Welcome to AAPA's News page where you will find current information about the Physician Assistant profession, and updates to our website. From this page, you will also be able to link directly to other pages of interest, such as Publications, the Academy's media kit, and contacts.
This page is frequently updated to provide you with the most current information on PAs and this fast-growing health care profession. We hope that, over time, you come to consider this page and AAPA's entire website as a primary source for the health care information you seek.
Senate Releases Merged Health Care Reform Legislation
Senate Majority Leader Harry Reid (D-NV) introduced the Patient Protection and Affordable Care Act this week, following a review by the Congressional Budget Office (CBO). The bill proposes to expand health care coverage by requiring most Americans to purchase health insurance coverage; creating new health insurance exchanges for individuals to select insurance plans; and imposing new insurance regulations that limit insurers’ ability to deny or cancel coverage based on pre-existing conditions and health status, and to vary premiums based on age, gender, and other factors.
CBO estimates that the legislation will cost $849 billion, reduce the number of uninsured Americans by 31 million, and cut the federal deficit by $127 billion over the next ten years. Review the CBO analysis of the new legislation here. Review a summary of the bill here.
PA Provisions in Senate Bill
The new Senate bill contains most of the PA provisions included in the Senate Finance and HELP versions of health care reform legislation. The legislation allows PAs to order skilled nursing facility care for Medicare patients. Additionally, the bill reauthorizes the Title VII Health Professions Programs of the Public Health Service Act with a 15% carve out for PA educational programs within the cluster on primary care medicine. The legislation fully integrates PAs into new medical home and chronic care management models of care. The new bill does not contain the Finance Committee provision allowing PAs to provide hospice care for Medicare beneficiaries, a decision that was reportedly prompted by a CBO re-evaluation of cost. (The House-passed health care reform legislation includes the PA hospice provision.) See Call to Action on the PA Hospice Provision.
Senate Timetable
The bill’s first test will be a procedural vote, possibly Saturday, to proceed with debate on the bill. Assuming that Senate leadership is successful in generating 60 votes, debate is expected to begin by Thanksgiving, with a goal of passing the bill by the end of the year and completion of a House-Senate Conference Committee by the end of January.
HHS Secretary Says that New Mammogram Screening Guidelines will not Change Federal Policy
HHS Secretary Kathleen Sebelius assured the public on Wednesday that new mammogram screening recommendations by the U.S. Preventive Services Task Force will not change federal insurance programs’ mammogram coverage policies. Released earlier this week, the new guidelines recommend that routine mammogram screening begin at age 50 and be conducted every two years. Secretary Sebelius emphasized that the task force is “an outside independent panel of doctors and scientists who…do not set federal policy.” See the Secretary’s statement here.
Center for American Progress Report Highlights Role of PAs
A November 2009 report, “Expanding the Primary Care Workforce,” recommends that the U.S maximize the current primary care workforce through better use of nurse practitioners and physician assistants, saying that “the primary care shortage requires us to maximize the use of every health care professional to the full extent of their training and competency.” Read more.
Robert Wood Johnson Foundation Launches Commission to Build a Healthier America
Saying that shortfalls in health affect Americans and the nation’s economy, the Robert Wood Johnson Foundation announced the creation of a new two-year commission to “focus on factors outside the health care system and identify non-medical, evidence-based strategies …to improve the health of all Americans. The commission will be co-chaired by Mark McClellan, M.D., Ph.D., and Alice Rivlin, Ph.D., both at the Brookings Institution. Learn more.
APHA Releases 2009 Edition of America’s Health Rankings
The American Public Health Association’s 20th version of America’s Health Rankings is now available. View your state’s ranking or download the entire report here. The report lists Vermont as the healthiest state and Mississippi as the least and finds that while disease treatment is improving, prevention is not. The report estimates the economic cost of obesity for all states.
The Senate has released its final bill and will begin consideration of the legislation within days. Unlike the House bill and the Senate Finance Committee's language, the final Senate legislation does not contain critically needed language to allow PAs to provide hospice care for Medicare patients.
Please contact your Senators today and urge them to reinsert in the final Senate bill the provision that would allow PAs to provide hospice care for their Medicare patients. While we are pleased to see a number of other PA priorities contained in the Senate bill, such as integrating PAs into new models of care and providing critical support for PA education programs, the hospice provision is a barrier that MUST be eliminated if PAs are to fully provide increased access to quality health care.
Have you joined our Grassroots Advocacy and Information Network (GAIN) yet? Our go-to advocacy corps, GAIN members are speaking out for the profession and making a difference on Capitol Hill. Sign up today and make your voice heard on Capitol Hill.
