AAPA expert tells California PA Board that research shows practice modernization hasn’t raised malpractice risk
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Summary
Sandra DePalma of the American Academy of Physician Associates told the board peer-reviewed studies and state reviews find no increase in malpractice payments or patient harm after relaxing supervision or practice-agreement requirements, and tied favorable practice environments to Rural Health Transformation funding opportunities.
The California Physician Assistant Board heard a national overview Feb. 23 from Sandra DePalma, vice president for reimbursement and professional practice at the American Academy of Physician Associates, who described research and state experiences showing that practice modernization for PAs did not increase malpractice risk and can improve access.
"A large body of research suggests that care provided by PAs produces health outcomes that are equivalent to physician provided care," DePalma told the board, citing analyses by MedPAC and other peer-reviewed studies. She summarized research looking at National Practitioner Data Bank malpractice payment reports and said the studies found no statistically significant increase in malpractice payments in states that relaxed practice agreements; in some analyses malpractice payments trended down after restrictions were removed.
DePalma described multiple studies and state reviews (New Hampshire, North Dakota, Massachusetts) that, she said, documented no decline in safety and, in several cases, increased workforce capacity after removing or relaxing collaboration/supervision requirements. She also noted that nearly two-thirds of U.S. jurisdictions now have advanced or optimal practice environments and that removing administrative burdens (ratios, mandatory written practice agreements, physician-on-site requirements) is associated with workforce growth and system efficiency.
DePalma linked practice environment to federal Rural Health Transformation (RHT) funding, explaining that RHT distributed some funds equally and allocated the other half based on factors including ruralness and workforce/practice environment; she said states could be positioned to receive additional incentives if they advance practice modernization elements relevant to the RHT scoring criteria.
Board members pressed on the panel's policy implications and scope: at least one board member emphasized the board's public protection role and questioned why policy recommendations are being discussed rather than legislative channels. DePalma said her intent was to provide background on RHT and state practice environments and to answer questions related to program eligibility and workforce implications.
The presentation was informational; the board did not vote on regulatory changes. Staff materials and DePalma's packet were shared with the board for follow-up.
