More on the PI-CME, aka CQI project.....

[physasst]

This was an email I received from another PA regarding the PI-CME.....Just as an FYI, as she actually was involved in the pilot.

 

 

 

 

I was a part of the pilot project that tested the performance improvement (clinical quality/research projects) for NCCPA. We did it starting in Oct. 2010 and finished in March, 2011. Originally there were 200 of us in the pilot, only 150 of us finished our projects. You can refer to my postings on clinician1.com where other PAs have made comments to what I originally said (Follow-up on the Clin Q1 Project for PAs), there is actually 5 postings on this topic there, but the one I refer to here has the most comments on it.

 

The clinical projects that NCCPA has now decided to incorporate are required by the MD profession. They are required to do a clinical improvement project every 2 years maybe? (I’m not sure of the time period). These projects are geared around improving your clinical practice area, improving your patient outcomes, etc. There were many comments on clinician1.com that stated supervising MDs were already overwhelmed with what they had to do and therefore they would not be willing to help us with our projects. From all of the comments I acquired, I compiled them and wrote the following memo to Ragan at NCCPA who was heading up the project:

 

Interoffice Memorandum

 

TO: Ragan Cohn, NCCPA

 

FROM: xxxxxxxxxxxxx, PA-C, MPH

 

RE: Clinical Q1 Project

 

DATE: March 21, 2011

 

Ragan, I’ve posted on Clinician1.com regarding the NCCPA doing the pilot project, Clinical Q1. From those two postings I’ve compiled the following comments which I believe need to be addressed by NCCPA to make the ClinQ1 project successful.

 

1. Physician Support/Clinic Management Support

For many PAs to be able to do a clinical quality improvement project they will need the support of their physicians whom they work for. If they are in a private practice setting the physicians are initially probably not going to be supportive of their PA having to do this project. Reasons will vary from a) it’s going to take time away from the PA seeing patients and bringing money into the practice to b) it’s going to be distracting for the PA and the other clinical staff to have to be involved in the project, c) the private practice MDs are not into doing any sort of research, they don’t understand the concepts of needing to do research and hence they will not support it and may indeed try to undermine it, maliciously or otherwise.

If the MDs are in academia, then they will probably come up with the following reasons: a) I’m involved in helping out the residents/fellows in doing their quality improvement project, I’m also required to do one, so I don’t have time to help you, nor do I desire to help you. b) I need you to be the work horse for this department or division, so you (the PA) don’t have time to be doing that, I need you to do this instead . . . .

Clinicial Management (usually those with a MBA) staff will not understand why the PA has to do the quality improvement project either. They will be reticent to allow the PA to do the project, they will put up road blocks such as: does the PA have the authority to do it, do they have IRB approval (even though they won’t need it, the managerial staff won’t see it that way), what about HIPPA violations, the PA needs to acquire the okay of the department head or higher up before going forward, etc. Is the project going to take time away from the PA seeing patients and being the ‘work horse’?

2. On the part of the PA involved they will have stumbling blocks such as: are they research minded (the majority are not), are they a visionary (can they foresee a problem and how to solve it, again many do not have this skill), time commitment (there will be many, many other things that will get in their way of doing the project such as family commitments, work commitments, social commitments, and/or volunteer commitments). The PA will also have to have a lot of initiative and motivation to get the project done, there will be a lot of starts and stops to the project initially. The PA will tell themselves that the project can wait, they have two years to do it in.

3. Expenses of the project: who’s going to pay for it, the PA’s work, the PA, NCCPA, whom?

Monies that will need to be expended may include: an excel software program (to do the simple statistical work needed), office supplies, computer technical help (IT expertise), EMR access and time surveying patient records.

4. Writing the project paper up: many PAs do not have the writing capability nor desire to write a ‘journal quality paper.' How will you deal with this?

5. PAs who are involved in a clinQ1 project need to understand that clinQ1 is a quality improvement project or a pilot project for a potential clinical research trial, it is not a research trial that needs IRB approval. This will need to be clearly delineated to the PA.

6. Who is going to read all of these handed in clinQ1 projects and assess them for completion of their requirement? Is the NCCPA going to have to hire additional staff to do this? If so, does this mean that the fees for the PA are going to go up? The NCCPA is looking at having to read initially 35,000 project papers in one year.

7. Will there be a list of questions for each PA to answer regarding their project which will then, when answered constitute their report?

