Visits to the Stead Center are by appointment only. Please call the NCAPA office for more information. Read More »

Visits to the Stead Center are by appointment only. Please call the NCAPA office for more information. Read More »

The Pulse | April 2014

In this issue:
President’s Message
Family Medicine
38th Annual NCAPA Summer Conference
Commercial Driver Medical Examiner Training
Make it Right
NCAPA Leadership Opportunities
Notes from the Office
For Students: NCAPA Endowment Scholarships
Endorsing Jeff Katz
CMS Releases Payment Data on PAs
ADULT IMMUNIZATION: Are YOU Meeting the Standards for Patient Care?
Palliative Care in Oncology – CME
Survey Shows Acceptance of PAs
PAs Can Be Essential in Stopping Drug Abuse
If Your Patient Was Using Drugs, Would You Know?

 

President’s Message

By Charlene M. Morris, DFAAPA, MPAS, PA-C

April 1st marked the first day of voting for national leaders with AAPA. Jeffrey Katz, a long-time leader of NCAPA whose policy expertise is next to none, is on the ballot as President-Elect. The other candidate, Vicki Chan-Padgett, is from Nevada and a former Air Force Officer and educator. Please join fellow members and cast your vote for this year’s election.

Remember that old saying “there is strength in numbers?” Those who have not rejoined NCAPA for 2014 may soon be receiving a telephone call from one of us. There are many benefits to being a member of NCAPA, from reduced conference and workshop rates, to discounts on review courses, insurance, and even scrubs.  We rely on our membership to enable us to advocate and lobby for important legislation.  I hope you will join me and encourage all PAs to renew. Thank you to Wanda Hancock and the membership committee for supporting and caring about NCAPA’s members, past, present and future.

NCAPA has now provided three Commercial Driver ME training courses, required prior to taking the certification exam. (And another one is coming up in May.) As much we may grumble about the requirements piled on us to continue doing what we have been doing, sometimes for decades, I took the training and learned a lot.  The new material and parameters protect all of us out on the highways. Kudos to NCAPA’s Marc Katz, Joshua Smith and Laura Geraghty for developing and presenting the course and keeping us awake all day!

Showcasing a medical specialty in the Pulse each month is something I would very much like to continue. Many students and new PAs need to hear of what we PAs can do in the vast landscape that is healthcare practice. If you would like to write a brief item on your specialty, please contact me or Kat Nicholas at NCAPA.  I have even developed a concise template to guide you and would gladly send that on to you. This month features the rewards of Family Medicine by Jeffrey Katz.

So the pollen has taken over our rural county and, with that, allergy sufferers and COPD patients have made their seasonal trek to our office. I promised that after this past horrid winter of cold, dark and snow that I would welcome any and all harbingers of Spring. I have delighted in the daffodils, the chirruping Martins and iridescent hummingbirds that return each year, and of course my garden gives me pleasure and good food. I have already harvested asparagus and my snow peas are well on their heliotropic journey!

With May flowers will come the AAPA meeting in Boston. I am honored to serve as chief delegate for NCAPA this year and look forward again to participating in the House of Delegates. For those needing CME, there are workshops and courses in a variety of specialties with an exhibit hall that usually requires a few day’s visit to behold. Of course, there is Boston with its many historical sites and self-paced History Trail that includes the famous North Church. “Pru Center” and its environs are always inspiring as I recall finishing the marathon there in 1986 and all those runners that came before and will continue many years hence. There are restaurants aplenty so you will never go hungry, including the Union Oyster House with seafood that has made Bean town famous. PAs and dignitaries from all over the US and several foreign nations will be attending. The energy and excitement at the annual AAPA conference is unparalleled. I hope to see many of you there.

Until we meet–

Charlene M. Morris

 

Family Medicine

By Jeffrey Katz, PA-C, DFAAPA

During my recent campaign for President-elect of the AAPA, I have frequently been asked how to encourage PAs to choose primary care. For over 23 years, I have practiced in rural family medicine, and I cannot imagine a better practice environment. Primary care PAs must communicate to PAs the gratification that we receive when working with our patients to address their health concerns.

