CAPA News July/August 2013 by CA Academy of PAs

News

Official Publication of the California Academy of Physician Assistants

July/August 2013

\The Magazine

SB 352 Medical Assistant Supervision Makes Its Way to The Governor’s Office by Teresa Anderson, MPH, Public Policy Director

he legislative process can often feel like a roller coaster ride. The kind that goes upside down and backwards six times, but stops in the middle for a split second, just long enough for you to catch your breath. It is fast moving and fun, but at some point you begin to wonder when it will come to an end. Fortunately, there are deadlines in the legislative process so even though there are twists and turns along the way, we know there is an end in sight. SB 352 Medical Assistants, a bill authored by Senator Pavley, would allow physician assistants, nurse practitioners and certified nurse mid-wives to supervise medical assistants across medical office settings, has taken many twists and turns along the way. Though we still have one of those upside-down and backwards loops to get through, the process is nearing the end. In the last CAPA News we asked all of you to ask your supervising physicians, medical assistants, nurses and others in your practice to sign a support letter for SB 352 Medical Assistants and fax it to the CAPA office. The purpose for doing this is to use these letters to demonstrate to legislators and the Governor the desire and will the medical community has to make this bill a reality. To date, we have received hundreds and hundreds of letters! Organized by profession and labeled with bright colored post-it notes, the

quality, cost-effective team-based care in the most efficient manner possible. A quick recap of the process so far… each and every step of the way

Ready for a day of lobbying! Teresa’s binder full of letters from medical offices throughout California. Thank you, CAPA members, for getting those letters signed by your office personnel and faxing them in.

letters are compiled in a binder and carried each and every step of the way as we made our way into legislator offices to lobby the bill. Needless to say, many are impressed with the number of support letters generated on behalf of SB 352. Our message has been strong and clear that it is time to eliminate legal restrictions and barriers to efficient, coordinated team-based care by allowing physicians to delegate the task of MA supervision to a PA, NP or CNM across all outpatient medical settings. Estimates range from 4-6 million newly insured Californians will be seeking health care services as the Patient Protection and Affordable Care Act is implemented. In any case, 4, 5 or 6 million, the health care system will need to be able to deliver high-

• April 8, 2013: SB 352 was heard in Senate Business and Professions and passed out of that committee with 9 Yes votes and 1 No vote • April 22, 2013: SB 352 was heard on the Senate Floor and made it off the floor with 36 Yes votes, 2 No votes and 1 Abstention • June 25, 2013: SB 352 was heard in Assembly Business, Professions and Consumer Protection and passed out of that committee with 10 Yes votes, 0 No votes and 3 Abstentions • August 8, 2013: SB 352 was heard on the Assembly Floor and made it off the floor with 0 No votes August 8 was 4 months to the day since our bill was introduced. We are anxiously awaiting the final loop as SB 352 makes its way to the Governor’s Office. THANK YOU to everyone who has been along for the ride; sending letters, making phone calls, testifying and lobbying this bill. 

News

At The Table

Editor Gaye Breyman, CAE

Left: At the May 20, 2013 meeting of the Physician Assistant Board. Board members present: (L to R) Sonya Earley, PA; Vice President, Cristina Gomez-Vidal Diaz; President Bob Sachs, PA-C; Catherine Hazelton; Charles Alexander, Ph.D. and Jed Grant, PA-C

Managing Editor Denise Werner Proofreaders Kim Dickerson Coryn Kulesza

Bottom Left: June 25, 2013, CAPA lobbyist, Kathryn Scott sits with CAPA’s Founding President, Rod Moser, PA-C, Ph.D. as they wait to be called to testify before Assembly Business and Professions Committee.

Editorial Board Jeremy A. Adler, MS, PA-C Roy Guizado, MS, PA-C Adam Marks, MPA, PA-C Bob Miller, PA Michael Scarano, Jr., Esq.

Bottom Right: On June 25, 2013, Public Policy Director, Teresa Anderson (left) and Executive Director, Gaye Breyman (right) attended a breakfast fundraiser in Sacramento for Assemblymember Holly Mitchell.

