The Pulse | July-August 2015

Summer: a time of vacation and being a little bit more laid back. Not so with your Academy, though. We have seen a flurry of activity in a number of NCAPA endeavors over the last few months.

The Governance Task Force is still diligently working on a comprehensive review of all NCAPA bylaws and policies to ensure they are still relevant to the Academy in 2015. If all goes as planned, the amended bylaws will be presented to the Board at the November BOD meeting and will be reviewed by the general membership in early 2016.

The Professional Development and Review Panel just finished a review of all presentations for the Summer Conference; a far cry from back in the day when speakers brought little square slides on the day of the meeting, put them in the projector, and hoped everything would just work right.

The Government Affairs Committee has been tirelessly working on our own House Bill 724, which would add a designated PA seat to the North Carolina Medical Board. I hope each of you contacted your Senators to express your support. As of this writing, the bill has passed the House, the Senate Health Committee and the Senate. The bill is now back to the House due to some technical language changed by the Senate (this does not alter our bill in any way). It was my hope with this message that I would be able to tell you our goal is now a reality, but we may have to wait a week or two. When the bill is passed and signed by the Governor (note my extreme optimism), we will send an email blast to each of you. Besides working with Bill 724, we also continue to monitor legislation that may impact PA practice and ensure that PAs are inserted wherever health care providers are mentioned. We remain at the table with all the potential changes dealing with Medicaid Reform.

With regard to upgrading our technology, we continue to review various proposals and solutions to ensure that NCAPA has the resources to propel us into the future. On a public affairs front, your Board of Directors has unanimously agreed to support NCAPA being a sponsor of Quit to Win-NC. This is a smoking cessation effort across the state sponsored by multiple medical associations and the pharmaceutical industry. And, lastly, a Public Relations Strategy will be presented at the August Board meeting regarding how NCAPA can not only educate PAs on the importance of the Academy, but also educate other medical professionals, legislators, and our patients about PAs.

With all this going on, let us not forget about the beach! If history repeats itself, as it does each year, there are still over 100 procrastinators out there who have not sent their registration in yet (let’s see if we can beat that number this year). Careful attention to details and planning ensures that you can enjoy quality CME with your fellow professionals in the lecture hall or, if you are staying in the Kingston Properties, relax and listen in your hotel room. Our panel of speakers includes distinguished clinicians and faculty to ensure that you get the most from your time with us, including multiple workshops to help with your clinical and procedural skills. In the afternoons there are activities on the beach for you and your family to enjoy. We will be hosting two receptions, Sunday and Thursday evening, for you to network and relax. And, finally, if want to venture out, Myrtle Beach offers countless dining and entertainment venues.

If you have any comments or concerns about anything going on in the Academy, please email me at pacmarckatz@mac.com and, if you are at the beach, be sure to come see me and say hello!

Thank you,

Marc Katz, PA-C

Budget Negotiations Continue; HB 724 Passes Senate

by Sarah Wolfe, Assistant Vice-President, McGuire Woods Consulting

This summer, the North Carolina General Assembly has been focusing primarily on budget negotiations. Although the new state fiscal year (SFY) began on July 1, 2015, House and Senate leaders are still unable to reach a compromise on their competing spending plans, wherein large and pivotal differences remain between the chambers. In the meantime, in order to keep state government running, the legislature passed a continuing resolution (CR), a temporary budget, on June 30, 2015. The CR will continue to fund state government operations until August 14, when it is set to expire.

Whether or not a budget agreement will be reached by August 14 is still up in the air. With budget negotiations occurring behind closed doors, the pace and timing of the discussions is very uncertain. Speculations about when a compromise will be reached and the legislature will adjourn for the year spans from August to December.

Continue reading for additional details about the budget, Medicaid reform, and other health care legislation.

