The Monitor - April 2021

President's Message
A Legislative Update

We are monitoring the bills below. This legislative session with adjourn on April 25, 2021.

2021 Legislation Updates and bills WAPA is supporting:

HB 1196 – Reimbursement for Audio-only Telemedicine – PRO

• Residents across the state lack quality access to broadband to participate in video visits.
• Some patients are unable to afford smartphones or computers to access telehealth services as well.
• Some patients, especially the elderly, struggle to manage video chats but can easily manage a phone call.
• Update: The bill passed the Senate Committee on Health & Long Term Care on 3/26 with an amendment that directs the telemedicine collaborative to study the need for an established relationship before providing audio-only telemedicine and report to the Legislature by December 1, 2021. Under the current bill, the audio-only telemedicine reimbursement requirement applies only if the covered person has an established relationship with the provider, beginning January 1, 2023. The amendment also clarifies that Medicaid patients will not be billed for audio-only telemedicine visits. The bill received a public hearing on 3/31 in the Senate Ways and Means Committee and is scheduled for executive action on 4/2. It is possible additional changes will be made by this committee.

SB 5169 – PPE Costs Reimbursement for Providers – PRO

• Smaller institutions have higher costs for obtaining PPE, this would benefit the rural clinics and critical access hospitals in our region.
• Update: The bill had a public hearing in the House Committee on Health Care & Wellness on 3/15 and passed out of committee unanimously on 3/17. The bill has remained in the Rules Committee for the last two weeks. It has until 4/11 to pass the Senate.

HB 1197 – PA Participation in Health Care Informed Consent – PRO

• Allows a patient, while competent, to designate a health care proxy by informing physicians, NPs, or PAs, who would then be required to sign and enter the information into the patient’s health record.
• Allows patients plan for emergencies, and allows PAs to record this information, making it easier on patients whose primary care provider is a PA.
• Update: The bill received a hearing in the Senate Committee on Law & Justice on 3/25 and was scheduled for a vote but failed to gain enough support to pass from the committee before the cutoff deadline.

SB 5246 – Increased Medicaid Reimbursement – PRO

• Improves reimbursement for services rendered by all medical providers, including PAs and NPs for persons, who are covered by Medicaid.
• Update: This bill failed to advance, but funding for this change was included in both the House and Senate budget proposals and is likely to be maintained in the final budget.

HB 1141 – PA Participation in Death with Dignity – PRO

• Current law allows only physicians to assist patients with end-of-life decisions. This bill allows PAs and NPs to perform the duties of an attending of consulting medical provider.
• In many rural settings, PAs and NPs are the sole Primary Care Provider for patients who have no or few physicians available for consultation. PAs and NPs in these roles know the patients much more intimately than their physician colleagues.
• Update: The bill received a public hearing in the Senate Committee on Health & Long Term Care on 3/17. WAPA signed in PRO and helped coordinate supportive written testimony. WSMA testified in opposition. There were concerns that this bill lacked the support to pass committee and WAPA organized outreach to legislators to support the bill. During executive action, concerns about PAs being able to provide this care were expressed by one senator. The bill passed committee and WAPA is working with other stakeholders to support the current version of the bill as it advances.

SB 5149 – Funding Foundational Public Health Services – PRO

• Helps build infrastructure and capacity for foundational public health systems, which have been underfunded in recent years, and have lacked the resources to respond to the pandemic.
• Update: The bill failed to advance and was not assumed in either the House or Senate budget as a mechanism to fund public health. Instead, both budgets funded public health out of the state general fund. The bill is not likely to advance.

5068 - Extending Coverage During the Postpartum Period – PRO

• Creates one year of postpartum coverage through Apple Health, improving patient care.
• Update: After passing from the House Appropriations Committee on 3/22 without amendments, this bill was sent to the Rules Committee. It passed from committee and is now eligible to come to the floor for a final vote in the Senate in the near future.

5140 Protecting Pregnancy and Miscarriage-related Patient Care – PRO

• Prohibits health care entities from restricting health care providers from providing services related to pregnancy complications that meet the standards of care.
• Update: The bill passed the House 57-41 on 3/24. The bill will need to go through the concurrence process since amendments were adopted by the House. The Senate will have the opportunity to concur with the changes made by the House or ask the House to rescind their changes.

HB 1129 – Limited licensure of International Medical Graduates – CONCERNS

• Creates a limited license for international medical graduates to gain clinical experience in Washington State so they can increase their likelihood of securing a residency.
• We have concerns about what will happen to limited license IMGs who are unable to secure a residency after their limited license expires.
• Update: The bill passed the Senate Committee on Health & Long- Term Care with an amendment that allows any appropriate medical practice located in Washington to nominate a qualified international medical graduate for a limited license. It also adds osteopathic physicians to those who may supervise an international medical graduate holding a limited license. The bill is now in the Rules Committee.