CAPA Board Of Directors President Adam Marks, MPA, PA-C president@capanet.org President Elect Jeremy A. Adler, MS, PA-C presidentelect@capanet.org Vice President Roy Guizado, MS, PA-C vicepresident@capanet.org Secretary Joy Dugan, MSPH, PA-C secretary@capanet.org Treasurer Bob Miller, PA treasurer@capanet.org Directors-At-Large Ana Maldonado, MPH, DHSc, PA-C dirana@capanet.org Cherri L. Penne-Myers, PA-C dircherri@capanet.org Kevin Robertson, MPH, PA-C dirkevin@capanet.org Jay Williamson, MS, PA-C dirwilliamson@capanet.org Student Representative Chelsea Hemming, PA-S studentrep@capanet.org

The CAPA News is the official publication of the California Academy of Physician Assistants. This publication is devoted to informing physician assistants to enable them to better serve the public health and welfare. The publisher assumes no responsibility for unsolicited material. Letters to the editor are encouraged; the publisher reserves the right to publish, in whole or in part, all letters received. Byline articles express the opinion of the author and do not necessarily reflect the views or policies of the California Academy of Physician Assistants.

The CAPA office is located at: 2318 S. Fairview St. Santa Ana, CA 92704-4938 Office: (714) 427-0321 Fax: (714) 427-0324 Email: CAPA@capanet.org Internet: www.capanet.org ©2013 California Academy of Physician Assistants

CAPA NEWS

AAPM Foundation Appoints PA to its Board

he American Academy of Pain Medicine (AAPM) Foundation recently appointed Jeremy Adler, MS, PA-C, to its Board of Directors. This is great news for Adler, the PA profession and the AAPM Foundation.

Adler is well respected in the field of pain medicine and practices at Pacific Pain Medicine Consultants in California. He brings the PA perspective and his years of experience in the specialty of pain medicine as a provider, lecturer and author to the AAPM Foundation Board. Additionally, Adler is the founder and Immediate Past-president of the San Diego Society of Physician Assistants, as well as the incoming President-elect of the California Academy of Physician Assistants. For more information on the AAPM Foundation or Jeremy Adler please contact capa@capanet.org. 

PA Data is Needed for Legislators and Policy Makers in Sacramento

California PA Practice in 2013 – A Leading Edge Survey California Academy of Physician Assistants

www.capanet.org/PAsurvey

Thank you to all who took the CAPA/OSHPD Workforce Survey. Congratulations Amy Jones, PA-C, (pictured above) winner of the iPad. OSHPD’s report should be published by the end of this year. When it is published, we will announce it in the CAPA News and on our website.

Someone Asked… by Bob Miller, PA, Professional Practice Committee Chair

his column is to briefly discuss some FAQs coming into the CAPA office. Hopefully others will find this information useful.

happening with Q. What’s Medicare and durable medical equipment (DME)? I heard about new signature requirements.

recently, PAs could order A. Until DME for Medicare beneficia-

ries as needed - without a physician co-signature. However there is a new Medicare rule pertaining to certain expensive and high volume DME and a new requirement for a physician documented face-to-face visit. As explained in an article in the Medicare Learning Network publication,“MLN Matter” MM8304 (revised on June 28, 2013) the face-to-face “encounter must occur within the 6 months before the order is written for the DME.” The visit may be conducted by a physician, PA, NP or CNS, but the documentation of the visit in the medical record must be signed (or co-signed) by the physician.

This new rule is a result of Section 6407 of the Affordable Care Act and was scheduled to go into effect on July 1, 2013. CMS has allowed a delay until October 1, 2013 when all are expected to be in compliance. AAPA has had input to reduce this added layer of administrative burden and according to Michael Powe, Sr. VP of Reimbursement and Professional Advocacy at AAPA, discussions are ongoing. The MLN Matters publication providing the list of DME included in this new rule can be found by Googling “MLN Matters MM8304.” This does not apply to Power Mobility Devices (PMDs) which are covered under a separate requirement. considering a job at a hosQ. I’m pital. Can the hospital bill for

services performed by a PA employee? It is not a teaching hospital. regard to Medicare “EnA. With tities authorized to receive