Dedicated PA Seat on the NC Medical Board

HB 724, Amend Composition of the NC Medical Board, the bill that will add an additional seat to the NC Medical Board specifically for a PA, is well on its way to becoming law. HB 724 passed the House unanimously in April, and the Senate on July 29. It will now go back to the House for a concurrence vote.

If all goes as expected, the bill could land on the Governor’s desk within a week. Once it reaches his desk, Governor McCrory will have 10 days to either sign into law or veto the bill. This far, there has been no opposition to the bill.

Firearms

After passing in the House with a final vote of 78-37 in June, last Thursday, July 24, the Senate Judiciary II committee approved HB 562, Amend Firearm Laws. The bill states that any written form, such as a health-related questionnaire, that a health care provider asks a patient to fill out, must clearly and conspicuously state that the patient is not required to answer any questions regarding lawful firearm and ammunition ownership.

The Senate chamber plans to debate the bill on the floor this week.

Medicaid Reform

HB 372, 2015 Medicaid Modernization, passed the House on June 23, 2015, with a final vote of 105-6. Sponsored by Rep. Nelson Dollar (R-Wake) and Rep. Donny Lambeth (R-Forsyth), HB 372 allows for provider-led entities (PLEs) to bid for contracts and manage networks of at least 30,000 of NC’s Medicaid recipients. HB 372 is supported by Gov. McCrory, NC Department of Health and Human Services (DHHS) Secretary Aldona Wos, and the NC Medical Society.

The Senate included their version of Medicaid reform within their budget proposal. The Senate’s plan calls for the formation of a new state agency, the Health Benefits Authority, to manage Medicaid. Currently Medicaid is housed under DHHS. The Authority would be responsible for contracting with managed care organizations (MCOs) and PLEs for Medicaid services. Under the Senate’s plan, the providers, which could be either MCOs or PLEs, would serve Medicaid recipients statewide. Further, the state would be divided into six regions, and the Authority would be authorized to contract with two additional PLEs within each region, if they chose to do so.

Upon releasing the budget, Senate budget writers stated that they prefer to contract with MCOs and PLEs in order to encourage competition, and that this proposal will give Medicaid patients a choice of three to five plans in which to enroll.

While both the House and Senate versions of Medicaid reform intend to move the state away from the current fee-for-service system in exchange for a full-risk capitated system, their differences are stark. How to best reform the state’s Medicaid system is currently one of the larger items in contention between House and Senate budget conferees, as they work through negotiations.

Performing Executions

HB 774, Restoring Proper Justice Act, a bill that would expand the list of persons allowed to administer the lethal injection, was passed by the Senate Judiciary II committee on Thursday, July 23. The bill adds PAs, nurse practitioners, emergency medical technicians, and emergency medical technician-paramedics to the list of persons permitted to administer and oversee the lethal injection. Currently, only licensed physicians may perform these duties.

Bill sponsor Rep. Leo Daughtry (R-Johnston) told the Senate Judiciary II committee that this bill was not an argument about the death penalty, since the punishment already exists in the state, but rather will get rid of the roadblocks that are in front of the death penalty right now. There are presently 148 people on death row in North Carolina and the last execution occurred in 2007.

The Senate plans to vote on HB 774 this week. If it passes, it will go to the Governor’s desk for a signature or veto.

State Budget

It appears that House and Senate budget leaders still have a long way to go before reaching an agreement on the state budget. In order to avoid a state government shutdown, the House and Senate were able to agree on a 45-day CR, which will keep the government funded at its current levels.

Aside from Medicaid reform, the House and Senate versions of the budget differ on several large items. The Senate’s version of the budget makes major policy changes in the areas of economic incentives and taxes, many of which House budget leaders have stated they are opposed to. The Senate’s spending plan includes a provision that would drop the current $45 million cap on sales tax refunds down to $1 million over a five year period. Many hospitals, among other non-profits, in the state have come out against the proposal, stating that it could lead to the closure of many rural hospitals.

