Moderator ventana Posted November 1, 2013 Moderator Share Posted November 1, 2013 In a final rule released today, the Centers for Medicare & Medicaid Services affirmed for the first time that PAs are authorized providers in Community Mental Health Centers. http://www.aapa.org/news_and_publications/pa_pro_now/item.aspx?id=6906 Now can PAFT and AAPA and NCCPA all go after making PAs full fledged primary care providers with the ability to partake in the EHR funds incentive, sign/order for VNA services, offer occ health to all populations including federal employees, If we can get the support of CMS and move forward to fully order everything we need to run a medical home with out physician co-sign..... thats progress! Lets ally with the NP groups and push this through!!! Link to comment Share on other sites More sharing options...
Gordon, PA-C Posted November 1, 2013 Share Posted November 1, 2013 If we can get the support of CMS and move forward to fully order everything we need to run a medical home with out physician co-sign..... thats progress! How would this fix anything? Even if CMS allows this, to me it doesnt mean anything because state laws still dictate that PAs work under "supervision" or "collaboration" or whtever you want to call it. Until the states give PAs 100 percent independence, nothing that CMS does matters that much. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted November 1, 2013 Moderator Share Posted November 1, 2013 How would this fix anything? Even if CMS allows this, to me it doesnt mean anything because state laws still dictate that PAs work under "supervision" or "collaboration" or whtever you want to call it. Until the states give PAs 100 percent independence, nothing that CMS does matters that much. While perhaps a worthwhile endeavor, I doubt PAs like ventana can afford to wait for such a thing to happen while business suffers. No state has moved to collaboration yet, so independence is likely a ways off. CMS means a great deal when getting reimbursed for work. Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 1, 2013 Author Moderator Share Posted November 1, 2013 While perhaps a worthwhile endeavor, I doubt PAs like ventana can afford to wait for such a thing to happen while business suffers. No state has moved to collaboration yet, so independence is likely a ways off. CMS means a great deal when getting reimbursed for work. How would this fix anything? Even if CMS allows this, to me it doesnt mean anything because state laws still dictate that PAs work under "supervision" or "collaboration" or whtever you want to call it. Until the states give PAs 100 percent independence, nothing that CMS does matters that much. I have to get so many "Doc" signatures on paperwork right now it is stupid - and there is more coming in that the regs for ACA failed to include PA or NP as able to sign face to face sheets which is now required to order DME > $1000 CMS is a HUGE player and all private insurance companies follow their lead Yes the states are another issue - ie ability to sign death certificates, the ability to order all scheduled 2-6 meds with out co-sign, ability to practice with out doc onsite.... On the national level CMS is the leader and this is one of the first times they have said a PA may lead a team - hopefully this is transfered to many different areas - sort of the snow ball effect - Really does it help to have me drive across town once a week and have my doc sign off on a stack of papers? or have him have to sign every death certificate? Heck that is not even a medical issue it is a legal issue only...... (and a state not a federal level issue) yes this is a big deal - - and yes it makes a BIG difference RIGHT NOW for me Link to comment Share on other sites More sharing options...
Guest Paula Posted November 3, 2013 Share Posted November 3, 2013 The state of Michigan has submitted a bill to allow nearly full autonomy for PAs. The senate bill releases the docs from supervision and delegation responsibilities. It will allow PAs (and NPs) to have independent prescribing rights and we would have to apply for the state controlled substance license in addition to the DEA. MI docs have both licenses currently and delegate prescribing to PAs. The bill has one small caveat in that all PA/NPs work as part of patient care teams and a physician will be part of the team. THe physician does not need to be the leader but is there for consultation. It is a huge step forward for PAs and if it passes it should start a domino effect with other states. The bill is also developing separate boards for each profession so the PA profession will be responsible for itself and will write its own rules for practice, conduct, disciplinary procedures, etc. There will also be a joint board of MD/DO/PA/NP will equal representation of each profession and we are tasked with working together cooperatively. The Michigan State Medical Society is in support of this and the MAPA wrote much of the bill with the help of a fabulous lobbyist. Times are a changin'. On another note...........CMS has great power and I believe influenced by AMA and their guild. It does matter what they put into law and some of these rules (maybe all) have to be changed in the legislature. It is not simple and cannot be done by a stroke of the pen. At least that is my understanding. I have written my state representative and senators about the HITECH act and all the issues Ventana speaks of . Actually, have done this several times. Gotta keep at it for the PA profession to be released from the dependent status. It is the worst position for us to be in. Collaboration is much, much better. Link to comment Share on other sites More sharing options...
bobuddy Posted November 3, 2013 Share Posted November 3, 2013 Paula - that is wonderful news! Is AAPA and PAFT on board with this? I hope it passes - we need just one state to start and then the rest should come with some time. It is our only shot at staying competitive with the NP's. Link to comment Share on other sites More sharing options...
primadonna22274 Posted November 3, 2013 Share Posted November 3, 2013 This is super interesting! I like the joint board idea. Seems so much smarter. Link to comment Share on other sites More sharing options...
