LETTER TO THE EDITOR: Optimizing health care resources in Delaware

I am a physician assistant who works in the state of Delaware and I see firsthand the need for medical providers. With the expansion of Medicaid that comes with the Affordable Care Act, the Medicaid-eligible population in Delaware will increase by 42,000.

Through practice, it has come to my attention that Delaware Medicaid does not enroll physician assistants (PAs) as individual providers. PAs are only enrolled as crossover providers. This means that a physician assistant can only see a Medicaid patient if Medicare is the primary insurance. This is an untapped resource caused by a labyrinth of antiquated regulations and status quo, a sentiment in the political process. Our $707 million tax dollars are not being optimized.

Delaware has had designated Health Professional Shortage Areas prior to enactment of the ACA, and the shortage will have more relevance as the newly insured now seek access. Delaware Medicaid has a resource in the physician assistant profession that can help mitigate this issue. Currently, Delaware Medicaid enrolls nurse practitioners (another type of non-physician medical provider). Medicaid is a state-run program that assists low-income individuals, families, and the disabled with health care. The Delaware practice for both nurse practitioners and physician assistants are comparable.

Physician assistants currently practice in Delaware and are able to see patients, diagnose and treat patients. Physician assistants work as a team with a supervising physician who is available for consult, but not necessarily involved in all direct patient care. PAs are very active in our community. Many of you have seen PAs and did not realize that you were actually seeing a team. PAs can take up the slack in areas that are suffering from a lack of primary care providers.

Enrolling PAs as individual providers helps with access to care and produces a means of direct measures of quality tied to an individual provider. Most importantly, this policy change decreases the gap in access; decreases costly emergency room visits because of lack of access; and increases longitudinal care by solidifying medical homes for patients’ chronic and preventive care.

Currently, there are 30 states that allow PAs to enroll into Medicaid as individual providers. Of the 30, 28 of these states have a Medicaid-to-general-population ratio of equal to, or less than, Delaware’s. Delaware’s Medicaid-to-general-population ratio is 13:50 (26 percent). This could still grow as a result of Medicaid expansion under the ACA.

Allowing physician assistants to enroll as individual providers in Medicaid is in line with Delaware Medicaid’s goals of providing quality care through “increased access and appropriate and timely utilization of health care services.”

PAs currently perform all the tasks necessary to care for these beneficiaries. The patient benefits from increased and timelier access to care. Medicaid benefits through decreased long-term cost, by decreasing aggregate morbidity due to increased access. There is already a process for enrollment. Hence, there is no need to create a new process or allocate additional resources for this policy change. There is a pronounced need.

In Delaware, PAs are already performing services needed by the Medicaid population. For the tax dollars, PAs can optimize care delivery to the Medicaid client by increased access. Physician Assistants are an untapped, underutilized resource in Delaware. Physician assistants can help Medicaid help people. This is a fix right in front of us. I call on readers to discuss this with local leaders and ask why this resource is untapped.

Robert Henry


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