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Name Change - Starting the Discussion


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The latest modernization of the PA laws has my comment for change, giving PAs the option to use the label "Physician Associate." Will it pass with my wording?  Not a chance as there is too much opposition even within our ranks.  However, I've tried to start the discussion at the state level.

 

Comments Submitted to the

SHB 1737 Joint PA Rules Committee on

Chapter 246-918 WAC

 

PHYSICIAN ASSISTANTS—MEDICAL QUALITY ASSURANCE COMMISSION

Draft Amended Rules as of 5/28/14

 

246-918-005 (DRAFT)
Definitions.

The definitions in this section apply throughout this chapter unless the context clearly requires otherwise:

(1) "Physician assistant" means a person who is licensed under chapter 18.71A RCW by the commission to practice medicine to a limited extent only under the supervision of a physician as defined in chapter 18.71 RCW.

(a) "Certified physician assistant" means an individual who has successfully completed an accredited and commission approved physician assistant program and has passed the initial national boards examination administered by the NCCPA.

(b) “Non-certified physician assistant” means an individual who:

(i) Successfully completed an accredited and commission approved physician assistant program, is eligible for the NCCPA examination, and was licensed in Washington State prior to July 1, 1999;

(ii) Is qualified based on work experience and education and was licensed prior to July 1, 1989;

(iii) Graduated from an international medical school and was licensed prior to July 1, 1989; or

(iv) Holds an interim permit issued pursuant to RCW 18.71A.020(1).

© "Physician assistant-surgical assistant" means an individual who was licensed under chapter 18.71A RCW as a physician assistant between September 30, 1989, and December 31, 1989, to function in a limited extent as authorized in WAC 246-918-250 and WAC 246-918-260.

 (3) "Commission approved program" means a physician assistant program accredited by the Committee on Allied Health Education and Accreditation (CAHEA); the Commission on Accreditation of Allied Health Education Programs (CAAHEP); the Accreditation Review Committee on Education for the Physician Assistant (ARC-PA); or other substantially equivalent organization(s) approved by the commission.

 (4) “Supervising physician” means a sponsoring or alternate physician providing clinical oversight for a physician assistant.

 (a) “Sponsoring physician” means any physician licensed under chapter 18.71 RCW and identified in a delegation agreement as providing primary clinical and administrative oversight for a physician assistant.

 (b) “Alternate physician” means any physician licensed under chapter 18.71 RCW or chapter 18.57 RCW who provides clinical oversight of a physician assistant in place of or in addition to the sponsoring physician.

 (5) “Delegation agreement” means a mutually agreed upon plan, as detailed in WAC 246-918-055, between a physician and physician assistant which describes the manner and extent to which the physician assistant will practice and be supervised.

(6) "Remote site" means a setting physically separate from the sponsoring or supervising physician's primary place for meeting patients or a setting where the physician is

present less than twenty-five percent of the practice time of the licensee.

(7) “Commission” means the Washington State Medical Quality Assurance Commission.

(8) “NCCPA” means National Commission on Certification of Physician Assistants.

(9) “Physician” means an individual licensed under chapter 18.71 RCW.

(10) “Osteopathic physician” means an individual licensed under chapter 18.57 RCW.

 

Subsection(s)

 

Tom Green

(1)(b)©

 

(5)

 

 

Johnny Michael Jones

(1)

Comments

 

Is there a way of auto sundowning these when they are all gone?

 

 

Would it be better to state the delegation agreements is between a sponsoring physician and a physician assistant?

 

 

“Physician Associate” is defined as a Physician Assistant who graduated from a Physician Associate or Clinical Associate program.

 

 

 

246-918-007
Application withdrawals.  (No change in the current rule.)

An applicant for a license or interim permit may not withdraw his or her application if grounds for denial exist.

