Moderator ventana Posted October 11, 2013 Moderator Share Posted October 11, 2013 so this week I got told by one of the small local hospitals that they would not communicate with my patients got admitted, as they didn't know me. then a local pharmacy who I have dealt with for 10+ years said that they were enacting the new guidelines that have been suspended/delayed implementation on ordering DME and home oxygen that requires a face-to-face with a physician signature, I no longer can sign this. Then the the local hospice stated that when a patient dies, they will likely need to call the collaborating physician and not me anymore, I have done this for the past 10 years to give the order to declare death by the registered nurse for hospice. So I go look at the Massachusetts guidelines, and by my reading I can indeed act as an agent for the physician in okay declaration of death by the RN, but I also see that now nurse practitioners can sign as they had a law passed last year that says they can sign anything a physician signs as long as it does not expand their scope of practice. So for things within one week on practice restriction. I am in practice for myself, I have a 1% physician co-owner/collaborating physician. I know these patients exceptionally well, it is a house call practice, in yet, regulations and rules in place are making it hard, in they seem to be getting more restrictive. Not sure this is a good thing for the PA profession long-term, certainly horrible for me in the short term. A final question: a quick Internet search shows that many states allow a PA to sign their death certificate, can people pipe in about rather a PA can sign a death certificate in their state. Granted is an informal poll. Example. Answer: Massachusetts physician or NP to sign death certificate PAs can not sign death certificate, specifically excluded in the regulations. Link to comment Share on other sites More sharing options...
bradtPA Posted October 11, 2013 Share Posted October 11, 2013 NC put it into place a year and a half ago. PAs can sign, as long as it is specifically delegated to us in our scope of practice agreement. Link to comment Share on other sites More sharing options...
Guest Paula Posted October 11, 2013 Share Posted October 11, 2013 Ventana: are you ready to take these issues to MAPA and AAPA and start asking for PA equity with NPs? Sounds like it is time. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 11, 2013 Moderator Share Posted October 11, 2013 In WA a PA can sign anything their sponsoring physician delegates to them up to and including anything the SP can sign. Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 11, 2013 Author Moderator Share Posted October 11, 2013 Ventana: are you ready to take these issues to MAPA and AAPA and start asking for PA equity with NPs? Sounds like it is time. I have already spoken with the AAPA and they are talking to the pharmacy, I have already spoken to AAPA via email and asked them to look into getting PAs to sign death cert, I have been HOUNDING AAPA on getting them to get PAs incentive money, recognition for what we provide, and to address the short comings in the CMS guidelines.... DME, F2F and ordering VNA services BUT I can't be the only one.... everyone has to write in and let their state chapters and AAPA know that they need to advocate for us PAs in the field..... Also, it is important for people to realize that even if this does not effect their own little job - ie a surgery PA likely is never asked to sign a death cert, but that does not mean they should ignore the issue but instead they should take the time to write in to their Reps or the AAPA or state agencies to support the advancement of PA as a whole profession! Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 12, 2013 Author Moderator Share Posted October 12, 2013 In WA a PA can sign anything their sponsoring physician delegates to them up to and including anything the SP can sign. no PA in the country can sign for VNA services No PA in the county will be able to order DME with out a signed Face To Face completed that is signed by the physician! This regulation has been put on hold, but some pharmacies/dme vendors are still stepping forward...... There are nataional level, ACA or CMS regulations that AAPA has got to get out in front of....... AAPA was asleep at the wheel when the incentive money for EMR went though WITHOUT PAs being eligible......... lets not let them stay asleep! Link to comment Share on other sites More sharing options...
peaceloveandPA Posted October 12, 2013 Share Posted October 12, 2013 I have already spoken with the AAPA and they are talking to the pharmacy, I have already spoken to AAPA via email and asked them to look into getting PAs to sign death cert, I have been HOUNDING AAPA on getting them to get PAs incentive money, recognition for what we provide, and to address the short comings in the CMS guidelines.... DME, F2F and ordering VNA services BUT I can't be the only one.... everyone has to write in and let their state chapters and AAPA know that they need to advocate for us PAs in the field..... Also, it is important for people to realize that even if this does not effect their own little job - ie a surgery PA likely is never asked to sign a death cert, but that does not mean they should ignore the issue but instead they should take the time to write in to their Reps or the AAPA or state agencies to support the advancement of PA as a whole profession! How do I find out who to contact in my state? (NC). I would like to help and so sorry you are going through this! Let food be thy medicine Link to comment Share on other sites More sharing options...
bradtPA Posted October 12, 2013 Share Posted October 12, 2013 How do I find out who to contact in my state? (NC). I would like to help and so sorry you are going through this! Let food be thy medicine http://www.ncapa.org Link to comment Share on other sites More sharing options...
Guest Paula Posted October 12, 2013 Share Posted October 12, 2013 Agree with you Ventana. PAs must get involved with asking AAPA to get out ahead of the game. I have emailed and contacted my state senators/representatives on every single issue that affects PAs. I too was extremely upset that AAPA was asleep at the wheel for the HITECH act and EHR incentives. It still makes my blood boil. We just started our EHR at the tribal clinic and the regional IHS office trainer was talking about the incentives. It was an interesting conversation to say the least. Is there any way we can get a waiver from the "corrected" rules that still did not solve the problem? Link to comment Share on other sites More sharing options...
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