Legislative Activity

Implementing Act 101 and 101 Countersignatures

The State Board of Medicine / State Board of Osteopathic Medicine are implementing changes to effectuate Act 100 /101 of 2013 (related to physician requirements for countersigning patient records completed by a physician assistant). Physicians who currently have a written agreement with a physician assistant, and who wish to change their current countersigning practice, must submit a written agreement change form and have the change approved by the Board. Physicians who are entering into a new written agreement will see the statutory amendment reflected in the new application form.

Prior to the enactment of Act 100/101 of 2013, a supervising physician was required to countersign 100% of the patient records completed by the physician assistant within a reasonable time, not to exceed ten days. Under the new rules, 100% countersignature within 10 days will be required only during each of the following time periods:

  • The first 12 months of the physician assistant’s practice post-graduation and after obtaining licensure.
  • The first 12 months of the physician assistant’s practice in a new specialty.
  • The first 6 months of the physician assistant’s practice in the same specialty under a new primary supervisor (unless, the new primary supervisor was registered as a substitute supervisor for at least six months under another written agreement).

If after the required time frames listed above, the supervising physician wishes to deviate from the 100% chart review, the supervising physician must complete and submit a written agreement change form, including specific details regarding how patient records will be selected for review and how often patient records will be reviewed.

This information should include specifics such as type or percentage of patient charts that will be reviewed, specific types or categories of patient cases that will be reviewed, and the review schedule, etc. In addition, the supervising physician must affirm that the review plan is sufficient to assure adequate review of the physician assistant’s practice.

Deviation from 100% review of patient records within 10 days will require Board approval.

The supervising physician will need to continue to perform 100% review of patient records within 10 days until the Board approves the amended written agreement.

Countersignature requirements in a facility are under the jurisdiction of the facility bylaws, the Pennsylvania Department of Health’s Health Care Facility Act, and The Joint Commission. Maintenance of 100% countersignature may still be required in your setting. The medical staff office, facility compliance office or the lead PA would be your resource for those details. A facility’s bylaws can be more restrictive than the state regulations for PA practice.

The written agreement change form can be found on the Medical Board’s website at www.dos.state.pa.us/med or the Osteopathic Board’s website at www.dos.state.pa.us/ost within the list of Board applications.

Acts 100 / 101 formalize the temporary authorization practice provision process as well.

The Acts approved a temporary authorization for Physician Assistants to practice pending formal approval of the “Application for Registration as a Supervising Physician.”

Upon submission of the application, Board staff will review the application only for completeness and issue a letter to the supervising physician providing the temporary authorization for the physician assistant to begin practice. If the application is not “complete” (i.e., required signatures are not provided, information is missing, fee is not included, etc.), a temporary authorization for the physician assistant to begin practicing will not be issued.

The temporary authorization, when issued, will provide a period of 120 days during which the physician assistant may practice, under the terms set forth in the written agreement as submitted to the Board. While practicing under the temporary authorization, the supervising physician shall countersign 100% of the patient records completed by the physician assistant within a reasonable time, which shall not exceed ten days. Within 120 days, the Board will notify the supervising physician of the final approval or disapproval of the application. If approved, a final approval of the written agreement will be issued to the Supervising Physician. If there are discrepancies that have not been corrected within the 120 day period, the temporary authorization to practice will expire.

Please note: The primary supervisor’s responsibilities also include:

• Providing a copy of the final Board approved written agreement to all substitute

supervisors.

  • Maintaining a current list of all locations where the physician assistant will perform duties.
  • Maintaining a current list of all substitute supervisors under which the physician assistant will work.
  • Notifying the Board of changes to the primary practice location utilizing a written agreement change form.
  • Ensuring that the physician assistant will not practice without supervision by either the primary supervisor or an authorized substitute supervisor.

The complete language for Act 100 / 101 can be found on the PSPA website, www.pspa.net under the Governmental Affairs tab legislative section. A reference table describing the implementation of Act 100 and 101 can also be found in the same section of the PSPA website. It is highly recommended that all PA’s confirm receipt of the temporary and final approvals from the Board(s) and retain a copy for your own file.

