LEGISLATIVE ACTION CENTER
Visit the AAPA Legislative Action Center to find out who your state and federal legislators are and what important legislation is pending.

House Bill 1251: Expansion of ratios under State Board of Medicine
House Bill 1252: Expansion of ratios under State Board of Osteopathic Medicine

House 1804: Expansion of scope and Malpractice limits under State Board of Medicine
House 2088: Expansion of scope and Malpractice limits under State Board of Osteopathic Medicine

WHY “PA” SHOULD ALSO STAND FOR “POLITICAL ACTIVIST”
David Ashner, Analyst, State Government Affairs

We are all impacted on a personal level by political decisions – decisions that affect things like our civil rights and the taxes we pay. In addition, PAs are affected professionally by politicians who pass laws, and by political appointees who regulate the PA profession. Most importantly, laws and regulations affect your patients. Every PA has had a patient whose most pressing need was not a different drug or a new therapy, but a change in the law. It is therefore the special obligation of PAs to understand the political process and use that knowledge to advance the interests of their patients and their profession.

There are many different ways that politics impacts the PA profession. State laws, which are the result of a long and sometimes grueling political process, can govern everything from which patients are covered by Medicaid to how many PAs a single physician may supervise. Before Pennsylvania’s legislators passed a law to license physician assistants in 1978, PAs weren’t even allowed to practice here. PAs should know how to work with the legislators who vote on those laws.

The first step is to stay informed. Read the newspaper and keep up with the state’s economy and political climate. Know what health bills are being considered by the legislature and the implications of those bills on health care. The most basic duty of any citizen in a democracy is to vote, and understanding the issues is a prerequisite to casting an informed vote. But knowing the issues backwards and forwards also allows you to take the next political step, which is to influence others.

Introduce yourself to your state legislators, and communicate with them on health care topics when your expertise could be valuable. If you can provide advice to a state senator on public health issues, such as smoking bans or bicycle safety laws, you will find a much more receptive audience when that PA supervision bill is up for consideration down the road. You could also work on a campaign for a candidate who shares your positions on important issues, or even run for office yourself.

Running for office is the pinnacle of political activity. As a PA, you may already know many of the people in your community because they are your patients, hospital or clinic staff and colleagues. You also have a deep understanding of the health care issues that are important to your community, and few issues are more important to voters than health care. You don’t necessarily have to give up clinical practice to run for political office – many governmental positions are compatible with continuing in full time clinical practice – but serving as an elected official gives you the opportunity to influence the health of your community on a much wider scale.

Along with laws passed by elected officials, PA practice is also governed by regulations adopted by appointed officials. Medical Board regulations, along with regulations from other agencies, often impact the PA profession at least as much state laws do. Unlike legislators, who must deal with the entire spectrum of public issues, regulators are focused on one specific area – in this case, medicine – and as such are expert in their field. Nevertheless, it is important for PAs and PA organizations to communicate with regulatory agencies. Attend medical board meetings if they are open to the public and submit comments on proposed regulations.

While it is possible to do these things as an individual, working through a group of PAs like PSPA is much more likely to carry weight with political actors. Working through an organization allows PAs to establish institutional relationships with other health care players in the political process, such as state medical societies and nursing groups. While PAs and other health care professionals may not agree 100% of the time, you’ll find that working together when there is agreement diminishes the frequency and intensity of disagreements on more controversial issues.


As published in the Summer 2009 PSPA News

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HOSTING A LEGISLATOR AT YOUR PRACTICE
David Ashner, AAPA State Governmental Affairs

One great way to educate elected officials is to invite them to your practice. Hosting a legislator is not only a useful way of informing office holders about the issues that are important to you and the patients you serve. It can also help you build a relationship with that legislator, which can be helpful down the road when you want to express an opinion about health care legislation that is being considered.

Here is a step-by-step guide that you can use if you want to host a state legislator at your practice:

1. Check with your clinic administrator and supervising physician to be sure they approve. Discuss ideal dates and times.
2. Do some background research on the legislator. You can usually find biographies on state legislature Web sites. If you are having trouble getting information on your legislator, contact David Ashner on the AAPA staff at dashner@aapa.org. If you find that your legislator has a particular interest that is relevant to your clinic (i.e. care for the elderly, women’s health, care for recent immigrant populations), be sure to emphasize that during the visit.
3. Contact the legislator or a member of his or her staff either by letter or phone. If this is after an election, congratulate them on their success and invite them to see “health care in action” at your clinic. Your message should be that you know health care is an important issue to them, and you’d like to give them the opportunity to see where health care is provided in their district and to discuss some of the challenges facing health care providers and their patients. Make sure that they know that you are a physician assistant and that they are aware of any PA-related bills that will be debated in the coming legislative session.
4. Confirm a date and time for their visit. Thirty minutes to an hour should be sufficient.
5. Prepare materials to give to the legislator. AAPA has fact sheets and issue briefs on a wide variety of topics, and Academy staff can help you pick the right materials for your situation. These materials are also available at AAPA’s Web site. Giving the materials to the legislator in a file folder with “Physician Assistants” printed on the tab will make it easy for the legislator to put the information in the right place once he or she is back at the office. Be sure to include your contact information or business card.
6. Spiff up the office and alert the staff. Consider making a “Welcome Representative/Senator _____” banner or poster for the office.
7. Invite the media, if it’s okay with the office administrator and your supervising physician. Also, be sure that inviting the media is acceptable to the legislator. If everyone agrees, contact David Ashner (dashner@aapa.org) on the AAPA staff for information on making the visit a media event.
8. Make a detailed schedule for the visit. Here’s a sample agenda:
     9:00 - Legislator arrives, PA host greets the legislator, introduces staff and physicians, and introduces the legislator to patients in the waiting room.
     9:10 - Tour of office and description of population served, special interests and roles of clinic staff. Be sure to mention any areas of particular interest to the legislator (i.e. “Dr. Jones is board certified in geriatric medicine,” or “Mrs. Miller is both our receptionist and our translator”).
     9:20 - Legislator, PA, and physician convene in conference room or office to discuss health issues in district. Coffee is served. Legislator is invited to share his or her health agenda for upcoming session and discuss other issues of particular interest. The PA’s role in the clinic is described by the physician-PA team. Physician discusses the importance of PA legislation (if applicable) to the legislator’s constituents (remember that the message must be about why the PA legislation is important to the legislator). Clinic group asks how they might help the legislator with health issues the legislator has identified. Someone takes notes for follow-up.
     9:30 - Media (if invited) arrives. Clinic staff and legislator pose for photos. Legislator is given opportunity to discuss health issues and the importance of the visit. If the media is not invited, have a staff person available to take pictures.
     9:45 - Legislator is thanked by everyone for taking time from his or her busy schedule to visit. Additional photos of legislator at clinic and with staff are taken.
9. Host the visit.
10. The same day - Contact your chapter’s Legislative Coordinator to review the visit.
11. The next day - Check the media for any mention of the event.
12. Two days later - Send a personal note thanking the legislator for the visit and include copies of photos.
13. The following week – Begin follow up on any items mentioned by the legislator.

So, there you have it: it’s as easy as one, two, thirteen. Remember, personal experience is the most significant motivator for legislators. Hosting a legislator at your practice takes less than an hour, but the experience of meeting a PA will stay with them for years beyond.

For more information, or for help preparing for an upcoming visit by a legislator, please contact David Ashner at dashner@aapa.org

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GOVERNMENTAL AFFAIRS NEWSLETTER ARTICLE
Mark DeSantis, PA-C Chairman

Scope of Practice Expansion wins Approval

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.