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2013 Summer Newsletter
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MTAPA Summer – Fall 2013 Newsletter

Table of Contents:

 

Don’t Miss MTAPA’s 23rd Annual CME Conference.. 1

President’s Letter.. 1

AAPA House of Delegates Report. 4

Review of AAPA Annual Conference.. 6

Rocky Mountain College PA Program Updates.. 8

2013 State Legislative Summary of Health Care Related Bills.. 8

 

Don’t Miss MTAPA’s 23rd Annual CME Conference

& General Membership Meeting, July 30 – Aug 2, 2013

 

Time is running out to pre-register for this year’s CME.  Please consider joining us in Billings next week, for an awesome educational and professional experience.  The conference opens with a Welcome Reception with special guest, AAPA’s President Larry Herman, Tuesday, July 30th at 7pm.  Lectures begin early Wednesday morning and continue for three full days, ending Friday, August 2nd.  The conference has been approved through the AAPA for a maximum of 22 Level 1credit hours.  Lecture schedule, faculty, hotel and all other pertinent information is available online at www.mtapa.com.  Pre-registering helps us plan accurately for set-up and meals, but it will be possible to register onsite as well.  Hope to see you there!

President’s Letter

 

Over the past year as President, I have had the pleasure of attending a couple of national events held by the AAPA, including IMPACT 13.  During these events, one repeated theme relates to the standards set by the AAPA regarding a modern practice act.  The “Six Key Elements to a Modern Practice Act” was drafted by the AAPA in 1991 and has been amended several times since.  “The model legislation reflects two principal concepts:  that physician assistants (PAs) should be licensed to practice medicine with physician supervision, and that PA scope of practice should be determined by supervising physicians.”  It is a national goal the advocacy outreach section of the AAPA has been working on, to help states attain since that time.  Most of the fifty states have reached between 1and 3 of these 6 goals, while other states have 4 or 5 and very few have reached all 6.  In Montana, we have met 4 of the 6 goals.  According to the lawyers at the AAPA, MT laws do not meet the number 4 goal: Adaptable Supervision Requirements or the number 5 goal: Chart Co-Signature requirements determined at the practice level. 

 

I believe it would be worth our time as an organization to discuss and consider trying to amend our practice act to reflect these goals to try to meet all 6 elements.  I would ask any member with interest or background knowledge on this issue, to contact me or any board member to get involved.  The Elements below come straight from the AAPA website.  Please refer to AAPA.org for more information including maps of each state, as well as a check list, which details where each state stands.

 

The Six Key Elements to a Modern Physician Assistant Act

 

1.     “Licensure” as the regulatory term

2.     Full prescriptive authority

3.     Scope of practice is determined at the practice level

4.     Adaptable Supervision requirements

5.     Chart Co-signature requirements determined at the practice level

6.     Number of PAs a Physician may supervise determined at the practice level

 

1.     “Licensure” as the regulatory term for PAs.   

 

                  Why this is important:

                 

a.)    Utilizes a term easily recognized by consumers.

b.)   Requires PAs to comply with laws governing “licensed health professionals” (i.e. child abuse reporting mandates).

 

2.     Physicians authorized to delegate prescriptive authority to include all schedules of drugs.

 

                  Why this is important:

 

a.)    Long-term treatment of pain, f/u of individuals with ADD/ADHD, acute pain symptoms, and other aspects of healthcare require the physician be able to delegate prescriptive authority for all schedules of medications to PAs.

b.)   The physician should determine what PA prescriptive authority best meets the needs of the practice.

 

3.     Scope of practice is determined by the supervising physician, PA, and any relevant facility staff.

 

                  Why this is important:

 

a.)    PAs have differing levels of experience.

b.)   Supervising physician is in the best position to evaluate the PAs competence.

c.)    Supervising physician should be able to customize patient care by delegating those aspects of care that the PA is competent to provide.

 

4.     Adaptable supervision requirements.

 

                  Why this is important:

 

a.)    PAs work as members of physician-directed teams in a wide variety of settings.

b.)   Physician workforce is stretched.

c.)    Appropriate supervision in a trauma center is not the same as appropriate supervision in a well-child clinic, physician must have flexibility.

d.)   Technology allows real-time remote evaluation of patients and patient data by physicians.

