Landmark legislation in Michigan

[EMEDPA]

Major PA Victory in Michigan

Dec. 21, 2016

PAs in Michigan are applauding the adoption of House Bill 5533 by both chambers of the legislature. The bill, awaiting the governor’s signature, will increase patient access to healthcare by modernizing and updating how PAs practice. Under the bill, physicians within PA-physician healthcare teams will be recognized as participating physicians instead of supervising physicians to better reflect the PA’s and physician's role within the team. The bill also removes physician responsibility for PA practice, making each member of the healthcare team responsible for their own decisions. And it removes the rigid ratio restriction that arbitrarily limited the number of PAs with whom a physician may practice. Last, the new law grants PAs more autonomy to serve patients by recognizing PAs as full “prescribers” rather than limiting their care to “delegated prescriptive authority.” 

This important legislation, which has been the priority for the Michigan Academy of PAs (MAPA) for the past two years, enacts key provisions of AAPA’s Model State Legislation for PAs, and is consistent with the revised Guidelines for State Regulation of PAs passed by the AAPA House of Delegates in May 2016. (This 

 explains the Model and Guidelines.) AAPA worked with MAPA to support this breakthrough legislation and commends the Michigan Academy on this huge accomplishment. The governor is expected to sign the legislation in the next few weeks. 

“PAs are already providing excellent care to patients across Michigan,” said Josanne K. Pagel, MPAS, PA-C, Karuna ® RMT, DFAAPA, AAPA president and board chair. “As the healthcare delivery system changes, so must the regulations and laws governing it. We applaud Michigan lawmakers for approving this important legislation which breaks down barriers that prevent PAs from practicing medicine to the top of their education and experience.”

R. David Doan III, MS, PA-C, president of the Michigan Academy of PAs (MAPA), was enthusiastic about the work of the chapter.

“Much like how PAs practice medicine, passage of this important legislation was a team effort. We worked with important allies like Michigan State Medical Society and Michigan Osteopathic Association,” Doan said. “We also came together as a profession to make the case for why this legislation will help patients. We are excited about these changes and how they will improve how we can deliver care.”

Critically, HB 5533 makes PAs responsible for their professional actions. Studies have documented that PAs provide high quality cost-effective medical care. Physician liability for PA care is no longer necessary and its elimination removes an undue burden on physicians. 

The bill also removes language defining PAs as an “agent” of the physician, a term employed decades ago to enable PAs to perform specific medical and surgical tasks on behalf of a physician. Some of these tasks included signing forms for sports physicals, accepting pharmaceutical samples or ordering specific tests or therapies. This term and concept are now outdated. Years ago, a common PA practice model was a single physician hiring a single PA. Today 32 percent of the PAs in Michigan are employed by hospitals and another 42 percent by group practices.

HB 5533 also fully recognizes PAs as “prescribers.” This is a change from PAs prescribing “as a delegated act of a supervising physician.” It reflects the level of autonomy PAs have in evaluating patients and writing prescriptions. It is also consistent with federal Drug Enforcement Administration (DEA) policy. In the eyes of the DEA, PAs are separate prescribers who must register and have their own individual DEA number before prescribing controlled medications for patients. 

PAs have a proven record of providing high-quality care and these improvements to PA practice are big wins for patients in Michigan.

 

 

[BruceBanner]

"The bill also removes physician responsibility for PA practice, making each member of the healthcare team responsible for their own decisions."

 

That's awesome. Call me crazy but that sounds like independence!! Or the closest thing we've ever seen. My wife is from MI and we have been thinking of moving there within the next few years...good news!!

[EMEDPA]

yup, that sounds like full practice authority...

[EMEDPA]

Related to the issue of FPA:

https://clinician1.com/read/articles/Full-Practice-Authority-What-It-Means-and-What-It-Doesnt

you will need a free clinician1 account to read this.

[Marinejiujitsu]

Holy crap. Out of nowhere. Awesome. Let's go California.

 

Sent from my SAMSUNG-SM-N920A using Tapatalk

[EMEDPA]

Holy crap. Out of nowhere. Awesome. Let's go California.

 

Sent from my SAMSUNG-SM-N920A using Tapatalk

let's go EVERYWHERE!

