History and Role Quiz 1

What do most states require between PAs and MD/DOs

an agreement with a specific physician

What states have change PA to Physican Associate

Delaware

Iowa

Maine

New Hampshire

Oregon

What states have passed title recognition legislation for physician associate

Kanas

Wisconsin

When can Physician Associate only be used (instead of assistant

In jurisdictions that have enacted title change or title recognition legislation

Must be consistent with individual state laws if patient facing

Must comply with employer policies, licensing policies, third-party payers, malpractice policies

PA Licensure Compact

A agreement between states to accept other state licenses

PA Practice Modernization

Working to update laws enacted in the 1970s

keep pace with evolving patient needs, technology, and innovations in healthcare delivery

What are the levels of modernatization

Foundational

Core

Optimal

What are key points to foundational modernizations

Licensure as regulatory term

Scope of practice at the practice lvel

Full prescriptive authority

Adaptable promixity

Co-Signing Requirements at the practice level

No ratio restrictions on the ratio

What are core modernization key poinys

PA Compact

Title Change

Harmonization Acts

Form Authenticaiton

Move from supervision to collaboration

Scope of practice determined by education, training, and experience

PAs practice medicine

PA responsible for care providied

Elimination of physician delegation

What are the key points of optimal modernaztion

Removal of the legal tether between PA and Physician

Separate PA board or one or more full PA voting members on medicial boards

Direct pay to PAs

Affordable Care Act (ACA)

Expands insurance coverage

Emphasis on prevention and primary care

How did ACA impact patient care

Increased coverage → potential for improved access to care

Reduced population of uninsured patients

How did ACA impact PA practice

Increased demand for primary care providers

Expands team based roles

Medicare and Medicaid

Public Insurance Programs

How did Medicare/Medicaid impact patient care

Determines access to services

How did Medicare/Medicaid impact PA practice

Defines reimbursement and billing

Influences practice setting and patient populations for PAs

Emergency Medical Treatment and Labor Act (EMTALA)

Requires emergency care and stabilization or transfer regardless of ability to pay

How did EMTALA impact patient care?

Ensures emergency care for all people

How did EMTALA impact PA practice?

employed in facilities that are bound by EMTALA

Federal Reimbursement Policy

Medicare recognizes PAs as billable providers

Payment for services linked to federal fee schedules

How does Federal Reimbursement Policy impact patient care

Influences care delivery models and provider availability

How does Federal Reimbursement Policy impact PA care

PAs bound by billing requirements

Allows for the financial viability of PA roles

Score of Practice Laws

Define what PAs are legally allowed to do in each state

What does the state dictate about PAs

Licensure

Scope of Practice

Supervision/Collaboration

What are the members of the healthcare team

Physicians

APCs

Nurse

Case Managers

PT / OT / ST / RT

Dietiatin

Training for Physicians

4-years Medical School

3-4 years of Residency

+/- Fellowship

Must choose specialty

Who licenses Physicians

State Board of Medicine

+/- Board Certification

Role of the Physician

Patient evaluation and management

Often acts as team leader

Advanced practice providers

The mid-level provider between a physician and a nurse

Training for a PA

2-3-years PA School

+/- Fellowship

No requirement to choose specialty

Who licenses PAs

State Board of Medicine

Who certifies PAs

NCCPA

Role of the PA

Patient evaluation and management

Training for NPs

2-4-years NP School after receiving BSN degree

Must choose specialty

Who licenses NPs

State Board of Education

Who certifies NPs

APRN (some states)

Role of the NP

Patient evaluation and management

Training for CNM

Some CNM programs require RN degree, some do not, all require Bachelor’s Degree of some sort

2-4 years of education post baccalaureate

Who licenses CNM

State Board

Who certifies CNM

CNM Exam

Roles of CNMs

Provide Women’s Health care from adolescence through menopausal years

Often involved in labor and delivery process

Training for CRNA

2-4-years CRNA School (Masters or Doctoral degree) after receiving BSN and passing NCLEX

Must have nursing experience prior to training

+/- Fellowship

Who licenses CRNAs

State Board

Role of CRNAs

Administer and monitor anesthesia or pain control

Inpatient or outpatient, pre and post operative

What members of the healthcare team are considered ACP

PA

NP

CNM

CRNA

Training for LPN

Technical School or Community College

Training for RN

Associates Degree or Bachelors Degree

Training for BSN

Bachelors Degree

Who licesneses Nusrses

State

Who certifies Nurses

LPN = NCLEX-PN Exam

RN/BSN = NCLEX-RN Exam

Role of the LPN

assists providers or nurse

Role of RN/BSN

direct patient care

Training for Case Manager

Bachelors Degree (often in nursing, healthcare administration, social work

Role of Case Manager

Assess healthcare needs and ensure that resources are in place to supply these needs