 

Subsection(s)

 

 

 

Comments

 

246-918-035

Prescriptions.  (DRAFT)

 

(1) A physician assistant may prescribe, order, administer and dispense legend drugs and schedule II, III, IV, or V controlled substances consistent with the scope of practice in an approved delegation agreement, and:

(a) The physician assistant has an active DEA registration; and

(b) All prescriptions comply with state and federal prescription regulations.

(2) If a supervising physician’s prescribing privileges have been limited by state or federal disciplinary action, the physician assistant will be similarly limited in his or her prescribing privileges, unless otherwise authorized in writing by the commission.

 

Subsection(s)

 

Tom Green

(2)

 

 

Comments

 

Should 2 clarify that this restriction applies only when the PA is being supervised by the physician whose practice is so restricted?

 

246-918-050
Physician assistant qualifications for interim permits. (DRAFT)

An interim permit is a limited license.  The permit allows an individual who has graduated from a commission approved program within the last year to practice prior to successfully passing the commission approved licensing examination.

(1) An individual applying to the commission for an interim permit under RCW 18.71A.020(1) must have graduated from an accredited commission approved physician assistant program.

(2) An interim permit holder will have one year from completion of a commission approved training program to successfully pass the NCCPA examination.  The interim permit may not be renewed.

(3) An applicant for a physician assistant interim permit must submit to the commission:

(a) A completed application on forms provided by the commission.

(b) Applicable fees as specified in WAC 246-918-990.

© Requirements as specified in WAC 246-918-080.

(4) An interim permit holder may not work in a remote site.

 

Subsection(s)

 

 

 

Comments

 

246-918-055 (DRAFT new section)

Delegation agreements.

 

(1) The physician assistant and sponsoring physician, must submit a joint delegation agreement application on forms provided by the commission.   

(2) The delegation agreement must specify:

(a) The names and Washington State license number of the sponsoring physician and alternate physician, if any. In the case of a group practice, the alternate physicians do not need to be individually identified;

(b) A detailed description of the scope of practice of the physician assistant.

© A description of the supervision process for the practice;

(d) The location of the primary practice and all remote practice sites and the amount of time spent by the physician assistant at each site.

(3) The sponsoring physician and the physician assistant shall determine which services may be performed and the degree of supervision under which the physician assistant performs the services.

(4) The physician assistant’s scope of practice may not exceed the scope of practice of the supervising physician.

 (5) A physician assistant practicing in a multi-specialty group or organization may need more than one delegation agreement depending on the physician assistant’s training and the scope of practice of the physician(s) the physician assistant will be working with.

(6) It is the joint responsibility of the physician assistant and the supervising physician(s) to notify the commission in writing of any significant changes in the scope of practice of the physician assistant.  The commission or its designee will evaluate the changes and determine whether a new delegation agreement is required.

(7) A physician may enter into delegation agreements with up to five physician assistants, but may petition the commission for a waiver of this limit. However, no physician may have under his or her supervision:

(a) More than three physician assistants who are working in remote sites as provided in WAC 246-918-120; or

(b) More physician assistants than the physician can adequately supervise.

(8) Within thirty days of termination of the working relationship, the sponsoring physician or the physician assistant shall submit a letter to the commission indicating the relationship has been terminated.

(9) Whenever a physician assistant is practicing in a manner inconsistent with the approved delegation agreement, the commission may take disciplinary action under chapter 18.130 RCW.

 

Subsection(s)

 

Tom Green

(2)(a)

 

 

 

 

 

 

 

(2)©

 

 

(7)

Comments

 

Comments 2a – the group of physicians should be defined in some way.  In a multispecialty group for example, the subgroup should be specifically defined. (orthpaedics, general surgery, emergency medicine etc.).

 

In a group practice, could an osteopathic physician also be a sponsoring physician?  If not does that need to be specified here?  I think is should be allowed since they can be supervising physicians.  In reality the two groups (DO and MD) should be combined under the same laws.  I understand that is not the point of this exercise but this is one of many examples why.

