PHYSICIAN ASSISTANT UTILIZATION DURING H1N1 EMERGENCY/PANDEMIC
The State Board of Medicine has been working with the Department of Health and others to address the potential need for physician assistants to be able to work outside of their written agreements during the nationally declared H1N1 health emergency. The State Board of Medicine has developed a cover memo, as well as letter templates that health care facilities should use when requesting waivers. One letter is for physician assistants currently working in health care facilities, the second letter is for physician assistants who may need to be brought on board emergently.
SCOPE OF PRACTICE EXPANSION WINS APPROVAL
, PA-C, Chairman, Governmental Affairs
Just before summer recess, the House and Senate approved our scope of practice expansion bills. It didn’t happen though without some political wrangling. We were cruising along just fine, having passed the house on a unanimous vote when suddenly we were picked up on the trial lawyers radar. Over the years we have managed to fly under that radar, but our luck ran out. Their group is powerful enough to cause a fair amount of havoc should they choose to do so. What caught their interest was the fact that we were asking for an expansion in our scope of practice, and that translates into increased risk. I did argue that what was being expanded hardly increased our risk of malpractice, but expansion of scope is expansion of scope in their eyes. They wrote to the respective legislative committees stating that they would block passage of our bills unless there was language placed in the legislation specifying minimal requirements on malpractice coverage for physician assistants.
All along, we have tried to keep this kind of language out of our legislative initiatives. But their request was supported as reasonable by the Medical Society and the Hospital Association. And as luck would have it, we had 48 hours to either accept minimal malpractice coverage limits or our bills would be dead in the water. This scenario takes me back to 1993 when we had to accept the “every third visit rule” or lose our proposed allopathic prescribing legislation.
The Governmental Affairs Committee and the PSPA board of directors contemplated the pros and cons of the minimal limits and in the end decided to accept the language in order to expand our scope of practice. The language calls for coverage in the minimum amount of one million dollars per occurrence or claims made. This was not a decision taken lightly by everyone involved. We understand that this may cause some hardship for certain individuals. Given the circumstances, the committee and the Board felt we had no choice other than to go forward. Since 2008 is a biennial license renewal year, the boards will require that we send proof of insurance at the minimum levels when we renew our licenses this fall.
One of the bigger headaches that our bills address is the ability to order physical/occupational and respiratory therapy. Their respective acts are being amended to allow them to accept our orders. The bills are included in this newsletter.
The Society hopes that our decision doesn’t create a great deal of hardship for our members. We act with the best interest of everyone in mind, but sometimes we are faced with tough decisions such as these. As our profession continues to grow and play an ever more important role in the delivery of health care in Pennsylvania, we are going to on the radar of an ever-increasing number of organizations.
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GOVERNMENTAL AFFAIRS ISSUE UPDATE
Mark DeSantis, PA-C, Chairman, Governmental Affairs
House Bills 1999 & 2051 have passed the house by a unanimous vote. They are now in the senate professional licensure committee. As outlined in the last issue of the PSPA News, these bills will expand our scope of practice on both the allopathic and osteopathic sides. At this point, we are encouraging everyone who lives in a district with a REPUBLICAN PENNSYLVANIA SENATOR, to write to them encouraging them to move the house bills out of committee to the senate floor for a vote.
Our proposed osteopathic prescribing regulations continue to be reviewed and amended at the State Board of Osteopathic Medicine. We have been attempting to keep the regulation language exactly the same as on the allopathic side to avoid confusion and create parity. One problem has been with schedule II prescribing. The osteopathic board wishes to mandate that the patient be examined by the physician after the first 30 days on a narcotic to determine/confirm the need for continued narcotic therapy. The PSPA along with the Medical Society and the Hospital Association of Pennsylvania presented to the Board, arguments to keep the regulations the same. Those efforts were unsuccessful. Overall, the differences between the two regulations will be minimal. We will continue to keep you updated as they proceed.
Governor Rendell Signs Bills
Mark DeSantis, PA-C, Chairman, Governmental Affairs Committee
Issue: Long term care facilities mid-level provider verbal orders
On August 3, 2004 a meeting was held with the PSPA, Hospital and Healthsystems Association of Pennsylvania, Department of Health’s Bureau of Facility Licensure and Certification, Pennsylvania Nursing Home Association and the Pennsylvania Medical Directors Association.
In mid July, the DOH had posted a notice on their message board that it was their opinion that PAs and NPs could not give a verbal order in a LTCF.
This meeting was called to work out possible solutions. The DOH did concede they would accept orders signed and faxed from a mid-level at this time. They had agreed to consider developing an interim policy to the LTCF Act to permit it. In mid October, a letter was sent from PSAP and HHAP to Dr. Calvin Johnson, Secretary to the DOH asking for an update on the creation of this interim policy. No response has been received to date.
The DOH has stated they will consider requests for exceptions to Section 211.3 (oral orders) of the DOH regulations governing Long Term Care Facilities submitted by nursing homes. In order for the exception to be considered, the LTCF must develop a policy that states that the provider giving the verbal order would speak directly to the nurse who was going to carry out the orders.
A letter requesting an exception to Section 211.3 (oral orders) of the LTCF Act should be sent to:
William Bordner, Director
Department of Health
Division of Nursing Care Facilities
Health and Welfare Building
Harrisburg, PA 17120
Phone (717) 787-1816
Fax (717) 772-2163
If you have further problems, questions or concerns regarding the giving of a verbal order in a LTCF, please contact the society office at firstname.lastname@example.org.
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DEPARTMENT OF HEALTH UPDATE ON HOSPITAL REGULATIONS
On Friday August 15th, 2003, the Department of Health (DOH) and the Hospital Association of Pennsylvania (HAP) came to an agreement on interim language for hospital order writing by Mid-Level Practitioners. This was a major achievement for us. For the past three months, the PSPA has been working with HAP, along with representatives from the CRNP’s, Nurse Midwives and the Medical Society to develop joint language as an interim policy to allow both written and oral orders within hospitals. At our last HAP conference call, we reviewed what the DOH had written and suggested some minor changes. Those changes have been agreed upon by all parties
The new Statement of Policy became effective immediately upon publication in the September 27, 2003 issue of the Pennsylvania Bulletin. Click here
to view the new policy statement.
What this means is the following:
1. We can now write and give verbal orders in our hospitals again.
2. HAP will be sending all of their member institutions a letter outlining the new policy
3. Site reviewers have seen the new policy and are being educated on it at this point.
4. Hospitals are going to have 90 days from publication in the Pennsylvania Bulletin to come into compliance with the new policy changes. In some form, the hospital bylaws must state that a PA/NP/NMW can write and give oral orders in the institution. Hospitals no longer have to file for an exception.
The overall re-write of the DOH regulations, Title 28, will occur starting sometime in the next 12 months.
ORAL ORDERS AND OTHER REGULATORY CHANGES
Effective December 20, 2003, the Pennsylvania State Board of Nursing amended its regulations at 49 Pa.Code §21.145 (Functions of the LPN) to permit licensed practical nurses (LPNs) to accept oral orders in other than urgent medical circumstances. An oral order is defined as a spoken order issued by a practitioner authorized by law and facility policy to issue orders for medical and therapeutic measures. Click here for more information