 

5.     Chart co-signature requirements determined by the practice.

 

                  Why this is important:

 

a.)    Important to use physicians’ time well.

b.)   Different practices require different methods of supervision.

c.)    PAs have varying levels of experience.

d.)   Each physician-PA team should be able to customize methods of oversight and review.

 

6.     No ratio limitation.

 

                  Why this is important:

 

a.)    The numbers of PAs a physician can safely supervise should be determined at the practice level.

b.)    Each setting and group of patients and providers is unique.

c.)    Physician should be authorized to customize their healthcare team.

 

To find these and more information, go to www.AAPA.org and look under “The PA Professional” tab and then choose “Federal and State Advocacy.”

 

The second item I would like to work on this year is to continue to improve our relationship with the Montana Medical Association (MMA).  As I am sure you have all heard we moved our administrative headquarters into the MMA office in Helena in 2011.  Jean Branscum, who is an advocate for PAs, now heads the MMA and also oversees the Montana Medical Legal Panel.  Previously, she served as the Executive Director the Board of Medical Examiners (BOME). 

 

We have partnered with the MMA on several occasions over the past two years.  In 2011 MTAPA board members were invited to attend the MMA Annual Meeting, and Kally Wilson, then President of MTAPA, was invited to participate in a panel discussion regarding the future primary care workforce in Montana.  The discussion was revealing in several ways, but it truly contrasted the PA vision to remaining partners with our physician colleagues, versus, the outlook of nurse practitioners.  

 

In addition, MTAPA and the MMA sent letters of support on each other’s behalf to the BOME regarding potential regulatory changes that would have had negative impacts on both professions.  We have done this successfully, stopping any undesirable change in physician or PA practice regulations.  This reciprocal support has been very powerful, and I believe will help pave the way for a recognized partnership as we move forward. 

 

Over the past two years the Physician Assistants in Montana have been included in the MMA annual directory.  Two years ago the MMA included PAs as a courtesy.  This past year, MTAPA stepped up and paid for the ability to be included in this directory.  We were able to gain the financial support from the AAPA, which placed an ad in the directory, helping MTAPA offset the associated directory costs.  As an MTAPA member, you have the ability to purchase a directory at the reduced cost of $40.00/copy (down from the standard $60.00/copy).  It is great to see our licensed PAs listed side by side with the physicians in the state.  If you have a chance to see the directory, or better yet, to purchase one, I would encourage doing so, as it is a great reference to have on hand. 

 

Finally, we have asked if PAs could become active members in the MMA organization to enjoy the benefits that their organization has to offer.  We have not been successful in these efforts as of yet, but we are encouraged to continue asking.  I feel confident that one year we will be welcome to join.  As healthcare delivery continues to change and the Patient Centered Medical Home,(PCMH), model continues to advance; I feel strongly that we will benefit from the ongoing close working relationship we keep with our Physician partners. 

 

Looking forward, there have been several states around the country that have gained a formal recognition from their respective medical societies.  The two states that presented at AAPA’s IMPACT on this were Michigan and Florida.  They noted through years of hard work and persistent effort, they have now been welcomed into the medical societies and have had public statements that have been declared by their medical associations recognizing them as working partners.  This has taken hard work on the part of many in order to get this happen.  I would like to see MT continue to move in this direction as we have tried to lay the foundation for this over the past few years.  I think that with champion PAs who would be willing to lead the efforts, we can continue to improve our relationship with the MMA and strengthen our profession along the way.  Please contact myself or any other MTAPA board member if you have interest in helping with these efforts.  Thank you.

 

Yours in good health,

 

Will Hunt, PA-C

MTAPA President

AAPA House of Delegates Report

 

Physician Assistants Dewey Hahlbohm and Matt Zemacke attended the AAPA House of Delegate (HOD) conference as MTAPA’s delegates in May 2013, in Washington, D.C.  The HOD is now primarily an “Advisory Body” to the AAPA Board of Directors (BOD).  This is the result of a 2010 legal interpretation of North Carolina non-profit statutes under which AAPA is incorporated.  As such, the HOD can make recommendations to the AAPA BOD, but cannot direct them to implement resolutions that the HOD endorses. 