 

 

Also, modify 2c to …practice including the number of PAs to be supervised by a physician at any one time.

 

Is 7 necessary at all?  Since the Commission must approve the delegation agreement and this allows for more than five PAs by exception to supervised by a physician, the remote site limitation is defined elsewhere, and the Commission would ultimately determine how many PAs the physician could appropriately supervised based on the delegation agreement.  Alternate suggestion for 7 – “ A physician may supervise only as many PAs as:

a.     The Commission determines can be adequately supervised based on the delegation agreement

b.     As specified in WAC …..120.

 

 

 

 

246-918-075
Background check—Temporary practice permit.  (DRAFT – minor revisions)

The commission conducts background checks on all applicants to assure safe patient care. Completion of a national criminal background check may require additional time for processing. The commission may issue a temporary practice permit when the applicant has met all other licensure requirements, except the national criminal background check requirement. The applicant must not be subject to denial of a license or issuance of a conditional license under this chapter.

(1) If there are no violations identified in the Washington criminal background check and the applicant meets all other licensure conditions, including receipt by the department of health of a completed Federal Bureau of Investigation (FBI) fingerprint card, the commission may issue a temporary practice permit allowing time to complete the national criminal background check requirements.

The commission will issue a temporary practice permit that is valid for six months. A one- time extension of six months will be granted if the national background check report has not been received by the commission.

(2) The temporary practice permit allows the applicant to work in the state of Washington as a physician assistant during the time period specified on the permit. The temporary practice permit is a license to practice medicine as a physician assistant.

(3) The commission issues a license after it receives the national background check report if the report is negative and the applicant otherwise meets the requirements for a license.

(4) The temporary practice permit is no longer valid after the license is issued or action is taken on the application because of the background check.

 

 

Subsection(s)

 

Linda Dale

(1)

 

 

 

 

 

 

Tom Green

(1) Thru (4)

Comments

 

“A one- time extension of six months may be granted if the national background check report has not been received by the commission.” I think it would be extremely unusual for an FBI background check to take longer than a few weeks so if it takes longer, I would be suspicious of the cause. I think we should put “may” to allow the Commission some room to deny if the circumstances are suspicious. To leave “will” in this rule means the Commission cannot deny it for any reason unless the background search is problematic.  

 

 

Comments:  Suggested changes to simplify and eliminate redundancy

From 1 down change to

Temporary Practice Permits:

1.     May be issued if the applicant has met all the requirements for a license except the national background check to allow for completion of the national background check.

2.     Are issued to allow the applicant to practice as a PA in the state of Washington for the time specified on the permit.

3.     Are issued for a period of six months with a one-time extension of six months if the background check has not been received by the Commission.

4.     Are no longer valid once the license has been issued or action taken . . .

 

Other content redundant or specified else where or not part of Temp permits such as requirements for full license.

 

 

 

 

 

 

246-918-080
Physician assistant—Requirements for licensure. (DRAFT)

(1) Except for a physician assistant licensed prior to July 1, 1999, individuals applying to the commission for licensure as a physician assistant must have graduated from an accredited commission approved physician assistant program and successfully passed the NCCPA examination.

(2) An applicant for licensure as a physician assistant must submit to the commission:

(a) A completed application on forms provided by the commission.

(b) Proof of the following:

(i) The applicant has completed an accredited commission approved physician assistant program;

(ii) The applicant has successfully passed the NCCPA examination.

© Other information required by the commission.

(d) All applicable fees as specified in WAC 246-918-990.

(e) Proof of completion of four clock hours of AIDS education as required in chapter 246-12 WAC, Part 8.

(3) The commission will only consider complete applications with all supporting documents for licensure.

(4) A physician assistant may not begin practicing without written commission approval of a delegation agreement for each working relationship.

