Progress in Washington in terms of OTP?

[ran2much]

Hey friends - As a state, have we who practice in Washington state made headway with regards to legal progress in OTP as yet?  At present, I know I still have a "supervising" physician and back ups to that physician in my community oncology practice.  Is this still true for all at the state level?  I didnt know if we are getting traction especially in terms of underserved areas or in disaster/volunteer situations.  Is anyone clear on whether it is listed as direct, indirect, or remote in terms of "supervision"? I will dig in on the state site and make some phone calls next week.  Just checkin to see what our practicing peeps know.  I like to think the pacific northwest is progressive.  I need to join WAPA and dig in.  Thanks in advance. 

tracy

[rev ronin]

Yes, you need to join WAPA.

The bill introduced last session died in committee.  It really didn't do anything significant, but did change supervision to collaboration.  An NP->ED physician testified against it, on the basis that she didn't know squat as an NP.  CRNAs wanted the PAs who do anesthesia barred by law from doing that.  The WAPA liaison made a big deal about it not being about independence.

[ran2much]

Thanks Rev Ronin.  I had seen the legislation.  Just hadn't heard the outcome.  Joining WAPA now. 

[MSPAC]

Yes, please join WAPA and get your colleagues to join too. Here's the latest email I got from their legislative committee chair:

Quote

 

Good morning everyone,

 

I wanted to bring you all up to speed on the discussion representatives from WAPA and I had with the WSMA leadership on Wednesday evening in Seattle. WAPA representatives were Eileen Ravella (current president), Lyle Larson (a past president) and me (Legislative and Health Policy Committee chair). The leadership from WSMA included Dr. Tom Schaff (current president) Dr. Bill Hirota (president-elect), Dr. Mika Sinanan (second vice-president) and Jennifer Hanscom (CEO).

 

SB5411 was a bill presented during the 2019 legislative session and the important points are:

1.       Changes the term “supervising physician” to “participating physician”

2.       The practice agreement is “maintained by the physician assistant’s employer or at his or her place of work” (instead of Olympia – allowing for better flexibility and more rapid deployment of the PA).

3.       Removes physician to PA ratio.

4.       Removes remote site language.

5.       Clarifies that the physician assistant “shall retain professional and personal responsibility for any act which constitutes the practice of medicine as defined in …..” (to help alleviate one concern that physicians have regarding being liable for the PA’s decisions.)

6.       Clarifies that physicians are not required by law to countersign orders “written in a patient’s clinical record or an official form by a physician assistant with whom the physician has a practice agreement.”

7.       The Medical Commission will license all PAs in the state, however the Board of Osteopathic Medicine and Surgery remains the disciplinary authority for PAs working with DOs.

 

Between the 2019 Legislative session and now, the WSMA Executive committee had decided that statements in the bill around the lack of supervision was concerning and they wanted to move from “neutral” to “oppose,” which would have effectively killed any hope we had of moving this bill forward during this session, or any sessions.

 

At our meeting on Wednesday evening we were able to come to agreement that we would not change “supervision” to “participating” in order to move forward with the remaining six points on this bill. We were very open with the WSMA group that PAs were being passed over, or not considered for hire, due to the supervision requirements and that PAs practice autonomously now; just consulting as needed. They stepped forward with the suggestion that this is a cultural change, which will take time, and they are willing to assist by educating physicians in regards to what supervision really means; they do not need to “look over our shoulder” in order to supervise us but need to be available for consultation when needed. We could have argued that this is what “collaborate” means, and the group at the table understood how PAs actually practice, but their constituency do not. Thus the education and cultural change, which will take time.  

 

The plan is to find out if the current bill can be amended with this “friendly amendment” or if we need to rewrite it. If we rewrite it, we will do a House Bill at the same time to, hopefully, cut the time for the bill to go through both branches during this short session.

 

If you have any questions, please contact me!

LD

 

And follow up from the WAPA president:

Quote

 

I'd like to add to Linda's response. We are truly in a time crunch. We are in the midst of hiring a lobbyist on a tight budget and hopefully if all works out we will be get a lobbyist hired within the next week and reach an agreement on the WSMA language.  Please encourage your fellow non WAPA PAs to join. We need to keep the momentum going on this bill. I agree Corey it feels like a gut punch but in this environment we have to take baby steps and "layer" our wins as we go toward independent practice. It is essential to our survival. 

 

Linda and I met with the nurse practitioner leg chair and we will continue to collaborate with the ARNPs on common ground issues such as DME prescriptions and they have agreed to endorse our bill. 

 

If the WAPA came out con on our bill, we would have to start over and we were unwilling to do that. For now the push is establish a presence at the capital through your legislators. The more people we can talk to now, the less education we have to do on leg day.

 

The lobbyist we are considering has family members that are PAs. That should help. The current lobbyist will cost the WAPA 36,000-40,000 a year that does not count the expense of leg day. As one lobbyist told me, if we were able to pay 80,000 a year we would have a greater chance of passing our bill because they could dedicate more time to our bill. 

 

Thanks for all  your support and what you do for your patients, they know that PAs are crucial to medical communities. Encourage your patients to contact their legislators as well. Won't hurt. Please let us know if you have questions.

 

This is a one step at a time endeavor.

 

Eileen Ravella PA-C

 

WAPA President.