Within the health and human services portion of the budget, there are many provisions that both the House and Senate agree on, including more funding and training for medical examiners. The Senate’s spending plan includes provisions that would repeal the state’s certificate of need laws by 2019, a requirement for the NC Boards of Dental Examiners, Nursing, Podiatry Examiners, and Medical Board to mandate continuing education on the abuse of controlled substances as a condition of license renewal, and an increase in Medicaid reimbursement to primary care physicians by 22 percent and 26 percent for obstetricians, effective January 1, 2016.

Notable 2015 Laws

Assault Emergency Workers/Hospital Personnel: Makes it a felony to assault hospital personnel and licensed health care providers who are providing or attempting to provide services in a hospital.

Jim Fulghum Teen Skin Cancer Prevention Act: Prohibits teenagers under the age of 18 to use a tanning bed. The bill was named after a Wake County state representative and retired neurosurgeon, Dr. Jim Fulghum. Dr. Fulghum passed away while serving as a state legislator in 2014, after a brief battle with cancer.

Right to Try Act for Terminally Ill Patients: Establishes a Right to Try Act in NC, which will expand access to investigational drugs, biological products, and devices for terminally ill patients.

For the latest updates on the legislation discussed above, check out the “Legislative Action Center” under the advocacy tab on www.ncapa.org.

39th Annual NCAPA Summer Conference

Embassy Suites, Kingston Plantation
Myrtle Beach, South Carolina
August 16-21, 2015

Register Now! Rates go up August 1!

Registration is open for our 39^th Annual Summer Conference! NCAPA combines the best CME conference for PAs with a family-friendly beach vacation.

Our full agenda is announced and we are proud to present a variety of interesting topics. There is truly something for any provider-each lecture hour on the agenda will include case studies and clinical pearls that will be useful in YOUR clinical practice.

Click here to view the full schedule.
Click here for conference information & registration

Patient Satisfaction Performance Improvement (PI) CME Now Available!

NCAPA has partnered with CME4Life to bring you this Patient Satisfaction Performance Improvement (PI) Project. This project will ship directly from CME4Life and is approved for 20 AAPA Category 1 Performance Improvement CME credits by the Physician Assistant Review Panel.

This PI CME project is designed to increase patient satisfaction and is comprised of 3 stages:

Stage 1: Compare your practice patient satisfaction to national benchmarks, performance guidelines set forth within your practice or other evidence-based standard. This score will be taken from the Press Ganey (or similar) score of your institution or you may complete the self-assessment scoring to give yourself a baseline score.

Stage 2: Using the guidelines of this PI-CME project, PAs will develop and implement the plan for improvement in patient satisfaction. This program will offer you suggestions along with guidance to increase patient satisfaction. You will choose three to implement over a 60-90 day period.

Stage 3: Evaluate the outcome of the improvement effort by comparing the results of the original data to new results or outcomes*.

*You do not need to demonstrate actual practice improvement in order to receive CME credit since the primary intent is to help you reflect on your own practice.

You can purchase this PI CME project in the NCAPA online store or by clicking here. NCAPA Members receive a special member discount on this item!

NCAPA Needs You!

from Cathie Feild, Executive Director

It’s still summer, but we are looking for members who would like to serve on one of NCAPA’s committees in 2016! Committees gather information, study issues, reach consensus, and make recommendations to the Board of Directors. Active committee involvement makes NCAPA a successful organization. (Click here to read committee descriptions.)

The President-Elect recommends people to serve as Committee Chairs and the Board of Directors votes on these appointments in September. Committee Chairs are notified of their appointments in early October so they can plan to attend the NCAPA Board meeting on November 14^th. Once Committee Chairs are appointed, committee members will be selected. So, we would like your application by August 28^th—right around the corner!

If you currently Chair or serve on a committee and would like to continue to do so in 2016, please complete the renewal application. If you are new to NCAPA committees and would like to be considered for a position, please complete the form found here. All appointments are for one year terms and begin on January 1, 2016. Please contact NCAPA’s Executive Director, Cathie Feild at Cathie.feild@ncapa.org if you have any questions. We appreciate your interest and look forward to working with you!

