Presentation is loading. Please wait.

Presentation is loading. Please wait.

© Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. PAs: Trends, Opportunities.

Similar presentations


Presentation on theme: "© Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. PAs: Trends, Opportunities."— Presentation transcript:

1 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. PAs: Trends, Opportunities and Challenges NCF 2015 San Diego

2 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. Speaker Disclosure Tricia Marriott, PA-C, MPAS, DFAAPA AAPA Director, Regulatory & Professional Advisory I am a full-time employee of the AAPA. I am a licensed and certified practicing PA, currently employed part-time by Yale Medical Group, Department of Orthopaedics. I have no financial/industry disclosures to report.

3 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. STATE UPDATE

4 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. Summary of changes by state:

5 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. Barriers to PA practice are falling Legislative Goals Full prescriptive authority Licensure as the regulatory term Scope of practice determined at the practice level No ratio restriction No co-signature requirement in law Adaptable supervision requirements 49 States & DC Made Positive Changes to State Law in 2014 State made PA-positive changes to law in 2014 RI DE DC

6 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA Highlights California Medical Board adopted regulations allowing PAs to assist in surgery without personal presence of physician. Kentucky decreased chart co-signature provision from 100% to 10% and abolished the physician-PA 30 minute proximity requirement. Alabama adopted a regulation authorizing PAs to prescribe Schedule II controlled substances. Ohio made multiple changes to laws impacting PA practice, including allowing PAs to perform admitting functions in inpatient settings, DNR orders, and allowing PAs to supervise hyperbaric oxygen techs.

7 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. States that enroll PAs States That Enroll PAs In The Medicaid Program RI DE DC AAPA July 2014 States where PAs have limited enrollment in Medicaid Program States that do not enroll PAs

8 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. AAPA Resources NEW! PA State Laws and Regulations-15th Ed. The most up-to-date and comprehensive collection of state PA laws and regulations, including the 50 states and the District of Columbia. Learn about general requirements for PA licensure, or take a deeper dive into state-specific PA laws and regulations. If you purchase the 15th edition, you will also receive the updated version in July. Your purchase includes a PDF that contains a link with the option to view the document as an eBook on your PC, Mac or mobile device.

9 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. FEDERAL UPDATE

10 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. CMS Progress Administrative Burden Reduction/Critical Access Hospitals removed 100% outpatient chart co- signature requirement for PAs and NPs, deferring to State law requirements. If no State law requirements for co-signature, then CMS would also not require. Federal Register May 12, 2014 Effective July 11, 2014 Admission Order and Certification for Hospital Inpatient Stays-physician certification requirement eliminated except for outliers. Admission orders written by a PA, NP or resident must be co-signed by a physician prior to patient’s discharge has not changed. Federal Register November 10, 2014 Effective January 1, 2015

11 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. CMS Challenges Conditions of Payment Hospice Home Health DME Diabetic Shoes Medical Nutrition Therapy Hospital Admission Order & Certification (IPPS) Supervision of Diagnostic Tests Supervision of Intensive Cardiac Rehab and Pulmonary Rehab (S.257 introduced last week) Conditions of Participation Restraints Standard -use of “LIP”. Used in Interpretive Guidelines only. Definition does not align with the Joint Commission glossary definition which allows for delegation. Licensed Independent Practitioner (LIP) For the purpose of ordering restraint or seclusion, an LIP is any practitioner permitted by State law and hospital policy as having the authority to independently order restraints or seclusion for patients.

12 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. Licensed Independent Practition er Not a term defined in federal statute, but has crept into everyday lexicon. Term continues to create barriers, despite the Joint Commission glossary disclaimer. In areas of the country where facilities have not yet utilized PAs, the “LIP” terminology leads them to believe PAs cannot provide care without physician present. The glossary disclaimer has not changed this. “Licensed Practitioner, as allowed by state law and facility policy” would be an appropriate substitute.

13 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. Nomenclature/What’s in a Name? Avoid “lumping” language: –“Mid-level” –Advanced practice clinician/professional –Physician extender –Allied health (PAs and NPs are not allied health by federal definition.) –Nonphysician practitioner/provider (NPP) Use proper professional titles: Clarity, transparency, truth in advertising and required by State law in many instances. –PA, Physician assistant (NOT physician’s assistants) –Nurse practitioner: NP, APRN, APN, CRNA, CNM

14 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. EMERGING TRENDS

15 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. PAs in Hospitals and Large Physician Practices PA/NP Credentialing Committee Created as a subcommittee of the Med Staff Credentialing Committee Charged with review of PA/NP applications for appointment and re-appointment Evaluates FPPE/OPPE reporting. Advises on new privileges and scope. Participates in disciplinary process. PA/NP Centralized Governance Parallels the physician governance structure: Chiefs at the division level, Director at the facility level, Executive Director at the system level. Creates infrastructure for policy development, consistency across the enterprise. Serves as liaison to physicians, administration and clinical operations teams.