reimbursement as a PA’s employer include individual physicians, medi-

cal groups, hospitals, nursing homes and other physician organizations or medical facilities authorized to bill Medicare for their services.” The above is an excerpt from the California Physician Assistant’s and Supervising Physician’s Legal Handbook (3rd Edition) written by Michael Scarano, Jr., Esq., CAPA Legal Counsel. Regarding commercial insurances, you would need to have the hospital billers look into how each insurer wants services provided by a PA to be billed and whether your hospital has specific contractual language with the insurer impacting PAs. Although some may say to just bill under the physician as “incident-to” that doesn’t necessarily mean the strict Medicare “incident-to” rules are required to be followed. In fact, “incident-to” only applies an outpatient setting, and it is therefore technically inapplicable to inpatient billing. Usually when commercial plans say “incident-to” they just mean to bill under the physician’s name and identifier. Some of this Continued on page 5

Inside This Issue At the Table................................................................ 2 AAPM Foundation Appoints PA to its Board................... 2 CCAPA/OSHPD Workforce Survey................................ 2 Someone Asked… .................................................... 3 CAPA: On The Road to Achieving Great Things For California PAs............................................................. 4 Three Amigos! Three CAPA Presidents.......................... 5

Oops! You Forgot to Renew Your PA License – Here is What NOT to Do When You Discover Your Mistake........ 8

2013 Conference Special Events................................ 19

A Little Bit Goes a Long Way....................................... 9

MICRA: The Basics..................................................... 23

One Common Goal: PA Education in California........... 10 Controlled Substances Education Course..................... 11 NeedyMeds Prescription Drug Discount Card to Help Californians Access/Afford High Quality Health Care..... 12

CAPA Continuity = Excellence...................................... 5

Looking Back: Meeting the Needs of a Population...... 13

Pharmacogenetics: Moving Toward Personalized Medicine................................................ 6

2013 CAPA Conference in Palm Springs..................... 14 CURES at CAPA......................................................... 15

AAPA Calls, CAPA Takes Action..................................... 7

PAs Trending............................................................. 16

Classified Ad............................................................... 7

2013 Conference Highlights...................................... 18

To Screen or Not To Screen........................................ 20 A Note from Lynne S. Newhouse, PA-C, RN................. 23 Make Each Rotation Count........................................ 24 Saturday, October 5, 2013 – Student Track............... 25 Student Medical Challenge Bowl Sign Up Now............ 25 How Did I Make That Mistake?.................................. 26 Welcome New Members............................................ 27 Local Groups............................................................ 27

JULY/AUGUST 2013

CAPA: On The Road to Achieving Great Things For California PAs by Adam Marks, MPA, PA-C, President

our years ago, as the newly elected CAPA Student Representative, I found myself driving on the CA-99 heading to Asilomar for the Annual CAPA Leadership Retreat. As a student at San Joaquin Valley College, the desolate freeway between Fresno and Bakersfield had become my daily commute. It also turned out to be “free therapy.” On this day, I remember sitting back in complete silence on my drive up north thinking “What did I get myself into?” At the time I had never been to a retreat, let alone one for a professional organization. So needless to say, I was a bit intimidated. That feeling was quickly dissipated as I slowly began to become acquainted with the current leaders and staff. I realized that we were all there for the same reason, to serve California PAs. At the time we did not have a formal vision statement, but looking back it was clear that we were working with a clear vision for the future. A lot has changed in four years. We are on the cusp of Patient Protection and Affordable Care Act (PPACA), our licensing body changed from a Committee to a Board (January 1, 2013), we worked with OSHPD to do the first comprehensive work force survey of California PAs in over 14 years and CAPA now has a formal vision statement to go along with our long-standing mission. PAs and this new CAPA Board are trending!! One thing has remained constant over the past four years: every retreat 4