NCAPA Announces HOD Delegates for the term July 1, 2015 – June 30, 2017

Thank you to all who voted and congratulations to those elected!

Chief Delegate: Wanda Hancock, NCAPA President (Jan. 1 – Dec. 31, 2016)

Delegates:

Marc Katz
Suzanne Reich
Samantha Rogers
Paul Hendrix
Alisha DeTroye
Joshua Smith

Alternate Delegates:

Linda Sekhon
Truett Smith

Student Leadership Retreat: Save the Date!

Each year, the NCAPA hosts a Student Leadership Retreat at the Stead Center in Durham for student members from all PA programs in North Carolina. This year’s event will be held on Saturday, October 10th. This retreat is designed by the NCAPA Student Representatives from PA programs across the state and is geared specifically to the unique concerns of PA students who are preparing to enter the profession. Students should mark their calendars now! Further information will be available in the Fall from your NCAPA Student Representative, as well as here in The Pulse.

NCAPA Regional Chapter Updates

Far West NC Physician Extender Associates’ (FWNCPEA) 2nd Annual Fall Conference will be on Saturday, September 26th from 9:00am to 4:00pm. The conference is FREE and includes continental breakfast and lunch. It will be held at the Balsam Mountain Inn, Balsam, NC. Lectures include Hypertension Update, Acute Abdomen, Testicle Cancer, Concussion Evaluation, EKG review, and ENT Pearls, providing 6 hours of AAPA (approval pending) category 1 CME. Register at www.FWNCPEA.com

You asked for it, you got it – NCAPA Networking Events

One of NCAPA’s goals for 2015 was to begin offering networking events for PAs throughout the State. We’ve been busy figuring out the logistics as we go along, but we do have our first event scheduled. The networking social will be held on Saturday, September 26th from 5:00 – 7:30 pm at the Balsam Mountain Inn, directly after the Far West NC Physician Extender Associates Fall Conference. We will be offering appetizers, beer and wine and a great opportunity to network with other PAs in a casual setting. You do not have to attend the conference to attend the social event, nor do you have to be a current member of NCAPA; but if you have a colleague who might be interested in learning more about NCAPA, please invite them along!

There is no charge to you for the social event, but we do ask that you RSVP. Simply email kat.nicholas@ncapa.org, with a subject line of September Social and let me know if you think you might join us, as well as how many will be attending with you (include yourself in the number).

NCAPA Leader Introduction: Frank Caruso

Frank Caruso, PA-C, is an NCAPA Director-at-Large and a member of the Nominating Committee. Originally from Long Island, New York, he graduated from SUNY at Stony Brook, NY and currently lives with his wife in Clemmons, NC. Frank works at Davie Medical Center in Bermuda Run while his wife, a DNP, teaches at Chapel Hill in the NP and DNP programs. Frank specializes in Musculoskeletal Medicine, and works in Urgent Care, Emergency Medicine, and Administration as well. He is also a fire fighter and paramedic, acting as Deputy Commander of NC-1, a federal disaster team.

What do you like best about being a PA?

I love working with patients, teaching students and helping solve operational issues in providing cost effective health care services.

How did you become involved in NCAPA?

I first became involved in NCAPA by giving lectures at the summer meeting, eventually deciding it was time to “give something back” on a state level to the PA profession.

Why do you think it is important to be involved in NCAPA?

I think it is important to stay informed and be represented as a PA, especially in these difficult times with health care reform.