 

Subsection(s)

 

Tom Green

 

 

Comments

 

Why are the requirements for Washington state background check and FBI Fingerprint card not specified here?  Are they somewhere else?  If so they should be referred to here.  I would remove stating specific full license requirements from Temporary Practice Permits section and include them only here.  What is other information required by the Commission.  It seems there are other requirements (FBI, WA background check mentioned in temporary practice permits)  but they are not specified here.

 

246-918-081
How to return to active status when a license has expired. (DRAFT)

(1) To return to active status the physician assistant must meet the requirements of chapter 246-12 WAC, Part 2 which includes paying the applicable fees under WAC 246-918-990 and meeting the continuing medical education requirements under WAC 246-918-180.

(2) If the license has expired for over three years, the physician assistant must meet requirements in (1) of this section and the current licensure requirements under WAC 246-918-080.

 

Subsection(s)

 

 

 

Comments

 

 

246-918-082 (DRAFT - new section)

Requirements for osteopathic physician assistant licensure

 

A person who holds an active, unrestricted osteopathic physician assistant license issued by the Washington State Board of Osteopathic Medicine and Surgery and meets current licensing requirements may apply for licensure as an allopathic physician assistant through an abbreviated application process. 

(1) An applicant for an allopathic physician assistant license must submit:

(a) Verification of an active, unrestricted license as an osteopathic physician assistant issued by the Washington State Board of Osteopathic Medicine and Surgery;

(b) A completed application on forms provided by the commission; and

© Any fees required under WAC 246-918-990.

(2) An allopathic physician assistant may not begin practice without written commission approval of the delegation agreement for each working relationship.

 

Subsection(s)

 

 

 

Comments

 

246-918-095
Scope of practice—Osteopathic alternate physician. (DRAFT – minor revisions)

The physician assistant practices under the delegation agreement and prescriptive authority approved by the commission whether the alternate supervising physician is licensed under chapter 18.57 or 18.71 RCW.

 

 

Subsection(s)

 

Tom Green

 

Comments

 

Is there a need comment on an Osteopathic Physician being able to function as a sponsoring physician when he may be part of an allopathic group?  In my opinion, such a physician should be allowed to do so.

 

 

246-918-105
Practice limitations due to disciplinary action. (DRAFT – minor revisions)

(1) To the extent that a supervising physician’s practice has been limited by disciplinary action under chapter 18.130 RCW, the physician assistant's practice is similarly limited while working under that supervising physician.

(2) The physician assistant shall notify his or her sponsoring physician of all cases opened by the commission in which he or she is involved including, but not limited to, complaints, investigations, and disciplinary action.

 

Subsection(s)

 

Linda Dale

(1)

 

 

Comments

 

I thought we were going to add language stating “unless otherwise permitted by the Commission” so the PA could keep working until they find another supervising physician (to prevent an access to care issue for the patients)?

 

246-918-120
Remote site. (DRAFT)

(1) A physician assistant may not work in a remote site without the approval of the commission or its designee. A physician may not supervise more than three physician assistants who are working in remote sites, or more physician assistants than the physician can adequately supervise.  A physician may petition the commission for a waiver of this limit.

(2) The commission or its designee may grant the use of a physician assistant in a remote site if:

(a) There is a demonstrated need for such use;

(b) Adequate provision for timely communication exists between the primary or alternate physician and the physician assistant;

© The responsible supervising physician spends at least ten percent of the practice time of the physician assistant in the remote site. In the case of part time or unique practice settings, the physician may petition the commission to modify the on-site requirement providing the supervising physician demonstrates that adequate supervision is being maintained by an alternate method, including, but not limited to, telecommunication. The commission will consider each request on an individual basis;

(3)The names of the supervising physician and the physician assistant must be prominently displayed at the entrance to the clinic or in the reception area of the remote site.

(4) A physician assistant holding an interim permit may not work in a remote site.

 

Subsection(s)

 

Linda Dale

(2)(a)

 

 

 

Comments

 

We wanted to strike this because the “demonstrated need” is a given if the PA is hired in the first place. It also could be construed as a restraint of trade issue if the Commission were to deny a physician the ability to hire a PA because the commission doesn’t feel there’s a need.