Key Contacts Still Needed!
A GAIN member mentions in passing that “Rep. So-and-So is a great guy and – oh, by the way – happens to be my neighbor.” And voila – a Key Contact is born! If you have an especially close or longstanding relationship with a Member of Congress, let us know by sending a quick note to Kristin Butterfield. We’ll plug you in to our network as someone to call on when a direct contact with a particular legislator is needed.
Register Now for AAPA’s Capitol Connection – February 22-23, 2010
Join forces with your fellow PAs and PA students in Washington, D.C., for a day on Capitol Hill and the opportunity to deliver an important message to Congress. AAPA's new Capitol Connection (formerly Adventures in Lobbying) conference will be held February 22-23, 2010. Make plans now to attend! Register here.
AAPA Federal Affairs staff is your resource on health care reform and other federal advocacy efforts. Do not hesitate to contact Sandy Harding, AAPA Federal Affairs Director, Kristin Butterfield, Assistant Director of Federal Affairs, or Kimberly Beer, Assistant Director of Federal Affairs, with your questions and suggestions.
Since 1996, the Emory University Physician Assistant Program's South Georgia Farmworker Health Project has taken groups of medical professionals and students to Decatur and Echols counties to provide free outpatient care to medically underserved migrant farm workers and their families.
Watch an audio slideshow of the South Georgia Farmworker Health Project here.
The project is the 2010 Host City Prevention Campaign site, and will receive a $10,000 check from AAPA, the PA Foundation, PAEA and the Student Academy of AAPA. The project receives no federal or state funding. Yet, volunteers typically treat 1,500 to 1,700 migrant and seasonal farm workers during the two weeks in the summer, and from 250 to 300 in the fall over the course of a weekend.
In December's PA Professionalmagazine, Emory PA Student Jodi Sindelar describes what it's like to be a project volunteer: "In the beginning, it is really overwhelming when you have a huge long continuously growing line of patients and it's11:30 at night. But knowing that you can rely on your fellow classmates and colleagues to get everything done and that we are going to be able to help the migrant farm workers and their families was something that we all felt by the end of the night was a huge accomplishment. It was a great experience being able to actually help people who were genuinely appreciative of the care that they were receiving."
For more information on the project, go to www.sgfhp.org.
Russ Dorr has been a PA for 38 years, and friends with author Stephen King for nearly as long. The two first met in 1974 when King became a patient at Dorr's clinic in Maine. At the time King had just one book under his belt, the novel Carrie. A short time later, Dorr began advising King on the gory medical details of books such as The Stand, The Shining, Pet Sematary and Misery, researching everything from how viruses mutate to how to cauterize a wound with a blowtorch.
He took on an even larger research role in King's November 10 release Under the Dome, a thriller about a small Maine town that suddenly becomes sealed off from the rest of the world by an invisible force field. One of the characters is Rusty Everett, a physician assistant who must deal with the mysterious medical situations that arise when a town is abruptly cut off from the rest of the world.
Click below to watch a video of Dorr talking about the PA character and what it was like to work with King on the medical details of the book.
Dorr will be featured in the February issue of PA Professional where he will discuss his relationship with King and how he came to be an adviser to one of the most successful authors of our time.
I sent out a tweet not too long ago reminding all the PAs on Twitter of what the hashtag for IMPACT 2010 was (for the record it's #aapa10), well I made a mistake & was promptly corrected by an Atlantan who is a fellow association pro.
My mistake was that I called Atlanta, HOTlanta. A phrase I have used many times on this blog, oops!
So I stand corrected. I vow that I will no longer call Atlanta HOTlanta, though I cannot be responsible for the other bloggers on The PAnel... ;)
So do you call it Atlanta, HOTlanta, The ATL, A-Town, The A, something else?
Click here for a printer-friendly version of this issue of Reimbursement Watch.
Medicare Releases 2010 Payment Rules – the Good, the Bad, and the . . .
A display copy of the annual Medicare Physician Fee Schedule was released on October 30 by the Centers for Medicare and Medicaid Services (CMS). The final rule, which contains a plethora of regulatory changes, initiatives, and clarifications, will guide Medicare's payment and coverage policies for health care professionals, facilities, and Medicare beneficiaries beginning January 1, 2010.
In August of this year, AAPA submitted official comments to CMS on a number of provisions contained in the proposed fee schedule rule. The 2010 final rule represents decisions reached by CMS officials after consideration of comments offered by interested parties.