8. Many PAs on the ‘clinician1.com’ site stated that they are not going to be willing to do this type of a quality improvement project unless some other requirement for their keeping their NCCPA status was removed and replaced with this project. So are you going to quit requiring the PANRE?

9. For those of us who did the pilot project for you, are you going to give us a ‘bye’ for the first two years this is initiated, i.e. we don’t have to do a project?

10. If the PA were to implement their Q1 project (because all you are asking is that they do a Q1 project and show the results, not that it is implemented per say) could this be looked at for the PA involved as their project for the next two years in their cycle? If the PA showed you some evidence that the project was implemened would they then not have to write up a whole new project paper for you during those 2 years?

11. Doing a clinQ1 project may very well deal with patient data. How do you want the PA to handle this?

12. If the PA does a clinQ1 project are you going to give them category I CME credit on an hour for hour involvement in their project?

13. What about those private practices who don’t have an EMR? Not having a EMR to cull data from will hamper the PA being able to do a project, what about these PAs?

 

These were all of the questions that were brought up on-line about the project and I believe you need to be aware and able to answer all of these questions for the clinQ1 to be successful.

 

Thanks for allowing me to be involved, if you have any questions please let me know.

 

 

For me to complete the project I ended up writing a 9 page synopsis of what I did as well as doing the research, which is time consuming. Ragan emailed me after the pilot project was over and advised me that my project was one of the ones that was of better quality. With all that said, these projects will be time consuming and despite my advising the NCCPA of the numerous questions and problems that PAs will have with it, they still implemented them. They based this decision on what the MDs are doing. My main question is who at the NCCPA is going to read all of these pilot projects every day? It will take at the bare minimum two additional staff readers (80,000 PAs/3 cycles of 2 years = 26K pilot projects due q 2 yrs. Each project = 8 pages text, = 500 words/pg = 4000 words/project. 4000 x 26,000/120K (about the average words in a book) = 888 books/2 = 444 books per year) to be read. There are 264 days in a working year, therefore each staff person will have to have read/graded 1 full book of scientific text per day at NCCPA to keep up with the projects being submitted. This is a major hurdle to get over I believe.

 

So despite my telling the NCCPA of major problems with implementing the clinical Q1 project idea they still did it anyway. Bottom line, is the clinical project the NCCPA has decided on is a research project, it will be time consuming, you will not have anyone else willing to help you out with it. I won’t be surprised to see a major uproar in the future over this with many, many PAs showing and telling the NCCPA that this just doesn’t work for them. I think the projects would have been much more do-able had the NCCPA allowed PAs to combine their work with their supervising MD’s work on the MD’s clinical project and they work as a team on it. Then it would not have been so overwhelming for either one of them.

 

Anyway, just some info to help clear up some items regarding the new requirements from the NCCPA.

[ToppDog]

I'm not seeing an upside to this. MD's are already opting to hire NP's so they don't have to deal with the supervisory duties that go along with hiring PA's. This looks like it will make that situation much worse. What am I missing?

[MMiller]

I am seriously starting to think the NCCPA is working against us, and not for us.

[jdtpac]

Although I see and agree that the PI-CME will potentially place a great burden on the practice, the PA and supervising physician, however, I don't understand the anxiety being expressed on this thread or the other threads regarding this issue. After reviewing the NCCPA website about these new requirements it seems pretty clear to me that PI-CME is optional and not mandatory at this time. Below is an excerpt from that website:

 

“change is accompanied by the institution of new, more specific continuing medical education (CME) requirements: 20 of the 50 Category I CME credits certified PAs are already required to obtain every two years must be earned through self-assessment CME or performance improvement CME (PI-CME)”.

For me, this does not become an issue until 2016 because I took my recertification in 2010 (for the fifth time). I hope the choice between self-assessment and PI remains the same, because for me isn't a no-brainer as to which one I will choose.

[MMiller]

Although I see and agree that the PI-CME will potentially place a great burden on the practice, the PA and supervising physician, however, I don't understand the anxiety being expressed on this thread or the other threads regarding this issue. After reviewing the NCCPA website about these new requirements it seems pretty clear to me that PI-CME is optional and not mandatory at this time. Below is an excerpt from that website:

 

“change is accompanied by the institution of new, more specific continuing medical education (CME) requirements: 20 of the 50 Category I CME credits certified PAs are already required to obtain every two years must be earned through self-assessment CME or performance improvement CME (PI-CME)”.

For me, this does not become an issue until 2016 because I took my recertification in 2010 (for the fifth time). I hope the choice between self-assessment and PI remains the same, because for me isn't a no-brainer as to which one I will choose.