CAPA NEWS

ushers in a new group of driven PAs looking to be involved in CAPA and ultimately looking for a way to serve California PAs. As I serve my final year as President, I look around the table at our current leadership team and I am proud of the commitment and diversity within that room. The CAPA 2013-2014 Board of Directors and Committee Chairs are a group of leaders from across the state in a variety of practice settings and representing a variety of academic institutions. The weekend of June 21, 2013, these leaders came together at the retreat and set a very strong agenda for the leadership year. One which I think is in line with our mission and moving us closer to our vision. The retreat is a great venue to develop future goals, but also a time to reflect and inform new leaders on what CAPA is doing currently. CAPA continues to be active legislatively; currently we have two bills faring very well in Sacramento. CAPA is sitting at more tables with stakeholders than ever before. We are shaping the future of health care and creating policies which will impact

everyday practice for California PAs. We continue to promote PAs as an essential part of team practice across all specialties and practice settings. Our committees are active and engaged. Our CME Committee and CPC have developed a fantastic educational program for our Palm Springs and CAPA at Napa conferences. Our CAPA staff and consultants are among the best there are. After the retreat, I found myself back on the road, my mind beginning to drift during the four hour drive home, reflecting on my last four years and this year’s retreat. I begin to reflect on my first CAPA road trip and the uncertainty felt during that long drive. That feeling too has changed over the last four years. I now drive home optimistically thinking about how CAPA, its leadership and PAs working across the state are shaping a profession that will thrive in this brave new world of health care. I am proud to be President of CAPA. Thank you for your CAPA membership. It matters a great deal. 

Front Row, L to R: Saloni Swarup, PA; Chelsea Hemming, PA-S, Ana Maldonado, MPH, DHSc, PA-C, Cherri Penne-Myers, PA-C; Michael Estrada, PA-C, MS, DHSc; Gaye Breyman, CAE; Teresa Anderson, MPH; Adam Marks, MPA, PA-C; Jeremy Adler, MS, PA-C and Roy Guizado, MS, PA-C Back Row, L to R: Eric Glassman, MHS, PA-C; Joy Dugan, MSPH, PA-C; Jay Williamson, MS, PA-C; Christy Eskes, PA-C and Bob Miller, PA

Three Amigos! Three CAPA Presidents by Gaye Breyman, CAE; Executive Director L to R: Eric Glassman, MHS, PA-C , President, 2010-2012; Jeremy Adler, MS, PA-C, current President Elect (President, July 2014) and Adam Marks, MPA, PA-C, President 2012-2014

have been with CAPA a long time and have had the pleasure of working with many CAPA Presidents. It is my belief (and I think has been proven over time) that CAPA is blessed with exactly the right woman or man for the job in a particular year/ time. The skills, talents and temperament of Presidents almost without exception mesh with the issues/challenges of the time. In the case of these three men, that has most definitely been the case. What I most admire is their integrity. And, they are incredibly smart and capable. Congratulations, you have again put the right people in place for CAPA leadership. We are doing great work on your behalf.

CAPA Continuity = Excellence

Front Row, L to R: Roy Guizado, MS, PA-C; Adam Marks, MPA, PA-C and Jeremy Adler, MS, PA-C; Back Row, L to R: Bob Miller, PA and Eric Glassman, MHS, PA-C

ob Miller, PA is CAPA’s Treasurer and a Past President of CAPA. You have seen his articles. You have seen his videos on the CAPA website (or should) and he has probably lectured at your California PA Program. He has been and continues to be a valued mentor to leaders – new and old. Roy Guizado is CAPA’s Vice President and PA Program Director at Western University. He came to CAPA with skills that have taken us through the process of strategic planning and visioning. With Roy’s help, last year’s Board of Directors created a formal vision statement. Roy has been on the CAPA Board for three years now and has contributed a great deal to the board room. The leaders pictured here and on the facing page make a DREAM TEAM of dedicated, purpose filled individuals who volunteer a tremendous amount of their time to make California PA Practice better. Thank them when you see them. Thank you CAPA members for electing them to office.

Someone Asked… Continued from page 5

confusion arises because PAs are not typically credentialed and contracted by the commercial insurance company. Medi-Cal adds another wrinkle in that all PA services are billed under the physician with a “modifier” (identifier) to identify services provided by a PA. There have been difficulties in the past when the PA provides a service and is employed by one corporation - the hospital - but the bill is submitted under the supervising physician’s

name from a separate corporation the medical group. Generally, if the physician or medical group does not contribute to the PA’s salary then there is no entitlement to the PA-generated reimbursement. Some, in the past, have made the PA an employee of the medical group so the PA and billing physician are both employed by the same entity. Others have found other strategies. So, explore what options exist at your

facility. The hospital billing department, legal department and the Medical Staff Office should weigh in. You might speak with other PAs at the facility to see if they are hospital employees or part of a medical group or even independent contractors. Make use of appropriate and knowledgeable resources to ensure compliance with laws/regulations as well as policies of insurers. 