Working within our current health care environment is stressful and frequently frustrating. Coordination of care is difficult when you do not receive records from specialists to whom you have referred your patient, or from ER and hospital visits. Patients frequently complain that the provider either did not listen to them or did not present information in a way that they could understand. Here is where primary care PAs can make a profound difference in our patients’ outcomes. I enjoy taking the time to break down medical jargon for patients who do not understand the term “cardiomyopathy” but can relate to the fact that their pump is not working efficiently. I receive daily faxes from insurers about my patients relating to medications that they have not taken. Yet the insurers have made no attempt to understand the reasons why patients are “noncompliant” with the standard of care. Perhaps the patient cannot afford the medication. Maybe they have experienced intolerable side effects.  Sometimes the patient simply cannot understand how the medication will help them or cannot even read the label.  Spending that extra few minutes inquiring about this can dramatically change patient outcomes.

Family medicine offers me the opportunity to inquire about the entire family and the struggles that they encounter. Imagine the grandparents caring for their grandchildren because the parents cannot or will not do so; the wife who is in an abusive relationship, but is unable to leave for whatever reason. I am gratified when a new mother, who I cared for as a child, brings her infant to me for care. It is heartwarming when a new patient reminds me that I cared for his mother over ten years ago and tells me, “I know if you were good enough for my Mom that I can trust you.”

I learned two important principles early in my practice; principles that I try to impress upon the PA students I precept. First, always be an advocate for your patient. Second, treat each person as you would want to be treated. Primary care PAs can follow through on these principles by working individually and collectively to ensure that all patients, no matter their race, gender, sexual orientation or economic status, receive the same high-quality, compassionate care.

 

New Workshops Announced!

38th Annual NCAPA Summer Conference

Embassy Suites, Kingston Plantation Myrtle Beach SC August 17-22, 2014

NCAPA has new workshops for the 38th Annual Summer Conference!  Here is what’s new for 2014:

EKG Boot Camp
Active Engagement Advanced Emergency Medicine
Commercial Driver Medical Examiner Training

Visit our conference information page to register for these exciting new options!

Click here for conference information and registration
Click here for hotel information and reservations

Don’t forget to make your hotel reservation soon!  Our room block is filling up.  You won’t want to miss out on our low negotiated rates!

 

Commercial Driver Medical Examiner Training

Ready to get certified? The Federal Motor Carrier Safety Administration (FMCSA) requires all medical examiners who wish to provide DOT/CDL exams to be trained and certified by May 21, 2014. The NCAPA training course is designed to follow FMCSA training guidelines and will prepare the medical examiner to pass the national certification exam. This course is approved for 6 hours of Category I CME*.

*This program has been reviewed and is approved for a maximum of 6.00 hours of AAPA Category I CME credit by the Physician Assistant Review Panel.  Physician assistants should claim only those hours actually spent participating in the CME activity.

Saturday, May 10, 2014 Cornerstone Healthcare, High Point, NC
Click here for conference information and registration

Friday, August 22, 2014 Embassy Suites, Myrtle Beach, SC
Registration Open Soon 

Can’t come to a training? NCAPA Commercial Driver Medical Examiner Training 4 DVD Set-PRESALE
The Commercial Driver Medical Examiner Training DVD series presented by NCAPA prepares medical examiners to perform CMV medical examinations according to the new FMCSA standards.  This DVD course includes 4 DVDs and a course workbook.  Upon completion of the DVDs, NCAPA will send you a Post-test to measure your knowledge of the material and prepare you for the FMCSA Medical Examiner Certification Test.  Purchase yours today!

 

Make it Right

By Wanda Hancock, Membership Committee Chair

There are many things in this world that are not equitable.  I, as many of you, have just prepared my taxes.  I was floored at the amount I am paying from my salary to support not only my own needs, but others’ needs as well.  It is a little disheartening to know that 2 ½ days a week are spent earning so others can have services, streets, food, funding and government representation.  Most of us are in the same position; these taxes are imposed, and there is little we can do to reduce them.  Our professional organization is different.  We PAs can have an impact.

