Roles and Responsibilities of Physicians Supervising PAs - Ontario ...
Roles and Responsibilities of Physicians Supervising PAs - Ontario ... Roles and Responsibilities of Physicians Supervising PAs - Ontario ...
Additional clinical responsibilities of the PSP typically include:• receiving the PA at the start of the contract and ensuring that the PA isoriented to the clinical setting• coordinating activities to help integrate the PA role into the existing clinicalteam (for example, a team meeting to introduce the PA and discuss roles)• providing clinical supervision to the PA at the start of the PA’s contract, andfor the duration of the probationary period• coordinating the development of the clinical practice agreement for the PA 7• coordinating the development and approval of authorizing mechanismsrequired for the PA to practice within the department (for example, medicaldirectives)• co-ordinating the clinical supervision of the PA by other physicians asappropriate. This includes determining when the PA is ready to besupervised by other physicians, and ensuring that other physicians are awareof their responsibilities as a PA supervisor.• providing ongoing supervision, oversight and coordination for the clinicalactivity of the PA for the duration of the contractAdditional administrative responsibilities of the PSP typically include:• ensuring the PA has completed any orientation, training or skills developmentnecessary for practice in that clinical setting• overseeing the scheduling of the PA’s clinical activities, ensuring thatappropriate supervision for the PA is available during all scheduled workhours• co-ordinating evaluation of the PA’s performance. This may include collectinginput from other physicians and team members for purposes of competencyevaluation, development of authorizing mechanisms, and performancemanagement.• acting as a resource for the PA and team should any clinical conflicts orquestions arise7The practice agreement documents the types of clinical work the PA will perform in thatpractice setting, and the amount and type of supervision they will receive when performingthat work. Further information on practice agreements can be found in the Delegation andMedical Directive Toolkits available through OHA, OMA and AOHC, and through theFederation of Health Regulatory Colleges of Ontario’s resources on delegation.Updated July 2011 8
5.0 OHIP Billing Rules for PA PracticeThe general rule is that physicians cannot bill for the work of Physician Assistantsunless the circumstances requires the active participation of the physician in theclinical activity of the PA. Thus,• if a supervising physician renders a service to the patient in addition to theservice rendered by the PA, then the physician may bill for the service theypersonally render.• if the clinical activity is provided without participation service being renderedby the supervising physician, then the supervising physician would not beable to bill for the service rendered by the PA.In defining participation service, the rules state that "it would be inappropriate forthe physician to submit a claim to OHIP for simply greeting the patient" -- areasonable contribution to the clinical encounter is required. The rules specifythat the physician must engage in the history, performance of any "necessary"(further) physical examination and communication of a diagnosis and/ortreatment plan.This does not mean that the physician must duplicate the service to bill for theirrole in review and oversight. In a circumstance where the PA has rendered aservice, but the physician meets with the patient, the physician may bill a partialor complete assessment or consultation if they perform the required elements ofthe service personally. This may be a fairly brief encounter depending on thenature of the service provided and the skills and experience of the PA. The feecode claimed must be consistent with the service performed by the physician.Updated July 2011 9
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5.0 OHIP Billing Rules for PA PracticeThe general rule is that physicians cannot bill for the work <strong>of</strong> Physician Assistantsunless the circumstances requires the active participation <strong>of</strong> the physician in theclinical activity <strong>of</strong> the PA. Thus,• if a supervising physician renders a service to the patient in addition to theservice rendered by the PA, then the physician may bill for the service theypersonally render.• if the clinical activity is provided without participation service being renderedby the supervising physician, then the supervising physician would not beable to bill for the service rendered by the PA.In defining participation service, the rules state that "it would be inappropriate forthe physician to submit a claim to OHIP for simply greeting the patient" -- areasonable contribution to the clinical encounter is required. The rules specifythat the physician must engage in the history, performance <strong>of</strong> any "necessary"(further) physical examination <strong>and</strong> communication <strong>of</strong> a diagnosis <strong>and</strong>/ortreatment plan.This does not mean that the physician must duplicate the service to bill for theirrole in review <strong>and</strong> oversight. In a circumstance where the PA has rendered aservice, but the physician meets with the patient, the physician may bill a partialor complete assessment or consultation if they perform the required elements <strong>of</strong>the service personally. This may be a fairly brief encounter depending on thenature <strong>of</strong> the service provided <strong>and</strong> the skills <strong>and</strong> experience <strong>of</strong> the PA. The feecode claimed must be consistent with the service performed by the physician.Updated July 2011 9
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