End of the PA Profession in Tennessee??

[Greg Cain PA-C]

For those who don't know, TennCare is Tennessee's version of Medicaid. Under a new proposal to cut TennCare spending, Tennessee's governor has proposed eliminating all TennCare reimbursements to PAs. Only physicians and nurse practitioners will be eligible for reimbursement. TAPA (Tennessee Association of Physician Assistants) and the AAPA are working on this, but the problem seems to be rooted in the fact that the centers for Medicaid Services (CMS) only recognizes physicians and nurse practitioners as “mandatory providers.” Physical therapists, occupational therapists, speech therapists, podiatrists, and physician assistants are considered “optional providers.” Who knew that federal law made such a big distinction between NPs and PAs? If this goes through all PAs in Tennessee will have to move or find a new profession! The AAPA must have been laying down on the job in Washington to have allowed such a big legal distinction between NPs and PAs to have developed. It wouldn’t surprise me if this thing grew to include other states or even go nationwide. Follow this link for the whole newspaper article.<O:p</O:p

http://www.knoxnews.com/news/2011/jan/28/300m-tenncare-cut-planned/<O:p</O:p

[jmj11]

Being a Tennessee boy, by birth, this caught my attention. This is a huge problem. The feds have had PAs and NPs on tiered system for some time, with the NPs on a higher tier. This is in thanks to a very heavy nursing lobby. I brought this to the attention a long time ago when the FMLA act was going trough and the language said that only a MD, DO or NP can sign it but a PA can sign it if it was co-signed by their supervising MD, DO or NP. Drove me nuts. The AAPA finally did get them to chance the language.

 

When the Obama health care bill first went to the house, it too had a tiered system, where MDs, DOs and NPs could be PCP (medical home) for a patient, but a PA could not unless they were directly supervised by one of the above (including NP). I, and many others brought this to the AAPA's attention. They did voice their opinion and got the final language changed.

 

Last night I was in a meeting about the HITECH act. It too discriminates against PAs and we can not get the health care dollars under this law unless we are in unique situations. ( I think the PA has to be the only clinic provider in an undeserved area to qualify, but you can correct me). I've said for a long time that the NPs have been working hard to put daylight between them and us and they are succeeding. People, including many PAs, say that I'm just being arrogant. I'm not. I just want the legislation to reflect reality. And when it doesn't PAs loose their jobs.

 

I'm glad the Tennessee academy and the AAPA are working on this. Hold their feet to the fire until they see results. Personally, this act by my mother's governor really offends me

[Davidson25]

I am a PA student in Tennessee and I graduate in May so this is a huge deal! There have been numerous letters sent out by TAPA concerning the issue and things they are trying to do to stop this. However, it seems that TennCare is going to continue with Medicaid's budget cuts but with some possible "negotiations". I have e-mailed the governor, but I am not sure that anything I do will have much of an impact. Also, the part of PAs being "optional" and NPs being "mandatory" really throws me.

[Davidson25]

I am a PA student in Tennessee and I graduate in May so this is a huge deal! There have been numerous letters sent out by TAPA concerning the issue and things they are trying to do to stop this. However, it seems that TennCare is going to continue with Medicaid's budget cuts but with some possible "negotiations". I have e-mailed the governor, but I am not sure that anything I do will have much of an impact. Also, the part of PAs being "optional" and NPs being "mandatory" really throws me. Any suggestions of what PAs in Tennessee can do or even PAs nationwide?

[ventana]

MASS does not recognize PA's but guess what - you just bill under MD's PIN/UPIN/NPI

 

Might make a difference for surgical special and would be a big step back for PA's but I doubt it will have as much negative effect as you think. In some ways it is easier to not be credentialed - every thing under doc's numbers and you get 100% instead of 85%

 

fight it - but don't panic that you will have to move....

[DrPA]

Looks like some people still don't understand what a PA is.

[GREATMDPA]

For some reason, the west coast is more friendly toward PAs than the midwest and east coast. Am I wrong to think that?

I know in Missouri, it's easier for NPs to find jobs than PAs.

Nevada, AZ, CA, Utah are PA friendly states in my opinion.

[bradtPA]

You can't get much better than NC, and we are east of the Mississippi;).

[Guest cabkrun]

For some reason, the west coast is more friendly toward PAs than the midwest and east coast. Am I wrong to think that?

