Will OTP affect our scope of practice negatively in some ways?

[PA-C]

I live/practice in a state where NPs have legal independence. However, at the practice where I work, they are still subject to the same quarterly chart reviews/collaborative relationships that us PAs have with the physicians per practice policy. My employer recently informed all of us providers that for the time being, all ED&Cs for malignant destructions will need to be performed by either a MD or a PA-C because Blue Cross Blue Shield in our state is currently considering destruction of malignant neoplasms “out of scope” for NPs and will not reimburse them. (This is ridiculous because NPs were previously performing this simple procedure without issue, but they achieved independence in this state either this year or last year and now all of a sudden they’re being told it’s “out of scope.”)

I am wondering if this decision from BCBS is related to the fact that because PAs still legally have to file a collaboration agreement with physicians, we are still viewed by the insurance company as a direct extension of physicians and thus most things that are within the physicians’ scope are considered within the PAs’ scope by default. However, since NPs do not formally have to “collaborate” with a physician, BCBS has decided that certain things are now out of their scope simply because they are not viewed as an extension of physicians due to that lack of a legal collaboration agreement. 

I hadn’t really considered how our scope could be affected negatively from independence until hearing about this from my employer. I am still all for OTP and feel strongly that we should push forward despite issues like this, I just thought it was interesting and wanted to share. Have any of you seen/heard of anything similar happening where you are?

[Lightspeed]

I think that little problems like that are a small concern compared to the benefits of independence for the provider. That situation you described affects the practice more than the NPs themselves. Insurance companies will always be looking for ways to get out of paying things, but I expect that over time they will be confronted with the reality that there will be pushback for them to pay, and then they will end up actually compromising by paying 85% as a justification of the “non physician provider” doing it vs the physician. Then at that point, they become the preferred provider because they are doing it 15% cheaper. 

Overall, being independent means you don’t have to filter your check through the doc to get your money. As a PA, you don’t bill directly and get your hands on anything until it passes through someone else’s sticky fingers. Even with OTP,  the “practice” always looms largest. So yes, while I still work for a larger entity for my main job, I still have my other job where the large entity is just me in association with my other “partners”. 

[sas5814]

insurance companies are about money not healthcare. They aren't your neighbors, your helping hands or anything other than a business that wants to make the most money. Their decisions will be driven by that.

I think any major change invokes the law of unintended consequences. I think they will be trivial compared to the improvement in our professional lives after OTP and direct payment from CMS finally happens.

Edited August 23, 2019 by sas5814

[Lightspeed]

1 hour ago, sas5814 said:

 

I think any major change invokes the law of unintended consequences. I think they will be trivial compared to the improvement in our professional lives after OTP and direct payment from CMS finally happens.

Is direct payment baked in to OTP?

[sas5814]

No it is a second issue but will likely pass this year.

[Brigid2010]

I don't wonder if OTP or some "divorce" from the term "SP" won't model, in practice law revisions, how the Certified Nurse Midwife role appears to operate in Canada right now.  My friend worked up there as a CNM from the US for a few years, and while CNMs operate as purely independent providers in Canada (as opposed to US, where they still operate via collaborative agreements w/independence in their scope of practice...similar to other APPs), they found that the actual scope of "independent" practice was actually much more limited, and VERY specifically confined, as to what they were allowed by their practice law to manage. 

In terms of specialty practice for PAs, I can't really comment on how dramatically scope of practice would change from how they operate now w/in individual settings in relation to their SPs.  I gather the changes from OTP would have much more of an impact on PAs in more traditional primary care settings.  Not so much in how most of us are already functioning in the practical day-to-day of patient management in settings like family practice or internal medicine, but rather in terms of the logistics like billing, and the scrabble-headache of being tied to a physician's licensure to validate our own licensure (which, frankly, to me, has been the real issue of "independence of licensure" vs "independence of practice").  I don't know how I feel about doing completely away w/ the collaborative role of a physician-APP team, not b/c most more experienced APPs won't necessarily grow into more independence, but b/c, as I was trying to say above, in a somewhat garbled form, I think implementing a practice law, for full independence for PAs, while definitely doable, would get tangled up in a lot of legal lingo regarding VERY specific parameters of what exactly that scope needs to entail, especially if it's to be adopted as a national standard, but according to each state's preferences.  IDK, is there a potential this might actually end up limiting the scope of practice within which some PAs are utilized, who have quite a bit of autonomy and laterality in their patient management, suddenly finding themselves forced to conform to more restrictive practice laws which no longer require an SP, but conversely, also limit what had been, perhaps, a more liberal practice setting? 