JULY/AUGUST 2013

Pharmacogenetics: Moving Toward Personalized Medicine by Jeremy A. Adler, MS, PA-C, President Elect

ave you ever seen two patients, with the same diagnosis, same demographics, same presentation, but widely different responses to medications? Most of us see this all the time. When patients are provided medications, four basic responses can be encountered. Of course, our goal is to provide an excellent therapeutic effect with little or no adverse effects. Sometimes though, patients have good results, but intolerable side effects. Others have no therapeutic effect “The ability to at all, but considerable adverse effects, prospectively select and yet others have essentially no effect, medications which neither good nor bad. If we are treating the have a high chance of same illness with the same medications, success and lower what can explain these variations in chance of toxicity is outcomes? There are pharmacodynamic very appealing.” and pharmacokinetic contributions, but more and more research implicates the patient’s unique genetics as an important contributor to explain the observed outcomes. More importantly, understanding your patient’s personal genetics may both help explain observed responses to medications, but potentially, prospectively help choose medications that are more likely to provide good therapeutic responses and low toxicities. In essence, personalize treatments for individual patients and reduce the need for the current method of trial and error when selecting pharmacotherapeutics. Pharmacogenetics is the study of how genetic variability impacts individual responses to medication. Now that the human genome has been sequenced, the individual genes 6

CAPA NEWS

which code for proteins involved in drug metabolism have been identified. As a part of pharmacology training, we all learned about drug metabolism. Drugs are often hydrophobic compounds that undergo extensive metabolism through Phase I (cytochrome P450) and Phase II (glucuronidation) to become more hydrophilic, and get excreted out through the renal system. The majority of drug metabolism occurs in the liver, making many medications susceptible to the “first pass” effect. The cytochrome P450 system is comprised of multiple enzymes that are identified by letters and numbers, such as CYP2D6 and CYP2C19. The enzymes metabolize specific drugs, termed substrates. Drugs can also change the effectiveness of the enzymes by inhibiting or inducing the enzymes. Foods can affect the enzymes as well; many are familiar with grapefruit juice causing an impact on many medications. Many clinically relevant drug-drug interactions occur as a result of cytochrome P450 (Phase I) metabolism. Although Phase II metabolism can cause drug interactions, these interactions occur much less frequently. The patient’s haplotype represents the combination of sequences of DNA inherited from each of their parents. Each parent provides an allele which can now, based on research, be used to make a prediction in the patient’s phenotype. The patient’s phenotype is the expected functionality of their enzyme based on the DNA sequence. Most drugs are anticipated to be extensively metabolized and therefore, a patient with a common or “normal” DNA sequence is expected to be an “Extensive Metabolizer.” It is not uncommon though for patients to have signal nucleotide mutations (SNPs) which means that one nucleotide in the DNA sequence is different than

the common sequence. These SNPs may or may not change the function of the enzyme that is coded by the mutated DNA. Some patients with mutations still are expected to have an extensive phenotype and metabolize medications normally; others though have decreased (“Intermediate Metabolizers”) or no function (“Poor Metabolizers”), while other mutations result in over active metabolism (“Ultra-rapid Metabolizers”). The impact of the patient’s phenotype on a particular medication depends on whether the medication is a pro-drug, active drug or has active metabolites. A “pro-drug” refers to a medication which has no effect in the form taken, but undergoes drug metabolism to transform into an active form. A “Poor Metabolizer” may have no effect from this type of medication because none of the requisite active form is produced. An “Ultra-rapid Metabolizer” may be at risk for increased toxicity (adverse effects) because more than expected amounts of the active metabolite can be produced. Codeine is a common example of a pro-drug. Codeine has basically no pain relieving effects, but must undergo metabolism through CYP2D6 to be transformed into morphine to have an analgesic affect. Up to 5-7% of the white population in the U.S. has poor CYP2D6 metabolism and therefore is unlikely to respond to codeine. This information would be very useful if a patient was going to be provided codeine after a painful procedure. Tramadol is a pro-drug as well. Think of patients who tell you they have no relief with tramadol, some of them may have underlying genetic mutations which objectively help explain this outcome. These patients are not all “drug seekers.” Continued on page 11