Can work inpatient, outpatient, home care

Training for PT

Doctorate

Training for OT

Masters

Training for ST

Master

Training for RT

Minimum associates

Role of Rehab Team

Provide assessment of patient’s therapeutic needs specific to their specialty and administer treatment

Who is a part of the rehab team

PT

OT

ST

RT

Training of Dietitians

Bachelors degree and Dietetics Internship

Role of the Dietitian

Provide assessment of patient’s dietary and caloric needs and administer treatment (TPN management)

Provide patient counseling

What PA schools were started by the federal goverment early in the profession

U.S. Public Health Service Hospital in Staten Island

Federal Bureau of Prisons in Springfield Missouri

When did the PA program from US Public Health Service Hospital begin

1966

Public Health Service Title VII

utilize state and federal grants to in part fund their programs

When did PA programs all programs converted into Master’s

2020

What tools do schools use to predict PANCE success

SAT

GRE

Minnesota Multiphasic Personalitiy Inventory Scores

GPA

Health Experience

What has been shown to be the best predicotr for success in PA school

long-standing accreditation performed significantly better than newer programs

What does DeSales require to apply to the PA program

500 hours of patient contact

Association of Postgraduate PA Programs (APPAP)

A membership organization for programs for post-grad PA training

Post-Grad Education for PAs

Like post-graduate residency program

Sponsored by some hospitals

Typical duration is 6-12 months

Who accerdits Post-Grad Programs for PA

ARC-PA

National Commission on Certification of Physician Assistants (NCCPA)

The organization who deals with national certification of PAs

Physician Assistant National Certifying Examination (PANCE)

The standardized exam for licensing PAs

How is PANCE structured

Multiple choice, computer administered

Five sections of 60 questions each, each lasting 60 minutes

=

PA-C means that a person has

Graduated from accerdited PA program

Passed the PANCE

How long are NCCPA certificates last

2 years

What are the requirements for maintaining NCCPA certificate

100 hours of CME every 2 years

What types of CME does NCCPA encourage

Peformance Improvement

Self-Assessment

Self-Assessment CME hours differ by other CME by

Getting awarded 50% extra (1hr = 1.5 hr)

How will Performance Improvement CME differ from other type

First 20 hours are double credit

How is CME awarded for precepting studnets

2 credits per 40 hours preception

Performance Improvement CME

Systematic approach to planning, implementing, and assessing quality improvement in the clinical practice setting

What does NCCPA accept as Performance Improvement CME

Activities designated as AAPA Category I PI-CME credit

Category I activities accepted for Part 4 MOC credit by an ABMS-member board

Category 1A activities accepted for Component 4 OCC credit by the American Osteopathic Association,

ABMS Multispecialty Portfolio Program activities

Self Assessment CME

The active process of a systematic review of one’s performance, knowledge base or skill set

What does NCCPA accept as Self-Assessment CME

AAPA Category 1 Self-Assessment Credit by AAPA

Physician Assistant National Recertifying Examination (PANRE)

A recertification exam for NCCPA

How frequently does PANRE need to be taken

Every 10 years

How is PANRE formatted

Composed of 240 multiple choice questions arranged in 4 blocks of 60 minutes each

Core Medical Knowledge (NCCPA Def)

the essential, foundational knowledge and cognitive skills required for PAs to provide safe and effective care for patients across the lifespan and across the spectrum of medicine, regardless of the specialty or area of practice

PANRE-LA

An alternative to the PANRE where 25 questions are given in quarters for 2 years, making up 200 questions

When do you apply for PANRE-LA

Year 6

Certificates of Added Qualification (CAQ)

NCCPA speciality certifications for PA

What specialities have CAQs

Cardiovascular/Thoracic Surgery

Dermatology

Emergency Medicine

Geriatric Medicine

Hospital Medicine

Nephrology

ObGyn

Occupational Medicine

Orthopaedic Surgery

Pediatrics

Palliative Medicine and Hospice Care

Psychiatry

Criteria for Obtaining a CAQ

Current PA-C certification

Possession of a valid, unrestricted license to practice as a PA in at least one jurisdiction in the United States or its territories, or unrestricted privileges to practice as a PA for a government agency

At least 75 credits of Category I specialty CME (25 within 2 years)

One to two years of experience

Procedures and patient case experience appropriate for the specialty

A specialty exam.

What originally developed the idea of PAs

inadequate healthcare

Feldshers

Russian field surgeons that were introduced to the army in the 1650s (Similar to PA)

feldsherism

policy of using non-physician providers for primary care in developing countries

Barefoot Doctors

Non-physician providers that worked on farming fields in China in the 1960s

Practicante

Non-physician providers in Puerto Rico in the early 1900s to provide rural care