Just thoughts I'm throwing out there. Frankly, working in an FQHC, I don't really think what/how I practice, would change that much as our PAs and NPs already operate with a fair amount of autonomy, in the scope of our practice, and what's determined as outside of our scope is really the provider comfort level with the complexity of the patient.  

Just sayin', in the long and short, there might need to be a differentiation in the language between what's meant as "autonomy of licensure" vs "autonomy of practice"/"independence of practice".  And that an independent practice law for PAs, while beneficial on certain fronts, might end up introducing unintended limitations to the scope within which certain individual practices, and APPs--primarily PAs in this instance--already function as essentially independent providers.  

Guess we won't know unless we try though, eh?

Edited August 23, 2019 by Brigid2010

[Lightspeed]

7 hours ago, Brigid2010 said:

I don't wonder if OTP or some "divorce" from the term "SP" won't model, in practice law revisions, how the Certified Nurse Midwife role appears to operate in Canada right now.  My friend worked up there as a CNM from the US for a few years, and while CNMs operate as purely independent providers in Canada (as opposed to US, where they still operate via collaborative agreements w/independence in their scope of practice...similar to other APPs), they found that the actual scope of "independent" practice was actually much more limited, and VERY specifically confined, as to what they were allowed by their practice law to manage. 

In terms of specialty practice for PAs, I can't really comment on how dramatically scope of practice would change from how they operate now w/in individual settings in relation to their SPs.  I gather the changes from OTP would have much more of an impact on PAs in more traditional primary care settings.  Not so much in how most of us are already functioning in the practical day-to-day of patient management in settings like family practice or internal medicine, but rather in terms of the logistics like billing, and the scrabble-headache of being tied to a physician's licensure to validate our own licensure (which, frankly, to me, has been the real issue of "independence of licensure" vs "independence of practice").  I don't know how I feel about doing completely away w/ the collaborative role of a physician-APP team, not b/c most more experienced APPs won't necessarily grow into more independence, but b/c, as I was trying to say above, in a somewhat garbled form, I think implementing a practice law, for full independence for PAs, while definitely doable, would get tangled up in a lot of legal lingo regarding VERY specific parameters of what exactly that scope needs to entail, especially if it's to be adopted as a national standard, but according to each state's preferences.  IDK, is there a potential this might actually end up limiting the scope of practice within which some PAs are utilized, who have quite a bit of autonomy and laterality in their patient management, suddenly finding themselves forced to conform to more restrictive practice laws which no longer require an SP, but conversely, also limit what had been, perhaps, a more liberal practice setting? 

Just thoughts I'm throwing out there. Frankly, working in an FQHC, I don't really think what/how I practice, would change that much as our PAs and NPs already operate with a fair amount of autonomy, in the scope of our practice, and what's determined as outside of our scope is really the provider comfort level with the complexity of the patient.  

Just sayin', in the long and short, there might need to be a differentiation in the language between what's meant as "autonomy of licensure" vs "autonomy of practice"/"independence of practice".  And that an independent practice law for PAs, while beneficial on certain fronts, might end up introducing unintended limitations to the scope within which certain individual practices, and APPs--primarily PAs in this instance--already function as essentially independent providers.  

Guess we won't know unless we try though, eh?