PA Student Receives First Lanny Parker Memorial Award

by Sue Reich, PA-C, MPAS, NCAPA Endowment Trustee

To those who knew and worked with Lanny Parker, he was the perfect combination of a caring PA and a smart, savvy leader. His knowledge of the world of medicine from the standpoint of governmental and regulatory issues as well as his ability to tease out the intricacies of third party reimbursement policies and procedures was uncanny. He spoke and easily understood the legal and regulatory “language” that many clinicians find confusing and foreign. Lanny served in multiple leadership positions in the NCAPA and was elected President of the Academy in 2002. Sadly, in 2004 we lost Lanny to a sudden fatal heart attack. His enthusiasm, passion and knowledge were then, and are still to this day, sorely missed.

During Lanny’s tenure with the NCAPA, he was a strong supporter of leadership by and mentoring of students. Thus, the NCAPA Endowment resolved that the Lanny Parker Memorial Fund would be earmarked to support PA students who are interested in seeking or expanding leadership opportunities. The Endowment Board of Trustees is pleased to congratulate the first grant recipient, Ms. Sarah Nelson, a PA student at Elon University. Sarah’s interest in leadership expanded into the realm of providing community service and she applied for and was awarded the grant to cover the expenses needed to attend the Southern Harm Reduction Conference, held in Asheville.

Sarah explains that although she was not entirely prepared for what to expect, her expectations were exceeded. Those attending the conference welcomed her involvement and interest, and she was treated to the North Carolina mountain hospitality and atmosphere. She explains, “the attendees had more passion for harm reduction than I ever thought possible.” The overall attitude during the sessions was that of a non-judgmental and compassionate approach. Sarah was exposed to people who are members of at-risk populations such as sex workers, drug addicts, and HIV-positive patients and she learned skills to enhance developing trust rather than resentment with those clients. “I learned about the real needs of these communities from the people who know best,” she shared. “I discovered so many helpful resources.” Sarah’s conclusions from her experience yielded the acknowledgment that she can now provide better care for at-risk patients and help reduce harm to them. She says, “The lessons I learned may seem simple…but are crucial if I am actually going to make a difference.”

Our friend and colleague, Lanny, were he still with us, would undoubtedly approve and express pride in this young PA professional’s willingness to step out of her comfort zone and expand her world view for the purpose of learning new skills that directly benefit those at highest risk of harm. This is leadership development at its best.

As you are inspired by this and other stories, please consider making a donation to the NCAPA Endowment, which continues to support PA students and practicing PAs and the patients and communities that benefit from their care. Find us on the web at https://ncapa.org/endowment

Lenoir-Rhyne University Selects Leaders for PA Program

from Lenoir-Rhyne University

Lenoir-Rhyne University recently appointed three medical professionals to direct the development and implementation of its Physician Assistant (PA) Studies Program. Certified PAs Richard Ball and Donna Lacey have been named Program Director and Clinical Director, respectively. The university has also welcomed Billy L. Price, Jr., MD as Medical Director of the program. Lenoir-Rhyne’s PA Program, upon completion of the accreditation process, is slated to open in January 2016. Read the full story here.

Healthiest You Challenge: Thank You

As many of you may remember, NCAPA was one of eight team sponsors of WCHL and Chapelboro.com’s 2015 Healthiest You Challenge. We sponsored one of 8 teams of individuals who spent six weeks working to get in shape and lose weight. A member of NCAPA’s team wrote to us and expressed her gratitude:

“Thank you for supporting me and my NCAPA Team members through the extraordinary experience offered via the 2015 Healthiest You Challenge! I met such great people, including enthusiastic participants, and wonderful, dedicated UNC Wellness Center staff who gave us their best during our intensive 6-week program. Each time I donned my gray NCAPA Team shirt to workout at Meadowmount, I thought about the NCAPA and their members who were supporting me and my teammates through this outstanding opportunity and experience… I ’ll continue to wear it with great pride and appreciation for your support!”

Congratulations to all participants in the Healthiest You Challenge. Keep up the good work!

CMS Releases Accountable Care Organization Regulations

from AAPA

On June 4, the Centers for Medicare and Medicaid Services released a final rule which provides regulatory guidance for the Medicare Shared Savings Program. The MSSP, which lays out requirements for Medicare accountable care organizations, was established to promote better quality care for Medicare beneficiaries by encouraging PAs, physicians and other health professionals, hospitals and healthcare organizations to improve patient care and the care experience, while also reducing the rate of growth in healthcare costs.