16 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. NEW CONSUMER EXPECTATIONS 16 Patient Satisfaction The Results Are In: Patients Love PAs A new AAPA survey conducted by Harris Poll finds: 93% agree PAs provide excellent patient service 93% agree PAs are going to be part of the solution 93% agree PAs add value to healthcare teams 92% agree having PAs at a practice makes it easier to get an appointment 91% agree PAs improve health outcomes for patients

17 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. Contribution to Quality and Safety Published Examples Wilson IB, Landon BE, Hirschhorn LR, et al. Quality of HIV care provided by nurse practitioners, physician assistants, and physicians. Ann Intern Med. (2005) 143(10): Conclusions: For the measures examined, the quality of HIV care provided by NPs and PAs was similar to that of physician HIV experts and generally better than physician non–HIV experts. Nurse practitioners and PAs can provide high-quality care for persons with HIV. Preconditions for this level of performance include high levels of experience, focus on a single condition, and either participation in teams or other easy access to physicians and other clinicians with HIV expertise. Moote, M., Englesbe, M., Bahl, V., Hu, H.M., Thompson, M., Kubus, J. & Campbell, D., Jr. (2010). PA-driven VTE risk assessment improves compliance with recommended prophylaxis. Journal of American Academy of Physician Assistants, 23(6), Conclusion: A physician assistant-driven VTE risk assessment process resulted in a dramatic increase in the number of patients within the health system who were prescribed appropriate orders for VTE prophylaxis according to published guidelines and according to individual patient risk. Brett E. Glotzbecker, MD, Deborah S. Yolin-Raley, PA-C, Daniel J. DeAngelo, MD, PhD, Richard M. Stone, MD, Robert J. Soiffer, MD, and Edwin P. Alyea III, MD Impact of Physician Assistants on the Outcomes of Patients With Acute Myelogenous Leukemia Receiving Chemotherapy in an Academic Medical Center Journal of Oncology Practice June 2013 Conclusion: The data demonstrate equivalent mortality and ICU transfers, with a decrease in LOS, readmission rates, and consults for patients cared for in the PA service. This suggests that the PA service is associated with increased operational efficiency and decreased health service use without compromising health care outcomes. Peter L. Althausen, MD, MBA,Steven Shannon, BS,Brianne Owens, MD,Daniel Coll, PA-C, Michael Cvitash, PA-C, Minggen Lu, PhD,Timothy J. O’Mara, MD, Timothy J. Bray, MD Impact of Hospital-Employed Physician Assistants on a Level II Community-Based Orthopaedic Trauma System J Orthop Trauma Volume 27, Number 4, April 2013

18 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. More Miranda Laurant, Mirjam Harmsen, Hub Wollersheim, Richard Grol, Marjan Faber, Bonnie Sibbald Cost-Effectiveness of Health Care Services? The Impact of Nonphysician Clinicians : Do They Improve the Quality and Cost- Effectiveness of Health Care Services? Med Care Res Rev : 36S John P. Nabagiez, MD, Masood A. Shariff, MD, Muhammad A. Khan, MD, William J. Molloy, PA-C, Joseph T. McGinn, Jr, MD Physician assistant home visit program to reduce hospital readmissions J Thorac Cardiovasc Surg 2013;145: Conclusions: The 30-day readmission rate was reduced by 25% in patients receiving PAHC visits. The most common home intervention was medication adjustment, most commonly to diuretic agents, medications for hypoglycemia, and antibiotics. Matthew Berger, MD William Southern, MD John Loehner, MD Hospitalist Expansion and Organization Results :The infusion of this oversight, which connects young, energetic, dedicated PAs with seasoned specialists who have devoted their careers to inpatient care has significantly improved the quality and organization of the private attending service. The hospitalist initiative has improved quality in a number of areas, including shorter length of stay, lower readmission rates, fewer long-stay cases, maintained continuity of care and better communication with the Montefiore Medical Group, a network of over twenty ambulatory care sites staffed by faculty and non-faculty physicians

19 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. Prevailing Myths & Misperceptions

20 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. Myths PAs/NPs cannot see new patients Physician must be in the office when PA/NP sees patients. Physician must see every patient. Physician will be sued for PA/NP error Reimbursement for services provided by PAs/NPs “leaves 15% on the table”. Patients won’t be happy. Commercial payers won’t pay.

21 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. Calls From the Field Conscious Sedation FPPE/OPPE competency measures Privileges for new technology (daVinci) Credentialing and Privileging new grads PAs taking call; cross coverage and call Critical Access hospitals

22 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. AAPA Resources Guidelines for Updating Medical Staff Bylaws: Credentialing and Privileging Physician Assistants (PDF)Guidelines for Updating Medical Staff Bylaws: Credentialing and Privileging Physician Assistants (PDF) EMTALA and Physician Assistants (PDF) –Can a PA take call? –Conduct a Medical Screening Exam? –Certify False Labor? –Sign transfer forms?

23 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. AAPA Resources Assessing PA Competencies Professional competencies for physician assistants include the effective and appropriate application of medical knowledge, interpersonal and communication skills, patient care, professionalism, practice-based learning and improvement, and systems-based practice. Competencies for the PA Profession 2012 (PDF) Position paper approved by the four organizations for the PA profession: NCCPA, ARC-PA, PAEA, and AAPA.Competencies for the PA Profession 2012 (PDF) Physician Assistants: Assessing Clinical Competence (PDF) This is a useful guide for regulators, hospitals, employers and third-party payers.Physician Assistants: Assessing Clinical Competence (PDF) FPPE and OPPE Are More than Just Acronyms (PDF) This article, published in AAPA's magazine PA Professional, speaks to the Joint Commission requirements ( and challenges) for Focused Professional Performance Evaluation and Ongoing Professional Performance Evaluation.FPPE and OPPE Are More than Just Acronyms (PDF) Sample Competency Assessment Tool (PDF) This sample, while specific to a PA with privileges in orthopaedics, can serve as a template for most other specialties, by aligning the specialty-specific page with the individual delineation of privileges. Sample Competency Assessment Tool (PDF)

24 © Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA Mill Road, Suite 1300 Alexandria, VA P F


Download ppt "© Copyright 2014 AAPA. All rights reserved. These materials may not be duplicated without the express written permission of AAPA. PAs: Trends, Opportunities."

Similar presentations


Ads by Google