Reimbursement Woes Drive PAs from Alabama
United Surgical Assistants is leaving the state of Alabama because of problems receiving reimbursement for PA services from Blue Cross and Blue Shield of Alabama, according to an article in today's Birmingham News.
Tampa-based United Surgical Assistants has operated in Alabama for three years and employs eight physician assistants in Birmingham and three in Mobile who assisted in 7,500 surgeries a year, according to company officials. But the group could no longer afford the losses in Alabama because the state's largest insurer didn't reimburse in most cases, said Matt Stevens, senior vice president of United Surgical Assistants.
The company operates in eight other states and the District of Columbia with a staff of about 100 physician assistants, Stevens said. Getting paid by private insurers is usually a struggle, but the company didn't expect such a large percentage of the state's coverage to disallow payment for physician assistants' services, he said.
This story demonstrates the relative fragility of the PA profession, even in 2008.
PA practice is flourishing in many areas of the country and many specialties, but in some ways PAs are still one troublesome insurer or a few misinformed legislators from being shut out of the practice of medicine.
Every PA program should e-mail this article to its students to emphasize the importance of being aware of the profession's unique issues and involved in the profession's organizations.
New York PAs made a real stink when a physician in that state tried to malign the profession a few months ago. There aren't a whole lot of PAs in Alabama to fight this, unfortunately. This situation calls for some kind of high-profile national response.
On the plus side, this is really a well-written and well-researched article by Anna Velasco of the Birmingham News. She even noted that the University of Alabama at Birmingham is pretty much the birthplace of the surgical PA profession.
Link
UPDATE (3:12 p.m.): It looks like I jumped the gun a little bit after reading the Birmingham News article. Apparently, this situation is more of a result of the details of Alabama's PA reimbursement law than an attack on PA reimbursement. The unfortunate fact is, I guess, that Alabama simply is not a great state for PA practice, and that’s probably why the state ranks 48th in PAs per capita, ahead of only Indiana, Mississippi and Arkansas. This is still an example of how tenuous PA practice can be, but probably is not comparable to the situation in New York.
For more history on the relationship between Alabama PAs and Blue Cross and Blue Shield of Alabama, here's ADVANCE's report from July 2004:
Alabama PAs Win Major Reimbursement Victory
Blue Cross and Blue Shield of Alabama (BCBS) must comply with a 1997 state law requiring reimbursement for physician assistant services, the Alabama Supreme Court ruled on July 16.
The decision should significantly improve the situation for PAs in Alabama, says former Alabama Physician Assistant Society president Rick Kilgore, PA-C, who has worked on this issue for several years. Fewer than 300 PAs currently practice in the state, and many of the graduates of the University of South Alabama PA program and University of Alabama at Birmingham surgical PA program leave the state after graduating, Kilgore says.
BCBS controls at least 70% of the private insurance market in the state, according to The Birmingham News, and Kilgore believes that percentage may be as high as 85%. Its refusal to pay for PA services severely hurts the incentive of physicians to hire PAs, especially in primary care, Kilgore says.
BCBS had refused to pay for PA services, despite a 1997 law requiring all insurers to reimburse for PAs. The case progressed from state court to federal court and back to state court before winding up in front of the Alabama Supreme Court, which heard oral arguments on April 6.
Although PAs made persuasive arguments over the years that they can help fill the state's desperate need for more health care providers—65 of 67 Alabama counties are medically underserved—the final Supreme Court ruling came down to whether the 1997 law applied to BCBS. The company claimed that it is not governed under the state's insurance laws unless the 1939 state law that established Blue Cross is also amended.
Five of the Alabama Supreme Court justices decided that the 1997 does apply to BCBS, while four justices sided with BCBS.
The decision has several implications, Kilgore says. BCBS must immediately begin paying for PA services and is responsible for back payments for PA services since the original August 1997 implementation of the law. BCBS may be responsible for damages to PAs and physician harmed by the company's refusal to comply with the 1997 law. The details are to be hammered out in state court. The PA victory represents the first significant victory for any health care group over BCBS, which uses its near-monopoly status to control the health care market in Alabama, Kilgore says. The Alabama PA experience could also provide a blueprint for PAs in other states who have problems with insurers, Kilgore says.