 

I suspect it's a matter of time before they no longer give us a "choice" on which we'll do, similar to the Pathway II that they did away with. My previous statement stands.

[jdtpac]

I am seriously starting to think the NCCPA is working against us, and not for us.

 

NCCPA has never worked for us, just as we are regulated in most states by a medical boards(made up mostly of physicians) whose mission is to serve and assure the public that we are properly licensed, NCCPA’s mission is the same for our certification. but I am sure you knew that.

[MMiller]

NCCPA has never worked for us, just as we are regulated in most states by a medical boards(made up mostly of physicians) whose mission is to serve and assure the public that we are properly licensed, NCCPA’s mission is the same for our certification. but I am sure you knew that.

 

I understand that they are merely a certifying organization. However, they make a ton of money off of us; running our profession into the ground with ridiculous hoops to jump through (and thusly possibly putting us out of business) is not the best way to keep them rich.

[jdtpac]

I understand that they are merely a certifying organization. However, they make a ton of money off of us; running our profession into the ground with ridiculous hoops to jump through (and thusly possibly putting us out of business) is not the best way to keep them rich.

 

Unfortunately, this is one of those situations that applies to"be careful what you ask for". as I said in another post a majority in the PA profession has been asking for a change in the recertification process. they have been asking for this for over 10 years. This is what they have come up with this is their solution. and they've done it with the academy and education association.

[Guest JMPA]

I totally agree, this is there way of punishing us for wanting a longer recert cycle. How in anyway does this improve one as a PA. It doesn't. It is an added burden. Yes it is of the MD model, but is our pay and compensation of the MD model?

[polarbebe]

There is no choice, you must complete two PI-CME every ten years.

 

http://www.nccpa.net/CertMain.aspx

 

Scroll all the way to the bottom:

 

"In addition, to make sure all PAs are benefitting from both self-assessment activities and PI-CME, during every 10-year certification maintenance cycle, PAs must complete at least two of each type of these activities. The new requirements are illustrated in the box."

[physasst]

Some more information....First off, John is right. You have a choice between self assessment and PI-CME.

 

I spoke with a friend with firsthand knowledge of all of this....although I am still unclear as to how the NCCPA will track the self assessment CME....??

Second..IF you do decide to do the QI project, there is no reason that you need a "physician" to help you. These are basic projects. That is why they do not require IRB review. Any PA worth his salt should be able to do one of these VERY, VERY easily. One example my friend gave, was determining if vital signs were documented properly and in the right place in every chart. Doing a review, and then developing a solution to improving it.

 

Third...Almost ALL physician groups already REQUIRE this PI-CME format. So they will already be doing this, that is, if you choose to work with one.

 

The FSMB (Federated State Medical Boards) recently met and UNANIMOUSLY (?sp) decided that logging CME and taking a periodic test WAS NOT SUFFICIENT to document continuing education. This was a decision by the FSMB. Additionally, physicians who do not have a process (IE; not board certified or going through a board process of continuing education) will be subject to new processes being developed by the State Medical Boards. They will include PI-CME and periodic examinations. So this will affect EVERYONE.

 

The FSMB is going to make this process more and more difficult with time....It may not immediately affect our NP colleagues, but as we are under the medical board, we will have to do this stuff.

 

Getting rid of the PANRE is not even CLOSE to an option. Not per the FSMB.

 

Just for some clarification...

[polarbebe]

Recheck the website there is no choice. Every PA must complete two PI-CME every ten years.

[physasst]

Recheck the website there is no choice. Every PA must complete two PI-CME every ten years.

 

Correct. I just clarified that with someone. You can do two self assessments AND two PI-CME every ten years. So we all be compelled to do this.

 

BTW, so are the physicians. This is not just picking on the PAs. I know the AAFP is establishing this as a requirement, as well as multiple other boards.

[ToppDog]

Correct. I just clarified that with someone. You can do two self assessments AND two PI-CME every ten years. So we all be compelled to do this.

 

BTW, so are the physicians. This is not just picking on the PAs. I know the AAFP is establishing this as a requirement, as well as multiple other boards.

 

There's the upside :) At least if the MD's are in the same boat as PA's they will be more apt to voice their opinion if things go awry. Thanks for bringing up this topic.

[CAAdmission]

The NCCPA is nothing more than a cancer which is growing fat and rich on our profession. Almost every decision the NCCPA has made in the last 3 years has been very poorly thought out. You would think they are modelling themselves after the federal government...

