From PA Jay Sommers, President, NAPA 03/21/2014 Dear Nevada PA Colleagues: As some of you are aware in the fall of 2013 the Clark County Medical Society (CCMS) proposed regulatory changes that were broadly felt by PAs and physicians to hinder patient access to care and destabilize the physician/PA relationship in the state of Nevada. The current regulatory changes that we are now addressing from the NSBME are called LCB R151-13RP1. The Nevada Academy of Physician Assistants (NAPA) Board has made its best efforts to be in frequent contact with PAs over this important issue. In an effort to be completely transparent and inclusive with all PAs throughout the state we have made a special effort to involve PA’s in Reno/Carson area along with Rural PA’s. The transformation of the NAPA over the past 3 months started slowly, but it has grown wings and we really appreciative of all the support that we have encountered along the way, throughout the state, as we strive to be the largest organization representing ALL PAs in Nevada! We have two Board members in the Carson/Reno area, one in Fallon, and 4 in the Las Vegas area. In an effort to prepare a response to the Nevada State Board, and the challenges facing PAs and patients in the state as regards to providing care, your NAPA Board and committee members have been in very frequent consultation with AAPA Senior State Advocacy Staff, legal representation, the executive staff of the Nevada State Board of Medical Examiners (NSBME), and many other key stakeholders. I would like to take a moment to especially thank the PAs in the Reno/Carson area (especially Board members Dan Coll and Ben Prohaska). Their proximity to the key legislators and NSBME members, along with flexible schedules and ability to take time from work, have been invaluable in fostering the improved understanding that only come from frequent personal contact. They have headed off lots of misunderstandings and provided clarifications and a sounding board by simply being able to casually interact with some of these folks during a coffee or lunch break . Additionally, we as a Board have been making an effort to work with all PAs, members and nonmembers alike, to get input and hear concerns. There were NAPA members and non-member PAs on the committee that drafted the finally approved language. From these discussions, and months of committee work, there is new proposed regulatory language that embraces the positive changes in the R151-13RP1 proposal as well as omitting language that is detrimental to the Physician–PA TEAM in Nevada. ****This link will take you to the PA revised proposed regulatory change to LCB R151-13RP1. *** The current Legislative Counsel Bureau (LCB) proposal R151-13RP1 without the suggested changes can be found at leg.state.nv.us/register/2013Register/R151-13RP1.pdf. Here’s why these changes are proposed: Looking at the LCB 151-13 attachment our regulatory proposed changes are identifiable in green, the proposed changes currently offered by the LCB and the NSBME are identified in blue, and the language to be stricken by the LCB and NSBME from the current regulations are identified in red. In NAC 630.370, section 4, number 6, page 4 you will find edited language that was created to solve the problem of a PA working with a multiple physician practice or in a hospital system. The NSBME contractual responsibilities and liability lie with registered supervising physicians, but to require every supervising physician to complete every aspect of the supervisory role would be duplicative and unnecessary. We were challenged to address this problem by creating an option for such situations. We came up with wording that can be adopted by the NSBME that would allow multiple physicians to supervise the PA, while making it clear that each of them is not responsible for all aspects of the supervisory role so long as one physician or a combination of physicians is fulfilling these requirements. *This model is created as an alternative option only, not a requirement for all multi-physician practices or hospitals. It will not replace the single physician/PA oversight model currently in place. Several other recommendations include: In NAC 630.360, section 3, number 4, page 2 we have recommended removing the proposed LCB/NSBME change to have a supervising physician name at the bottom of every chart entry. Some PAs told us that this would be an unnecessary burden in their practice. In NAC 630.370, section 4, number 2, page 3 we have recommended removing the proposed change requiring a supervising physician to co-sign 5% of your charts. We believe, as does the AAPA and AMA, that chart co-signature policies should be determined at the practice level. For instance a new PA may need 100% of the charts signed while a seasoned PA will need less. In in NAC 620.495, section 6, page 9 we are supporting the revision currently on the NSBME draft that one physician may supervise up to 4 PAs or NPs or any combination of the above at the time medical care is being provided. (Currently this number is at 3). Please review the proposed changes. We believe these changes reflect positive steps for patient access to care in a state ranked 49th in access to healthcare, it provides continued stability of the physician/PA relationship, and creates the development of a new and more efficient oversight model for a multi-physician practice. We welcome your feedback. We consider it vital that this be a proposal from all PAs in the State of Nevada. If you have concerns or questions about the proposed regulatory language, please contact us. Contact information listed at the bottom of this letter. This is a call to action!! We need your involvement. 1. If you support this proposal, then please indicate your support by signing the attached online petition. This petition has been CREATED by a number of PAs in the North and will be a great (and very easy) rallying cry from PAs. The petition can be found at chn.ge/1mbdXaX MUCH PREFERED------------} 2. You can show support by sending a letter directly to the NSBME. A letter template can be found here. This letter can be sent by you and any Physicians in your practice that you can get to sign one! The State Board LOVES hearing from its Physicians about how this will affect their Practice! (We have left it in WORD format so that you can add information about your particular clinical situation and add your name). Letters can be sent to: Nevada State Board of Medical Examiners 1105 Terminal Way Suite 301 Reno, NV 89502 fax: (775) 688-2321 Letters and other written comments on this regulation will be accepted until close of business on May 1, 2014 3. Please consider attending the NSBME public hearing on April 10th at 10:30 AM. This meeting is an invitation for everyone to speak who has a stake in these changes. We would LOVE to see PAs and Physicians show up and speak about how these proposed changes would affect their practice. The meeting will be video conference and held in two locations: In Las Vegas: Nevada State Board of Medical Examiners/Dental Examiners 6010 South Rainbow Blvd. Bldg. 1, Ste A Las Vegas, NV In Reno: Nevada State Board of Medical Examiners 1105 Terminal Way Suite 301 Reno, NV More details are in the notification of public hearing posted here: medboard.nv.gov/Regulations/2013/Notice%20of%20Intent%20to%20Act%20Upon%20Regulation.pdf Important to note: spoken comments at the meeting are more powerful if they are also written and handed in. If you plan to speak, come ready to read prepared comments and submit those comments to the NSBME in writing. Please do not be intimidated to speak. The board is eager to hear how these changes will affect each practice on an individual basis. If you would like to just come and state you agree with the changes put forth by NAPA and your PA colleagues then please come and do so. Numbers are power in these meetings. Sincerely, The Nevada Academy of Physician Assistants Board of Directors Jay Somers (President) JCSomers@aol Steven Kiss (Secretary/Treasurer) stevenjohnkiss@hotmail Bart Anderson (Rural Director) pabartman@gmail Dan Coll (Northern-Nevada Director) danieljohncoll@gmail Gerry Jones (Chief Delegate) gjonespa@gmail Gary Manley (Southern-Nevada Director) [email protected] Ben Prohaska (Board Member at Large) bprohaska@hotmail If you are NOT yet a NAPA member PLEASE consider joining us at: NevadaPA ALSO join our Facebook page at: “Nevadapa”. This alert is being sent to you via the AAPA Legislative Action Center at the request of your state chapter. NAPA and AAPA: Partners in Advocacy If you no longer wish to receive e-mail from us, please click here.
Posted on: Fri, 21 Mar 2014 20:21:59 +0000
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