WAPA News
Resolutions for the 2010 AAPA House of Delegates
The resolutions for the 2010 AAPA House of Delegates (HOD) have been released and reviewed by your WAPA delegates. We would like to hear your feedback before the HOD begins Atlanta on May 29th. Your delegates are listed below. All resolutions can be found here for your consideration. (This link will prompt a download of all text files in one folder.)
Briefly, there are three reference committees, each with their set of resolutions. The following explains a few of the more important resolutions within each committee:
- Reference Committee A (deals with bylaws and operations): These resolutions follow much anticipation after the AAPA engaged a law firm in 2009 to review their level of compliance to the Bylaws and Articles of Incorporation in North Carolina. Details can be found in the April Delegate News. This review has prompted many recommendations to the governance structure. In addition, there are resolutions to make the HOD process more defined and efficient. While we believe that this restructure is a good faith effort on behalf of the AAPA to address charter compliance, there is language that could have a dramatic effect on the relationship between the House of Delegates and the AAPA Board of Directors. We expect vigorous debate on these matters. (Of note see Resolution A-01)
- Reference Committee B (addresses education, membership and certification): A few resolutions revolve around the issue of specialty exams and accreditation of Post Grad Programs (pros and cons). The AAPA has consistently stood against specialty exams and specialty certification in an effort to keep the PA profession “flexible” to the healthcare needs of society. They feel specialty certification and exams may alter the ability of PA’s to move from one specialty to another throughout their career (see resolutions B-07, B-09, B-10, B-11). Despite this stance, the NCCPA has proceeded to develop 5 specialty exams that will roll out in 2011 (described on their website). Because of this, resolution B-12 calls for the AAPA to consider another certifying body besides that of the NCCPA! WAPA supports the flexibility of our profession but recognizes the inevitability of upcoming specialty exams. The collective opinion of the HOD will be reflected after discussion of all of these resolutions in Atlanta.
- Reference Committee C (focuses on professional practice, government affairs and public policy): Resolutions primarily add new or clarifying statements that define the AAPA’s stance takes on various topics from volunteer leaders, consumer health information, the PA’s role in medical homes, to health information technology, PAs in underserved communities, and persons with disabilities. Of particular interest is the definition of family (resolution C-21) as well as resolution C-17 regarding comprehensive health reform which has been updated to represent current changes in national policy developments over the past year.
Give us your thoughts:
AAPA Delegates
Chief Delegate: Kaye Kvam, MPAS, PA-C
2 year Delegate: Jason Hussey, PA-C
1 year Delegate: Randall Dickson, MPAS, PA-C
1 year Delegate: Louis Koncz, PA-C
1 year Delegate: Allison Warmington, PA-C
Health Care Reform Summary
Compliments of Heart Rhythm Society:
Timelines. For your assistance, please see below for a short summary of the timelines within the health care legislation.
Within a year
· Provides a $250 rebate to Medicare prescription drug plan beneficiaries whose initial benefits run out.
· Provides A two‐year temporary credit subject to an overall cap of $1 billion to encourage investments in new therapies to prevent, diagnose, and treat acute and chronic diseases. The credit would be available for qualifying investments made in 2009 and 2010.
90 days after enactment
· Provides immediate access to high-risk pools for people who have no insurance because of preexisting conditions.
Six months after enactment
· Bars insurers from denying people coverage when they get sick.
· Bars insurers from denying coverage to children who have preexisting conditions.
· Bars insurers from imposing lifetime caps on coverage.
· Requires all group health plans and plans in the individual market must provide first dollar coverage for preventive services.
· Requires insurers to allow young people to stay on their parents’ policies until age 26.
2011
· Requires individual and small group market insurance plans to spend 80 percent of premium dollars on medical services. Large group plans would have to spend at least 85%.
2012
· Encourage physicians to join together to form “accountable care organizations” to gain efficiencies and improve quality.
· Establishes a hospital value-based purchasing program for acute care hospitals.
· Directs CMS to track hospital readmission rates for certain high-cost conditions and implements a payment penalty for hospitals with the highest readmission rates.
2013
· Increases the Medicare payroll tax and expands it to dividend, interest and other unearned income for singles earning more than $200,000 and joint filers making more than $250,000.
· Alters the Medicare physician payment (SGR) to include a new value-based payment modifier.
· Establishes a national pilot program on payment bundling for hospitals, doctors, and post-acute care providers
2014
· Provides subsidies for families earning up to 400 percent of the poverty level – or, under current guidelines, about $88,000 a year – to purchase health insurance.
· Requires most employers to provide coverage or face penalties.
· Requires most people to obtain coverage or face penalties.
· Institutes additional insurance market reforms, including limitations on pre-existing health conditions, and rating rules (only vary on age, geography, and family size)
· Medicaid eligibility will increase to 133 percent of poverty for all non-elderly individuals.
· Continues the second phase of the small business tax credit for qualified small employers.
· Requires certain providers – including long-term care hospitals, inpatient rehabilitation facilities, PPS-exempt cancer hospitals and hospice providers –to implement quality measure reporting programs.
