A Tale of Two Requests

[rev ronin]

My SP of record (I work in a group practice with 9 MDs and 3 other PAs) is gone this week, and today I was designated to handle his incoming requests--FAX, emails, the works.  No biggie, do it all the time, and we all cover for each other, PAs for MDs and vice versa.  But today, I got two requests:

 

1) Hospice initiation orders for Ms. X., a very elderly lady who was seen two days ago and was discharged home to comfort care. in big bold letters, "MUST BE SIGNED BY AN MD--NO COVERING PROVIDERS" or some such language is all over the FAX cover sheet.  Wasn't the first time I'd seen such language;  I usually just shrug and throw that paperwork into the already-overworked doc-of-the-day's inbox.  This time, though...

 

2) The statewide Electronic Death Reporting System notification that Ms. X (yes, that's the same Ms. X as above) had died yesterday at home and that her cause of death needed to be certified within 48 hours, before my SP returned.  Now, as Washington State PAs already know, PAs can do that.  I had actually gotten set up on the system well over a year ago, but never needed to use it until today.  Turns out it's pretty straightforward, and there was nothing particularly confusing about what caused this patient's demise, so I just went ahead and did it.

 

Ironic that I am authorized to legally state why a patient died (in cases where the county coroner has no interest in taking on investigative responsibility on him or herself, of course) but not to initiate hospice orders. Sad that hospice is a political football where PAs are pointlessly restricted from authorizing care.

[ventana]

Yes - the system makes no sense....

 

I have come to the conclusion that the AMA is likely fighting tooth and nail to prevent NPs from getting the right to advance their profession at all (turf battle).  Due to this we PAs are 100% incapable of ordering VNA, certifyig for hospice, (federal level) but the state level things we can indeed do - ie certify death and in some states sign the certificate....

 

topics like this is why PAs need PAFT to get AAPA to lobby HARD for us

 

It is INSANE that we can not do everything a PCP does if we are an established PCP - VNA, Hospice, Death Cert, sign for DME, order home O2, sign for expensive DME.......

[gbrothers98]

sounds like a situation to turn over to your state pa society and see if they can make some state legislative headway. if there is not a law or statute prohibiting your institution of orders then what you are dealing with is organization or insurance prohibition and again the state pa society could make a case. if it is a medicare issue, then the aapa should work on this with the aapa pac and give us our dues worth.

good luck with that.

respectfully

george brothers pa-c

[rev ronin]

It's not a state issue, George.  Medicare Hospice rules are the sole issue, as I understand it.

[whoRyou]

Is this the same thing Rev http://www.dads.state.tx.us/services/crs/incidentforms/? In TX it looks like its through (if I am understanding it correctly) Medicaid. In WA state check this out (although I am sure you know this already Rev) http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/DataReportingandRetrieval/ElectronicDeathRegistrationSystemEDRS.aspx

[ventana]

National Level

 

Medicare sets the rules - and typically everyone follows....

[rev ronin]

Yes, EDRS is the system I was referring to.