Here's a look at some of provisions in the final rule:
Medicare is projecting a 21.2 percent decrease in the 2010 fee schedule. This payment decrease, based on a congressionally mandated payment formula known as the sustainable growth rate (SGR), is not a surprise. Health care professional groups such as AAPA have been lobbying Congress for months to have the decrease rescinded. For the past 8 years Congress has intervened to offset the proposed decrease. It is expected that Congress will play the same role this year to avoid payment reductions. Nearly everyone, including CMS officials, wants to prevent the decrease.
"The Administration tried to avert the pending fee schedule cut in the FY 2010 budget proposal that it submitted to Congress, and remains committed to repealing the SGR," said Jonathan Blum, director of the CMS Center for Medicare Management.
CMS will permanently remove the cost of physician-administered drugs from the definition of physician services in the SGR. This action will mitigate future fee schedule decreases, but excluding the cost of physician-administered drugs won't affect the 2010 schedule.
CMS officials made a decision to eliminate reimbursement for outpatient and inpatient consultation codes (except for G codes that are used to bill consults as part of the telehealth benefit). Reimbursement that had been paid for consultations will result in increased payments for existing new and established patient evaluation and management or E/M services in a budget neutral manner. Payment adjustments will be made to the surgical global period payment to reflect the higher value of E/M office services furnished during the 10- or 90-day post-op timeframe.
A benefit category for cardiac and pulmonary rehabilitation services was established. However, CMS stated that the statutory language in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires that a physician provide immediate and direct supervision of cardiac, intensive cardiac, and pulmonary rehabilitation services.
AAPA argued, and CMS officials agreed, that in the 2010 Outpatient Prospective Payment System proposed rule, PAs have the ability to provide direct supervision of services they personally perform within State scope of practice and hospital privileging guidelines. In addition, statutorily PAs provide care to Medicare beneficiaries based on the overarching concept that PAs deliver "physician services," and the inability of PAs to supervise cardiac and pulmonary rehabilitation services will hinder beneficiary access to these vital services.
CMS responded that it is their belief that MIPPA language was specific to physician performance of the direct supervision responsibilities in these specific areas and that they did not have the authority to extend the supervision responsibilities to non-MDs/DOs. AAPA reimbursement staff will continue to pursue this issue with CMS officials.
Language that defines a PA as a "qualified person" eligible to provide kidney disease patient education services to patients with Stage IV chronic kidney disease.
An increase in the Medicare payment percentage for mental health services from 50 to 55 percent. Medicare will adjust its payment percentage each year until it reaches the 80 percent payment threshold - putting coverage of mental health services at the same rate as other Medicare covered services.
The addition of 30 Physician Quality Reporting Initiative measures that health care professionals utilize to report quality care measures and qualify for the 2 percent Medicare bonus payment.
A payment increase in the initial preventive physical exam or the so-called "Welcome to Medicare exam" that is provided for Medicare beneficiaries within the first 12 months of Medicare enrollment.
While some specialists are less than pleased at the CMS decision to eliminate consult codes from the Medicare payment system, the policy change is a net gain for PAs and the physicians with whom they practice. Current policy allows PAs to personally perform consultations. However, CMS policy says that a physician and a PA can't share a consult. For most evaluation and management (E/M) services in the hospital setting, if both a PA and a physician treat the same patient on the same calendar day, the entire service can be combined and billed under the physician, if the physician and the PA have a common employer. In 2006 Medicare policy changed and excluded consultations from being billed as a shared service.
The elimination of the use of consult codes by Medicare means that virtually all hospital E/M codes/services may be shared between physicians and PAs, resulting in the ability for physicians to collect 100 percent of the Medicare fee schedule (as opposed to payment at 85 percent when billed under the PA) when both health care professionals provide care to the same patient on the same day.
While AAPA feels that PAs should be separately recognized when they deliver patient care, we realize that certain hospitals and physicians were limiting the ability of PAs to participate in the performance of consultations because Medicare policy did not allow that service to be shared. PAs should encourage billing personnel to utilize billing software to help keep tract of the PA's contribution to revenue and patient care, despite the fact that many PA-provided services are being captured and billed under the supervising physician.
Pick Up the Phone or Answer the E-Mail Message
AAPA Reimbursement Department staff members are reaching out to state chapter leaders in an attempt to engage in a focused discussion about reimbursement conditions in each state. Over the next few weeks, state chapter leaders can expect a request to engage in a conference call discussion about state reimbursement issues including Medicaid, Medicare, workers' compensation, and private insurers.
Reimbursement reports are being prepared and will be sent out to each state. Every effort is being made to include as many chapter officers/leaders as possible in these conference calls. Understanding the busy clinical schedules that most PAs have, Reimbursement Department staff is offering to host these calls in the evening.