The PAs licensed to practice in this state total almost 5,000. Currently, only about 1200 licensed PAs pay membership dues to NCAPA, plus we have about 600 student members. The sad part is that, in many cases, their practice will pay for those dues, but they choose not to participate.  They choose not to pay their dues and take an active role in our profession.  Consider the situation.  We provide the representation to make our practice laws better through legislative advocacy.  We support continuing education development.  We pay for the infrastructure to impact improved reimbursement for all PAs in the state.  We do all of this for those who choose not to participate.  There are seemingly very few, if any, working PAs who cannot afford dues to NCAPA, while all PAs reap the benefits.

NCAPA tries to make it right.  For those who have fallen on hard times and cannot afford to pay, we have relief for them in the form of approval based fee reduction.  For students, we offer a flat rate of $10 for membership the entire time they are in school.  New graduates are paying back loans and the cost of certification, so the cost of a one year membership is reduced by 50% for new PAs during their first year out of college. Even with our efforts to encourage membership in NCAPA, more than half of the PAs practicing in our state benefit from membership while not becoming members themselves. You and I carry the entire burden for this.  Yet, when PA reimbursement was low and our practice laws were not good, we had a greater percentage of practicing PAs who were actually members of NCAPA; they made things right for us.

The Membership Committee is actively making contacts with over 700 PAs who CHOSE not to renew their dues this year.  We are asking that you help us make it right.  Ask your PA classmate, co-worker, or friend if he or she is a member.  If they aren’t, ask them to participate.  Ask them to pay their share to move PAs forward and get the recognition we need and deserve in the healthcare arena.

If you are not at the table, you are lunch.  It takes money to be at the table.  That money comes from our dues.  The hard work and efforts are attributed to a handful of individuals who give limitless hours to make it better for us all.  While we would hope that all PAs would want to be involved and pay their share, the hard truth is that many need a nudge.  Help us provide that extra effort by individually asking all those you know to assist us in making our professional activities in North Carolina the best ever.  Ask them to choose to make it right.

 

NCAPA Leadership Opportunities

Current Board Vacancy

NCAPA has an opening on its Board of Directors for a limited term ending December 31, 2014.  This vacancy is due to current Director-At-Large Billy Collins taking advantage of a new job opportunity out of state.

The Bylaws call for the Board of Directors to fill Billy’s vacant seat, which they plan to do at the May 3rd Board meeting. The vacancy will provide an excellent opportunity for someone interested in participating in NCAPA leadership.  The Nominating Committee extends to Fellow or Associate members the opportunity to nominate yourself or another consenting eligible member for this open position.

The deadline to notify the Nominating Committee and/or NCAPA central office of your interest is fast approaching–April 18, 2014.  To do so, please contact Sandy Pierce, Nominating Committee Chair, or Cathie Feild, NCAPA Executive Director.

Nominations for 2015 Board Positions

The time is now for nominating yourself or a colleague to serve on the NCAPA Board of Directors for two-year terms that begin January 1, 2015.  Positions open for nominations are:  President-Elect (1 year, followed by 1 year as President and 1 year as Immediate Past President), Vice-President, Secretary, Director-at-Large (two positions) and Nominating Committee (one position).  Please contact any of the members of the Nominating Committee or the NCAPA central office for additional information, questions, or to provide written nomination of candidates (must have nominee’s consent).  Written nominations must be received by June 1, 2014, but the sooner the better!  Download the Nomination Form

We appreciate your involvement and support in making the PA profession vibrant and strong in North Carolina.

 

Notes from the Office

By Cathie Feild, NCAPA Executive Director

We are pleased to announce two staff changes at the NCAPA office.  Kat Nicholas, who had been serving as NCAPA’s administrative assistant, was promoted to Director of Membership and Marketing on April 1, 2014.  Kat is taking over from Lee Busselman who retired on March 31,2014.  Among other duties, Kat will provide staff support to the following committees:  Membership, Student Affairs, and Communications and Marketing.  You may reach Kat at kat.nicholas@ncapa.org.