 

Approximately 12 resolutions were presented to the House of Delegates.  These were primarily administrative matters and fine-tuning of AAPA policy.  Many of the resolutions were “Extracted” for further debate, discussion, and consideration prior to voting whether or not to approve them.  Three resolutions drew passionate debate and are highlighted below. 

 

There was significant discussion, much of it quite passionate, surrounding a decision made by the BOD in February 2013.  The HOD understood the BOD and HOD relationship was one of full collaboration, cooperation and communication regarding significant decisions that would come before the Board.  However, the BOD decided in February 2013 to eliminate all volunteer committees, commissions and work-groups without consulting with or informing the HOD.  Much angst and distrust was directed at the BOD for having made this unilateral decision, which some believe eliminated several essential planning and fact-finding committees and their on-going work.  

 

After 4-5 hours of contentious discussion and debate, the HOD recommended to the BOD to appoint a task force to look at the volunteer structure of AAPA and communicate recommendations for future improvements to the HOD and BOD.  Further, the HOD requests the BOD appoint a task force to recommend improvements in BOD/HOD communications and cooperation.

 

The second major issue was about a late submitted resolution to recommend changing the title of Physician Assistants to “collaborative” vs. “supervised” medical professionals.  This resolution reminds me of a resolution presented last year to change the PA name from Physician Assistants to Physician Associates.  If this “collaborative” phraseology is adopted, it will potentially require each state and territory with licensed PA’s to change their state laws before this can be fully implemented.  

 

As was the case with Physician Assistants vs. Physician Associates, there may be no predicting the economic impact of this resolution.  In addition, state medical boards and state legislatures may not view this in a friendly light, perhaps setting back legislative advances that have been hard fought and won over the past 45 years. 

 

In addition, the term collaborative is a term widely used by the NP profession.  Testimony heard at the HOD stated that the NP definition of “collaboration” means “Team based practice, without hierarchy or rank structure.”  This is quite different from the long-held view of PA’s working in “Physician led team practice.”

 

Because of the NP’s adoption and advocacy of the term “collaborative”, it has become a “dirty word” amongst some physicians, groups, and medical societies.  The Montana delegation was pleased to have this resolution referred to committee for further study and presentation to the 2014 HOD.

 

The third resolution was on Gun Control, presented by the American Society of Surgical PA’s.  This resolution included expansion of the current terminology in AAPA policy on “handguns”, to restate that as “guns”.  This resolution also included a laundry list of items that would be specified, including ban on assault weapons, large capacity magazines, limiting ammunition purchases, requiring trigger locks in homes, background checks for all gun purchases, closing private gun show “loopholes”, reporting persons exhibiting dangerous behaviors, etc.

 

Because of concerns about infringement of the constitutional right to bear arms, the laundry list of specified requirements, and possible state specific concerns with the wording of the resolution, this was referred back to committee for further study.  Results of this further study will be brought to the 2014 HOD. 

 

Montana’s representation in the HOD is an important duty for the MT Academy of Physician Assistants to continue supporting.  There are many issues impacting PA’s at the National level that also impact PAs in Montana.  Maintaining awareness of trends in health care, government legislation, and their impact on PA specific issues is crucial if MTAPA is to remain ahead of changes in the rapidly evolving health care environment of 2013.       

 

Lastly, a delegation of Montana PAs met with Megan Marino, Health Care Legislative Analyst for Representative Steve Daines on Tuesday May 28th.  As this was an AAPA conference with a focus on Military and Veteran issues, Ms. Marino was thanked for Rep. Daines continued support of Veterans issues in the House of Representatives.   

 

Dewey Hahlbohm, PA-C

MTAPA Chief Delegate to the AAPA HOD

Review of AAPA Annual Conference

 

This year’s annual AAPA CME meeting, IMPACT “13, took place in Washington, D.C. Saturday, May 25th through Wednesday, May 29th.   The 5-day event featured a variety of lecturers and educational sessions.  This year’s focus was on Veteran PAs, the health of Veterans, and service to Veterans.  The meeting was attended by upwards of 6,000 PAs. 