2015
· Establishes the Independent Payment Advisory Board (IPAB).
2018
· Imposes a 40 percent excise tax on high-end insurance policies.
2019
· Expands health insurance coverage to 32 million people.
Aetna Payment Policy Change
Dear Washington State Leaders,
Please find attached an excerpt from Aetna’s March, 2010 OfficeLink newsletter. The newsletter announces a change in policy regarding payment for services provided by PAs. Aetna will decrease its payment for service provided by PAs, NPs, and nurse midwives to 85% of the physician contracted rate effective June 1, 2010. As part of this policy change, Aetna is asking that PAs be officially listed in their network provider directories. The newsletter may be found in its entirety here: Office Link newsletter. Scroll to your state, select the March 2010 edition, and go to page 4 for the relevant information.
AAPA recommends the following:
· For additional details, practices / facilities should contact their Aetna provider representative for the billing implications of this change in policy.
· Note that there are strict legal prohibitions against state or national chapters and associations negotiating payment amounts with private third party payers. Review the Anti-Trust Implications of Negotiating with Third-Party Payers. Individual practices are able to negotiate payment levels with third party payers.
· As always, practice contracts with payers should include specific language that says that PAs are covered for services consistent with state law guidelines for supervision and scope of practice.
Preliminary information from Aetna indicates that the payer is allowing services to be billed using a billing concept similar to Medicare’s “incident to” billing provision. Therefore, if “incident to” guidelines are met, PAs may bill office services under the physician’s name with reimbursement at 100% following implementation of the new policy in June, 2010. We are seeking written verification of this policy as well as the following:
· the potential applicability of Medicare’s “split/shared” billing provision;
· implications for credentialing/enrollment;
· placement of the NPI on claim forms; and
· the ability of PAs to enroll as primary care providers.
Please check AAPA’s private payer postings for policy updates as they become available.
Feel free to contact me directly should you have any questions.
Tricia Marriott, PA-C, MPAS, DFAAPA
Director, Reimbursement Policy
American Academy of Physician Assistants
950 North Washington Street
Alexandria, VA 22314
703/836-2272 Ext 3219
tmarriott@aapa.org
Expanding the Primary Care Workforce
Center for American Progress Report Highlights Role of PAs
A November 2009 report, “Expanding the Primary Care Workforce,” recommends that the U.S maximize the current primary care workforce through better use of nurse practitioners and physician assistants, saying that “the primary care shortage requires us to maximize the use
of every health care professional to the full extent of their training
and competency.” Read more
Special Message from State Health Officer Dr. Hayes on us of Antivirals
Hospitals Referring More Disruptive Physicians to the Washington Physicians Health Program
By Jean Colley
This article was reprinted with permission from the February 2009 issue of WSMA Reports.
Over the last four to five years, hospital leaders in Washington state and elsewhere have experienced a change in how aggressively they deal with physicians behaving less than professionally. The pace of change accelerated last July when the Joint Commission issued a “sentinel event alert” announcing that beginning January 1 hospitals must have a code of conduct defining “disruptive and inappropriate behaviors” by all health professionals,
including physicians, and hospital leaders must implement a process for addressing disruptive behaviors by any employee. The alert prompted hospitals across the state to refer disruptive physicians to the Washington Physicians Health Program for confidential evaluation and treatment. (The WPHP helps physicians impaired by alcohol, drugs, or any other physical or mental condition.)
The WPHP had been receiving about one such a referral a month, but in the months since the alert, it has been receiving one referral a week. “Hospitals have become exquisitely sensitive to the issue of disruptive physician behavior,” said Mick Oreskovich, MD, CEO of the WPHP .
“Instead of just relying on general policies, they recognize they must look at people who are the root cause of the problem.” Referral to WPHP typically comes after multiple incident reports and after informal and formal meetings between the disruptive physician and hospital leaders have failed to lead to a change in behavior. (See sidebar on steps to a referral to WPHP .) Smaller hospitals may be more likely to refer to WPHP because they lack the in-house expertise to handle disruptive physicians. “Most of the referrals show a pervasive pattern,” said Dr. Oreskovich. “We are seeing a lot of people who had been problematic for a long time.” Most physicians referred to the WPHP are younger men practicing subspecialties that involve procedures. They have exhibited repeated outbursts of anger by shouting or throwing objects, criticized other staff in front of peers, other staff or patients, or written critical personal comments about other staff in the chart.
