In this issue:
By Don Metzger, PA-C
Earlier this year, we reported that the NCAPA Board of Directors voted to change NCAPA’s Mission Statement. It now reads, “NCAPA provides innovative solutions to empower our members to enhance their careers and advocate for optimal health care.” Many of our members, and PAs from all over the country, are aware that NCAPA puts on two of the best CME conferences available anywhere—the Recertification Exam Review Conference held in Durham, NC in late winter, and the Annual Summer Conference held in Myrtle Beach, SC each August. These events certainly fit our mission statement by empowering members to enhance their careers with the latest information about clinical practice.
However, I wonder how many PAs are aware of the tremendous amount of advocacy work NCAPA does for the PA profession? For example, in this issue of The Pulse, you will find important information about Medicaid—both enrolling in the new Medicaid claims processing system and signing a petition requesting that the NC legislature keep our system of medical homes. During the past week, your NCAPA Government Affairs Committee quickly worked to mobilize support against an AMA House of Delegates resolution that would restrict PA practice. The efforts we have made building positive relationships with other medical organizations in North Carolina, such as the NC Medical Board, the NC Medical Society, and the NC Academy of Family Physicians help enormously when we need support for efforts to protect PA’s right to practice fully within the scope of their training and under current law.
Other helpful information in this issue of The Pulse includes tips on having successful QI meetings and information on NC’s new death certificate. So, read on for more news and information you can use and encourage your colleagues to learn about all NCAPA does to “provide innovative solutions to empower our members to enhance their careers and advocate for optimal health care.” Maybe they would like to join you as a member of NCAPA.
August 18 – 23, 2013 ~ Kingston Plantation Embassy Suites ~ Myrtle Beach, SC
Why not combine your beach vacation with continuing medical education?
40+ Hours of CME* for PAs, NPs and ATCs
Have you heard 82% of our attendees come back year after year? Come be part of the NCAPA family! Where else can you get five breakfasts, four lunches and two receptions ALL INCLUDED with your conference registration? Guest packages include these meals as well, so feed the family!
Our sessions start early and end early so you can get outdoors and enjoy the miles of beautiful beaches and all that the Kingston Plantation and Myrtle Beach have to offer. With tournaments on the beach each afternoon, SPLASH! Waterpark, eight pools, a lazy river, tennis, volleyball, and more we promise you will have a great time and make new friends!
You’ve asked and we are delivering: each lecture will have at least one case study to maximize your learning.
*The NCAPA plans to request over 40 hours of AAPA Category I CME credit from the PA Review Panel. The total number of approved credits is yet to be determined.
There have been proposals to turn North Carolina’s Medicaid program over to out-of-state managed care organizations. We need you to do two simple things TODAY!
1. SIGN: Go to http://www.ournchealthcare.com/sign-our-petition/ (a website and petition developed by the NC Academy of Family Physicians) and personally sign the petition saying you support responsible Medicaid Reform, meaning reform that:
- Builds on our nationally recognized platform of medical homes;
- Keeps Medicaid dollars in-state versus sending them to out-of-state managed care companies; and
- Is transparent and provides adequate opportunity for stakeholder input.
2. SHARE: Tell your healthcare colleagues and other community leaders to go to the website and also sign the petition. The more people who sign this, the better.
Beginning July 1, 2013, Medicaid claims will be reimbursed from a new system called NCTracks.
A letter regarding NCTracks was sent to all NC DHHS providers by NC DHHS Secretary Wos. The letter included comments from the Secretary as well as a checklist of actions that need to be taken prior to July 1. The letter also included the Authorization Code for the CEP registration process.
Completion of the CEP process is essential to ensure that providers receive claims payment via Electronic Funds Transfer and have access to the NCTracks Provider Portal (to retrieve Remittance Advice, among other functionalities.)
During the CEP registration, providers will:
- Designate an Office Administrator (business owner or manager) and provide an email address.
- Designate a Billing Agent (if you submit claims through a clearinghouse).
If you are a Billing Agent, sign a Trading Partner Agreement Provide bank account information for electronic payment.
To help make the transition to the new NCTracks system as smooth as possible, both online and classroom training is available. For a full list of training opportunities, go to www.nctracks.nc.gov.
If you do not have the CEP letter or have questions regarding the CEP registration process, please contact the CSC Help Desk at 1-866-844-1113 or NCMedicaid@csc.com.