 

The conference included a packed educational agenda during the day and an equally busy social agenda each evening.  Additionally every morning kicked off with a special address.  These ranged from the hilarious sarcasm of the “Capitol Steps” to the more serious issues of Veterans affairs.  Elizabeth Dole gave a talk titled “Caring for the Caregivers of Veterans” and outlined her non-profit organization the Elizabeth Dole Foundation.  More information on this foundation can be found at www.dolefoundation.org.  The highlight came on Tuesday morning when the Secretary of Health and Human Services, Kathleen Sebelius spoke about our current healthcare system and the Affordable Care Act. 

 

The AAPA conference also includes the annual House of Delegates (HOD) Meeting, where each state, including Montana, sends PA representatives to vote on AAPA issues.  The HOD meeting was a 2 ½ day event addressing several national issues, which resulted in several resolutions.  (See article by MTAPA Chief Delegate Dewey Hahlbohm, for more details.)  

 

The conference concluded with “Capitol Hill Day”, where PAs from all over the country went to Capitol Hill to lobby their elected senators and house representatives for Physician Assistants issues.  The Montana PA delegation was able to meet with staffers from all three of our elected officials.  On Tuesday, we were able to meet with Representative Daines’ staff, and on Wednesday we met with both Senator Baucus’ and Senator Tester’s staff.  We had a good discussion about the role that PAs play in today’s healthcare environment and gave several examples of how PAs are making a difference on the front lines of healthcare.  We were able to provide concrete ways in which PAs are improving access to healthcare, improving the quality of healthcare and helping to reduce healthcare costs.  We urged our congressmen to remove federal barriers to allow PAs to provide care to the full spectrum of patients.  Two such barriers that have been center stage for PAs over the past few years are (1) allowing PAs to order and provide care to Hospice patients and (2) allowing PAs to evaluate and treat Federal Workers Compensation patients.  We need to continue to urge lawmakers to change the language in these two key areas to improve access to healthcare.  These remain outdated barriers that are due for a change!

 

I would encourage all of you to reach out to our representatives in Washington, D.C.  Please tell them how you feel about PAs in Montana and encourage them to support legislation that improves the practice for PAs.  If you need any information about the current issues or any active bills in front of the 113th Congress, please do not hesitate to contact me, or the AAPA advocacy center.  The AAPA has all of the information you may need to help form any statement or open a conversation.  Below is contact information for Montana’s congressmen for your convenience.

 

Senator Max Baucus

www.baucus.senate.gov

 

Washington Office:

511 Hart Senate Office Building

Washington DC 20510

Tel (202) 224 - 2651

Fax (202) 224 - 9412

 

Montana Office: (Helena)

30 West 14th Street, Suite 206

Helena, MT 59601

Tel (406) 449 – 5480

Fax (406) 449 - 5484

 

Senator John Tester

www.tester.senate.gov

 

Washington Office:

706 Hart Senate Office Building

Washington DC 20510

Tel (202) 224 - 2651

Fax (202) 224 - 8594

 

Montana Office:

208 North Montana Avenue, Suite 202

Helena, Montana 59601

Tel (406) 449-5401

Fax (406) 449-5462

 

Representative Steve Daines

www.daines.house.gov

 

Washington Office:

206 Cannon House Building

Washington DC 20515

Tel (202) 225 - 3211

Fax (202) 225 - 5687

 

Montana Office:

910 North Last Chance Gulch, Suite B

Helena, Montana 59601

Tel (406) 502-1435

Fax (406) 502-1436

 

Please plan to join us in Billings, July 30th - Aug 2nd, for our 23rd Annual CME Conference and General Membership Meeting.  We have a great lecture schedule and outstanding speakers.  Our keynote address will be given by the AAPA President, Larry Herman.  The conference will begin with a Welcome Reception for Mr. Herman the evening of Tuesday, July 30th.  Please plan to join us in welcoming Mr. Herman to Montana!