AAPA Calls, CAPA Takes Action by Jeremy A. Adler, MS, PA-C, President Elect

n June 11th, four days before the American Medical Association (AMA) House of Delegates would hear a resolution with a strong potential to significantly impact PA practice (possibly prohibit PAs from even suturing), the AAPA held a conference call to educate and seek assistance from “It was important state chapters and constituent organizato convey that these tions. The resolution as written, expanded prohibitions should not the definition of surgery to include apply to PAs who are “repair or removal of practicing as members of an organ or tissue,” and says that “surgery is performed physician-PA teams.” for the purpose of structurally altering the human body.” Although parts of the resolution were somewhat unclear, the implication was that surgery is to be performed only by physicians. If it had been adopted as presented, the resolution would call certain aspects of medical practice, which are currently performed by PAs, and well within the standard of care in many specialties across the country, into question. Additionally, the resolution stated that “invasive procedures employing radiologic imaging are within the practice of medicine and should be performed only by physicians with appropriate training and credentialing.” The resolution held that “technical aspects of certain invasive procedures may be performed by appropriately trained, licensed or certified, credentialed non-physicians under direct and/ or personal supervision of a physician.” Direct or personal supervision required the physician to be

in the facility or in the room where the procedure is being performed. AAPA provided a list of AMA delegates from each state or specialty organization they represented. Their hope was that all chapters would reach out to those delegates, describe our concerns, and recommend a course of action protecting the PA profession. It was important to convey that these prohibitions should not apply to PAs who are practicing as members of physicianPA teams. Physicians, as team leaders, should have the flexibility to delegate to PAs within the parameters of state law. There wasn’t much time to contact the delegates because they would be getting on a plane to get to the AMA HOD. CAPA jumped into action. CAPA’s Executive Committee had just returned from the CMA’s Health Care Leadership Academy on June 2, 2013 where we met with many physician leaders who were delegates to the AMA HOD.

a letter was drafted and sent via Federal Express to all 35 delegates. CAPA was also successful in reaching many of the delegates by phone. On June 15, Resolution A-16 was heard in the AMA House of Delegates. The final outcome was extremely modified from its original form. Surgery was not defined as in the initial resolution and the focus shifted to specialized pain procedures. What could have significantly affected the employability of numerous PAs in California, and around the country, was thwarted. Working for CAPA’s membership, CAPA’s committed leaders and staff allowed for a quick response to AAPA’s request. We were also reaffirmed in our unique relationships with physicians as the California Medical Association’s Delegation to the AMA played an important role in the outcome of the resolution. 

California is a large state with over 35 delegates. Within 24 hours,

Chapman University is seeking a qualified Director of Clinical Education for its developing Physician Assistant Studies Program For more information please view the web page at http:// web.chapman.edu/jobs/jobs.aspx?cat=3. Interested applicants should submit a letter of application, curriculum vitae or resume, proof of NCCPA board certification & CA licensure, and three professional references to: Dr. Michael Estrada, Director Physician Assistant Studies Program at estrada@chapman.edu.

JULY/AUGUST 2013

Oops! You Forgot to Renew Your PA License – Here is What NOT to Do When You Discover Your Mistake by Gaye Breyman, CAE; Executive Director

t happens, you forget to renew your PA license on time. You realize this either just before your biennial birthday month ends or worse yet, after the end of the month.

Delinquency Fee If you are renewing 30 days past the expiration date, you must also include a $25 delinquency fee with your payment.

If it is after the end of the month, you are practicing without a license. You need to have a PA license to practice. What you do NOT want to do now is mail your payment and accompanying documents to the PO Box shown on the renewal form. Mailing it there will take 4 to 8 weeks.

License Renewal Requirements You must complete the License Renewal Application form and include with your renewal payment. We are unable to renew your license without the completed form.