Sincerely,

Mark DeSantis, PA-C Gerry Grega, PA-C

PSPA Governmental Affairs Committee Chair PSPA President

House Bills Become Law

The PSPA is proud to announce that the House & Senate voted in favor of House Bills 1348 and 1351 giving supervising physicians the option to eliminate countersignature! The bills were signed by the Governor on November 26th and will become effective 60 days from the time of signature.  As you may remember, the PSPA negotiated a deal with the Pennsylvania Medical Society to amend countersignature as follows:

The supervising physician must countersign 100% of patient records completed by the PA within 10 days:

1) For the first 12 months post-graduation and until initial licensure

2) For the first 12 months in a new specialty

3) For the first 6 months in the same specialty but new practice

The supervising physician written agreement needs to contain a statement that indicates the number, (if any), frequency and criteria for chart selection for physician review after the 100% requirement timeframe has passed.

The bills also delineate the time frame for the Boards to review applications and work agreements. The language reads as follows:

“Upon submission of the application, board staff shall review the application only for completeness and shall issue a letter to the supervising physician providing the temporary authorization for the physician assistant to begin practice. If the application is not complete, including, but not limited to, required information or signatures not being provided or the fee not being submitted, a temporary authorization for the physician assistant to begin practicing shall not be issued. The temporary authorization, when issued, shall provide a period of 120 days during which the physician assistant may practice under the terms set forth in the written agreement as submitted to the board. Within 120 days the board shall notify the supervising physician of the final approval or disapproval of the application. If approved, a final approval of the written agreement shall be issued to the supervising physician. If there are discrepancies that have not been corrected within the 120- day period, the temporary authorization to practice shall expire.”

It will be extremely important that particular attention is paid to completing the application correctly so that the temporary authorization may be granted.  The process since its inception last spring is taking anywhere from 3-10 days on average as long as the applications have been completed correctly.  We suggest that you review the application yourself before it is submitted by the office manager, facility administrator or supervising physician.  The more eyes that see it, the less chance of the application being rejected for incompleteness.

The Boards are currently working on the implementation process.  Until that process is in place, countersignature of PA charts must continue as usual.  Stay tuned for further information.

LEGISLATIVE ACTION CENTER

Visit the AAPA Legislative Action Center to find out who your state and federal legislators are and what important legislation is pending.

Legislative Alert Letter February 15, 2014

Implementation of Act 100 and Act 101 Countersignature modification and temporary authorization to practice table

Act 100 / House Bill 1348: Countersignature modification and temporary authorization to practice under the State Board of Medicine
Act 101 / House Bill 1351: Countersignature modification and temporary authorization to practice under the State Board of Osteopathic Medicine

Bill summary
The PSPA is proud to announce that the House & Senate voted in favor of House Bills 1348 and 1351 giving supervising physicians the option to eliminate countersignature! The bills now move on to the Governor’s office for signature. They become effective 60 days from the time of signature. As you may remember, the PSPA negotiated a deal with the Pennsylvania Medical Society to amend countersignature as follows:

The supervising physician must countersign 100% of patient records completed by the PA within 10 days:

  1. For the first 12 months post-graduation and until initial licensure
  2. For the first 12 months in a new specialty
  3. For the first 6 months in the same specialty but new practice

The supervising physician written agreement needs to contain a statement that indicates the number, (if any), frequency and criteria for chart selection for physician review after the 100% requirement timef rame has passed. The legal Counsel for both boards have been modified the written agreement change forms at this time. In order to modify your present requirement for 100% countersignature within 10 days, the new written agreement change form will need to be approved by the board.

The bills also delineate the time frame for the Boards to review applications and work agreements. The language reads as follows:

“Upon submission of the application, board staff shall review the application only for completeness and shall issue a letter to the supervising physician providing the temporary authorization for the physician assistant to begin practice. If the application is not complete, including, but not limited to, required information or signatures not being provided or the fee not being submitted, a temporary authorization for the physician assistant to begin practicing shall not be issued. The temporary authorization, when issued, shall provide a period of 120 days during which the physician assistant may practice under the terms set forth in the written agreement as submitted to the board. Within 120 days the board shall notify the supervising physician of the final approval or disapproval of the application. If approved, a final approval of the written agreement shall be issued to the supervising physician. If there are discrepancies that have not been corrected within the 120- day period, the temporary authorization to practice shall expire.”

It will be extremely important that particular attention is paid to completing the application correctly so that the temporary authorization may be granted. The process since its inception last spring is taking anywhere from 3-10 days on average as long as the applications have been completed correctly. We suggest that you review the application yourself before it is submitted by the office manager, facility administrator or supervising physician. The more eyes that see it, the less chance of the application being rejected for incompleteness.