On April 14, Helen Hammond joined NCAPA as the Office Administrator.  Helen has previous experience working for non-profits at the American Society of Echocardiography and the NC Rural Economic Development Center.  Helen will handle a multitude of duties including providing administrative support for conferences and membership, helping with building management, assisting the Executive Director, and serving as receptionist.  Helen can be reached at Helen.hammond@ncapa.org.

Please join me in congratulating Kat on her promotion and welcoming Helen to NCAPA!

 

For Students: NCAPA Endowment Scholarships

June 11 is the deadline to apply for 2014 NCAPA Endowment Scholarships. You must be a current member of NCAPA and be entering or enrolled in your second or final year in a physician assistant program in the state of North Carolina in 2014. To be considered, we must receive your completed application, done either online or by mail, and an official transcript from your PA program. Official transcripts (no copies please) should be mailed to:

NCAPA, att. Kat Nicholas,
1121 Slater Road, Durham, NC 27703.

Applications and official transcripts must be received or postmarked by June 11, 2014.  Applications may be submitted by USPS, fax, or online.

 

Endorsing Jeff Katz

The NCAPA Board of Directors is pleased to endorse the candidacy of Jeffrey Katz for President-Elect of the American Academy of Physician Assistants (AAPA). Jeff has contributed to NCAPA and AAPA in numerous leadership positions over the years. We believe he is an excellent choice to lead the profession nationally as President-Elect and, ultimately, as President of AAPA. The election is taking place now.   If you are an AAPA member, we urge you to consider Jeff Katz when you cast your vote!

 

CMS Releases Payment Data on PAs and Other Health Professionals

from AAPA

Reacting to calls for increased transparency, the Centers for Medicare & Medicaid Services released data April 9, revealing the number of patient care services provided and
Medicare reimbursement paid to more than 880,000 healthcare professionals, including PAs.

CMS officials suggested that releasing the data could help consumers understand health costs, help providers deliver better care and improve the detection of fraudulent billing activities. The data illustrate that in 2012 there were more than $252 billion in charges and $77 billion in payments under Medicare Part B.

The data showed 40,403 PAs in the database with average 2012 Medicare payments of $18,942 per PA. Total yearly payments to all PAs under their national provider identification numbers were $765,300,000.

The data released by CMS provides a look at PA practice, but it doesn’t tell the full story.

A substantial portion of the patient care services PAs deliver will not be attributed to the PA in the Medicare claims database, because under existing Medicare billing policy many PA-provided services are legally billed under the physician with whom the PA works.

AAPA is actively monitoring the data release and encourages PAs to report to the Academy any inaccurate information they find in the CMS database. For additional information contact Michael Powe, AAPA Vice President of Reimbursement and Professional Advocacy, at michael@aapa.org.

 

ADULT IMMUNIZATION: Are YOU Meeting the Standards for Patient Care?

Information from the CDC

Vaccination is a critical preventive health measure. Making sure your patients are up-to-date on vaccines recommended by the Centers for Disease Control and Prevention (CDC) gives them the best protection available from several serious diseases. The National Vaccine Advisory Committee (NVAC) recently revised and updated the Standards for Adult Immunization Practice to reflect the important role that ALL healthcare professionals play in ensuring that adults are getting the vaccines they need.

These new standards were drafted by the National Adult Immunization and Influenza Summit (NAIIS) of over 200 partners, including federal agencies, medical associations, state and local health departments, pharmacists associations, and other immunization stakeholders. What makes adult immunization a priority for leaders in medicine and public health? First and foremost, adult vaccination rates are very low (National Health Interview Survey, 2012). For example, rates for Tdap and zoster vaccination are 20% or less for adults who are recommended to get them. Even high risk groups are not getting the vaccines they need – only 20% of adults younger than 65 years old who are high risk for complications from pneumococcal disease are vaccinated.

