The Florida House of Representatives has passed by a margin of 100 to 19 a bill to increase the number of physician assistants (PAs) a single physician may supervise from four to eight. The Florida Senate will consider the bill next.

Expanding the role of physician assistants is often considered a possible solution to concerns about access to basic healthcare, especially primary care, and to lowering the overall cost of healthcare. However, most states, including Florida, have set limits on the number of PAs a physician may supervise out of concern that the amount of direct supervision of each individual PA will decrease with each additional PA the physician is supervising.

According to the American Academy of Physician Assistants, legislative caps like these hamper “physicians’ ability to customize care for their particular specialty, setting and patient population.” Therefore, it is preferable to let practices determine their own supervision levels for PAs, not legislators.

However, with care provided by a PA typically billed through the physician’s Provider Identification Number (PIN), there is a certain financial benefit in using more PAs per physician. With each additional PA, the physician could be marginally more productive and able to bill more.

According to government data compiled and organized by the Wall Street Journal last year, Florida is one of the top states in healthcare spending on physician and clinical services. Therefore, how a proposed doubling of its current cap on PAs per physician plays out may be closely watched by other states.

Among states that do have caps, the limit on PAs per physician is generally between four and two. In a search of state records, HealthCXO could not find any states that allowed as many as eight PAs per physician — although such arrangements are of course allowed in states without legislative restrictions on physician-PA ratios.

The Florida bill (HB 1275) was sponsored by Rep. Larry Ahern (R-St. Petersburg) and also simplifies the reporting system for PAs who work under multiple physicians in a hospital. Currently, such PAs must report all the physicians they work with to the Florida Department of Health. If HB 1275 becomes law, these PAs would only need to report their primary supervising physician.

HB 1275 was amended in two notable ways before it passed the Florida House. One amendment exempts dermatologists’ offices from the increased ratio, as dermatology is believed to require more hands-on supervision by a physician. The second amendment added would allow physicians to supervise PAs at a site other than their primary office for the provision of specialty skin services as long as the PA had completed certain specified training.

The bill does not mandate any specific level of supervision per PA with the increase in the PA-physician ratio, and allows physicians to supervise PAs at locations where they themselves are not physically present, as long as they are easily reachable through telemedicine technologies. This was a sticking point for some legislators who voted against the bill.

"I wanted to support this until I read it and there is no definition of what supervision is," Rep. Carl Zimmerman (R-Dunedin) told the Associated Press.