[IDCtoPA]

Well, it is definitely a step in the right direction but it is not Full Practice Authority as outlined by the AAPA Task Force. In any case,

Congrats to MAPA and all the PAs in Michigan who worked hard to achieve what is a significant step forward. 

 

"In order to realize PA Full Practice Authority and Responsibility, AAPA would have to adopt policy changes and take action to:

• Emphasize our profession’s continued commitment to team-based practice.

• Support the elimination of provisions in laws and regulations that require a PA to have and/or report a supervisory, collaborating or other specific relationship with a physician in order to practice.

• Advocate for the establishment of autonomous state boards, with a voting membership comprised of a majority PAs, to license, regulate, and discipline PAs.

• Ensure that PAs are eligible to be reimbursed directly by public and private insurance."

 

Aside from the fact that the Michigan Bill uses Physician's Assistant in every instance it it also continues to require a "Practice Agreement" with a "Participating Physician". I pasted this section of the new law below. 

 

"Sec. 17047. (1) A physician’s assistant shall not engage in the practice as a physician’s assistant except under the terms of a practice agreement that meets the requirements of this section. (2) A practice agreement must include all of the following: (a) A process between the physician’s assistant and participating physician for communication, availability, and decision making when providing medical treatment to a patient. The process must utilize the knowledge and skills of the physician’s assistant and participating physician based on their education, training, and experience. (b) A protocol for designating an alternative physician for consultation in situations in which the participating physician is not available for consultation. © The signature of the physician’s assistant and the participating physician. (d) A termination provision that allows the physician’s assistant or participating physician to terminate the practice agreement by providing written notice at least 30 days before the date of termination. (e) Subject to section 17048, the duties and responsibilities of the physician’s assistant and participating physician. The practice agreement shall not include as a duty or responsibility of the physician’s assistant or participating physician an act, task, or function that the physician’s assistant or participating physician is not qualified to perform by education, training, or experience and that is not within the scope of the license held by the physician’s assistant or participating physician. (f) A requirement that the participating physician verify the physician’s assistant’s credentials. (3) The number of physician’s assistants in a practice agreement with a participating physician and the number of individuals to whom a physician has delegated the authority to perform acts, tasks, or functions are subject to section 16221."

[ventana]

 

Major PA Victory in Michigan

Dec. 21, 2016

  The bill also removes physician responsibility for PA practice, making each member of the healthcare team responsible for their own decisions.  \

Last, the new law grants PAs more autonomy to serve patients by recognizing PAs as full “prescribers” rather than limiting their care to “delegated prescriptive authority.” 

This important legislation, which has been the priority for the Michigan Academy of PAs (MAPA) for the past two years, enacts key provisions of AAPA’s Model State Legislation for PAs, and is consistent with the revised Guidelines for State Regulation of PAs passed by the AAPA House of Delegates in May 2016. w we can deliver care.”

Critically, HB 5533 makes PAs responsible for their professional actions. Studies have documented that PAs provide high quality cost-effective medical care. Physician liability for PA care is no longer necessary and its elimination removes an undue burden on physicians. 

The bill also removes language defining PAs as an “agent” of the physician, a term employed decades ago to enable PAs to perform specific medical and surgical tasks on behalf of a physician. Some of these tasks included signing forms for sports physicals, accepting pharmaceutical samples or ordering specific tests or therapies. This term and concept are now outdated. Years ago, a common PA practice model was a single physician hiring a single PA. Today 32 percent of the PAs in Michigan are employed by hospitals and another 42 percent by group practices.

HB 5533 also fully recognizes PAs as “prescribers.” This is a change from PAs prescribing “as a delegated act of a supervising physician.” It reflects the level of autonomy PAs have in evaluating patients and writing prescriptions. It is also consistent with federal Drug Enforcement Administration (DEA) policy. In the eyes of the DEA, PAs are separate prescribers who must register and have their own individual DEA number before prescribing controlled medications for patients. 

 

 

 

Wow,

that is great

 

I highlighted some of the high points - truly amazing and a HUGE step in the right direction

 

For the naysayers of AAPA - they too had a hand in this....