I know in Missouri, it's easier for NPs to find jobs than PAs.

Nevada, AZ, CA, Utah are PA friendly states in my opinion.

 

Depends upon which part of CA. Southern it could be true they are more PA friendly. Here in the Bay Area it's a bit tougher. Huge Nursing lobby in California in general and a major teaching hospital that puts out 75 NPs a year thru a MEPN program. Quite a few other NP programs as well.

[GREATMDPA]

You can't get much better than NC, and we are east of the Mississippi;).

 

Nice to know :)

Please do tell about NC, I've never been there before. Thanks

[marilynpac]

NC, one of the most beautiful states in the US!!! Taxes are high though, very PA friendly and has a lot of southern charm.

[Eventide]

NC will be more of a hot spot if Tennessee shuts it down.

[Joelseff]

NC has Checker's Burgers!!!! And really friendly people. I used to go to Raleigh-Durham to visit friends when i was stationed in Norfolk, VA....I would consider living there.

[Hemegroup]

For those who don't know, TennCare is Tennessee's version of Medicaid. Under a new proposal to cut TennCare spending, Tennessee's governor has proposed eliminating all TennCare reimbursements to PAs. Only physicians and nurse practitioners will be eligible for reimbursement. TAPA (Tennessee Association of Physician Assistants) and the AAPA are working on this, but the problem seems to be rooted in the fact that the centers for Medicaid Services (CMS) only recognizes physicians and nurse practitioners as “mandatory providers.”

 

Yup, people don't view 'assistants' as equal with 'practitioners'. Sad, the name change is so long overdue. I just took my first position with a group who is very PA-friendly, but the CEO holds NPs in higher esteem ... because this is one of the 14 states where NPs can practice without any supervision. I made it very clear how PA accreditation is different from NP accreditation (about half PAs and half MDs and DOs, versus Nursing boards), and reminded him that NPs do not rotate in Surgery. Still, it is what it is. Sad sad sad, but not a lost cause ... a name change and continued education of the medical community as well as the public, and we're still good. Our median salary is generally still higher, anyways, which should say something.

 

Seriously tho, change the name and we are golden.

 

National salary report for NPs and PAs: http://nurse-practitioners-and-physician-assistants.advanceweb.com/Features/Articles/National-Salary-Report-2010.aspx

[dpc511]

ventana is correct. We will get around the issue by simply billing under the MD if this thing ever goes through. It certainly wouldn't be an ideal situation, but not the end of the world. The real problem, though, is that this is indicative of the view that many of our legislators have of PAs. The distinction made here between PAs and NPs is what scares me the most. And to think I voted for Bill Haslam...Ouch.

[andersenpa]

From Clinician 1

 

Thanks, AAPA.It turns out that Tenncare wants PA’s to be providers. It is CMS that makes the distinction between NP’s and PA’s, with NP’s being “mandatory” providers and PA’s being “optional” providers. Tenncare has protested this arrangement, but CMS refuses to put optional and mandatory providers on the same list. In order to be able to limit annual visits of Tenncare patients, and meet budget cuts, Tenncare has to play along for now, and try to negotiate changes. This came up a year ago. The state of Tennessee passed a one year tax on hospitals that brought in enough revenue to avoid cuts. This tax expires in July 20011. Hopefully, it will be renewed by the state legislature and this will put off this mess, at least temporarily. TAPA (Tennesee Academy of Physician Assistants) is a super organization. They rock! Very few PA’s in Tennessee know, and few seem to care, how much their state organization has done for them.Unfortunately, this problem is on a federal level. While the NP’s were diligently working to further their profession, the AAPA was asleep at the wheel. They were not working with CMS to get us classified as mandatory providers. They were hiding under their rock, afraid that the big bad AMA was going to come and get them.TAPA is working diligently with the state to get a work around solution. Tennessee is a terrific state, and our legislators are very sympathetic and appreciative of PA’s for the most part. Please don’t sit around and feel sorry for us in Tennessee, because this is your problem, too, if you are a PA. When your cash strapped state has to cut its’ Medicaid program, you will also be thrown out. After all, you are optional.

