Message from the President - December 2017

Constance D. Huynh, MPH, PA-C, President

In my previous post in the WAPA Monitor, I stated that as president I wanted to hear from you to determine what kind of barriers you’re experiencing in your practice. I’ve heard from many of you, and the WAPA Board certainly has its hands full working on your behalf.

One of the first things I do when WAPA receives a request/concern/complaint/criticism is to classify it as national, state, or institutional to determine whether it is within the purview of WAPA to address. As one may surmise, most of the national issues are beyond our reach to change, but we can certainly support and advocate for them. With that in mind, here’s what we’re currently working on:

National Level: National issues including the repeal of the PANRE and Center for Medicare and Medicaid Services (CMS) reimbursement issues like Home Health. WAPA is a constituent organization of AAPA, and we support their current efforts to address these. Occasionally, a national issue arises out of the blue that takes everyone by surprise. WAPA recently learned that a school in Tennessee, Lincoln Memorial University, has developed a Doctorate of Medical Science (DMS) degree. The target candidate for this program include PAs with a minimum of 3 years of clinical experience. After 2 additional years of training, they are granted the DMS degree. The first class began this fall. This university has hired a lobbyist to approach state legislatures, including Washington, to petition for licensure in this state. As best we can tell, if implemented, these graduates would not practice as PAs, but would directly compete with us for positions as independent providers. Our lobbyist and I are meeting with this group shortly to determine exactly what they’re proposing. We’ll keep you posted.

State Level: Perhaps the greatest challenge WAPA faces right now is with the Washington State Department of Labor and Industries (L&I). Recently, the Nurse Practitioners petitioned L&I for 100% reimbursement, the same as physicians. I testified at a L&I hearing in August that while PAs did not object to the NPs being reimbursed at the same rate, to do so without raising reimbursement for PAs at the same time would place us at an unfair disadvantage in the market, as practices would selectively refer patients to NPs and/or only hire NPs for new positions. I’m including their response here. WAPA has received legal guidance stating we must bring our challenge to the denial to the Governor within 30 days. We/WAPA submitted a legal brief (click here to view the 15 page legal brief ). Submitted on November 23, 2016, the Governor would need to act by January 6, 2017. WSMA has also written a letter of support on this issue, (click here for the letter) If you or your practice sees L&I patients, we really want to hear from you.

*On January 6, 2017, the Governor denied our appeal. We will be discussing our next steps with our lobbyist at our 1/21/17 board of directors meeting.

Institutional Level: We’ve heard from many of you regarding barriers to practice ranging from confusion of policy for refill prescriptions to institutions who hire only Nurse Practitioners and will not consider qualified PAs. Within the last month, we learned from practicing PAs in three different Providence Health System institutions that a new policy has been instituted within their system requiring a 5 chart/week review and once a month meeting for PAs and their physician. New hires may require 10 chart reviews a month. Providence stated that this was driven by the Department of Health after a delegation agreement was rejected “because it did not spell out a specific plan for ongoing review.” Of course, this applies only to PAs and not NPs within Providence/Swedish System. Our lobbyist is in contact with representatives from the DOH to investigate this further.

It’s important to note that WAPA cannot change your institutional privileging, bylaws, or policy. However, we can and do meet with administrators and managers to provide guidance and clarify areas of misperception and provide opportunities for enhancement of PA practice. That, in turn, helps the practice run more effectively, and provides better patient care, outcomes, and satisfaction. That’s what we’re really here for after all.

Independent Practice: As a result of your input and the current state of affairs for PAs in this and other states, the WAPA board will be hosting a forum at WAPA’s Spring Conference to address the concept of full practice authority and responsibility. We plan to invite representatives from key players of our state’s organizations to begin discussions in earnest to address barriers to PA practice and the concept of independent practice for PAs in Washington State. This will be open to all conference attendees. I hope you’ll attend.

Contact me: [email protected]

Constance D. Huynh, MPH, PA-C