It shouldn’t be a mystery what specialty practice (or practice in general) for PAs would look like with the correct measures taken. It would simply look like what NPs have in independent states. I guess the big question for me is whether OTP accomplishes this. I haven’t seen anything indicating that OTP does much besides shifting the collaborative/supervisory role from a specific physician, and instead towards a group of facility. Other benefits could be thrown in there like little or no chart review, etc, but I think that critical inclusions to have are your own boards, practice that is not constrained by being required to be employed (ie the ability to open up a shop on your own without any agreement with any other entity), and independent billing. You touched on some of those themes I mentioned here, so I can see many similar things are on your mind too. The more I see of OTP, the more I think that rather than being an incremental step towards the ultimate goal, it’s another animal altogether... one that diverts useful energy that could be spent simply doing the things that move the needle towards what NPs have. It’s just that PAs feel so beat down as a profession that they are placated by any effort that seems like something is being done. Too many years of status quo actions seems to have put them there. But maybe just some solid first steps really are a big deal. 

[Kaepora]

Is this Oklahoma?  BCBS is trying to deny PAs and NPs a lot of things unless they can prove they were trained to do it during their programs.  Specifically, Family NPs are being denied what BCBS considers to fall under the SOP of Acute Care NPs.  These FNPs, however, are successfully challenging this by proving they have been properly trained OTJ and have logged "X" number of cases and CEUs.  

[Lightspeed]

The problem they are going to be up against is justifying their reluctance to pay. There comes a point where they can’t deny everything that is reasonably documented and performed. If they can point to justification due to poor performance of a procedure, then that’s one thing. To always just say no means eventually they aren’t an insurance company. It seems pretentious of them to flex muscle over a facility’s choice of staffing. I feel like eventually, patience for that kind of thing will run thin. They can win the battle and lose the war with that attitude.

I have noticed that lately everything seems to require a pre authorization, even meds that are dirt cheap. 

[Joelseff]

It shouldn’t be a mystery what specialty practice (or practice in general) for PAs would look like with the correct measures taken. It would simply look like what NPs have in independent states. I guess the big question for me is whether OTP accomplishes this. I haven’t seen anything indicating that OTP does much besides shifting the collaborative/supervisory role from a specific physician, and instead towards a group of facility. Other benefits could be thrown in there like little or no chart review, etc, but I think that critical inclusions to have are your own boards, practice that is not constrained by being required to be employed (ie the ability to open up a shop on your own without any agreement with any other entity), and independent billing. You touched on some of those themes I mentioned here, so I can see many similar things are on your mind too. The more I see of OTP, the more I think that rather than being an incremental step towards the ultimate goal, it’s another animal altogether... one that diverts useful energy that could be spent simply doing the things that move the needle towards what NPs have. It’s just that PAs feel so beat down as a profession that they are placated by any effort that seems like something is being done. Too many years of status quo actions seems to have put them there. But maybe just some solid first steps really are a big deal. 

OTP, when AAPA first put it out, had 3 major "heads" or goals. 1st to have on site practice restrictions loosened/eliminated (SP, DSAs, chart cosigs etc) 2nd was direct billing and 3rd was our own board. California had to fight and sacrifice the others in order to keep the practice site provisions, elimination of DSA and naming a specific CP/SP portion alive But we lost the direct billing and possibly the PA only board (though I think CAPA is trying to work with the state BOM to have more PA presence or have our own boards outright-I think this would be ideal). If this bill passes, we will be on PAR with the NP practice laws and regs in California (NPs have not yet attained independence here though I think it is just a matter of time and I am rooting for them to do that so we can also push for it). 

I am surprised though on how fast we have gotten some states to even consider any part of OTP. North Dakota from what I understand has full OTP. 3 or 4 other states have parts of OTP. So I can see the walls falling down in time and I have to say the NPs and their move for independence probably gave us a leg up unintentionally.

