What PAs can't do.... because of regulations...

[ventana]

This is an informational that AAPA put out

Details what we should be able to do, but can't - due to outdated regulations....

 

 

 

 1. Hospice: Medicare beneficiaries may rely on PAs as their principal healthcare provider. But, Medicare does not authorize PAs to certify the need for hospice care or provide or manage hospice care. This omission creates roadblocks to continuous, clinically appropriate care for patients (and their families) at a time when they are most vulnerable.

 

2. Home Health: PAs are able to provide home healthcare for their patients who are on Medicare, but they are not allowed to order home healthcare or manage the patient’s home healthcare plan. A physician, who may have no prior experience with the patient, is required to certify (and recertify) the need for home healthcare and the Medicare patient’s care plan, adding unnecessary steps and costs to the system.

 

3. Buprenorphine: PAs may prescribe buprenorphine to manage pain, but may not prescribe buprenorphine for the treatment of opioid addiction. Federal law and opioid treatment program guidelines must be updated to allow PAs to prescribe buprenorphine to treat the epidemic numbers of individuals with opioid addiction.

UPDATED - we can do this now!!

 

 

4. Medicaid EHR Incentive: The HITECH Act, contained in the 2009 stimulus bill, did not extend the Medicaid electronic health record (EHR) incentive payment to PAs in the same way it did for physicians and NPs. As a result, Medicaid patients receiving medical care from PAs do not realize the same benefits from EHRs as do patients seen by other practitioners. Additionally, cost-efficient medical practices that utilize PAs are penalized by the ineligibility to receive the EHR incentive. The law creates an inherent disincentive for community health centers and other medical practices that serve a large number of Medicaid beneficiaries to employ PAs.

 

5. Reimbursement: PAs are the only health professionals who are restricted from directly receiving payment for the services they deliver to Medicare beneficiaries. This restriction limits the efficient provision of care, constrains the business arrangements in which PAs practice, and creates barriers to care in medically underserved communities in which PAs own medical practices. Just as important, it obscures transparent tracking of the volume © American Academy of PAs 2 and quality of medical and surgical services provided by PAs through Medicare. PAs are the only Medicare providers subject to this type of reimbursement language, which should be updated to better reflect the care they provide to patients and to provide increased flexibility for PAs to participate in new and evolving models of care.

 

6. Physician Co-signatures: Medicare requires a physician co-signature for certain orders and patient care services provided by PAs including home healthcare plans and inpatient hospital admission orders. This requirement imposes unnecessary paperwork on physicians who may not be familiar with the patient, obfuscates accountability of care, causes delays, and adds unnecessary steps and cost to the Medicare program. As a result, this outdated requirement should be removed.

 

7. Federal Workers’ Compensation: All state workers’ compensation programs cover care provided by PAs. However, the Federal Employees’ Compensation Act (FECA) has not been updated in over 40 years and will not permit PAs to diagnose and treat federal employees who are injured on the job. The outdated FECA law results in reduced access to care for federal employees who rely on PAs as their principal healthcare professional, as well as federal workers who reside in medically underserved communities where a PA may be the only healthcare professional available. Additionally, the outdated law adds unnecessary costs to the FECA program as federal workers are advised to seek care through a hospital emergency department rather than to receive medical services through a medical practice where a PA is the sole onsite practitioner.

 

8. Diabetic Shoes: PAs diagnose and treat illnesses, manage complex medical care, prescribe medications in all states, and assist in surgery – but, regulations promulgated by the Centers for Medicare and Medicaid Services (CMS) do not allow PAs to order diabetic shoes. With the aging U.S. population and prevalence of diabetes, it is absurd a PA can manage a patient’s diabetes and other complex chronic conditions, but is not permitted to order diabetic shoes.

 

9. PACE: CMS regulations exclude PAs from being an employee or contracted provider in the Program of All-inclusive Care for the Elderly (PACE), a Medicare and Medicaid program designed to help patients meet their healthcare needs in the community instead of going to a nursing home or other inpatient facility. CMS has also denied state waivers to allow PAs to provide medical care through PACE – despite the fact PAs provide medical care to Medicare and Medicaid beneficiaries, provide complex, chronic care management and manage patient panels across the nation.