AAPA is pleased that CMS responded positively to a number of our suggestions that were submitted in official comments to the agency which led to the following:

PAs being defined as “ACO professionals” along with physicians and advanced practice nurses.
Reiterating that the Affordable Care Act officially designates PAs as primary care practitioners.
PAs being moved into Step 1 of the beneficiary assignment methodology so that patients who receive a plurality of their services from a PA can be covered in the ACO. Without this change beneficiaries would have been required to receive the majority of their care from a physician.
PAs not being required to undergo a special process to prove that they practice in primary care as part of the ACO patient attribution methodology.

An area of concern is the CMS clarification that to be included in the ACO a beneficiary needs to have at least one primary care service delivered by an ACO physician. AAPA feels that meeting this requirement will be a challenge for some practices, especially in offices/clinics in which the PA is the primary health professional and a physician is not physically on site. AAPA will continue to advocate for patient inclusion in ACOs when all care is delivered by a PA.

For additional information contact Michael Powe, AAPA’s Vice President of Reimbursement & Professional Advocacy at michael@aapa.org.

Value-Based Reimbursement Means Opportunities for PAs

from AAPA’s PA Professional

The way healthcare providers are reimbursed for their care is changing, but the transition seems to offer some genuinely exciting opportunities for PAs. Value-based care will reward teamwork and communication, and may allow many PAs, especially in primary care, to “return to their roots”—to spend more time with patients and to focus more on education and prevention. Through value-based reimbursement, providers are reimbursed based on the health outcomes of their patients, rather than on the volume of patients they see. Read the full story here.

People to People: PAs to Australia Opportunity

from the People to People Ambassador Citizen Program

The People to People Ambassador Citizen Program is organizing a delegation of physician assistants to travel to Australia. Australia has developed their first PA programs and graduated their first classes over the past several years. The People to People Ambassador Citizen program hopes to establish international relationships and strengthen the PA career worldwide by meeting with its Australian counterparts. Michelle Kavin, PA-C, contacted NCAPA with the hope of finding PAs who would be interested in this unique opportunity. The program is currently slated for March 3-12, 2016. Find more information here.

NC Rural Center Seeks Input on Advocacy Agenda

From the North Carolina Rural Center

Last year we heard from you, our Rural Partners, that rural North Carolina needs to begin speaking with a clearer and more united voice. You asked us to help coordinate an effort to do exactly that, and we took your charge to heart. This summer, we will be traveling to six North Carolina towns to gather your input as we craft a rural advocacy agenda to benefit the entire state.

Register now:

August 4 Clinton

August 6 Henderson

August 11 Troy

As rural/urban discussions heat up in the N.C. General Assembly and elsewhere, we hope you’ll make time to join us. Rural North Carolina is home to more than four million people, each of whom deserves a voice in the policy debate.

Patient and Family Engagement: A Partnership for Culture Change

from the North Carolina Institute of Medicine

Patients who are actively involved in their health and health care tend to have better outcomes and care experiences and, in some cases, lower costs. The American Institutes for Research defines patient and family engagement as “patients, families, their representatives, and health professionals working in active partnership at various levels across the health care system to improve health and health care.” Implementing patient and family engagement strategies has led to fewer hospital-acquired infections, reduced medical errors, reduced serious safety events, and increased patient satisfaction scores. Because of the potential for improved health outcomes and patient satisfaction, patient and family engagement has emerged as a critical strategy for improving the performance of our health care system. Read the full description here.

Welcome Members!

Welcome to our renewing and our brand new members! The following members have joined or renewed their membership since our last issue. Thank you all for your support of NCAPA and all PAs in North Carolina!

In this issue:

President’s Message

by Marc Katz, PA-C