(provided by the NDCHHS)
There are several steps providers must take in advance of NCTracks going live July 1, or risk not having claims processed and paid in the new system. The checklist below can help you determine whether you are “on track” for NCTracks.
- Register in the new system as a Currently Enrolled Provider (CEP), which you can do at www.nctracks.nc.gov. Click on the Provider Services link in the upper-left corner, and then click on the Provider Enrollment link in the upper-left corner. Scroll down to the section on the page labeled “Currently Enrolled Provider NCTracks Registration.” Follow the instructions on the Website and complete the registration. Registration requires your Authorization Code <<Auth Code>> and your National Provider Identifier (NPI) <<Masked NPI_1>>. The Website will initially require you to enter the Authorization Code as well as the full NPI or Atypical ID. Only a portion of your NPI is printed above. While registering, you will:
- Designate an Office Administrator (business owner or manager) and provide an email address.
- Designate a Billing Agent (if you submit claims through a clearinghouse); if you are a Billing Agent, sign a Trading Partner Agreement.
- Provide bank account information for electronic payment.
- Obtain an NCID for your Office Administrator and additional NCIDs for staff who will access NCTracks. You may obtain an NCID by going to ncid.nc.gov and clicking on “Register!”.
- Train in the new system. You can choose instructor-led sessions or computer-based training. You must have an NCID to access those pages. For a guide to NCTracks training, including course recommendations by office function, go to www.nctracks.nc.gov.
- Verify your taxonomy codes and locations at http://ncmmis.ncdhhs.gov/taxonomy.asp.
DO NOT DELAY. YOUR PAYMENTS COULD BE DISRUPTED.
For more information on any of these steps, call 866-844-1113, or e-mail NCMedicaid@csc.com
A new death certificate will go into use on January 1, 2014 in North Carolina.
Here is a summary of information on the new death certificate from NCDHHS, Vital Records:
- In 2003, the US Standard Death Certificate was updated and must be used by January 1, 2014 by all states, per federal requirements. NC still uses the 1989 US Standard and a separate certificate for Medical Examiners.
- Beginning January 1, 2014 NC will use only one certificate, updated per the 2003 US Standard requirements and include the Medical Examiner’s section.
- A Vital Records/Vital Statistics team researched other states’ forms, and all federally required fields to create this form. The final product (include link to death certificate) is based on the following criteria:
a. Contains all the federally required National Center for Health Statistic’s data fields.
b. Contains fields to meet NC General Statutes.
c. Must be a one-page, single-sided, 8” x 11” form for multiple operational reasons including, but not limited to:
* Printing capacities and requirements for funeral homes
* Storage binder sizing/costs
* Data accuracy
* Adaptable to future EDRS system
(The 2003 US Standard was originally designed for an electronic death registration system. Since NC does not have an electronic system, the new death certificate must be implemented in paper format.)
Informational and training materials are currently being developed and will be available later this year on the Vital Records website.
The 2013 AAPA House of Delegates session will be remembered for its attempt to clarify functions of the House and the Board of Directors. A precipitating factor was the abolishment of many Commissions and Work Groups by the AAPA Board of Directors. A number of resolutions dealt with this theme. In the end resolutions to try to get an exemption from the North Carolina Not for Profit Corporation Statue (AAPA was incorporated in North Carolina) and Elections of Directors at Large were asked to be sent to Task Forces for further consideration. After other resolutions that dealt with this theme were passed by the House of Delegates, the AAPA Board of Directors decided to keep the current House Commissions in place until July when the Board will again review that decision and make further recommendations.
AAPA Specialty Organizations sought to increase their representation in the House, but that resolution was defeated. A resolution to recommend to NCCPA that PAs may take the recertification exam up to five times in each of the fifth- and sixth-year cycles was also rejected.
A discussion on the existing policy on Gun Control Legislation brought much debate with an eventual decision to refer for further study and recommendations.
Papers were amended and approved on Health Information Technology, Federally Employed PAs, Non-Discriminatory Mental Healthcare Coverage, PA Education Funding, Comprehensive Healthcare Reform, Competencies for the PA Profession, and Human Rights.
Finally, a late-submitted resolution that dealt with recognizing PA practice as collaborative medical practitioners as opposed to supervised medical providers was also referred for further study and will be brought back to the House.