 

It's not perfect but looks like we are moving the chains some. So I think it is a step wise approach and I think the leadership foresaw some of this (from private conversations I have had with some PA leaders). It is still an uphill battle but I think it's worth fighting for and we have to take what we can get. Hopefully one day, the whole shabang [emoji4]

 

Here is AAPAs info page on OTP if you haven't had a chance to read it:

 

 

https://www.aapa.org/advocacy-central/optimal-team-practice/

 

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[Lightspeed]

1 hour ago, Joelseff said:

OTP, when AAPA first put it out, had 3 major "heads" or goals. 1st to have on site practice restrictions loosened/eliminated (SP, DSAs, chart cosigs etc) 2nd was direct billing and 3rd was our own board. California had to fight and sacrifice the others in order to keep the practice site provisions, elimination of DSA and naming a specific CP/SP portion alive But we lost the direct billing and possibly the PA only board (though I think CAPA is trying to work with the state BOM to have more PA presence or have our own boards outright-I think this would be ideal). If this bill passes, we will be on PAR with the NP practice laws and regs in California (NPs have not yet attained independence here though I think it is just a matter of time and I am rooting for them to do that so we can also push for it). 

I am surprised though on how fast we have gotten some states to even consider any part of OTP. North Dakota from what I understand has full OTP. 3 or 4 other states have parts of OTP. So I can see the walls falling down in time and I have to say the NPs and their move for independence probably gave us a leg up unintentionally.

It's not perfect but looks like we are moving the chains some. So I think it is a step wise approach and I think the leadership foresaw some of this (from private conversations I have had with some PA leaders). It is still an uphill battle but I think it's worth fighting for and we have to take what we can get. Hopefully one day, the whole shabang

Here is AAPAs info page on OTP if you haven't had a chance to read it:

https://www.aapa.org/advocacy-central/optimal-team-practice/

 

I feel like of the three legs they could have chosen to focus on, they picked the wrong one. The other two were not very valuable by comparison. Switching from one person supervising PAs to “the practice” just reinforces the reality that mom and pop single physician practices are giving way to corporatized multi provider practices that are still only controlled by physicians. Real supervision of you guys hasn’t been a thing for quite some time unless you consider the subordinate position required in many specialties. It’s almost like OTP grants PAs enough distance from chart review to offload liability and increase convenience of physicians, while still locking you guys in to an outdated employment relationship. Is it progressive to have the provisions that don’t require filing of a contract, but negated by the requirement of needing to be employed to practice? What good is that if it still leaves a Pa at the mercy of an employer? Speak up and they ship you out and you don’t work.

I’d suggest the profession not get too caught up on getting 50 state OTP before they aim a lot higher. I said in another post that if I didn’t know better, OTP was a plant by nurses to have PAs waste energy on a fruitless endeavor....or by physicians to make their lives easier while not really helping PAs put daylight between the fields. Literally, you all have a case study in independence (NPs) front and center (when you all aren’t saying bad things about them). Why not skip all the tepidness and say to the world “these folks (NPs) do this on their own in half of all states, we can do that too if you let us!” Go to the states where NPs are independent to make that push. 

EVERYONE here complains about the mismatch with NPs, but NOBODY comes out and says to straight up push to be independent (apart from just saying it should be done). No plan. Everything incrementalist. There’s 50 states and nobody among the 50 state orgs is thinking outside the box. I’ve mentioned Alaska, Montana, and Wyoming as places to get this started. INDEPENDENCE. Get it started there and use access for the rural population as your rallying cry. Sorry, OTP is for losers. I mean that as a way to emphasize that something better is out there that doesn’t involve you guys groveling at every turn, even during what seems to be your accomplishments. Anyone who wants to retain that “special” relationship with physicians needs to understand that even if there is a laudable reason behind wanting to maintain that, it leaves you all in the dust in the face of what NPs are doing. 

