Assuring quality for physician assistants: Accreditation, certification, licensing, and privileging

Introduction

Health insurance plans are becoming broader in regard to the scope of treatments they cover. These changes include mental health and behavioral health parity; fewer restrictions on preexisting conditions; and the coverage of supplemental services, such as physical therapy, massage therapy, acupuncture, and other holistic health services. Insurers want to be certain that clinicians have the appropriate education and background to qualify them to perform treatments and procedures.

Credentialing is a systematic process of collecting and verifying qualifications for individual professionals, and groups of professionals or organizations, including educational programs. The purpose of credentialing is to assess background and legitimacy for a professional or entity to provide services and grants the right, through a title or credit, to provide specific services. Credentialing affects physician assistant (PA) students initially when they are enrolled in their programs of education from the standpoint of accreditation of the PA education program. Subsequently, when PA graduates enter the health care marketplace, an individual level of credentialing occurs nationally through passing the Physician Assistant National Certification Examination (PANCE) and the processes whereby graduates gain access to state, insuring, and employing institutions. PA students, PA graduates, and the institutions charged with educating them must understand and accept the significant responsibility of credentialing that allows them the right to perform or provide services. This chapter discusses two separate and distinct credentialing procedures: the credentialing (accreditation) of PA programs by the Accreditation and Review Commission on Education for the Physician Assistant (ARC-PA) and the credentialing of individual PAs by the National Commission on Certification of Physician Assistants (NCCPA), state licensing boards, and specific institutions.

Physician assistant education program accreditation

Accreditation is the process of credentialing PA programs, which is defined as official recognition and approval or vouching that a program maintains standards that qualify the graduates for professional practice and provides them with credentials. PA programs have undergone remarkable professional growth that belies the relatively short history (∼50 years) of the profession. In terms of acceptance and privilege to practice clinically, the accreditation process that evaluates PA programs is fundamental both to the safety of patients and the PA profession’s success.

Accreditation review commission on education of the physician assistant

Accreditation is a voluntary, formal process of external peer review, encompassing the evaluation of an institution or education program to determine whether it meets the standards set up by the accrediting body. If the program or institution meets the set standards, the accrediting body grants recognition that established qualifications and educational standards have been met. The ARC-PA is the recognized accrediting agency that protects the interests of the public and PA profession and the welfare of students by defining the standards for PA education and evaluating PA educational programs within the territorial United States to ensure their compliance with the standards.

The accreditation of PA programs began in 1971 when Essentials of an Accredited Educational Program for the Assistant to the Primary Care Physician were developed under the auspices of the American Medical Association’s (AMA’s) Subcommittee of the Council on Medical Education’s Advisory Committee on Education for Allied Health Professions and Services. Many evolutions to PA program accreditation have occurred since that time. On January 1, 2002, the Accreditation Review Committee on Education for the Physician Assistant became the Accreditation Review Commission on Education for the Physician Assistant. This may have been a minor name change, but it was a monumental step forward because the ARC-PA became a freestanding accrediting agency for the evaluation and accreditation of PA educational programs in the United States. The ARC-PA is the sole authority for PA program accreditation.

The role of the ARC-PA is the following:

1.
Establish educational standards using broad-based input.
2.
Define and administer the process for comprehensive review of applicant programs.
3.
Define and administer the process for accreditation decision making.
4.
Determine whether PA educational programs are in compliance with the established standards.
5.
Work cooperatively with its collaborating organizations.
6.
Define and administer a process for appeal of accreditation decisions.

The goals of the ARC-PA ( Box 8.1 ) dovetail with its mission to “protect the interests of the public and PA profession, and the welfare of students by defining the standards for PA education and evaluating PA educational programs. . . to ensure their compliance with those standards.”

Box 8.1

PA , physician assistant.

The Goals of the Accreditation Review Commission on Education of the Physician Assistant

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Foster excellence in PA education through the development of uniform national standards for assessing educational effectiveness.
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Foster excellence in PA programs by requiring continuous self-study and review.
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Assure the general public, as well as professional, educational, and licensing agencies and organizations, that accredited programs have met defined educational standards for preparing PAs for practice.
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Provide information and guidance to individuals, groups, and organizations regarding PA program accreditation.

