The orthopaedic physician's assistant: Defining our value in an orthopedic surgical practice

Introduction

Orthopedics Today is pleased to welcome the American Society of Orthopaedic Physician’s Assistants as a regular columnist and collaborator. Jason Mazza, ASOPA president, will serve as editor of this new quarterly column, In it he will provide updates for orthopedic surgeons and allied health professionals on the role of the Orthopaedic Physician’s Assistant in the orthopedic practice.

Joan-Marie Stiglich, ELS
Senior Vice President

Running an efficient orthopedic practice that is both effective and profitable has become challenging in the wake of declining third-party reimbursement, increased demands of an aging population, emerging technology, increased regulation of health care entities, and sharp economic changes. In light of these concerns, new demands are continually placed on the practicing orthopedic surgeon. To address these issues, patient access will need to be improved at the same time that practitioners are looking to provide more cost-effective and efficient care.

Physician extenders and allied health professionals support efficient care delivery while helping to maintain a high quality of care for patients and provide a better balance to the physician’s professional workload. With several different allied health providers in orthopedics who can serve as a physician extender, which can provide you with the most value?

Value

Jason Mazza

To answer this question, we must first define value. The value of a medical professional is dependent upon the perspective of multiple end users, including the employing practice, supervising physician and patients. Therefore, the value of a physician extender can be defined by evaluating their importance in four key areas of a successful orthopedic practice. First: Can the physician extender provide the best possible care to patients? Second: Can the physician extender maximize practice efficiency? Third: Can the physician extender maximize practice reimbursement? And fourth: Can the physician extender minimize practice liability? The last two points are also major factors to consider with the choice of hiring a particular physician extender.

Let’s examine the value of an orthopaedic physician’s assistant (OPA). The OPA is a specialized physician extender who is trained to work either one-on-one with an orthopedic surgeon or as a part of a team to provide cost effective and efficient care to patient. The origins of the OPA can be traced back 40 years to a time when a physician shortage was projected. As a result, training and recognition of assistants in various specialties began and the development of the OPA profession arose from the concept of physician extenders. Within our specialty of orthopedics, surgeons were looking for trained individuals who could assist them with patient-care responsibilities, immobilization techniques, and assisting in surgery. The American Academy of Orthopaedic Surgeons (AAOS) pioneered this concept and developed formal training programs in the 1960s. In the late 1970s, the National Board for Certification of Orthopaedic Physician’s Assistants (NBCOPA) was created as a mechanism of certifying trained individuals as OPAs. During this period, the NBCOPA worked with the American Society of Orthopaedic Physician’s Assistants (ASOPA) and created a set of practice guidelines that has since defined the function and responsibilities of OPAs.

OPA duties

Providing the best possible care for orthopedic patients is the hallmark of the OPA profession. It is accepted that a patient’s perception about an orthopedic practice is based on much more than quality of care. Nonclinical factors such as wait time, office staff friendliness and communication affect a patient’s degree of satisfaction. As the supporting role for the surgeon, the OPA can provide a positive patient experience in all of these areas.

In today’s orthopedic practice, the role of the OPA varies. In general, the OPA is trained to take an appropriate patient history; assist with examinations; perform injections; schedule ancillary procedures; apply and remove casts, braces and splints; serve as first surgical assistant; and provide accurate patient education.

Orthopaedic physician’s assistants have knowledge, skills, and training in three critical areas of orthopedics including assisting with patient management, fracture management, and assisting in surgery. According to a 2010 study conducted by ASOPA, more than 55% of surveyed fellow members hold additional certification and/or licensure in the areas of surgical assisting, X-ray technology, wound management, athletic training and clinical research. The other added benefit of the OPA compared with other physician extenders is that they have a minimum of 5 years experience in orthopedics before they are eligible to become board certified. None of the other allied health providers have this requirement and necessary training directly in orthopedics.

By having the skills and training as aforementioned, an OPA can often eliminate the need for other full-time employees (FTEs). The OPA can effectively be part of the patient encounter from start to finish. This helps to move patients efficiently from the evaluation stages through treatment. While there is a growing line of patients in the waiting room, the OPA can help the surgeon complete the workup on each patient ensuring nothing is missed so that the surgeon can make an accurate diagnosis and formulate a treatment plan. This strategy allows the physician to see more patients per day while being able to spend time with patients who have complex problems and require more one-on-one time. This allows a practice to maximize efficiency.

Reimbursement

Reimbursement for the OPA comes in two forms, direct and indirect. Direct reimbursement often comes as a result of surgical assistant fees. Currently, OPAs are not eligible to receive payment from Medicare or Medicaid for assisting in surgery. On the other hand, direct reimbursement for an assistant in surgery is often paid by third-party payers. Progressive cuts in reimbursement for surgical assistants, in general, including PA-Cs, ARNPs, CSAs have been the recent trend and is expected to continue into the foreseeable future. The actual payments and amounts vary not only from state to state, but also amongst individual insurance plans and procedures performed. A clear knowledge of what types of cases are reimbursable under a particular plan can help in calculating potential income from this source.

The second part of the cost-benefit of OPAs comes from indirect payments. As previously discussed, well-trained OPAs can make an orthopedic practice more efficient. The financial benefits to the practice are numerous. Consider a surgeon who is able to perform an extra one or two new-patient consultations per hour with the help of the OPA triaging. If you were to calculate the additional practice revenues from this yearly, revenues can easily exceed $100,000. Additional revenues to the physician practice include fees collected from self-administered orthopedic bracing and soft-good programs conducted by OPAs. Those OPAs who hold additional certifications can also add to various revenue streams within a practice. Collectively, the direct and in-direct reimbursements can help justify a salary commensurate with a mid-level practitioner.

The last area of evaluation is that of practice liability. Many physician extenders practice either independently or in a quasi-autonomous role of the surgeon. As discussed earlier, the OPA works directly under the supervising surgeon to provide support in all aspects of a patient’s care. The true benefit to this type of working relationship is threefold;

lThe surgeon is seeing his or her own patients which provides a greater continuity of care along with a greater sense of satisfaction on behalf of the patient. Malpractice risks are lowered when patients are satisfied;

lAs the working relationship between the supervising surgeon and OPA is often a close one based on trust and communication, the OPA ultimately develops a thought process like their supervising surgeon providing a strong basis for good patient care and patient safety; and

lBecause the supervising surgeon is seeing all of his or her own patients in conjunction with the OPA, the benefit of having full control in all decision making moderates risk and liability.

In summary, the OPA profession has had a defined role to our surgeons and patients for 4 decades. Working as a physician extender, the OPA can help improve the efficiency of an orthopedic practice. Our level of knowledge and technical skills can offer surgeons the opportunity to see more patients, decrease patient waiting times, and allow for better one-on-one care which, in turn, can produce improved patient satisfaction ratings, practice reimbursement and lower the cost of care.

As the demand for orthopedic care increases over the next two decades associated with the elderly population shift, allied health professionals will need to play a large role in helping orthopedic surgeons provide care to these patients. The goal of the OPA profession is to continue to find ways to educate ourselves, our patients, and our surgeons about our role and to improve our value now and in the future.

• Jason S. Mazza, M.Sc, OPA-C, CSA, SA-C, CCRC, is president of the American Society of Orthopaedic Physician Assistants (ASOPA) and works with John H. Shim, MD at Florida Sports, Orthopaedic & Spine Medicine in Tampa, Florida. Please direct all questions or comments to orthoopa@mindspring.com.