Heres an example of NP incrementalism:

https://www.fredericksburg.com/lifestyles/healthy-living/new-law-lets-nurse-practitioner-set-up-her-own-shop/article_42e428ce-1802-5a3c-83ee-dfdfe1e41af8.html

In Virginia, NPs weren’t independent, and it was looking like your typical good old boys, physician controlled southern state. Now, after 5 years of “collaborative” practice with a doc (or a filed plan for referring complex cases!), you are cut loose for FULL independent practice. I think Illinois did the same thing with a 2 year collaboration. How long until they scrap the collaboration portion entirely? I give it a couple years. Rest assured the nursing orgs aren’t just sitting back and content with what they have there. So when nurses get a foot in the door, it’s not a slipper, it’s a boot, and they don’t settle for fake progress. They give a little on how long it takes to get full independence, but in the end, it’s full independence you acquire after you pay your dues. Not a “maybe”, or a “we’ll have the medical board look at it case by case”, or a “if doctors think there is a need for it”.... it’s the real deal, and it kicks in without a hitch, and it’s overseen by nurses. 

That’s how you incrementalise. Those two states are states where I never though NPs would get the drop on doctors... Illinois and Virginia. Old money, physician establishment states with giant physician education complexes now have a direct pathway to full independence for NPs, complete with their professions in those states regulated by boards of nursing, composed only of nurses. 

What’s OTP again? Nobody has to sign your charts, but now you work for docs instead of a doc (but maybe still just one doc if he owns the practice... it’s all up to them, not the PAs). To quote Jack Nicholson in a few good men: “please, tell me you have something more....” Please tell me that the profession has more up their sleeve for the advancement of the PA field that Optimal TEAM Practice. The “team” seems less interested in having everyone play like everyone else. Get rid of the team and play some individual sports. 

Edited August 24, 2019 by Lightspeed

[Joelseff]

I feel like of the three legs they could have chosen to focus on, they picked the wrong one. The other two were not very valuable by comparison. Switching from one person supervising PAs to “the practice” just reinforces the reality that mom and pop single physician practices are giving way to corporatized multi provider practices that are still only controlled by physicians. Real supervision of you guys hasn’t been a thing for quite some time unless you consider the subordinate position required in many specialties. It’s almost like OTP grants PAs enough distance from chart review to offload liability and increase convenience of physicians, while still locking you guys in to an outdated employment relationship. Is it progressive to have the provisions that don’t require filing of a contract, but negated by the requirement of needing to be employed to practice? What good is that if it still leaves a Pa at the mercy of an employer? Speak up and they ship you out and you don’t work. I’d suggest the profession not get too caught up on getting 50 state OTP before they aim a lot higher. I said in another post that if I didn’t know better, OTP was a plant by nurses to have PAs waste energy on a fruitless endeavor....or by physicians to make their lives easier while not really helping PAs put daylight between the fields. Literally, you all have a case study in independence (NPs) front and center (when you all aren’t saying bad things about them). Why not skip all the tepidness and say to the world “these folks (NPs) do this on their own in half of all states, we can do that too if you let us!” Go to the states where NPs are independent to make that push. 

EVERYONE here complains about the mismatch with NPs, but NOBODY comes out and says to straight up push to be independent (apart from just saying it should be done). No plan. Everything incrementalist. There’s 50 states and nobody among the 50 state orgs is thinking outside the box. I’ve mentioned Alaska, Montana, and Wyoming as places to get this started. INDEPENDENCE. Get it started there and use access for the rural population as your rallying cry. Sorry, OTP is for losers. I mean that as a way to emphasize that something better is out there that doesn’t involve you guys groveling at every turn, even during what seems to be your accomplishments. Anyone who wants to retain that “special” relationship with physicians needs to understand that even if there is a laudable reason behind wanting to maintain that, it leaves you all in the dust in the face of what NPs are doing. 

Heres an example of NP incrementalism:

https://www.fredericksburg.com/lifestyles/healthy-living/new-law-lets-nurse-practitioner-set-up-her-own-shop/article_42e428ce-1802-5a3c-83ee-dfdfe1e41af8.html

In Virginia, NPs weren’t independent, and it was looking like your typical good old boys, physician controlled southern state. Now, after 5 years of “collaborative” practice with a doc (or a filed plan for referring complex cases!), you are cut loose for FULL independent practice. I think Illinois did the same thing with a 2 year collaboration. How long until they scrap the collaboration portion entirely? I give it a couple years. Rest assured the nursing orgs aren’t just sitting back and content with what they have there. So when nurses get a foot in the door, it’s not a slipper, it’s a boot, and they don’t settle for fake progress. They give a little on how long it takes to get full independence, but in the end, it’s full independence you acquire after you pay your dues. Not a “maybe”, or a “we’ll have the medical board look at it case by case”, or a “if doctors think there is a need for it”.... it’s the real deal, and it kicks in without a hitch, and it’s overseen by nurses. 