 

Yours in good health,

 

Will Hunt, PA-C

MTAPA President

Rocky Mountain College PA Program Updates

 

Important changes have recently taken place at Rocky Mountain College (RMC).  We are excited to announce that Heather Heggem, PA-C, MPAS was named Rocky’s PA Program Director.  Additionally, the previous director, Bob Wilmouth, M.D. was named President of Rocky Mountain College.  The students are also delighted to welcome two new PAs to the faculty, Jennifer Beverly, PA-C, MPAS and Michael Yorgensen, PA-C, MPAS.

 

Excitement and anticipation are coursing through the blood of RMC PA students. The class of 2013 is weeks from graduation, the class of 2014 is weeks from beginning clinical rotations and the class of 2015 is only one week away from beginning their didactic year.  This exciting time does not come without some nervousness and apprehension.  The class of 2013 is approaching their PANCE exam and the class of 2014 has upcoming exams including the first PACKRAT exam.

 

The class of 2014 is busy trying to absorb as much information as possible before heading out into clinical rotations.  We spent the spring semester shadowing PAs around Billings and recently began seeing our first real patients at Riverstone Clinic in Billings.  The experience has been an enlightening and encouraging opportunity to work with a diverse patient population.  After 12 months of course work we are thankful to have such a great introduction into real world, everyday medicine.

 

Laura Roemmich, PA-S

John Breneman, PA-S

MTAPA Student Representatives

2013 State Legislative Summary of Health Care Related Bills

 

Arguably, the biggest legislative issue related to medicine, centered on the decision to not accept federal funds to expand Medicaid.  Expansion of Medicaid was supported by Governor Bullock (D) but was voted down by the Republican majority legislature.  The issue received significant media exposure in Montana and nationwide, as it highlighted debate over the Affordable Care Act.

 

Many other issues with local implications were also considered.  The amount of bills in a particular session can be Summary of 2013 Legislative Session overwhelming and difficult to follow.  The following non-exhaustive summary was generated by using the Montana Medical Association website, as well as the LAWS function for bill tracking through the state of Montana.  Below are some of the bills that passed:

 

1) House Bill 28:  County review of maternal deaths was allowed (review of child deaths was already allowed).

 

2) House Bill 16:  Involuntary detention laws were revised. (To clarify that someone can be committed or detained if their mental health disorder prevents them from providing for their own basic needs “food, clothing, shelter.”)

 

3) House Bill 104:  The killing of an unborn fetus was criminalized (excluding abortion.)

 

4) House Bill 310:  Lawsuits for wrongful life/ wrongful birth were outlawed. (Medical providers cannot be sued by parents or children if medical intervention kept the child alive and the child subsequently suffered.)

 

5) House Bill 391:  Parental consent is required for abortions of minors (under 18.)

 

6) House Bill 459:  Health care cannot be refused to patients who do not disclose their ownership, or use of firearms.

 

7) Senate Bill 323:  Worker’s compensation prescribing – Physicians may query the prescription drug registry before prescribing to patients on workers comp.  These queries are supposed to be reflected in the medical record.  It also states: “Ongoing prescriptions for Schedule II and Schedule III drugs may be prescribed only by a treating physician.”

 

8) House Bill 583:  A Montana Suicide Review Team was established.

 

9) Senate Bill 84:  Established a legal framework for “Patient Centered Medical Homes (PCMH).”

 

10) Senate Bill 112:  Established youth concussion protection laws.

 

MTAPA took an active role on a few bills.  In particular, we testified that PAs should be included in the list of providers appropriate for the Maternal Death review, and lobbied to get PAs specifically mentioned among providers listed the Medical Homes.  

 

While MTAPA has been very active for several years with the Board of Medical Examiners, which implements administrative rules regarding PA practice in Montana, MTAPA’s efforts at the 2013 state legislature included trips to Helena by myself and other online meetings attended by other board members.  However we hope to track issues relevant to PAs and act on them as they surface.  If you have interest in becoming more involved in legislative issues, please let us know at MTAPA.

 

We anticipate continuing to collaborate with the Montana Medical Association staff, which has been instrumental in sharing information and identifying important issues.  We appreciate the assistance of the MMA, and also hope to strengthen our own resources of PAs who are informed and ready to take action. 

 

Aaron Derry, PA-C

MTAPA Legislative Chair

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6/7/2017
2017 MTAPA Annual CME Conference