 

246-918-130
Physician assistant identification. (DRAFT – minor revisions)

(1) The physician assistant, at all times when meeting or treating patients, must wear  identification as a physician assistant.

(2) A physician assistant may not present himself or herself in any manner which would tend to mislead the public as to his or her title.

 

Subsection(s)

 

Tom Green

(1)

 

 

 

 

 

(2)

Comments

 

 

1.     Suggested change:  “When practicing as a PA, the PA must clearly identify himself or herself as a PA and must appropriately display on his or her person identification as a PA.”  Comments:  The PA is often interacting with others in a practice setting and the statement meeting or treating patients suggests that is the only time they need to properly identify themselves.  They also practice when they are not in the presence of others (phone etc.) so the id badge is not helpful.

 

2.     Change may to must.  Comment:  Must is used in 1 and the requirements should be consistent.

 

 

246-918-150
Assistance or consultation with other physicians. (DRAFT – minor revision)

(1)  A physician assistant may assist or consult with a physician other than his or her supervising physician concerning the care or treatment of the supervising physician’s patients, provided it is done with the knowledge and concurrence of the supervising physician. The supervising  physician must maintain on file a written statement which instructs the physician assistant as to who may be assisted or consulted with and under what circumstances, or if no list is possible, then the method to be used in determining who may be consulted or assisted. The sponsor retains primary responsibility for the performance of his or her physician assistant.

(2) Responsibility of a nonsponsoring physician. A nonsponsoring physician using or advising a physician assistant as indicated in subsection (1) of this section, shall assume responsibility for patient services provided by a physician assistant if the physician:

(a) Knowingly requests that patient services be rendered by the physician assistant; or

(b) Knowingly consults with the physician assistant concerning the rendering of patient services.

 

Subsection(s)

 

 

 

Comments

 

246-918-171
Renewal and continuing medical education cycle. (DRAFT)

(1) A physician assistant must renew his or her license every two years on his or her birthday.  Under WAC 246-12-020, initial credentials issued within ninety days of the  physician assistant’s birthday do not expire until the physician assistant’s next birthday.

(2) Each physician assistant will have two years to meet the continuing medical education requirements in WAC 246-918-180. The review period begins on the first birth date after receiving the initial license.

 

Subsection(s)

 

 

 

Comments

 

246-918-175

Retired active license. (DRAFT – new section)

 (1) To obtain a retired active license a physician assistant must comply with chapter 246-12 WAC, Part 5, excluding WAC 246-12-120 (2)© and (d).

(2) A physician assistant with a retired active license must have a delegation agreement approved by the commission in order to practice except when serving as a “covered volunteer emergency worker” as defined in RCW 38.52.180(5)(a) and engaged in authorized emergency management activities.

(3) A physician assistant with a retired active license may not receive compensation for health care services;

(4) A physician assistant with a retired active license may practice under the following conditions:

(a) In emergent circumstances calling for immediate action; or

(b) Intermittent circumstances on a part-time or full-time nonpermanent basis; and

(5) A physician assistant with a retired active license must renew every two years and must report one hundred hours of continuing medical education at every renewal.

 

Subsection(s)

 

 

 

Comments

 

246-918-180
Continuing medical education requirements. (DRAFT)

(1) A physician assistant must complete one hundred hours of continuing education every two years as required in chapter 246-12 WAC, Part 7.

(2) In lieu of one hundred hours of continuing medical education the commission will accept:

(a) Current certification with the NCCPA; or

(b) Compliance with a continuing maintenance of competency program through the American Academy of Physician Assistants (AAPA) or the NCCPA; or

© Other programs approved by the commission.

(3) The commission approves the following categories of creditable continuing medical education. A minimum of forty credit hours must be earned in Category I.