 

The winds of change are blowing, and the times are a changin.....

[Joelseff]

|>

 

Sent from my SAMSUNG-SM-G870A using Tapatalk

[rpackelly]

Wow!!!!!

[rpackelly]

Approved by Gov. Snyder yesterday evening.

[Michigander]

I'm a PA in Michigan and I think it's generally great news. There was also a bill allowing NPs to prescribe Schedule II and do some other things that was passed and signed at the same time. However, my health care system is slowly going to be looking into what this actually allows us to do. They are a generally conservative system. I was just told this week that I can no longer sign orders for home oxygen or hospital beds. I don't know if it's Medicare or my system that decided this. I can't sign orders for PT/OT/SLP (NPs are now able to do so). Hopefully this will shake out to allow us autonomy and change the deep culture in some places of seeing us as "physician extenders" who can do the stuff docs don't want to do. 

[Guest Paula]

I practiced in Michigan for 6 years from 2008 to 2014 and still hold a MI license.  I have always had a WI license and I live near the MI/WI border of the Upper Peninsula.

 

I just might have to go back to work in MI  (Just kidding!)

 

I am the current president of the WI Academy and we are working towards full MSL implementation.....will take a couple of years but MI has helped us by passing this legislation.  I was hoping WI would be the first to implement MSL and MI beat us to the punch.  But we can still improve and go for the language that we don't "need" a physician in order to practice.......

 

Can someone from MI tell me why the apostrophe s was not deleted from the legislation?  

[rpackelly]

As far as I can tell from the government web sites, the nursing bill, HB 5400, has not yet been signed.

 

Michigan PAs are explicitly able to order PT services and NPs were not until the new bill passed.

 

I do not know about the apostrophe, that was my first thought.

[LT_Oneal_PAC]

Agreed. I'm really happy that these steps have been taken its close to perfect. This should give us even more motivation to push for removing the relationship all together. It's still not FPA to me if a PA can't do so much as clip a hang nail without having a relationship agreement.

Well, it is definitely a step in the right direction but it is not Full Practice Authority as outlined by the AAPA Task Force. In any case,

Congrats to MAPA and all the PAs in Michigan who worked hard to achieve what is a significant step forward.

 

"In order to realize PA Full Practice Authority and Responsibility, AAPA would have to adopt policy changes and take action to:

• Emphasize our profession’s continued commitment to team-based practice.

• Support the elimination of provisions in laws and regulations that require a PA to have and/or report a supervisory, collaborating or other specific relationship with a physician in order to practice.

• Advocate for the establishment of autonomous state boards, with a voting membership comprised of a majority PAs, to license, regulate, and discipline PAs.

• Ensure that PAs are eligible to be reimbursed directly by public and private insurance."

 

Aside from the fact that the Michigan Bill uses Physician's Assistant in every instance it it also continues to require a "Practice Agreement" with a "Participating Physician". I pasted this section of the new law below.

 

"Sec. 17047. (1) A physician’s assistant shall not engage in the practice as a physician’s assistant except under the terms of a practice agreement that meets the requirements of this section. (2) A practice agreement must include all of the following: (a) A process between the physician’s assistant and participating physician for communication, availability, and decision making when providing medical treatment to a patient. The process must utilize the knowledge and skills of the physician’s assistant and participating physician based on their education, training, and experience. (b) A protocol for designating an alternative physician for consultation in situations in which the participating physician is not available for consultation. © The signature of the physician’s assistant and the participating physician. (d) A termination provision that allows the physician’s assistant or participating physician to terminate the practice agreement by providing written notice at least 30 days before the date of termination. (e) Subject to section 17048, the duties and responsibilities of the physician’s assistant and participating physician. The practice agreement shall not include as a duty or responsibility of the physician’s assistant or participating physician an act, task, or function that the physician’s assistant or participating physician is not qualified to perform by education, training, or experience and that is not within the scope of the license held by the physician’s assistant or participating physician. (f) A requirement that the participating physician verify the physician’s assistant’s credentials. (3) The number of physician’s assistants in a practice agreement with a participating physician and the number of individuals to whom a physician has delegated the authority to perform acts, tasks, or functions are subject to section 16221."