISFACTION SURVEYCOMMUNICATION, PAIN MANAGEMENT, OVERALLHOSPITAL CAREREIMBURSMENT WILL BE LINKED TO IMPROVEMENTPRESS GANEY 50% OF ALL U.S. HOSPITALS

J Orthop Trauma. 2013 Apr;27(4):e87-91. doi:10.1097/BOT.0b013e3182647f29.Impact of hospital-employedphysician assistants on a level IIcommunity-based orthopaedictrauma system.Althausen PL1, Shannon S, Owens B, Coll D, Cvitash M, LuM, Oʼmara TJ, Bray TJ

PRIOR STUDIES MILLER et al J.T. 1998 “33% DECREASED LOS, TRANSFER TIMES TO OR, TOFLOOR” CHRISTMAS et al J.T. 2005 SIMILARFINDINGS

RENO STUDY DESIGN ‘PRESENCE’ VS. ‘ABSENCE’ OF PA CARE INTRAUMA PATIENT TRIAGE TIME, TOTAL ED TIME, TIME TO OR, SETUPTIME, TOTAL OPERATING TIME, ANTIBIOTICS, DVTMEDS, SURGICAL COMPLICATIONS, LENGTH OF STAY. WE USED COST PER MINUTE DATA FROMHOSPITAL(OR 24.06, ED 0.76) DATA ANALYZED WITH SAS 9.2 MICROSOFTWITH P VALUES 0.05

RENOWN REGIONAL TRAUMACENTER STUDY DESIGN 1 YEAR STUDY 2007 1,000 PATIENTS 2 PAs/ 8am-8pm / 1 PA present MondaySaturday MDs PRIVATE PRACTICE, NORESIDENT/MEDICAL STUDENT HELP MDs PRIMARY ED RESPONDERS MULTIPLE DATA POINTS REVIEWED

RESULTS PA CHARGES 703,896.00 PA COLLECTIONS 125,246.00 COLLECTION RATE OF 17.8% COVERED ONLY 50% OF PAsSALARY/BENEFITS

RESULTS BEST POTENTIAL SAVINGS INEMERGENCY DEPARTMENT PAS DECREASED ED TIME MEAN 175MINUTES 133.53/PATIENT VISIT THEREFORE, PA INVOLVED GROUP 41,394SAVINGS TO HOSPITAL AND MISSEDOPPORTUNITY (no PA GROUP) OF 91,735 TOTAL SAVINGS OF NEARLY 150,000.00

RESULTS BEST POTENTIAL SAVINGS INEMERGENCY DEPARTMENT EXPEDITING ED RESPONSE TIMES,DECREASED TOTAL ED TIME, TRANSFER TOOR AND FLOOR ‘INDIRECT’ COST SAVINGS MORE PATIENTSCAN BE SEEN IN ED/UNIT TIME

LENGTH OF STAY PAs positive impact in allcategories of call-trauma patients,0.61-day decrease in LOS 1200/patient(Average cost/day Nevada 2,403.00)

RESULTS MINIMAL IMPROVEMENT IN OPERATINGROOM PARAMETERS, SETUP TIME, OR TIME OTHER STUDIES HAVE SHOWN 20% TIMESAVINGS OR 3-4 HOURS/24 HOUR WORK DAY ( ?reno. uses 1st assists, fellows, mature or staff)

RESULTSQUALITY OF PATIENT CAREIMPROVEMENTDVT PROPHYLAXIS INCREASED .6.73%POST OPERATIVE ANTIBIOTICS . 2.88%DECREASED POSTOP COMPLICATION RATE 4.67%INCREASED INCIDENTIAL FINDINGS 7.4%

CONCLUSIONS LEVEL-ll TRAUMA CENTER PAs BENEFIT EMERGENCY ROOM EFFICIENCY, DECREASINGTIMES TO OR, LENGTHS OF STAY, IMPROVEDQUALITY OF CARE COLLECTIONS DO NOT COVER ‘DIRECT COSTS OFSALARY/BENEFITS BY ADDING ‘INDIRECT COST’ RESULSTS INREVENUE NEUTRAL COST CENTER

CONCLUSIONSGOVERNED BY STATE AND HOSPITALREGULATIONS – UNDERSTANDING THEREGULATIONS CRITICAL TO SUCCESS OFPA EFFICIENCY

CONCLUSIONSRENO UTILIZATION RESPOND TO TRAUMA ACTIVATIONS ASSIST IN OR ATTEND MULTIDISCIPLINARY ROUNDS DISCHARGE PLANNING ROUNDS SPLINTS, TRACTION PINS, DRESSINGCHANGES, PAIN MANAGMENT

HCAHPSHOSPITAL CONSUMER ASSESSMENT OF HELATHCAREPROVIDERS AND SYSTEMSSATISFACTION SURVEYCOMMUNICATION, PAIN MANAGEMENT, OVERALLHOSPITAL CAREREIMBURSMENT WILL BE LINKED TO IMPROVEMENTPRESS GANEY 50% OF ALL U.S. HOSPITALS

J Orthop Trauma. 2013 Apr;27(4):e87-91. doi: 10.1097/BOT.0b013e3182647f29. Impact of hospital-employed physi