Louisiana Board of Medical Examiners proposes rules LIMITING Physician-PA Teams

[PAdaddy]

The Louisiana State Board of Medical Examiners published rules on July 20, 2011, which, if adopted as written, would limit medical care provided by physician-PA teams in the following manner:

• Restrict physicians from delegating certain services without providing direct or personal supervision.
  
• Authorize the board to create on-going requirements for the levels of supervision for specific procedures by posting requirements on its Web site.
  
• Limit physicians who are contracted or employed by a hospital to supervising PAs who are employed or contracted to the same hospital.
  
• Order hospitals to assign PAs to the same department and facility as the supervising physician.
  

The Louisiana Academy of Physician Assistants vigorously opposes these rules, which will be considered at an August 29 public hearing. The Louisiana Medical Board is accepting written public comment until August 19.

[PAdaddy]

I've reached out to the AAPA and LAPA asking for more detailed information as to what "certail services" the LSBME is proposing to limit. I've also asked if there is some quality data or sentinel event that has caused the LSBME to take such a drastic shift in support for PA's providing care to the patients of Louisiana.

 

Thoughts?

[Contrarian]

The Louisiana State Board of Medical Examiners published rules on July 20, 2011, which, if adopted as written, would limit medical care provided by physician-PA teams in the following manner:

• Restrict physicians from delegating certain services without providing direct or personal supervision.
  
• Authorize the board to create on-going requirements for the levels of supervision for specific procedures by posting requirements on its Web site.
  
• Limit physicians who are contracted or employed by a hospital to supervising PAs who are employed or contracted to the same hospital.
  
• Order hospitals to assign PAs to the same department and facility as the supervising physician.
  

The Louisiana Academy of Physician Assistants vigorously opposes these rules, which will be considered at an August 29 public hearing. The Louisiana Medical Board is accepting written public comment until August 19.

 

 

Sorry... but don't really see a problem here and if what is proposed is reasonable:

 

• Restrict physicians from delegating certain services without providing direct or personal supervision.
  
• Authorize the board to create on-going requirements for the levels of supervision for specific procedures by posting requirements on its Web site.
  

Here we had always had a list of specific services/procedures that REQUIRE direct or personal physician supervision... and they had always been posted as a download on the state website. (I just looked and couldn't locate them... ??maybe they were recinded??)

• Limit physicians who are contracted or employed by a hospital to supervising PAs who are employed or contracted to the same hospital.
  

Makes sense to have the SP and the PAs credentialed by the same institutions. How can a physician supervise or sponsor a PA who works across town at a hospital that they (The SP) don't even have privileges at...??? As long as the SP can also supervise other PAs in offices in separate practices then its reasonable and makes sense. So if a SP had a private practice office where he/she seen patients and had a PA there... but also worked as a hospital employee at a hospital across town and supervised 2 PAs there... and this is ok... I don't see a problem.

• Order hospitals to assign PAs to the same department and facility as the supervising physician.
  

Again... makes sense. Can't have a Internal Medicine or Surgical PA in one hospital supervised or sponsored by a Peds or Derm Physician at a separate facility. across town.

Sorry... just don't see the issue here...

[andersenpa]

C- to me the key issue is the need for "direct/personal" supervision nor "certain services".

Outside the OR I don't know any services that I provide- to some of the highest acuity patients that exist- that require "direct or personal" supervision.....

[Contrarian]

Andersen...

I hear ya... but since you wrote above and specifically illuminated... 'Outside the OR'... it seems that you do agree that some services DO need direct supervision...??? It has yet to be determined what those services are in Louisiana... and I'm sure that things will evolve there, hopefully in a reasonable direction like the practice acts here did.

 

Apparently a few PAs and SPs in Louisiana demonstrated a need for the board to set/define/spell-out reasonable supervision. As usual... few bad apples/actors sour the bunch and make it difficult for the orchard.

 

You inspired me to go into my files and get the hardcopy of that old list:

 

 

MQAC Physician Assistant Standardized Procedures Reference & Guidelines (policy # 656-99OS revised 11/98)

 

 

The commission has used the following number system and definitions to define levels of supervision:

 

1= Perfoms under the general supervision of the responsible physician, but does not require any immeadiate contact under notmal circumstances.

 

2= Performs with the knowledge and concurrance of the physician. The physician must be available for consultation, but need not be present in the room when services are being performed.