That’s how you incrementalise. Those two states are states where I never though NPs would get the drop on doctors... Illinois and Virginia. Old money, physician establishment states with giant physician education complexes now have a direct pathway to full independence for NPs, complete with their professions in those states regulated by boards of nursing, composed only of nurses. 

What’s OTP again? Nobody has to sign your charts, but now you work for docs instead of a doc (but maybe still just one doc if he owns the practice... it’s all up to them, not the PAs). To quote Jack Nicholson in a few good men: “please, tell me you have something more....” Please tell me that the profession has more up their sleeve for the advancement of the PA field that Optimal TEAM Practice. The “team” seems less interested in having everyone play like everyone else. Get rid of the team and play some individual sports. 

 

That all sounds great but what most people who state things in the theme of "why take their (physicians, legislators etc) crap? look at the NPs... " often forget that NPs are backed by Nurses who happens to control the largest and most powerful lobby/union in the country. PAs are only 120k people strong nationally and only have 25% (these are close to real numbers according to a speech I heard) of these 120k PAs actually supporting our national and state associations. We have neither the clout nor the coffers to support the kind of fights that you propose. I wish we did have your numbers and money. I would love to have PA's be able to afford to sponsor Bill after Bill that fail year after year until we wear them out and they give in, we simply cannot. So we have to be more selective. And the OTP initiative all began not because of desire for independence (as in hanging out our own shingle) per se but because we PAs have lost jobs because their SPs died or left practices. That was why that main head or leg was the main focus of OTP.

 

But thanks for your support and input...  

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[Cideous]

2 minutes ago, Joelseff said:

That all sounds great but what most people who state things in the theme of "why take their (physicians, legislators etc) crap? look at the NPs... " often forget that NPs are backed by Nurses who happens to control the largest and most powerful lobby/union in the country. PAs are only 120k people strong nationally and only have 25% (these are close to real numbers according to a speech I heard) of these 120k PAs actually supporting our national and state associations. We have neither the clout nor the coffers to support the kind of fights that you propose. I wish we did have your numbers and money. I would love to have PA's be able to afford to sponsor Bill after Bill that fail year after year until we wear them out and they give in, we simply cannot. So we have to be more selective. But thanks for your support...

 

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I could see a day within the next 5-7 years where NP's completely dominate the "non-physician" provider market.  Not because of training, but because of legislative victories and yes....because of their name vs ours.  Something we could change tomorrow if we had the will to do, which for some reason we do not.  

When they finish dominating us, there will be a real discussion about the final two outcomes for our profession.

 

1.  The profession dies in all the big markets and states, PA schools close in mass and what's left of the profession becomes a small niche in small markets.  Most likely. 

2.  We are somehow rolled into and under the NP umbrella.  Less likely.  Perhaps they require us to get some type of "nursing training for providers", test...pass the RN boards and then grandfather us in with the NP title.  Unfortunately they have no incentive to take us under their legislative wing.

If option number 2 sounds crazy, you have not been paying attention to the NP independence victory streak that has been going on, while we struggle to get a weak OTP passed.

[Joelseff]

 

I could see a day within the next 5-7 years where NP's completely dominate the "non-physician" provider market.  Not because of training, but because of legislative victories and yes....because of their name vs ours.  Something we could change tomorrow if we had the will to do, which for some reason we do not.  

When they finish dominating us, there will be a real discussion about the final two outcomes for our profession.

 

1.  The profession dies in all the big markets and states, PA schools close in mass and what's left of the profession becomes a small niche in small markets.  Most likely. 