It is also with great pride that I let everyone know that Gail Curtis was elected Speaker of the House of Delegates. Gail has been active in the House for many years with recent elected positrons of Second Vice Speaker and First Vice Speaker. She is part of the faculty of the Wake Forest PA Program, and a long-time member of NCAPA, serving as the president of our organization in 1994. We wish Gail great success with her new position.
PA Engagement: Membership Maintenance —Joining, Connecting, Networking, Learning
By Rick Ulstad, PA-C
Choosing the PA profession was a smart choice. All of us can confirm this, regardless of background, specialty, or area of interest. Choosing to be involved in our professional association is an equally smart choice. Incentives, benefits, and membership affiliation can spark and reignite individual passion for the PA profession, and also save you money—both short term and long term.
NCAPA is currently 35+ years and running, and continues to thrive in this emerging economy. The hard work has paid off and it shows. It is our PA professional organizations—especially NCAPA, which is the only organization in North Carolina devoted solely to the interests of PAs—which ensure stability, promote vitality, and demand change when growth is necessary. NCAPA has promoted the value of the physician-PA team and advocated for rules and regulations that allow PAs to practice to the fullest extent of their training, making North Carolina one of the best states in which to be a PA.
Why join or maintain NCAPA membership? Advocacy specialists, professional development opportunities, multiple discounts, and wide-ranging CME programs create a formula for success in our chosen profession. Specific examples include:
- Reductions in insurance rates (disability and liability) through partnerships with Mass Mutual and Health Care Providers Service Organization (HPSO) make it practical to protect your financial future.
- Comprehensive resources and assessment courses are targeted for the PA to assess knowledge and prepare for boards.
- PA-designed accessories from Medelita with a 15% markdown for scrubs and comfortable jacket-wear are practical, cost-effective purchases.
- Discounted access to the Medical Letter‘s electronic resources helps ensure appropriate, cost-effective dispensing and avoid preventable drug interactions.
- Free Rx association programs for uninsured and under-insured patients help guarantee access for patients who need it the most.
- Top-notch CME programs—NCAPA conferences, regional workshops, and online offerings—make learning invigorating and fun. The members-only discounts are an added bonus!
Whether you are a seasoned PA, new grad, retiring, or just want “the card with benefits,” there is a place for you as a member. We urge you to continue your membership, and stay connected—for yourself, for your practice or affiliation, and most importantly for the PA profession as it advocates for optimal health care and transforms the delivery of patient-centered, team-based care.
QI Measures for Clinical Practice:A Practical Guide to Improve Your QI IQ
By Rob Bednar, PA-C and Tanya Darrow, PA-C
With the new changes in healthcare involving Patient-Centered Medical Home, Accountable Care Organizations, and the implementation of Meaningful Use, healthcare providers are looking more at how to efficiently and effectively deliver quality care. For PAs this has, and should always be, an essential part of how we practice. In fact, Quality Improvement Meetings are a job requirement.
Per the North Carolina Medical Board:
“…PAs in a new practice arrangement, meetings with the primary supervising physician must occur monthly for the first six months to discuss clinical matters and quality improvement (QI). After the first six months, such meetings must take place at least every six months. All meetings must be documented.”
So what exactly should this QI meeting entail? The essence of these meetings should involve ways to look at how one is practicing compared to current standards of care as well as looking at patient outcomes and determining where improvements can be made. Because the PA profession covers such a wide array of specialties and subspecialties these meetings are often tailored to one’s own practice. For example, PAs in Primary Care may focus more on long-term outcomes relevant to disease management, while PAs in surgery may focus more on honing surgical techniques or procedures within their scope of practice. The following items should be documented for review, if needed:
- Clinical Issue Presented (standard of care for specific disease states, improvements for techniques, etc.)
- Improvements/Recommendations to improve current clinical practice measures discussed
- Signature of both Supervising Physician (NOT back-up supervising physicians) and PA (or PAs)
There are various tools available, as well, that can serve as a modifiable template:
- PLAN—plan a change or test how something works.
- DO—carry out the plan.
- STUDY—look at the results. What did you find out?
- ACT—decide what actions should be taken to improve.
- FOCUS—define the process to be improved.
- ANALYZE—collect and analyze data to form a baseline.
- DEVELOP—based on data, develop action plan for improvement, including tool to measure/monitor.
- EXECUTE/EVALUATE—implement and measure improvement.
DMAIC Tool. For those familiar with Six Sigma, the DMAIC tool can be used.