Each year, tens of thousands of adults needlessly suffer, are hospitalized, and even die as a result of diseases that could be prevented by vaccines. However, a recent national survey showed that most US adults are not even aware that they need vaccines throughout their lives to protect against diseases like shingles, pertussis, and hepatitis.

Adults trust their healthcare professionals to advise them about important preventive measures. Most health insurance plans provide coverage for recommended adult vaccines. And, research indicates that most patients are willing to get vaccinated if recommended by their doctor. However, most patients report their healthcare providers are not talking with them about vaccines, missing opportunities to immunize. Incorporating vaccine assessments into routine clinical care is key to improving vaccination rates.

CDC is calling on ALL healthcare professionals to make adult immunization a standard of patient care in their practice by integrating four key steps:

1. ASSESS immunization status of all your patients in every clinical encounter. This involves staying informed about the latest CDC recommendations for immunization of adults and implementing protocols to ensure that patients’ vaccination needs are routinely reviewed.

2. SHARE a strong recommendation with your patients for vaccines that they need. Key components of this include tailoring the recommendation for the patient, explaining the benefits of vaccination and potential costs of getting the diseases they protect against, and addressing patient questions and concerns in clear and understandable language.

3. ADMINISTER needed vaccines or REFER your patients to a provider who can immunize them. It may not be possible to stock all vaccines in your office, so refer your patients to other immunization providers in the area to ensure that they get the vaccines they need to protect their health.

4. DOCUMENT vaccines received by your patients. Help your office, your patient, and your patients’ other providers know which vaccines they have had by participating in your states’ immunization registry. And for the vaccines you don’t stock, follow up to confirm that patients received recommended vaccines.

For more information and resources to improve adult immunization practice, visit:  www.cdc.gov/vaccines/hcp/adults

 

Palliative Care in Oncology – CME

The Piedmont Association of Physician Assistants, PAPA, would like to invite you to a CME event:

“Palliative Care in Oncology:  Too Little, Too Late?” 

Thursday, May 1, 2014
Reception:  6:00pm, light refreshments, Lecture:  7:00pm
Forsyth Country Club,  3101 Country Club Road,  Winston-Salem, NC  27104 

For more information, click here.

 

Survey Shows Acceptance of PAs

Business Wire

A new consumer survey shows access to good and affordable healthcare is the number one concern of Americans today. The survey, conducted for the National Commission on Certification of Physician Assistants, captured opinions from 1,000 consumers across the U.S. aged 21-64 with health insurance and found that more than 94 percent of respondents are willing to be seen by a physician assistant instead of a physician.

“Improving the affordability of health insurance for the previously uninsured is clearly an admirable aim, but as millions of newly insured begin to seek more care and as the Boomers continue to age and consume more health care services, people are understandably worried that there will not be a doctor readily available when they need one,” says NCCPA Board Chairman James Cannon, D.H.A., PA-C. “Certified physician assistants are a big part of solving the issue of access to health care as they can do most things a doctor can do. As more patients enter the market seeking health care, PAs are well positioned to meet these demands by providing high quality care and educating patients on how to best manage and improve their own health.”

Certified PAs must pass rigorous certification requirements, are licensed by state medical boards and are held to the same high standards of care that physicians provide. Certified PAs practice medicine with physicians, and can take histories, conduct physical exams, diagnose and treat illnesses, order and interpret tests, prescribe medication, counsel patients on preventative health care, assist in surgery and perform a variety of procedures.

“The model for health care going forward is to deliver the right care at the right time at the right cost,” adds Cannon. “Certified physician assistants are key players in this complex equation, delivering quality patient care and cost-effective outcomes in every specialty and clinical setting in the U.S.”  READ MORE

 

PAs Can Be Essential in Stopping Drug Abuse

by Wanda Hancock, MHSA, PA-C

Last year, NCAPA’s President, Don Metzger, asked our organization to support Project Lazarus, a secular group that believes communities are ultimately responsible for their own health and that every drug overdose is preventable. While many of our patients require pain medications, we must be vigilant in identifying those who abuse the prescription process.  It is our duty to protect our patients, our community, and our prescriptive authority. The PAs in North Carolina can make a tremendous contribution to Project Lazarus, with very little effort.