SB 5229 – Health Equity Continuing Education – NEUTRAL

• Directs the boards and commissions of all health professions to adopt rules establishing a health equity CME requirement. This will help provide health care professionals with tools to care for patients of diverse identities and backgrounds and to be knowledgeable about issues such as cultural sensitivities, patterns of disparities, and implicit bias, all of which can impact patient care and health outcomes.
• We would like to ensure that adequate employer sponsored health equity training can satisfy the training requirement.
• Update: The bill passed the House 57-41 on 3/24 and will go to the Senate for concurrence since the House amended the bill to partially delay implementation until 2023.

SB 5370 – Mental Health Advanced Directives – PRO

• This bill makes changes to the mental health advanced directives statute.
• NPs and PAs were removed from an early iteration of the bill but have been reintroduced. WAPA supports the inclusion of PAs in the final version of the bill.
• Update: The bill passed the House Committee on Health Care & Wellness on 3/24 and is in the Rules Committee. In committee, one amendment was offered but failed to pass. The amendment would have restored language that provides the option that if a declarer's spouse is an agent, the spouse remains the agent even if the declarer and the spouse become legally separated or divorce, unless there is a court order to the contrary or the declarer has remarried.

SCR 8402 – Extension of Executive Orders (including Delegation Agreement Suspension) – PRO

• This will reduce red tape and administrative burdens to allow improved access to care, especially for rural communities.
• Update: This SCR passed the Legislature on January 18th.

The Monitor - Summer 2020

PDF of Summer 2020 Newsletter

Physician Burnout, Interrupted

The Monitor - Winter 2020

PDF of Winter 2020 Newsletter

The Monitor - November 2019

MESSAGE FROM THE WAPA PRESIDENT

Dear Colleagues,

WAPA is aware that there are continued delays in the hiring of Physician Assistants as they wait for credentialing finalizations in their applications to practice.

WAPA has been in communication with Kimberly Romero at the Medical Commission to address the delays and we have been assured that the Commission is working diligently to clear the backlog, with the goal of being caught up in the month of November.

Incomplete information on the delegation agreements (DA) along with failure to apply for licensure at the same time the DA is sent, has only compounded the delays in these applications. It is critical that PAs apply simultaneously to expedite credentialing.

The current legislation: SB 5411, we hope to pass this session will place the DA at the practice site and allow for flexibility if your supervising physician changes or the PA changes employment. This will eliminate the burden of DA approval from the Commission with the exception of licensure. The Commission is in full support of this change.

Join WAPA and your colleagues in passing this crucial legislative change by attending our PA Lobby day on February 5th. Appointments will be made by WAPA for Legislative Day in Olympia at our capital. If you cannot attend, consider writing to your representative in support of SB5411.

Please continue to email WAPA regarding your concerns so we can advocate on your behalf. If you are not a member, please join today! We cannot work on behalf of Washington PAs without your membership dues.

Eileen Ravella, PA-C
President

PA LOBBY DAY

February 5, 2020
Olympia Washington
Governor Hotel-621 South Capitol Way

Physician Assistants of Washington. Please save this date and join us on our 2nd PA Lobby Day.

More Information

Register Today!

2019 WAPAs 1st PA Lobby Day

……from the Editor

The Monitor is changing delivery to you at your request. PAs have asked for more frequent contact on issues that involve them and their practice, as well as newsworthy events facing PAs in the State of Washington. Thus, we are happy to bring our members publications every other month starting with the newsletter you are now reading.

We would also like to start featuring, along with the AAPA campaign of, “PAs do That!” and would love for you to send your photos in with doing what PAs do on the job, as volunteers, in labs, on calls, etc. Please email them to [email protected]

Thank you and we look forward to hearing from you!

Tei Habenicht, PA-C
WAPA Newsletter Editor

WAPA CME Programs

April 25-28, 2020: Join us this spring at the Seattle Airport Marriott Hotel for over 30 hours of category I CME plus new workshops and events. You won’t want to miss this conference! Online registration will be open December 2, 2019. Visit us online next month for a schedule and more information. www.WAPA.com

October 29-31, 2020: Our fall program will be at Suncadia Resort in Cle Elum (90 miles east of Seattle). Join us for some great lectures while taking in the magnificent natural beautiful surroundings. The lodge has spectacular river valley and mountain views! Learn while relaxing in this majestic retreat.

Get vaccinated now!

That’s the message from Washington Department of Health as we enter into flu season.