In its role in accrediting PA programs, the ARC-PA encourages excellence in PA education by establishing and maintaining minimum standards of quality for educational programs. The ARC-PA cooperates and collaborates with several organizations to establish, maintain, and promote appropriate standards of quality for educational programs. Endorsed by a broad consensus within the medical community, the standards represent current, nationally accepted guidelines for all aspects of program operation. Because medical education and the health care system are both in major transformation, the standards continue to evolve to meet the needs of patients and society. The ARC-PA regularly reviews the content of the standards and seeks feedback on their validity and clarity from its collaborating organizations and members of the PA education community. Periodic reviews may result in the creation, elimination, or revision of a specific standard.

The standards, initially adopted in 1971, have been revised many times over the years, with its most recent major revision in 2010 and many clarifying changes in the interim. A copy of the most current standards (fifth edition) is available in PDF downloadable format at http://www. arc-pa.org/wp-content/uploads/2019/11/Standards-5th-Ed-Nov-2019.pdf . The standards are under continuous scrutiny and are amended frequently. Please see the website for the most current edition. The fifth edition of the standards became effective on September 1, 2020.

The ARC-PA standards constitute the minimum requirements to which an accredited program is held accountable and provide the basis on which ARC-PA confers or denies program accreditation. The standards are used to develop, evaluate, and require continuous self-analysis of PA programs. To offer curricula of sufficient depth and breadth to prepare all PA graduates to practice in a dynamic health care arena, the standards reflect that a commonality in the core professional curriculum of programs remains desirable and necessary. The standards are designed to allow programs to remain creative and innovative in program design and in the methods used to enable students to achieve student learning outcomes and program expectations and acquire competencies needed for entry into clinical practice.

As delineated in the standards, PAs are academically and clinically prepared to practice medicine as members of patient-centered medical care teams. The collaborative medical team relationship is fundamental to the PA profession and enhances the delivery of high-quality health care. Within the collaborative medical team practice, PAs make clinical decisions and provide a broad range of diagnostic, therapeutic, preventive, and health maintenance services. The clinical role of PAs includes primary and specialty care in medical and surgical practice settings. PA practice is centered on patient care and may include educational, research, and administrative activities.

The professional curriculum for PA education includes basic medical, behavioral, and social sciences; patient assessment and clinical medicine; supervised clinical practice; and health policy and professional practice issues. The standards encompass current, nationally accepted guidelines for all aspects of PA program operation, including institutional responsibilities, admissions processes, faculty qualifications, curricular components and design, expected learning outcomes or competencies for students, supervised clinical practice, classroom laboratory and library facilities, clinical affiliations, student issues, fiscal stability, program publications, record-keeping systems, and administration.

The accreditation review commission on education of the physician assistant standards

The ARC-PA standards are organized into three main sections: (1) administration, (2) curriculum and instruction, and (3) evaluation. Each of these components has sets of pertinent standards denoted with a concise statement of the principles that represent each standard. The administration section primarily consists of institutional responsibilities, resources, and support, including faculty, personnel, and operational aspects of the program within the sponsoring institution. The section on curriculum and instruction outlines commonalities of aspects of the preclinical curriculum, including providing applied course content for core biomedical knowledge, clinical problem solving, patient assessment, and student learning outcomes as expected by the individual program. This section also addresses supervised clinical education with clinical preceptors in the community in designated experiences both across the lifespan and in a variety of specified settings. The evaluation section addresses the program having an ongoing “robust and systematic process of ongoing self-assessment” to assess how effectively the program performs quality improvement throughout all aspects of the program. The process must include self-identification by the program of its strengths and weaknesses through analysis of collected data. Plans for remediation of weaknesses and continuous improvement are made apparent in this section.

The accreditation process

The ARC-PA accreditation process is designed to accomplish the following:

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Encourage educational institutions and programs to continuously evaluate and improve their processes and outcomes.
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Help prospective students and other members of the public to identify programs that meet nationally accepted standards.
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Protect programs from internal and external pressures to make changes that are not educationally sound.
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Involve faculty and staff in comprehensive program evaluation and planning and stimulate self-improvement by setting national standards against which programs can be measured.

The accreditation process that evaluates PA programs is fundamental to the profession’s success, protects the interests of the public, and fosters excellence in PA programs. This voluntary process is available only to qualified PA programs sponsored by a single institution. The sponsoring institution must be accredited by a recognized regional accrediting agency and be authorized by this agency to confer a graduate degree to graduates of the PA program.

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