PAs and OTP

What is Optimal Team Practice?

Optimal Team Practice (OTP) occurs when PAs, physicians, and other medical professionals work together to provide quality care without burdensome administrative constraints. 

To support Optimal Team Practice, states should eliminate the requirement that each PA have an agreement with a specific physician, and end the disparities between PAs and other medical providers in professional regulation and payment arrangements.


Interested in OTP updates and resources? Join NYSSPA today!

Optimal Team Practice FAQs

Q) Why do PAs want to practice without a physician agreement?

PAs are seeking flexibility to practice effectively in today’s healthcare environment.
When the PA profession was created more than 50 years ago, most PAs and physicians worked together in a solo or small private practice. Today, many physicians and PAs work in group practices or hospital settings where laws that require PA-physician agreements interfere with their ability to make practice-level decisions about patient care teams. When a PA isn’t tethered to a specific physician by a rigid agreement, PA employers (health systems, hospitals, and group practices) can be more flexible in determining healthcare teams. This will allow them to more effectively meet patient needs.

Eliminating the requirement for an agreement with a specific physician will also make it easier for PAs to practice in medically underserved communities where there are not enough physicians (and in some cases, no physicians) to care for patients. PAs would also be able to provide volunteer medical services and respond to disasters and emergencies – situations in which physicians might not be available or willing to enter into agreements with PAs.

Q) Why do PAs want to be eligible for direct payment from Medicare and insurers?

Allowing PAs to be eligible for direct payment will eliminate an important disparity between PAs and other providers, particularly NPs. Unlike physicians and advanced practice registered nurses (APRNs), which includes NPs, PAs are not eligible for direct payment from Medicare and nearly all commercial insurance payers. Most payers require that payment be made to the PA’s employer, which can unintentionally limit PA employment opportunities with staffing companies and in certain practice arrangements. Because PAs can’t receive payment directly, PAs can’t participate in certain employment opportunities, even though physicians and APRNs can.

As the healthcare system continues its rapid transformation toward more innovative care models, PAs must have the same reimbursement flexibility enjoyed by other medical professionals, so they are not disadvantaged in the marketplace compared to NPs.

Q) Why do PAs want changes to the boards that regulate PA practice?

Today, physicians are regulated by state medical boards composed of physicians. Nurses are regulated by boards made up of nurses. Only PAs are regulated by boards that often have no members actively working in their own profession. This means the boards that regulate PA practice have no knowledge of current PA practice or how rules and regulations may affect PA practice. This lack of insight can lead to unnecessary restrictions and administrative burdens for PAs, physicians and employers.

PAs deserve what physicians and nurses already have regulatory boards that have current knowledge about their profession. States can determine whether this is best accomplished by creating separate PA boards or by adding PAs and physicians who work with PAs to medical or healing arts boards.

Q) Why are these changes good for patients?

Numerous studies have shown that PAs provide high-quality patient care and are medical providers who bring value to patients and PA employers. Currently, the retirement or sudden relocation, disability or death of a physician with whom a PA has an agreement with can mean the PA can no longer provide healthcare services to patients, even if the PA has been their primary care provider. Ultimately, when state laws and regulations remove the requirement for a PA/physician agreement, patients will have greater access to care, especially for medically underserved populations and patients in rural areas.

Q) Why are these changes good for healthcare employers?

When PAs aren’t tethered to a specific physician by rigid agreements, their employers can be more flexible in creating healthcare teams, allowing them to more effectively meet patient needs and reduce provider burnout. Ending the agreement also removes physician liability for the care that PAs provide when physicians are not involved, and reduces physician and employer risk of disciplinary action for administrative reasons. Also, allowing PAs to receive payments directly will expand the number of available providers through the use of healthcare staffing companies and other business arrangements that require PAs to reassign insurance payments.

Q) Why are these changes good for physicians?

Physicians will benefit from these changes in many ways. First, the elimination of agreements with PAs would mean that physicians will no longer be responsible for care provided by the PA when the physician is not involved. This could substantially reduce physician exposure to liability. Second, healthcare teams could be determined on a case-by-case basis at the practice level, allowing physicians to work with different PAs on different cases. Third, it would allow physicians to work with PAs more easily when they are employed in hospitals, health systems, and other corporate structures that use staffing companies. Currently, PAs are often prevented from participating in these staffing arrangements since, unlike NPs, they are not eligible for direct payment, and, therefore, cannot reassign their insurance reimbursements to the staffing company.

Q) Will federal laws and regulations also require changes?

Medicare policy says: “State law or regulation governing a PA’s scope of practice in the State where the services are performed applies.” However, the current Medicare statute uses the word “supervision” to describe how physicians work with PAs. Medicare rules must also change as state laws describing team practice continue to evolve, moving away from the word and concept of “supervision.” AAPA is advocating for these changes and encouraging the Centers for Medicare and Medicaid Services to update its guidelines and regulations to reflect this new model.



P: 917-679-4005