 

3= Perform tasks with the physician.

 

 

Medical and surgical procedures

 

1... Phlebotomy

1... Injections including Introvenous medications

1... Excise and drain abscesses

1... Non-Podiatric footcare

1... Cryotherapy

1... Tonometry

1... Cerumen extraction

1... Wound debridement

1... Treatment of Pilonidial cyst with abscess

1... Treatment of hemorrhoids, anal fissures, peri-anal abscesses

1... insert and remove drains

1... Treat ingrown toenails

1... Fluorescein stain eyes

1... Pack bleeding noses

1... Remove foreign bodies

1... Insert and remove central catheters

2... Sclerosis and removal of lower extremity varicose veins

2... Biopsies

2... Joint injection and taps

2... Excise and treat warts, cysts and lesions

3... Aspirate Breast Mass

 

 

Emergency Procedures

 

1... Cardioversion

1... Intubation

1... Treat Poisonings

1... Nasogastric tube insertion

1... Cardiac resusitation

1... IV Cutdowns

1... Treat Burns

 

 

Diagnostic and Therapeutic Procedures

 

1... CBC

1... Gram Stain, wet mount, KOH prep and Darkfield microscopy

1... Serum Glucose determination

1... PAP smears

1... Diathermy

1... Anoscopy

1... Urinalysis

1... Throat cultures

1... Pregnancy testing

1... Obtain and interpret ECG/EKG

1... Diagnostic and Therapeutic ultrasound

1... Bladder catherization and taps

2... Exercise stress testing

2... Perform and interpret radiological procedures including performing and reading x-rays

2... Sigmoidoscopy-flexible and ridgid

2... Pulmonary function testing

2... Ordering or infusing chemotherapy agents

2... Spinal taps

2... Thoracentesis

3... Urethral dilitation

 

 

Orthopedic Procedures

 

1... Apply Spicas

1... Fit Braces

1... Excision of dorsal ganglion upper extremity

1... Cast application and removal

1... Apply traction

1... Place and remove pins, wires or screws

1... Physical Therapy

2... Reduce fractures and dislocations

2... Tendon repair - upper extremity extensor tendon repair

 

Obstetrics-Gynecology Procedures

 

1... Prenatal care and deliveries

1... Birth Control

2... Insert and remove IUDs

2... Endometrial, cervical and vulvar biopsy

2... Insert Norplant

2... Colposcopy

 

Major Surgery

 

1... Pre and Post op care

1... Suturing (including major lacerations)

1... IV Cutdown

1... Surgical Assisting (???)

1... Wound Debridement

1... Closure

2... Circumcision

2... Vein Harvesting

2... Vasectomy

3

... Intensive Care (???)

 

Hospital Procedures

 

1... Injection of ABX into chest tubes

1... Insert or remove catheters, including Foley

2... Take emergency room call

2... Order boold and components, hyperalimentation

3

... Paracentesis

3

... Insert & remove Arterial lines

3

... Insert & remove Swanz-Ganz catheters

3

... Insert & remove Central Venous Pressure lines

3

... Place and remove Chest tubes

 

Psychiatric Evaluations, Counseling and Patient Education

1... Behavior modification

1... Sexual Assault counseling

1... Nutritional Counseling

1... Crisis Intervention

1... Sexuality Counseling

1... "Social Work" (housing and food)

1... Long and short term therapy

1... Chemical dependency counseling, treatment and referral

 

Anethesia Procedures

1... Topical

1... Local

2... Infiltrative

2... Joint injection

3

... Ophthalmic

3

... Blocks such as:

digital

ulnar

radial

pundendal

cervical

paracervical

Administrative Procedures

 

1... Admissions

1... Discharge Summaries

1... Pronouncing and documenting death

1... Dept of Transportation Physicals

1... Labor and Industries exams and certifications

 

656-99OS Revised 11/98

 

 

 

 

 

 

 

 

 

This list was distributed by the MQAC back in the day upon initial licensing.

Now that I have read it again... I find some of it odd but do seem to vaguely recall that this list was one of those PA= supervision versus PA-C= sponsorship things... and that the above list only applied to PAs and their supervisors but not to PA-Cs and their sponsors.

 

They may have recinded/abolished the above list all-together... I'm not sure.

 

Contrarian

[EMEDPA]

YUP, must be a very old list. I don't have an md at the bedside everytime I do a digital block....