House Bill 1251: Expansion of ratios under State Board of Medicine
House Bill 1252: Expansion of ratios under State Board of Osteopathic Medicine
House 1804: Expansion of scope and Malpractice limits under State Board of Medicine
House 2088: Expansion of scope and Malpractice limits under State Board of Osteopathic Medicine

WHY “PA” SHOULD ALSO STAND FOR “POLITICAL ACTIVIST”

We are all impacted on a personal level by political decisions – decisions that affect things like our civil rights and the taxes we pay. In addition, PAs are affected professionally by politicians who pass laws, and by political appointees who regulate the PA profession. Most importantly, laws and regulations affect your patients. Every PA has had a patient whose most pressing need was not a different drug or a new therapy, but a change in the law. It is therefore the special obligation of PAs to understand the political process and use that knowledge to advance the interests of their patients and their profession.

There are many different ways that politics impacts the PA profession. State laws, which are the result of a long and sometimes grueling political process, can govern everything from which patients are covered by Medicaid to how many PAs a single physician may supervise. Before Pennsylvania’s legislators passed a law to license physician assistants in 1978, PAs weren’t even allowed to practice here. PAs should know how to work with the legislators who vote on those laws.

The first step is to stay informed. Read the newspaper and keep up with the state’s economy and political climate. Know what health bills are being considered by the legislature and the implications of those bills on health care. The most basic duty of any citizen in a democracy is to vote, and understanding the issues is a prerequisite to casting an informed vote. But knowing the issues backwards and forwards also allows you to take the next political step, which is to influence others.

Introduce yourself to your state legislators, and communicate with them on health care topics when your expertise could be valuable. If you can provide advice to a state senator on public health issues, such as smoking bans or bicycle safety laws, you will find a much more receptive audience when that PA supervision bill is up for consideration down the road. You could also work on a campaign for a candidate who shares your positions on important issues, or even run for office yourself.

Running for office is the pinnacle of political activity. As a PA, you may already know many of the people in your community because they are your patients, hospital or clinic staff and colleagues. You also have a deep understanding of the health care issues that are important to your community, and few issues are more important to voters than health care. You don’t necessarily have to give up clinical practice to run for political office – many governmental positions are compatible with continuing in full time clinical practice – but serving as an elected official gives you the opportunity to influence the health of your community on a much wider scale.

Along with laws passed by elected officials, PA practice is also governed by regulations adopted by appointed officials. Medical Board regulations, along with regulations from other agencies, often impact the PA profession at least as much state laws do. Unlike legislators, who must deal with the entire spectrum of public issues, regulators are focused on one specific area – in this case, medicine – and as such are expert in their field. Nevertheless, it is important for PAs and PA organizations to communicate with regulatory agencies. Attend medical board meetings if they are open to the public and submit comments on proposed regulations.

While it is possible to do these things as an individual, working through a group of PAs like PSPA is much more likely to carry weight with political actors. Working through an organization allows PAs to establish institutional relationships with other health care players in the political process, such as state medical societies and nursing groups. While PAs and other health care professionals may not agree 100% of the time, you’ll find that working together when there is agreement diminishes the frequency and intensity of disagreements on more controversial issues.

As published in the Summer 2009 PSPA News

HOSTING A LEGISLATOR AT YOUR PRACTICE

One great way to educate elected officials is to invite them to your practice. Hosting a legislator is not only a useful way of informing office holders about the issues that are important to you and the patients you serve. It can also help you build a relationship with that legislator, which can be helpful down the road when you want to express an opinion about health care legislation that is being considered.

Here is a step-by-step guide that you can use if you want to host a state legislator at your practice:

  1. Check with your clinic administrator and supervising physician to be sure they approve. Discuss ideal dates and times.
  2. Do some background research on the legislator. You can usually find biographies on state legislature Web sites. If you are having trouble getting information on your legislator, contact David Ashner on the AAPA staff at dashner@aapa.org. If you find that your legislator has a particular interest that is relevant to your clinic (i.e. care for the elderly, women’s health, care for recent immigrant populations), be sure to emphasize that during the visit.
  3. Contact the legislator or a member of his or her staff either by letter or phone. If this is after an election, congratulate them on their success and invite them to see “health care in action” at your clinic. Your message should be that you know health care is an important issue to them, and you’d like to give them the opportunity to see where health care is provided in their district and to discuss some of the challenges facing health care providers and their patients. Make sure that they know that you are a physician assistant and that they are aware of any PA-related bills that will be debated in the coming legislative session.
  4. Confirm a date and time for their visit. Thirty minutes to an hour should be sufficient.
  5. Prepare materials to give to the legislator. AAPA has fact sheets and issue briefs on a wide variety of topics, and Academy staff can help you pick the right materials for your situation. These materials are also available at AAPA’s Web site. Giving the materials to the legislator in a file folder with “Physician Assistants” printed on the tab will make it easy for the legislator to put the information in the right place once he or she is back at the office. Be sure to include your contact information or business card.
  6. Spiff up the office and alert the staff. Consider making a “Welcome Representative/Senator _____” banner or poster for the office.
  7. Invite the media, if it’s okay with the office administrator and your supervising physician. Also, be sure that inviting the media is acceptable to the legislator. If everyone agrees, contact David Ashner (dashner@aapa.org) on the AAPA staff for information on making the visit a media event.
  8. Make a detailed schedule for the visit. Here’s a sample agenda:
    9:00 – Legislator arrives, PA host greets the legislator, introduces staff and physicians, and introduces the legislator to patients in the waiting room.
    9:10 – Tour of office and description of population served, special interests and roles of clinic staff. Be sure to mention any areas of particular interest to the legislator (i.e. “Dr. Jones is board certified in geriatric medicine,” or “Mrs. Miller is both our receptionist and our translator”).
    9:20 – Legislator, PA, and physician convene in conference room or office to discuss health issues in district. Coffee is served. Legislator is invited to share his or her health agenda for upcoming session and discuss other issues of particular interest. The PA’s role in the clinic is described by the physician-PA team. Physician discusses the importance of PA legislation (if applicable) to the legislator’s constituents (remember that the message must be about why the PA legislation is important to the legislator). Clinic group asks how they might help the legislator with health issues the legislator has identified. Someone takes notes for follow-up.
    9:30 – Media (if invited) arrives. Clinic staff and legislator pose for photos. Legislator is given opportunity to discuss health issues and the importance of the visit. If the media is not invited, have a staff person available to take pictures.
    9:45 – Legislator is thanked by everyone for taking time from his or her busy schedule to visit. Additional photos of legislator at clinic and with staff are taken.
  9. Host the visit.
  10. The same day – Contact your chapter’s Legislative Coordinator to review the visit.
  11. The next day – Check the media for any mention of the event.
  12. Two days later – Send a personal note thanking the legislator for the visit and include copies of photos.
  13. The following week – Begin follow up on any items mentioned by the legislator.

So, there you have it: it’s as easy as one, two, thirteen. Remember, personal experience is the most significant motivator for legislators. Hosting a legislator at your practice takes less than an hour, but the experience of meeting a PA will stay with them for years beyond.


GET TO KNOW YOUR LEGISLATOR

The PSPA is embarking on a public education plan involving the state senators and representatives for the Commonwealth of Pennsylvania. The message behind the campaign is to help educate these legislators about the concept of the Physician Assistant.

A standardized packet of information will be prepared for each legislator. A PA in their legislative district will be contacted to deliver this packet of information to their local office. Scheduling an appointment will potentially ensure that the PA may be able to have some time to meet with the legislator or their aide. By being one of their constituents who would be familiar with the health care market for their area, a greater impact will be made. The topic for discussion is the education and utilization of Physician Assistants. By providing this basic information, the legislator will gain a working knowledge of PAs. As health care legislation crosses their desk, they may review it with a better understanding and a more open eye.

In those instances where the PA is unable to make a visit because of time restraints, a phone interview with the legislator followed by a letter on your office letterhead may be a step in the right direction. That legislator may contact you in the future for input on health related issues or legislation. In that event, a PSPA staff person would be available for assistance or to possibly accompany you on any needed meetings.

Now is the time to approach our legislators and make them our allies. Accurate information and a firm handshake may prove invaluable in the future.

Please volunteer for the Get to Know Your Legislator Campaign!

GOVERNMENTAL AFFAIRS NEWSLETTER ARTICLE

Scope of Practice Expansion wins Approval

Just before summer recess, the House and Senate approved our scope of practice expansion bills. It didn’t happen though without some political wrangling. We were cruising along just fine, having passed the house on a unanimous vote when suddenly we were picked up on the trial lawyers radar. Over the years we have managed to fly under that radar, but our luck ran out. Their group is powerful enough to cause a fair amount of havoc should they choose to do so. What caught their interest was the fact that we were asking for an expansion in our scope of practice, and that translates into increased risk. I did argue that what was being expanded hardly increased our risk of malpractice, but expansion of scope is expansion of scope in their eyes. They wrote to the respective legislative committees stating that they would block passage of our bills unless there was language placed in the legislation specifying minimal requirements on malpractice coverage for physician assistants.