[delco714]

WwwI graduate in a year, now's not the time to start doubting the direction of the profession. My stomach was in knots reading this thread.

 

General medical panre

Eventually forced into specialty certification?

And cme

And now this on top?

 

It's not just superfluous, it's a hindrance for most working PAs.

[MMiller]

WwwI graduate in a year, now's not the time to start doubting the direction of the profession. My stomach was in knots reading this thread.

 

General medical panre

Eventually forced into specialty certification?

And cme

And now this on top?

 

It's not just superfluous, it's a hindrance for most working PAs.

 

Welcome to being a PA. We have a certifying association that apparently wants to see how far we can bend without breaking (NCCPA), a "professional association" that is a joke (AAPA), and a profession-wide collective desire to try and please our physician overlords, many of whom want to see us fail (MDs).

 

Good luck.

[CAAdmission]

Amen, MMiller.

 

While there are certainly a lot of good physicians out there, I have found it convenient to think of our profession like mushrooms. And physicians are the turds upon which we are growing...

 

While the AAPA is ineffectual, the NCCPA is pure evil. I hope the devil torments them with a red hot pitchfork for their great work in singlehandedly altering the nature of our profession. Why do we want to look more like the medical profession? Wasn't it under their watch that our healthcare system has essentially collapsed?

[Tayce]

Although I cannot agree enough with the above posts I also have a small inner sunshine thinking that at least they put us on the same model as the MDs. There are many downsides but now we'll have the argument that we are doing the same thing the MD's have to do. Maybe someday this will allow for better bridging programs or to allow us favor in the eyes of the "turds upon which we are growing." LOL

[mainiac]

Welcome to being a PA. We have a certifying association that apparently wants to see how far we can bend without breaking (NCCPA), a "professional association" that is a joke (AAPA), and a profession-wide collective desire to try and please our physician overlords, many of whom want to see us fail (MDs).

 

Good luck.

 

This whole new redo is a TOTAL JOKE!

I dont care if MD's r doing this! We dont do what they do! We dont get paid what they r paid! Why do I care what they hav 2 dew!?

If they dont change this IT WILL B TIME 2 change fields! as this is total BS!

[CAAdmission]

Misery loves company. I think it is mainly an issue of the physicians saying, "our system sucks, let's see who else we can make miserable."

 

By the time this ridiculous trickle down effect is over, the maintenance staff will be doing QI projects. You're bound to see them doing MRI scans on mop-heads before you know it.

[andersenpa]

This whole new redo is a TOTAL JOKE!

I dont care if MD's r doing this! We dont do what they do! We dont get paid what they r paid! Why do I care what they hav 2 dew!?

If they dont change this IT WILL B TIME 2 change fields! as this is total BS!

 

We do what they do. We both practice medicine.

What we get paid is almost completely independent of that fact.

[physasst]

This whole new redo is a TOTAL JOKE!

I dont care if MD's r doing this! We dont do what they do! We dont get paid what they r paid! Why do I care what they hav 2 dew!?

If they dont change this IT WILL B TIME 2 change fields! as this is total BS!

 

Well, it isn't going to change. As Andersen notes, what we get paid is independent of the fact that we both diagnose and treat patients.

[CAAdmission]

We have a funadmental difference from physicians that you are overlooking: physician oversight. The automatic and ongoing quality control associated with being a PA lies in the fact that there is always a supervising physician in the picture that should be continuously assessing the quality of our care. Docs are free to function completely independently, so they perhaps they need some additional process to reign them in.

 

At its best, the QI process is going to be bureaucratic masturbation. It will make people feel good with no real results. Everywhere you go, you hear the mantra of team healthcare. Well, as things now stand, the physician is the captain of the team, and it is up to the doc to drive quality. I imagine that there are a lot of docs - prehaps the preponderance - who want their PAs to see patients and generate revenue and not get involved in pedantic QI projects.

[EMEDPA]

I imagine that there are a lot of docs who want their PAs to see patients and generate revenue and not get involved in pedantic QI projects.

agree. several of my sp's of record probably don't even know I am assigned to them. the way we function is that the doc of the day signs all charts regardless of who they are assigned to. I don't think I have even worked with any of my sp's of record in over 6 months. it took me awhile to find a doc to sign off on my CAQ stuff and it ended up being a doc who has been my sp in the past at another location but now works with me again in a non-sp role.

any requirement that the docs be involved in our cme is doomed to failure unless it is just "sign here".