I belonged to the AAPA for many years. About 8 years ago, I realized that, not only were they not helping my profession, they were hurting it. I would read from them where they were “in dialogue” about a problem or where they “sent a memo” protesting something. I never read about any real action. I dropped out, not wanting to help my enemies.I will not be a member again until I am shown proof that they are furthering the PA profession.This will spell disaster for PA’s in Tennessee who see large amounts of adult Tenncare patients.

I am close enough to retirement that the AAPA’s incompetence and inaction will not hurt me financially. But it breaks my heart to see the profession that I love so dearly go down the drain because of the timidity of its’ national organization.

[Greg Cain PA-C]

MASS does not recognize PA's but guess what - you just bill under MD's PIN/UPIN/NPI

 

Might make a difference for surgical special and would be a big step back for PA's but I doubt it will have as much negative effect as you think. In some ways it is easier to not be credentialed - every thing under doc's numbers and you get 100% instead of 85%

 

fight it - but don't panic that you will have to move....

 

That's not the point. We have worked hard to get where we are today and this is a big step backwards. I don't think the AAPA is doing enough on this and several other issues. While NPs have established themselves as "independent practitioners," many in our professional leadership continue to hold on to the antiquated view that we should remain "dependent" on physicians. I think that many PAs believe that being dependent on physicians will help keep physicians and the AMA aligned with our interests. NOT TRUE. Human beings are self-interested actors particularly in the arena of professional turf. Month by month I see NPs making great strides politically while PAs seem to remain static or are losing ground. Additionally, as Hemegroup mentioned, we need that professional name change if society and the politicians who make our practice laws are ever going to respect us and think of us as anything other than medical office assistants. Where is the AAPA on these issues?

[Greg Cain PA-C]

From Clinician 1

 

Thanks, AAPA.It turns out that Tenncare wants PA’s to be providers. It is CMS that makes the distinction between NP’s and PA’s, with NP’s being “mandatory” providers and PA’s being “optional” providers. Tenncare has protested this arrangement, but CMS refuses to put optional and mandatory providers on the same list. In order to be able to limit annual visits of Tenncare patients, and meet budget cuts, Tenncare has to play along for now, and try to negotiate changes. This came up a year ago. The state of Tennessee passed a one year tax on hospitals that brought in enough revenue to avoid cuts. This tax expires in July 20011. Hopefully, it will be renewed by the state legislature and this will put off this mess, at least temporarily. TAPA (Tennesee Academy of Physician Assistants) is a super organization. They rock! Very few PA’s in Tennessee know, and few seem to care, how much their state organization has done for them.Unfortunately, this problem is on a federal level. While the NP’s were diligently working to further their profession, the AAPA was asleep at the wheel. They were not working with CMS to get us classified as mandatory providers. They were hiding under their rock, afraid that the big bad AMA was going to come and get them.TAPA is working diligently with the state to get a work around solution. Tennessee is a terrific state, and our legislators are very sympathetic and appreciative of PA’s for the most part. Please don’t sit around and feel sorry for us in Tennessee, because this is your problem, too, if you are a PA. When your cash strapped state has to cut its’ Medicaid program, you will also be thrown out. After all, you are optional.

I belonged to the AAPA for many years. About 8 years ago, I realized that, not only were they not helping my profession, they were hurting it. I would read from them where they were “in dialogue” about a problem or where they “sent a memo” protesting something. I never read about any real action. I dropped out, not wanting to help my enemies.I will not be a member again until I am shown proof that they are furthering the PA profession.This will spell disaster for PA’s in Tennessee who see large amounts of adult Tenncare patients.

I am close enough to retirement that the AAPA’s incompetence and inaction will not hurt me financially. But it breaks my heart to see the profession that I love so dearly go down the drain because of the timidity of its’ national organization.

 

I am actually considering applying to an NP bridge program. If I do that I won't even have to retake my boards every six years. Once you are an NP it is for life and all you have to do maintain it is your CMEs. As far as the AAPA I never renewed my membership after graduated from school. They seem to be an ideological dictatorship and the only way people make it into leadership positions is to think just like those who came before them. The only thing I have seen AAPA lobby hard for in Washington was Obama care, which is opposed by 60% of the country! Way to get out there and chose your battles AAPA! Meanwhile back at the ranch NPs are knocking our socks off when it comes to professional turf, but at least Obama and the AMA will like us. Speaking of the AMA, why does the AAPA want so desperately to be liked by them? Does the AAPA know that less than 20% of U.S. physicians are members? Even physicians don't like the AMA, but the AAPA thinks it is important to kiss up to the AMA. We have no national leadership for this profession and if we don't get one soon we won't have a profession!!