These discussions allow chapters to learn about the most up-to-date policies that govern reimbursement in their states, as well as strategies to change policies that limit PA practice.
Reimbursement Watch is a bi-monthly newsletter written by Michael Powe, AAPA Vice President of Health Systems and Reimbursement Policy. You are more than welcome to reprint items, just credit American Academy of Physician Assistant's Reimbursement Watch. Your comments, questions, and suggestions are welcome. Phone 703-836-2272 ext. 3211, Fax 703-684-1924 or Write: AAPA 950 North Washington Street, Alexandria, VA 22314-1552. E-mail address:
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Photo credit: The Austin American-Statesman At St. Monica Catholic Church in Cameron, soldiers prepare the flag to be presented to Joleen Cahill at the funeral for her husband, Michael G. Cahill. Joleen Cahill said her husband loved his job as a [physician assistant] at Fort Hood.
Hundreds paid tribute Sunday to PA Michael G. Cahill, 62, the only civilian to die in the Fort Hood shooting spree. More than 500 of his family members and friends attended a funeral Mass at St. Monica's Catholic Church in Cameron, Texas, on Nov. 15.
The Austin American-Statesman reported that "Michael Cahill was given a full military funeral at the church where he worshipped every week. Pallbearers in Army dress uniforms carried his flag-draped casked out of the chapel while bagpipes played "Amazing Grace." Across the street from the church, Cameron residents gathered on their front lawns to watch the service.
Cahill was given a rifle volley salute, and the flag was handed to his widow, Joleen. His friends and family members said they will remember him not just as an Army National Guard veteran, but also as a devoted family man who was rarely seen without a cigarette in one hand and his trademark seldom-washed coffee cup in the other."
An obituary that appeared in the Billings Gazette, of Billings, Mont., reports that Cahill's interment will take place in the spring of next year in Montana.
In lieu of flowers, donations can be made to Soldier's Angels, TAPS (Tragedy Assistance Program for Survivors), National Association of Free Clinics or Doctors Without Borders. There is an account set up at Classic Bank in Cameron, Texas, for those wishing to support the Cahill Family. Make the check payable to Jolene Cahill; send it to Classic Bank, 102 N. Houston Ave., Cameron, TX 76520-3321. Please include a note telling the bank it's for PA Michael G. Cahill's widow.)
I'm not sure how many are aware of this, but Atlanta is the home of the largest aquarium in the world. The Georgia Aquarium opened in 2005 after a generous donation from Home Depot founder Bernie Marcus as well as many other corporate partners.
AND the IMPACT 2010 Opening Reception will be held there on May 29th from 8pm to 11:30pm. (that's so cool to me)
To learn a little more about this awesome destination, visit the Georgia Aquarium all over the web:
Words are to the clinician, what the scalpel is to the surgeon. But this valuable diagnostic tool can be drastically "dulled" by language and cultural barriers and a lack of health literacy.
Amid growing concerns about racial, ethnic and language disparities in health care, The Joint Commission and the U.S. Department of Health and Human Services Office for Civil Rights recently released a video to identify alternatve communications methods to improve patient-provider interactions.
In a press release, The Joint Commission and HHS explained that effective communication is a critical aspect of safe, quality patient care. The video will help health care organizations determine the best methods of care for meeting these communication needs.
Language access is a matter of national importance. Many patients of varying circumstances require alternative communication methods -- more than 28 million people with hearing loss, reports the National Institute on Deafness and Other Communication Disorders. And there are about 47 million people who speak a language other than English living in the United States, according to the U.S. Census Bureau.
For more information on the video, go here. To Watch the 32-minute video, go here.
In a rare, late Saturday session on November 7, the U.S. House of Representatives passed HR 3962, the Affordable Health Care for America Act, by a 220-215 vote. A summary of the House-passed bill may be viewed here. HR 3962 removes current barriers to care provided by PAs by allowing PAs to order skilled nursing facility care and to provide hospice care for Medicare patients. Additionally, the House bill reauthorizes the Title VII Health Professions Programs of the Public Health Service Act, the only federal source of funding for PA educational programs. The bill fully integrates PAs into new medical home and chronic care management models of care.
Senate Action
The Senate expects to receive a score this week from the Congressional Budget Office (CBO) on the merged Finance and HELP Committee bills and begin debate on the bill next week. Senate Majority Leader Harry Reid’s (D-NV) goal is to pass the bill by the end of the year and complete a House-Senate Conference Committee by the end of January.