All along, we have tried to keep this kind of language out of our legislative initiatives. But their request was supported as reasonable by the Medical Society and the Hospital Association. And as luck would have it, we had 48 hours to either accept minimal malpractice coverage limits or our bills would be dead in the water. This scenario takes me back to 1993 when we had to accept the “every third visit rule” or lose our proposed allopathic prescribing legislation.

The Governmental Affairs Committee and the PSPA board of directors contemplated the pros and cons of the minimal limits and in the end decided to accept the language in order to expand our scope of practice. The language calls for coverage in the minimum amount of one million dollars per occurrence or claims made. This was not a decision taken lightly by everyone involved. We understand that this may cause some hardship for certain individuals. Given the circumstances, the committee and the Board felt we had no choice other than to go forward. Since 2008 is a biennial license renewal year, the boards will require that we send proof of insurance at the minimum levels when we renew our licenses this fall.

One of the bigger headaches that our bills address is the ability to order physical/occupational and respiratory therapy. Their respective acts are being amended to allow them to accept our orders. The bills are included in this newsletter.

The Society hopes that our decision doesn’t create a great deal of hardship for our members. We act with the best interest of everyone in mind, but sometimes we are faced with tough decisions such as these. As our profession continues to grow and play an ever more important role in the delivery of health care in Pennsylvania, we are going to on the radar of an ever-increasing number of organizations.

HOUSE BILLS FAIL TO PASS IN 2011-2012 SESSION

In a disappointing ending to the 2011-2012 legislative session, House Bills 1832 and 1833 failed to move out of the Senate Professional Licensure Committee. As you know, these bills sought to eliminate countersignature of our charts and change the written agreement process with the state boards from an “approval” process to being “filed” with the boards. The Society and our lobbyists’ spent a full year garnering support for these bills before their introduction. We had the backing of many groups as well as the Pennsylvania Medical Society. In the late summer, the Medical Society pulled their support after concerns were voiced by several Board of Trustee members. This came as a complete surprise to not only the PSPA but the Senate Professional Licensure Committee (SPLC). Alternative language was then developed in an attempt to salvage the legislation. We met with the Medical Society in an attempt to change their minds, but were unsuccessful. Without their support, the bills did not move out of the SPLC.

In October of every year the leadership of the Medical Society changes. Their newly elected president has voiced the desire to work with us in developing amenable language. We will be working on that over the next few months and reintroduce legislation next year. As with the previous legislative session, you and your supervising physician will be asked to once again write letters in support of our new bills. Watch your email, snail mail, PSPA web site and this newsletter for further information. Thank you for your continued support of the Society. We will persevere in making the necessary legislative changes to advance the PA profession and the physician/PA team.

Please complete our survey so that we may be able to better understand the challenges you face as a PA in Pennsylvania. Thank you.

UPCOMING LEGISLATIVE AGENDA 1-2011

Upcoming Legislative Agenda
As we begin 2011, the PSPA is preparing to embark on another 2-year legislative session. Republicans have taken control of the house and senate and we have a new republican Governor. Our legislative agenda includes making the necessary changes to our regulations that put us in line with the AAPA’s six key elements that should be found in state regulations. Pennsylvania already has three of the key elements in place and we are looking add the other three.

Issues we are planning to address are:
1. Changing our work agreements from “approved” to “filed” with the Boards of Medicine and Osteopathic Medicine. This would allow PAs to begin working immediately once their paperwork has been submitted to the boards.
2. Removal of counter-signature requirements in all practice settings
3. We will also be working on allowing PAs to sign state and municipal police physicals, day care and foster care physical forms, as well as amending the Public Utility Commission regulations to allow PAs to sign emergency shut off forms.

The legislative and regulatory session is 2 years in length. Completion of our goals will hopefully take less than the full two years. We will notify you when we need you and your supervising physicians to write letters of support to your legislators. Now is a good time to introduce yourself to your representative and senator for your district. Let them know what a good job you do providing care to their constituents. You don’t have to mention our agenda or discuss politics, just let them know who you are and that you are available to answer questions if needed.

Finally, and as always, your input and suggestions are appreciated to help us identify other barriers to practice. Please contact the PSPA office if you have further suggestions.