The schizophrenia of physician extender utilization

Area of Science:

• Healthcare policy
• Health services research
• Medical economics

Background:

• The Patient Protection and Affordable Care Act (ACA) of 2010 incentivizes the formation of Affordable Care Organizations (ACOs).
• Patient Centered Medical Homes (PCMHs) are emerging as a primary model for ACOs, evolving from retail clinic structures.
• PCMHs increasingly utilize physician extenders (PAs), necessitating a review of their regulatory framework.

Purpose of the Study:

• To examine the evolution and organizational structure of Patient Centered Medical Homes (PCMHs).
• To analyze the current regulatory landscape governing PCMHs.
• To propose appropriate tort reform for PCMHs that utilize physician extenders.

Main Methods:

• Review of legislative and policy documents related to the ACA and ACOs.
• Analysis of the business and operational structures of PCMHs.
• Examination of existing legal and market regulatory mechanisms for healthcare organizations.
• Assessment of tort reform options, including no-fault and enterprise liability.

Main Results:

• PCMHs are a significant component of ACOs, influenced by the ACA.
• The current regulatory environment presents challenges for policing business structures employing physician extenders within PCMHs.
• Existing legal and market mechanisms are not optimally suited for regulating PCMHs.

Conclusions:

• Neither current legal nor market regulatory mechanisms are ideal for overseeing PCMHs that employ physician extenders.
• Introduction of no-fault or enterprise liability coverage is proposed as the most suitable tort reform for PCMHs.
• This reform aims to improve the regulation and oversight of PCMH business structures and their use of PAs.