AMA Continues Commitment to Health Reform
The American Medical Association (AMA) House of Delegates convened in Houston, Texas for their 2009 mid-year meeting on November 7-10. Calling this a “defining moment” for the AMA, President J. James Rohack, MD outlined seven critical elements that the AMA sees as essential to achieving meaningful health system reform: cover all Americans; expand choice and eliminate denials based on “pre-existing” conditions; protect the patient-physician relationship; promote quality, prevention and wellness; repeal the Medicare physician payment formula; reduce defensive medicine and streamline administrative processes. The AMA offered its support of HR 3962, the “Affordable Health Care for American Act” which was passed by the U.S. House of Representatives as the AMA Delegates were meeting in Houston. AMA delegates engaged in spirited debate regarding HR 3962. President Rohack acknowledged that HR 3962 is not the perfect bill and that the AMA will continue to advocate for changes that help make the system better for patients and physicians as the legislative process continues. A major focus of AMA advocacy efforts in the U.S. House of Representatives now turns to support for HR 3961, the “Medicare Physician Payment Reform Act of 2009.” The AAPA has official observer status in the AMA House of Delegates. Mary Ettari, MPH, PA-C, a past-president of the Academy currently serves as our official liaison to the AMA.
Health Affairs and RWJ Health Policy Brief
Health Affairs and the Robert Wood Johnson Foundation released a new health policy brief this week on the public insurance option contained in the House-passed health care reform bill. The brief describes how the plan would work, as well as the views of supporters and opponents of the public plan. To learn more click here.
H1N1 News from the FDA
On November 10, Margaret A. Hamburg, M.D., Commissioner of the Food and Drug Administration, released an open letter to health care professionals on the development of the H1N1 vaccine. She thanked health care professionals for their work thus far in responding to the H1N1 influenza outbreak and communicated her hope that information on the manufacturing and approval processes for the vaccine would help health care professionals respond to patients’ questions. See the letter here. View AAPA information on influenza and H1N1.
News and Reports
A new survey conducted by the National Alliance on Mental Illness reveals several key findings on depression. Among the findings are that over 50 percent of caregivers who responded to the survey had been diagnosed with depression themselves and that over 60 percent of people living with depression report that they rely on care provided by primary health care physicians rather than mental health professionals. The full survey may be reviewed here.
Meanwhile, a study conducted by Avalere found that the use of community health centers is associated with lower health care spending, including lower use of emergency department visits, fewer inpatient hospital admissions, and shorter inpatient length of stay. Read the study here.
Congress is Home: A Good Reason to Schedule a Visit
Members of the House and Senate are home for the Veterans’ Day long weekend -- and so all PAs are urged to connect with legislators Nov. 12-16 in the district. Be sure to thank House members for the PA provisions contained in the House bill, and urge Senate members to support provisions intheir final bill that would allow PAs to order skilled nursing facility care and provide hospice care for their Medicare patients, that integrate PAs into new models of care such as the medical home, and that provide critical support for PA education programs. Click here for more tips on meeting with your legislator.
GAIN – 1300 Strong and Growing!
Have you joined our Grassroots Advocacy and Information Network (GAIN) yet? Our go-to advocacy corps, GAIN members are speaking out for the profession and making a difference on Capitol Hill. Sign up today and make your voice heard on Capitol Hill.
Key Contacts Still Needed!
A GAIN member mentions in passing that “Rep. So-and-So is a great guy and – oh, by the way – happens to be my neighbor.” And voila – a Key Contact is born! If you have an especially close or longstanding relationship with a Member of Congress, let us know by sending a quick note to Kristin Butterfield. We’ll plug you in to our network as someone to call on when a direct contact with a particular legislator is needed.
Register Now for AAPA’s Capitol Connection – February 22-23, 2010
Join forces with your fellow PAs and PA students in Washington, D.C., for a day on Capitol Hill and the opportunity to deliver an important message to Congress. AAPA's new Capitol Connection (formerly Adventures in Lobbying) conference will be held February 22-23, 2010. Make plans now to attend! Register here.
AAPA Federal Affairs staff is your resource on health care reform and other federal advocacy efforts. Do not hesitate to contact Sandy Harding, AAPA Federal Affairs Director, Kristin Butterfield, Assistant Director of Federal Affairs, or Kimberly Beer, Assistant Director of Federal Affairs, with your questions and suggestions.
News
I sent out a tweet not too long ago reminding all the PAs on Twitter of what the hashtag for IMPACT 2010 was (for the record it's 
Click here
I'm not sure how many are aware of this, but Atlanta is the home of the largest aquarium in the world. The Georgia Aquarium opened in 2005 after a generous donation from Home Depot founder Bernie Marcus as well as many other corporate partners.