According to the website for Project Lazarus, North Carolina has higher than average overdose death rates. Nearly all of these deaths involve prescription opioid pain relievers, collectively called “other and synthetic narcotics.” These include methadone, oxycodone, fentanyl, morphine, tramadol, and hydromorphone.  While the Piedmont area of NC had a high rate of overdoses, Project Lazarus has drastically reduced these numbers.

We hold the key to prevention of these abuses and overdoses.  I was made painfully aware of this just recently.  There was a patient in our practice who had been treated for renal stones.  She requested pain medications several times.  Often these requests were made to several different providers in our practice.  When I realized that she was requesting another prescription, I began to investigate and found that she had recently been given a prescription by a provider in our practice just a few days before.  In fact, she received prescriptions for more than 60 Percocet in a two week period.  When I investigated further, I realized she had actually filled prescriptions for more than 650 narcotics over five weeks.  There were five different providers and four different pharmacies, all in different towns. This was an unusual case and the authorities were contacted to further investigate.

One of the greatest impacts PAs can have is to be aware of prescription drug use and possible abuse.  It is quick and easy to do.  Signing up for Controlled Substance Reporting is very valuable in making the determination to “ask the questions before writing the script”.  The process is straightforward and I strongly encourage you to check it out here; sign up if you are not already registered and use it. It is a rare week that I do not look up at least one of our patients, especially the new ones.  The other providers started coming to me to check out their patients as well. Now they are enrolled and using the program regularly.

Please be a responsible provider and assist in the prevention of drug abuse; look before you write.

 

If Your Patient Was Using Drugs, Would You Know?

From NIH

The National Institute on Drug Abuse (NIDA), part of the NIH, is pleased to inform you of a host of NEW, science-based resources—via its NIDAMED initiative—to help you manage patients at risk for substance use disorders, including prescription drug abuse.

• ACP Module to Enhance Practice Procedures. NIDA and the American College of Physicians (ACP) are excited to announce the launch of the Addressing Substance Use online module—developed for ACP Practice Advisor℠—to help with implementing screening, counseling, and referral to treatment. Available at no cost to ACP and non-ACP members.

• Attention PAs and NPs! Get CME/CE credit for opioid and pain management courses through AAPA and AANP.  For AANP, the approved credit includes 1.0 pharmacology. These modules will continue to be available through Medscape for AMA PRA Category 1 Credit™ and ANCC Contact Hours.

Medical School Faculty: “Knowing When to Say When: Transitioning Patients from Opioid Therapy,” is the latest problem-based learning curriculum resource from the NIDA Centers of Excellence for Physician Information.

If you have questions about these CEs or any of the other NIDAMED resources, contact nidacoeteam@jbsinternational.com.

MORE FOR CLINICIANS
• Opioid Prescribing Resources. Check out this new webpage featuring patient agreement and consent forms, as well as resources about aberrant drug-taking behaviors and commonly used long-acting opioids.

• Screening, Assessment, and Drug Testing Resources. Visit the new webpage that provides guidance for clinicians and direct access to trusted alcohol and drug screening tools.

MORE FOR MEDICAL SCHOOL FACULTY
• Targeted Teaching Resources. NIDA case studies and videos accessible on two new webpages:  

Substance Use Disorder Patient Case Studies  

Physician–Patient Communication Skills Videos

 

Safe and Competent Opioid Prescribing Education

The Boston University School of Medicine is pleased to offer, at no cost, an online education program, SCOPE of Pain: Safe and Competent Opioid Prescribing Education. This case-based activity addresses how to: assess for opioid misuse risk; safely and appropriately initiate or modify opioid regimens; monitor for benefit, risk and harm; and continue, change or discontinue opioid therapy.
The program also includes multiple short educational videos that model complicated provider-patient interactions around prescribing opioids for chronic pain including provider debriefs and reflections. These videos can serve as effective teaching/trigger tapes during educational sessions.  READ MORE