Physicians referred to WPHP for disruptive behavior generally do not have substance abuse problems. If they have been accused of sexual misconduct, they are referred directly to the Medical Quality Assurance Commission. One surgeon threw clamps and needle holders at team members in the operating room. He later admitted that he’d done that a few times, and yes, he’d used profanity and raised his voice, but it was only because they weren’t paying attention. He didn’t see a problem with that. The hospital medical staff executive committee finally ordered him to go to the WPHP for a psychiatric evaluation or lose his OR privileges. He was diagnosed with a depressive disorder and prescribed medications and psychotherapy in his home community. He eventually learned how to ask for what he needed in the OR without frightening his co-workers and has returned to work. Disruptive physicians with depression or bipolar disorder respond most quickly to treatment, said Dr. Oreskovich. Those who need coaching or mentoring may need years of help, but most do respond positively in time. In the last two years, WPHP has had only two-three cases in which practitioners lost their privileges—and their livelihood— because they failed to respond to treatment. Not surprisingly physicians referred for disruptive behavior aren’t happy about it. Said Dr. Oreskovich, “They simmer quite a while before they get grateful. Initially, they are very angry at the way this process occurred and angry at having to go see WPHP . It takes a while before they can see their own responsibility in it, much more than physicians referred for chemical dependency.” Despite concerns by many physicians, Dr. Oreskovich has not seen any cases that were clearly retaliatory. “That doesn’t mean it is not going to happen, but in our experience, the concern is unsubstantiated.”
What’s behind the bad behavior? Tensions between hospitals and medical staffs have increased in the last few years over how physicians practice in hospitals. Physicians who have traded independent practice for hospitalist positions have had to give up autonomy and agree to oversight of their practice patterns and scope of practice in return for regular hours and a steady salary. Which tests to order and which medications to prescribe are now parts of a hospital policy, not the physician’s personal judgment. Surgeons don’t have control over who works with them in the operating room from day today. “The landscape has changed,” said Dr. Oreskovich. “That change has increased physicians’ stress and unfortunately, lots of physicians have maladaptive coping styles. They expect the institution to change, when the only thing that can change is their attitude and their response. Instead of coming up with workable solutions to what they see as problems they start making demands. We know that making demands doesn’t work very well, and this puts them in conflict.” Society has very high expectations of the quality of care. “We as patients all expect the best possible care, and we get very upset when it isn’t perfect” he said. “Physicians not only expect perfection from themselves but from everybody else involved with care. Physician expectations of perfection can become toxic. A lot of the time, physicians begin taking potshots at coworkers or the administration. They don’t realize it changes the milieu when they are too critical or too irritable. It put patients at risk because it affects communication within the team.”
The Joint Commission leadership standard requires the entire medical staff to demonstrate core competencies in interpersonal skills and professionalism and understand effective conflict resolutions strategies. With a concerted educational effort and committed leaders, Dr. Oreskovich is optimistic that the problem of disruptive physician behavior may actually not be a long-lasting problem, at least to the degree it is now.
Health care organizations that ignore disruptive behaviors by hospital staff expose themselves to litigation from both employees and patients, according to the Joint Commission. Studies link patient complaints about unprofessional, disruptive behaviors and malpractice risk. The commission notes that several surveys have found that most care providers have experienced or witnessed intimidating or disruptive behaviors.
What to do… The WSMA recommends that all disruptive physician policies be incorporated into the medical staff bylaws, reviewed by independent legal counsel and voted on by the active medical staff. WSMA is updating its model medical staff bylaws, which will include a model disruptive behavior policy. If you are a WSMA member you can contact Tim Layton, JD, WSMA Director of Legal Affairs, at tim@wsma.org.
To view the Joint Commission sentinel event alert cited in this article, go to www.jointcommission.org/ SentinelEvents/SentinelEventAlert/sea_40.htm.
For more on the WPHP , go to www.wphp.org/.
King County Public Health Reserve Corps (PHRC)
My name is Kevin Lawson, I am an AmeriCorps Vista volunteering with King County Public Health. Specifically in Public Health the Reserve Corps (PHRC), a group of both medical and non-medical volunteers that are prepared to augment the King County health system and Public Health staff during an emergency. Our main goal is to have pre-screened/pre-trained volunteers to call upon in case of a major health disaster (such as an earthquake or pandemic flu). In a sense, we are creating a registry of volunteer personnel to accelerate their implementation into our disaster response. A group like this will greatly increase our ability to quickly and effectively respond to any future disaster.
Currently we are gearing up to launch our big PHRC recruitment campaign with transit ads, direct mail, and in person recruitment strategies (i.e. recruitment fairs, etc.). We have made contacts with several medical associations throughout the state in search of methods to get information out to their members. We also have worked very closely with local colleges and other organizations to fill various non-medical roles. One group of volunteers we need is physician assistants. Attached are two documents, one is a general information flyer, while the other is an Op-Ed on the PHRC. More information is available on our website at (http://www.metrokc.gov/health/).
As for the PHRC, it is a very minimum requirement volunteer position only requiring the completion of a 3 hour orientation, two online FEMA courses as well as BBP training, but plays a vital role if activated during an emergency. Applying is very easy online. Liability is covered by the state. If you think of any method that we could utilize to get our information out to your members about filling this position please let me know. Some examples include a link on your website, annual conferences we can attend, newsletters, ect. Thank you very much for your help.
Kevin Lawson, AmeriCorps King County Public Health Vista
Public Health Reserve Corps
Public Health- Seattle & King County
401 Fifth Avenue, Suite 1300
Seattle, WA 98104
206-263-8034
425-269-4700 cell
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