[rudypa]

So, if you are not a provider for Medicaid....the concern is other private insurance will follow suit??

[Greg Cain PA-C]

So, if you are not a provider for Medicaid....the concern is other private insurance will follow suit??

 

 

That's it. Also ER and hospital based practice (where you have higher percentages of TennCare patients) will come to an abrupt end as well. This is the sort of thing that could have such a widespread impact that we can't even predict the full extent of how it will impact PAs. Clearly there will be fewer PA jobs and make them less desirable employees than NPs. Based on that, there will more PAs looking an ever smaller number of jobs in the state. That will lead to lower salaries. Its basic supply and demand (Economics 101), more people looking for fewer jobs = lower wages. The good news is I'm sure that the NPs will be more than willing to step in and fill those vacated PA jobs though.

The AAPA has said that they are on the job though!! LOL Where were they when the NPs were getting themselves elevated to the same status as MDs under the law (mandatory providers) while PAs are still considered optional providers - on par with speech therapists? My guess is that the AAPA was busy pushing Obama Care while they allowed our profession to go down the tubes. They no longer get any dues from me, and they never will until they get it together and start becoming effective advocates for the profession instead of using member dues to push personal political agendas.

[rudypa]

My guess, this does not hold up. Especially where healthcare "reform" is wanting to go and the need for primary providers. The AAPA and its members and patients will flood this state's office with faxes and emails, he will reconsider the elimination of PA under the cuts.

[jmj11]

While there may be ways around this, billing under the SP and etc. I, once again, see a strong principle. How would women feel in 1920 if the government told them, "We've looked at this suffrage issue and here's what we are going to do for you girls (then the man winks). Just come to the polls and bring your husband's id and we will let you cast a vote under your husband's name. We will actually give your husband two votes, one for himself and another one he can share with you if he wants. That should stop this worrying inside your little pretty heads and fixes everything and everybody goes home happy. Okay?"

[deborah212]

While there may be ways around this, billing under the SP and etc. I, once again, see a strong principle. How would women feel in 1920 if the government told them, "We've looked at this suffrage issue and here's what we are going to do for you girls (then the man winks). Just come to the polls and bring your husband's id and we will let you cast a vote under your husband's name. We will actually give your husband two votes, one for himself and another one he can share with you if he wants. That should stop this worrying inside your little pretty heads and fixes everything and everybody goes home happy. Okay?"

 

Wow. That does seem to hit pretty close to home.

[Greg Cain PA-C]

While there may be ways around this, billing under the SP and etc. I, once again, see a strong principle. How would women feel in 1920 if the government told them, "We've looked at this suffrage issue and here's what we are going to do for you girls (then the man winks). Just come to the polls and bring your husband's id and we will let you cast a vote under your husband's name. We will actually give your husband two votes, one for himself and another one he can share with you if he wants. That should stop this worrying inside your little pretty heads and fixes everything and everybody goes home happy. Okay?"

 

Perfect analogy.

 

Most of the PAs I know who own their own clinics in TN see alot of TennCare patients. They will be lucky if they can even keep their offices open.

[GREATMDPA]

I am actually considering applying to an NP bridge program. If I do that I won't even have to retake my boards every six years. Once you are an NP it is for life and all you have to do maintain it is your CMEs. As far as the AAPA I never renewed my membership after graduated from school. They seem to be an ideological dictatorship and the only way people make it into leadership positions is to think just like those who came before them. The only thing I have seen AAPA lobby hard for in Washington was Obama care, which is opposed by 60% of the country! Way to get out there and chose your battles AAPA! Meanwhile back at the ranch NPs are knocking our socks off when it comes to professional turf, but at least Obama and the AMA will like us. Speaking of the AMA, why does the AAPA want so desperately to be liked by them? Does the AAPA know that less than 20% of U.S. physicians are members? Even physicians don't like the AMA, but the AAPA thinks it is important to kiss up to the AMA. We have no national leadership for this profession and if we don't get one soon we won't have a profession!!

 

 

What is the NP bridge program?