2.  We are somehow rolled into and under the NP umbrella.  Less likely.  Perhaps they require us to get some type of "nursing training for providers", test...pass the RN boards and then grandfather us in with the NP title.  Unfortunately they have no incentive to take us under their legislative wing.

If option number 2 sounds crazy, you have not been paying attention to the NP independence victory streak that has been going on, while we struggle to get a weak OTP passed.

Maybe? Or maybe not? I don't see the sky falling but definitely see some rough waters ahead. Thing is not every PA is paddling. I don't mind fighting and have supported AAPA my state society and PAFT. I'll support any other pro-PA organization that comes around. I don't not like what lightspeed is proposing (pick a bigger fight) but merely statingvthe fact that we (PAs) at the moment cannot fight at that level yet.

 

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[Cideous]

9 minutes ago, Joelseff said:

Maybe? Or maybe not? I don't see the sky falling but definitely see some rough waters ahead. Thing is not every PA is paddling. I don't mind fighting and have supported AAPA my state society and PAFT. I'll support any other pro-PA organization that comes around. I don't not like what lightspeed is proposing (pick a bigger fight) but merely statingvthe fact that we (PAs) at the moment cannot fight at that level yet.

 

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I see it more like a dam breaking then the sky falling.  With every legislative victory by NP's the pressure builds up on the dam.  In this new world of corporate medicine, investor groups and large hospitals decisions to hire are now mostly made by admins with little to no interest in training.  They decide based on state law restrictions, pay scale and how much money they can save by not needing to have a doc supervise anymore.  That is where we are falling short.

[Joelseff]

I see it more like a dam breaking then the sky falling.  With every legislative victory by NP's the pressure builds up on the dam.  In this new world of corporate medicine, investor groups and large hospitals decisions to hire are now mostly made by admins with little to no interest in training.  They decide based on state law restrictions, pay scale and how much money they can save by not needing to have a doc supervise anymore.  That is where we are falling short.

I agree. We need every PA in this though is my point. We are fighting a huge war against a huge army with 1/4 of our total man power and funds. And unfortunately We aren't Spartans lol

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[rev ronin]

11 hours ago, Lightspeed said:

I have noticed that lately everything seems to require a pre authorization, even meds that are dirt cheap. 

Threadjacking a bit, but Kaiser just denied pregabalin for one of my patients ($24 for 60 @ 75 mg per GoodRx) with Lidoderm ($144 for 60) as a listed formulary alternative... so I prescribed it.

[Lightspeed]

10 hours ago, Joelseff said:

That all sounds great but what most people who state things in the theme of "why take their (physicians, legislators etc) crap? look at the NPs... " often forget that NPs are backed by Nurses who happens to control the largest and most powerful lobby/union in the country. PAs are only 120k people strong nationally and only have 25% (these are close to real numbers according to a speech I heard) of these 120k PAs actually supporting our national and state associations. We have neither the clout nor the coffers to support the kind of fights that you propose. I wish we did have your numbers and money. I would love to have PA's be able to afford to sponsor Bill after Bill that fail year after year until we wear them out and they give in, we simply cannot. So we have to be more selective. And the OTP initiative all began not because of desire for independence (as in hanging out our own shingle) per se but because we PAs have lost jobs because their SPs died or left practices. That was why that main head or leg was the main focus of OTP.

 

But thanks for your support and input...  

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So the numbers are roughly 115,000 for PAs and 270,000 for NPs (I’m not throwing that out there to correct you, but for the math coming next). So NPs are over 2x your numbers AND yes, backed by tue HUGE almost 2 million strong nursing lobby. I get that. But I think everyone that suggests our success is just due to that is underestimating the fact that there is something more to our victories. Nurses gained ground even back when nurses were “just” nurses, and a punchline for the good old boys club... even back when PAs felt comfy being under the umbrella of the good old boys in the physician crowd. I think OTP is respectable in a lot of ways, but I think it was a solution for a different time... not for this point where you have such monumental challenges before you... the kind of challenges where even physicians could forgive you for speaking out of turn (they have some challenges of their own). So the time really is right to cast off the blinders. You have to ask yourself whether nurses are getting ahead because of some ancillary support from their lobby, their small numbers compared to the million plus physicians, or their tenacity to simply TRY. Nurses never set their sights to simply get a better deal, they set their sights on freedom. There are 50 states, and one test bed is a good place for you guys to start.