 

10. Graduate Medical Education (GME): PAs are integral to the nation’s healthcare delivery system, but GME funds are not used to support PA education. GME funding should be extended to support the education of PAs in hospital settings, as well as outpatient community settings providing primary medical care. By excluding PAs, GME currently creates educational and employment disadvantages for the PA profession. Modernizing GME to support PA education would extend equitable treatment across healthcare professions, ultimately benefiting patient care.

Top_Ten_Federal_Barriers_April_2016.pdf

[LKPAC]

well, the first step is recognizing the problem.  Now, what are they doing about it?

[Reality Check 2]

So, AAPA has pointed this all out.

Do they have a plan of attack to break down the barriers?

Nice to list them but what is the plan of action?

[ventana]

1-2 both have a bill in the house and senate that AAPA is lobbying HARD for

might pass

 

many other agencies are on board

 

#3 already done

 

they are moving forward pretty quickly!!  

(far better then they used to be!!)

[jdenning]

The "physician must sign" home health orders makes me crazy on an a daily basis

[Reality Check 2]

The "physician must sign" home health orders makes me crazy on an a daily basis

 

AMEN

My catch phrase - I can declare you dead and give you scheduled drugs but I can't get you diabetic shoes or home health...................................

[taotaox1]

I can give out dangerous schedule 2 drugs, manage every condition under the sun, and order 5000$ imaging studies and no one bats an eye.  God forgive I give someone diabetic shoes or have a PT work with a wheelchair bound patient at home.... I need a REAL doctor to THAT kind of complex medicine.

 

lol.

[aquafresh11]

The diabetic shoes one drives me nuts, but I am surprised that not being able to order diabetic education isn't listed. I can be a CDE, but I can't refer someone on medicare to one. 

[Reality Check 2]

The only thing in my world right now WORSE than not being able to sign for home health all by myself is being EXPECTED to sign for home health that someone at the hospital ordered without even telling us the patient had been admitted.

 

I get a wad of papers to sign without knowing anything about what happened.

 

THEN, I have to research. THEN, my truly wonderful doc has to hear the 60 second blurb on what happened and THEN he signs the papers with me.

 

By then, we are both exhausted and actually worried about signing for something we didn't actually order.

[ventana]

The only thing in my world right now WORSE than not being able to sign for home health all by myself is being EXPECTED to sign for home health that someone at the hospital ordered without even telling us the patient had been admitted.

 

I get a wad of papers to sign without knowing anything about what happened.

 

THEN, I have to research. THEN, my truly wonderful doc has to hear the 60 second blurb on what happened and THEN he signs the papers with me.

 

By then, we are both exhausted and actually worried about signing for something we didn't actually order.

How about all that

 

THEN having the hospital based VNA report you to the board for a supervision question, with out even every having the slightest bit of professional courtesy to contact you first?

 

Closed my practice ASAP once they started that game.....

 

Not cool at all - and yes regulations do affect care and the practice of PAs

[LKPAC]

In many of these cases, PAs were an oversight.  No one set out to say that "PAs can't prescibe diabetic shoes."  Somehow, in either the law making or rule writing procedures, we accidentally got left out of the mix.  In my opinion, AAPA should be on top of this.  Whenever laws are being written, or rules being promulgated, they need to be on top of this in advance to make sure we're not forgotten .  Am I wrong?

[sk732]

I had a med student with me the other day and I had a guy with a broken foot who needed a cast boot...since we don't have them in the ER, I had to send the guy with an Rx to one fo the physio places that sold the things...and had to get my SP of the day's co-signature and billing number.  He seemed pretty taken aback by that - you know, like I can nuke someone til they glow, give them all sorts of goodies/baddies but still can't legally prescribe an appliance.  Things aren't better up here :-D.

 

SK

[Guest Paula]

CME forces us to commit fraud, then will prosecute us for it.