The flu vaccine is now available statewide at most pharmacies and health care provider offices. Everyone 6 months old and older, including kids, teens, pregnant women and healthy young adults, should get vaccinated.

The flu is a highly contagious disease that can cause severe, even deadly illness. Young children, pregnant women, people 65 years and older, and those with certain chronic health conditions are at high risk from complications of the flu. PAs as health workers and caregivers of babies and older adults should get vaccinated to protect themselves and those they care for.

In 2018, 241 people in Washington died from the flu and its complications.

Washington state provides all recommended vaccines – including flu vaccine – at no cost for kids through age 18. These vaccinations are available at health care providers across the state. Providers may charge an office visit or administration fee, however a family who can’t afford the fee can request the fee be waived.

For help finding a health care provider or flu vaccine location, or to learn more about flu, visit www.KnockOutFlu.org

Washington State rules on Vaping/Tobacco use

Starting January 1, 2020, the Washington State Department of Health launches House Bill 1074; which will make it illegal to sell tobacco and vapor products to anyone under the age of 21. This follows an investigation into lung illness related to vaping, which had identified 12 cases statewide to date that led to an emergency rule banning the sale of flavored vapor products.

Teenagers were found vaping and using nicotine at alarming rates. In 2018, one in five Washington 10th graders and almost one in three 12th graders reported using vapor products (Healthy Youth Survey). Raising the legal age to 21, will help protect young people as their brains are particularly vulnerable to nicotine before this age, and in hopes to prevent developing a lifelong addiction to nicotine.

Our Featured PA: Randall Kelly PA-C

My Physician Assistant (PA) journey began at the University of Washington MEDEX NW program in Seattle, Washington. It was an amazing educational experience, as fellow students became colleagues and faculty advisers became mentors. Following graduation from MEDEX NW, my professional career as a Physician Assistant began in cardiothoracic and vascular surgery in Eastern Washington. This was arduous, but also extremely fulfilling; long hours equated to learning a great deal about surgery and medicine overall.

After several years, I elected to return to Seattle and began an amazing journey in Interventional and Vascular Radiology (IR). I loved working in IR, performing a myriad of surgical procedures, from port implants to myelograms to assisting in kyphoplasty procedures. Besides the joy I experienced with being in the operating room, I especially enjoyed the people I worked with. It felt amazing to work with a close-knit group of interventionalists, surgical technologists, sonographers, x-ray technologists, radiologists, clinical staff and more, at three separate hospitals in the Seattle area. It was very difficult to pull myself away from this professional place of bliss.

But a greater purpose called me. That purpose was based on love and family and after considerable resistance, I found myself returning to Eastern Washington, married, basking in family life and starting a journey in addiction medicine. I wasn’t quite sure what to fully expect upon joining a fast-growing addiction medicine practice. What I soon discovered was an area of medicine that brought me tremendous professional fulfillment.

For those that know me well, I tend to wear my emotions on my sleeve, and I discovered that addiction medicine was my calling in the next stage of my professional career. As amazing as it was to see countless hearts beating in the chests of patients in the operating room, it was equally amazing to emotionally connect with a person struggling in the throes of heroin addiction, guilt, depression, regret and saying things that help pull that person from a place of despair. As incredible as it was to perform the many image-guided surgical procedures, it was equally incredible to see a patient that voiced appreciation for my support and encouragement, as they have logged 3 days of sobriety. My adrenaline fix was fulfilled with these interactions.

In response to the many deaths associated with the opioid epidemic, federal laws have changed to allow PAs and Nurse Practitioners to not only prescribe special medications to treat certain substance use disorders, but recently, the number allowable has increased to match our physician colleagues. This is a game changer, as PAs continue to work to update PA practice laws in states across the country. So, as I look back on the near decade of my PA career, I’m thankful for the journey and for those shoulders I have stood on and those I continue to stand on today. Not sure what the next 10 years will look like, but I feel blessed to continue my calling; supporting and treating those struggling with substance use.

Randall Kelly, PA-C
WAPA Member and Region 2 Director

Equinox Clinic’s booth at a health fair. Randall Kelly and Rio McWilliams

HEAL WA - VisualDx

As a Washington Physician Assistant, you have access to VisualDx through HEALWA. Contact Patricia Devine at [email protected] for your access code.

VisualDx is a peer reviewed, award-winning diagnostic clinical decision support system designed to enhance diagnostic accuracy, aid therapeutic decisions, and improve patient safety.

VisualDx saves clinicians’ time and improves diagnostic accuracy. Use it to build and compare differential diagnoses, starting with a general medicine chief complaint. Check for drug reactions, consider treatment alternatives, and confirm findings. Included are therapy guidelines and resources.

Try it now!

[email protected] | https://heal-wa.org/