discogenic Posted November 3, 2013 Share Posted November 3, 2013 The state of Michigan has submitted a bill to allow nearly full autonomy for PAs. The senate bill releases the docs from supervision and delegation responsibilities. It will allow PAs (and NPs) to have independent prescribing rights and we would have to apply for the state controlled substance license in addition to the DEA. MI docs have both licenses currently and delegate prescribing to PAs. The bill has one small caveat in that all PA/NPs work as part of patient care teams and a physician will be part of the team. THe physician does not need to be the leader but is there for consultation. It is a huge step forward for PAs and if it passes it should start a domino effect with other states. The bill is also developing separate boards for each profession so the PA profession will be responsible for itself and will write its own rules for practice, conduct, disciplinary procedures, etc. There will also be a joint board of MD/DO/PA/NP will equal representation of each profession and we are tasked with working together cooperatively. The Michigan State Medical Society is in support of this and the MAPA wrote much of the bill with the help of a fabulous lobbyist. Times are a changin'. On another note...........CMS has great power and I believe influenced by AMA and their guild. It does matter what they put into law and some of these rules (maybe all) have to be changed in the legislature. It is not simple and cannot be done by a stroke of the pen. At least that is my understanding. I have written my state representative and senators about the HITECH act and all the issues Ventana speaks of . Actually, have done this several times. Gotta keep at it for the PA profession to be released from the dependent status. It is the worst position for us to be in. Collaboration is much, much better. If I'm reading the legislation correctly, it should be easier for PAs to own their own practices in Michigan as well: "The Business Corporation Act prohibits one or more PAs from organizing a PC that will have only PAs as shareholders. Senate Bill 569 would delete this prohibition." Link to comment Share on other sites More sharing options...
Guest Paula Posted November 3, 2013 Share Posted November 3, 2013 Yes, PAFT is on board with it and I have offered a letter of support to MAPA once it goes into discussion mode within the Senate. AAPA, I'm told is also on board. Yes, it will be easier for PAs to own their own practices. Senate bills 568, 569 and 570 submitted by Senator Marleau. You can google and get the link to read the bills. There are some bugs yet to work out. I think it would be an excellent idea for PA state chapters to send a letter of support to MAPA and cc the AAPA regarding the bills. I am hopeful the bills will pass without too many changes. We all would practice within our scope of practice as determined by our respective boards. The NPs will have the most problem with the bills since they have "independent NP practice" in MI, but not independent prescribing for controlled substances. All professions give up something and all professions gain something. I see it as a win/win situation for all parties involved. Link to comment Share on other sites More sharing options...
Gordon, PA-C Posted November 3, 2013 Share Posted November 3, 2013 Yes, PAFT is on board with it and I have offered a letter of support to MAPA once it goes into discussion mode within the Senate. AAPA, I'm told is also on board. Yes, it will be easier for PAs to own their own practices. Senate bills 568, 569 and 570 submitted by Senator Marleau. You can google and get the link to read the bills. There are some bugs yet to work out. I think it would be an excellent idea for PA state chapters to send a letter of support to MAPA and cc the AAPA regarding the bills. I am hopeful the bills will pass without too many changes. We all would practice within our scope of practice as determined by our respective boards. The NPs will have the most problem with the bills since they have "independent NP practice" in MI, but not independent prescribing for controlled substances. All professions give up something and all professions gain something. I see it as a win/win situation for all parties involved. NPs will be 100 percent opposed to this bill, as I found this little nugget hidden in senate bill 570 (http://www.legislature.mi.gov/documents/2013-2014/billanalysis/Senate/pdf/2013-SFA-0568-S.pdf). "Require a PA or APRN to be a care team member in order to practice." This bill would essentially end NP independence and force them to participate in a "care team" consisting of at least 1 physician. They will fight tooth and nail against it, and seeing as how nurses have by far the strongest lobby among doctors or PAs, I think this bill has very little chance of passing. Link to comment Share on other sites More sharing options...
Guest Paula Posted November 4, 2013 Share Posted November 4, 2013 NPs will be 100 percent opposed to this bill, as I found this little nugget hidden in senate bill 570 (http://www.legislature.mi.gov/documents/2013-2014/billanalysis/Senate/pdf/2013-SFA-0568-S.pdf). "Require a PA or APRN to be a care team member in order to practice." This bill would essentially end NP independence and force them to participate in a "care team" consisting of at least 1 physician. They will fight tooth and nail against it, and seeing as how nurses have by far the strongest lobby among doctors or PAs, I think this bill has very little chance of passing. Yes, that is the concern. That's why I said it gives PAs nearly full autonomy. The bill didn't go far enough. I would have put in the language that all licensed medical providers must work in collaboration with each other but a physician was not required ( but recommended) to be on the patient care team. Link to comment Share on other sites More sharing options...
Guest JMPA Posted November 4, 2013 Share Posted November 4, 2013 so essentially this bill releases mds from liability related to supervision but still enforces that PAs and NPs be required to work in a team (non-independence), this bill is a step forward for MDs and a step backwards for the PA profession. Reference to the MI bill. Link to comment Share on other sites More sharing options...
Guest Paula Posted November 5, 2013 Share Posted November 5, 2013 so essentially this bill releases mds from liability related to supervision but still enforces that PAs and NPs be required to work in a team (non-independence), this bill is a step forward for MDs and a step backwards for the PA profession. Reference to the MI bill. No, I don't see it that way. It gives PAs autonomy and physicians do not delegate/supervise. It gives PAs the ability to have our own board and responsibility for our profession. Why would you think autonomy/collaboration is a step backwards? PAs should be responsible for their own work and we all know how "supervision" is fake. The patient care teams are collaborative teams...but I get your point. Link to comment Share on other sites More sharing options...
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