Edited August 25, 2019 by Lightspeed

[PA-C]

20 hours ago, Kaepora said:

Is this Oklahoma?  BCBS is trying to deny PAs and NPs a lot of things unless they can prove they were trained to do it during their programs.  Specifically, Family NPs are being denied what BCBS considers to fall under the SOP of Acute Care NPs.  These FNPs, however, are successfully challenging this by proving they have been properly trained OTJ and have logged "X" number of cases and CEUs.  

It’s in Illinois

[VeryOldPA]

This is the same doom and gloom that was being predicted back in 1982. Things may change but the PA profession is never going to go away

[rev ronin]

1 hour ago, VeryOldPA said:

This is the same doom and gloom that was being predicted back in 1982. Things may change but the PA profession is never going to go away

I think this view has merit.  A few years ago, PAs had higher salaries and better opportunities than NPs, and markedly so.  Now, things are changing.  BUT, while wages might get driven down over this, it doesn't make sense--practically, politically, or economically--for the PA profession to come to an end.  Look no further than the ongoing prevalence of, for example, Podiatrists.  No one starves as a podiatrist, and while they may get a lot of "Didn't Pass the Mcat" disrespect, they still do a lot of good for a lot of patients.  Is there anything a podiatrist can do that an orthopedist couldn't?  So why does podiatry still exist when orthopods make more money? Someone always has to do the dirty work, that's why. Worst case scenario? We end up with more of the dirty work.

[Cideous]

On 8/24/2019 at 8:54 PM, rev ronin said:

I think this view has merit.  A few years ago, PAs had higher salaries and better opportunities than NPs, and markedly so.  Now, things are changing.  BUT, while wages might get driven down over this, it doesn't make sense--practically, politically, or economically--for the PA profession to come to an end.  Look no further than the ongoing prevalence of, for example, Podiatrists.  No one starves as a podiatrist, and while they may get a lot of "Didn't Pass the Mcat" disrespect, they still do a lot of good for a lot of patients.  Is there anything a podiatrist can do that an orthopedist couldn't?  So why does podiatry still exist when orthopods make more money? Someone always has to do the dirty work, that's why. Worst case scenario? We end up with more of the dirty work.

Man, that may be true but damn was that depressing......lol

[surgblumm]

This post is sort of a walking down memory lane type but nevertheless a keen observation. There is a tremendous belief that OTP will be a reality and in a relatively short time. This was never true of "name change" and I am excited and amazed.

[Cideous]

2 hours ago, surgblumm said:

This post is sort of a walking down memory lane type but nevertheless a keen observation. There is a tremendous belief that OTP will be a reality and in a relatively short time. This was never true of "name change" and I am excited and amazed.

Until our name is changed, little else matters.  Perception is reality in this world and right now the perception is we are "assistants".  That is going to make it stupid hard to get anything passed.  Legislators are idiots.  Increasing anything for an "Assistant" is  like dragging a car up hill....

[VeryOldPA]

12 hours ago, Cideous said:

Until our name is changed, little else matters.  Perception is reality in this world and right now the perception is we are "assistants".  That is going to make it stupid hard to get anything passed.  Legislators are idiots.  Increasing anything for an "Assistant" is  like dragging a car up hill....

I have been successfully advocating for PA legislation for 38 years. Everything from prescriptive privileges to controlled substance prescribing to removing PA Physician ratio to this yearreplacing supervision with collaboration and getting rid of practice agreements. I have NEVER ONCE had a legislator oppose a legislative change because PAs are “assistants”. There have been legislators opposed because PAs are not physicians.

BTW  the overwhelming majority of legislators are not “idiots”. To be sure there are some who qualify for that distinction but most are intelligent, well read, educated professionals who take their responsibilities seriously.