One thing to keep in mind is QI meetings should not focus on the PA as simply an employee. For example, a simple statement such as, “[PA] has shown great improvement in efficiency and punctuality over the past few months. There are no concerns regarding current clinical practice so nothing was reviewed” is not an acceptable statement. If there were no concerns identified in the six months there are constant changes in medication and techniques that could serve as the clinical issue to be evaluated.
As a practicing PA in the same practice for even a time as brief as a few years, it can be very tempting to oversimplify required QI Meetings in order to save time and “get back to work.” This is especially true for those in practice with a good rapport with their supervising physician. For new graduates, a QI meeting may make you feel as though you’re being sent “to the Principal’s Office,” as one of my colleagues put it. Still, these meetings are essential not only for improving patient care but also for maintaining the integrity of the PA profession. In fact, starting in 2014, QI measures will be required for PAs as part of maintenance of certification (more information regarding these changes can be found at the NCCPA website: http://www.nccpa.net/CertMain.aspx).
Another important point for the practicing PA to remember: these QI meetings need to be done with each supervising physician (not back-up supervisors). If a PA has more than one supervising physician registered with the Board (example: part-time jobs) these meetings must take place with each.
Are you uncertain how to best get more involved in NCAPA or your local PA organization? Are you a new PA graduate who would like to get your feet wet in a leadership position? Have you served in PA leadership for years and need some new ideas? Then you’ll want to save the date of September 7 for PA Leadership Boot Camp. There will also be a Regional Chapter Workshop for current Regional Chapter Leaders and those who want to get more involved in regional PA organizations on September 8.
Through my involvement in the NCMS Leadership College, I’m organizing these two events for the fall. If you are interested in participating, please email me (firstname.lastname@example.org) and I’ll send you updates as they become available.
Are you ready to be counted, PAs? The annual AAPA Census is open and waiting for your information! This year, PAs who take the census are automatically entered to win a free $500 gift card.
The data collected through the census is used for advocacy and publications such as the Salary Report—now available free to AAPA members. (Nonmembers get 20 percent off the Salary Report when they complete the census). The census is open to everyone who has ever graduated from a PA program.
Census information informs a wide range of stakeholders, from employers and the U.S. Bureau of Labor Statistics, to the elected officials who determine federal and state legislation and funding. Take the AAPA Annual Census>>
Be an active contributor to your PAEC! Advocacy is a dynamic and on-going process. It doesn’t start or stop on Election Day. We advocate for our profession throughout the year to develop and enhance our legislative relationships.
Join the Campaign: Please consider contributing to the PAEC. Donating just one hour of your salary each year can have a huge impact on your professional practice throughout your career. Please challenge your colleagues to do the same and help champion the goals of the PAEC. Please help preserve, strengthen and expand the PA practice in North Carolina!
In addition to its advocacy, professional development and continuing medical education, the Academy also offers a number of members-only discount programs. Get 15% off regular prices for scrubs and lab coats through Medelita–apparel designed by a PA, for PAs!
Other members-only discounts:
- Challenger: Discounts on comprehensive review and assessment courses.
- The Medical Letter: Discounted access to the full suite of electronic products offered by The Medical Letter.
- Disability Insurance: Through an arrangement with MassMutual, you can apply for individual disability income insurance at discounted rates.
- Liability Insurance: NCAPA has partnered with Healthcare Providers Service Organization (HPSO), the nation’s number-one provider of professional liability insurance to healthcare professionals.
- Discount Drug Card Program: NCAPA is offering a FREE prescription assistance program for uninsured and underinsured patients.
NCAPA is partnering with CME4Life to bring you John Bielinski, Jr, MS, PA-C’s “Demystifying Emergency Medicine” eight-hour Category I CME DVD series! This series is designed to give you immediate tools in emergency medicine for patient care. The series includes four DVDs: Secrets of Laboratory Medicine, Secrets of Pulmonary Medicine and CXR Interpretation, Secrets of Chest Pain and Advanced 12 Lead EKG Interpretation, and Common Emergency Medicine Complaints. Order the DVD series or get more information at our Online Store.
You couldn’t attend the review conference but still want the handouts? You are in luck! NCAPA is selling the study materials comprised of all the presentation slides from our conference. The presentations are a review of all organ systems based on the PANRE Exam Blueprint. This will be a perfect study tool for the PANRE or for any health care professional looking for a review. You may purchase an electronic copy on a flash drive. To order study materials, go to the Online Store.