   

Category I

Continuing medical education activities with accredited sponsorship

Category II

Continuing medical education activities with nonaccredited sponsorship and other meritorious learning experience.

(4) The commission adopts the standards approved by the AAPA for the evaluation of continuing medical education requirements in determining the acceptance and category of any continuing medical education experience.

(5) A physician assistant does not need prior approval of any continuing medical education. The commission will accept any continuing medical education that reasonably falls within the requirements of this section and relies upon each physician assistant’s integrity to comply with these requirements.

(6) A continuing medical education sponsor does not need to apply for or expect to receive prior commission approval for a formal continuing medical education program. The continuing medical education category will depend solely upon the accredited status of the organization or institution. The number of hours may be determined by counting the contact hours of instruction and rounding to the nearest quarter hour. The commission relies upon the integrity of the program sponsors to present continuing medical education for the physician assistant that constitutes a meritorious learning experience.

 

Subsection(s)

 

Linda Dale

 

 

Comments

 

WAPA has found a method to allow those non-certified PAs to log their CME so that the Commission can audit them at will. WAPA could also send the commission a list of the CME logs of those renewing their licenses each month. At our “best guess” there may be around 340-360 PAs who did not maintain their NCCPA certification so we could do this in order to allow easier auditing for the commission.

 

246-918-250

Basic physician assistant-surgical assistant (PASA) duties. (DRAFT)

 

The physician assistant-surgical assistant (PASA) who was not eligible to take the NCCPA certifying exam shall:

(1) Function only in the operating room as approved by the commission;

(2) Only be allowed to close skin and subcutaneous tissue, placing suture ligatures, clamping, tying and clipping of blood vessels, and  cauterizing for hemostasis under direct supervision;

(3) Only be allowed to assist the operating surgeon.  The PASA may not perform any independent surgical procedures, even under direct supervision.

(4) Have no prescriptive authority; and

(5) Only write operative notes.  The PASA may not write any progress notes or order(s) on hospitalized patients.

 

Subsection(s)

 

 

 

Comments

 

246-918-260
Physician assistant-surgical assistant (PASA)—Use and supervision. (DRAFT)

The following section applies to the physician assistant-surgical assistant (PASA) who is not eligible to take the NCCPA certification exam.

(1) Responsibility of PASA. The PASA is responsible for performing only those tasks authorized by the supervising physician(s) and within the scope of PASA practice described in WAC 246-918-250. The PASA is responsible for ensuring his or her compliance with the rules regulating PASA practice and failure to comply may constitute grounds for disciplinary action.

(2) Limitations, geographic. No PASA may be used in a place geographically separated from the institution in which the PASA and the supervising physician are authorized to practice.

(3) Responsibility of supervising physician(s). Each PASA shall perform those tasks he or she is authorized to perform only under the supervision and control of the supervising physician(s).Such supervision and control may not be construed to necessarily require the personal presence of the supervising physician at the place where the services are rendered. It is the responsibility of the supervising physician(s) to insure that:

(a) The operating surgeon in each case directly supervises and reviews the work of the physician assistant-surgical assistant. Such supervision and review shall include remaining in the surgical suite until the surgical procedure is complete;

(b) The PASA shall wear identification as a "physician assistant-surgical assistant" or "PASA" In all written documents and other communication modalities pertaining to his or her professional activities as a PASA, the PASA shall clearly denominate his or her profession as a "physician assistant-surgical assistant" or "PASA";

© The PASA is not presented in any manner which would tend to mislead the public as to his or her title.

 

Subsection(s)

 

 

 

Comments

 

Please note: Michael Concannon’s comments are attached separately.

 

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Wow, I didn't realize Washington state had separate DO and MD boards. I thought only osteopathically militant states like Pennsylvania did this. Total waste of resources and absolutely unnecessary. In PA I had to apply to the DO board if my SP was a DO...of note, the MD and DO boards shared the very same address, floor and PO box. Totally wasteful.

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