You Will Want to Drive or Overnight Ship your renewal fee, delinquency fee (if applicable), License Renewal Application form, and Change of Address form (if applicable) to: Physician Assistant Board 2005 Evergreen Street Suite 1100 Sacramento, CA 95815 Department of Consumer Affairs

Physician Assistant Board Excerpted From the Physician Assistant Board’s Website:

Failure to Renew Practicing as a physician assistant without a renewed license may lead to disciplinary action against your license. There is no renewal grace period. Licenses not renewed by the expiration date are considered “delinquent.” If you have not received the renewal notice within four weeks of expiration date of your license or you are renewing your license just prior to the expiration date, you may renew by completing the following steps: Renewal Fee Renewal payments are accepted in person at our office, via U.S. mail, or overnight express mail. The renewal fee is $300. Payments may be a personal check, money order, or cashier’s check. Make the check or money order payable to “Physician Assistant Board.” 8

CAPA NEWS

Where to Send Please send your renewal fee, delinquency fee (if applicable), License Renewal Application form, and Change of Address form (if applicable) to: Physician Assistant Board 2005 Evergreen Street Suite 1100 Sacramento, CA 95815 How long is my license valid? Your license expires biennially during the month of your birthday. The expiration is based on your birth month and not your birth date. License Renewal Procedure Currently active licensees may not renew earlier than 3 months prior to the expiration date of their license. To renew your license, you must submit your renewal on or before the expiration date. Complete the renewal form and include the current renewal fee and submit to the “Physician Assistant Board.” You must complete both boxes on the front of the renewal form. Please allow 4-8 weeks for processing. Not renewing your license on time is always stressful and not without consequences. You may want to put your biennial renewal date into your calendar now and renew a month or two early! It is a nice gift to you. 

A Little Bit Goes a Long Way by Sonny Cline, PA-C, MA, M.Div, Political Action Committee Chair

n January of 2008, Barack Obama raised $28 million online with 90 percent of those transactions coming from people who donated $100 or less and 40 percent from donors who gave $25 or less. In 2009, despite the recession, Salvation Army bell ringers raised a record $139 million, which was mostly made up of coins and dollar bills. Why were so many willing to give to these causes? In the case of the Obama campaign, maybe the donors were Democrats and always gave to the party. Most probably they hoped for a change with which they were in agreement. Perhaps some people simply became caught up in the momentum of the campaign and wanted to be a part of something bigger than themselves. Whatever the case, their contributions added up to a great sum of money and ultimately led to Barack Obama becoming president of the U.S. What about the Salvation Army? This is a Christian-based organization with a straightforward goal to help the needy. During December, the month when they collected the $139 million, most people are

the AAPA. Just $10 per PA, that’s it. Amazing, isn’t it? Many of us spend that amount weekly on specialty coffees at our favorite coffeehouses. I won’t even talk about pedicures, a good bottle of wine (so essential though), a massage, that trip to the city for the weekend (love those), that hot new place to eat downtown (my favorite)… The list is long regarding our indulgences. So it seems like a no-brainer to donate to yourself. That’s right, yourself, because the CAPA PAC is completely about supporting you as a PA and helping you to achieve your goals and have the wonderful career in the field of medicine that you have trained so hard to enter.

feeling stretched financially already. Furthermore, this record amount was donated during a recession! I have had patients defer their own medical care for a month during December because they were “short on money.” Yet many of these same people likely gave at least a little something for someone else. This speaks volumes about who we are as a country and makes me proud, but I digress. The truth is that small donations by many people can have a significant impact, and that’s why your contribution, no matter the amount, makes a big difference to the CAPA PAC. This past year we have made significant progress in our visibility at the state capitol. More and more, important decision-making groups are learning about who we are and what we do in the health care industry. As they learn about the CAPA PAC and better understand what we are capable of doing, they include us in finding solutions to the health care problems.

It’s kind of like your 401k. If you invest regularly, it grows and you find yourself free of worry as you think about your future because you have put in place the necessary building blocks for a secure future. Let’s work together to build that same secure future for our careers and for those who will come after us as PAs. As always, thanks for being part of the solution and healing the sick. You’re doing great work. 

There are over 9,000 PAs in the state of California. If everyone gave $10, we would raise more money than any PA PAC in the nation and more than

Yes, I Want to Do My Part for the PA Profession in California (Donate online at www.capanet.org or mail this form to the CAPA office.) Name____________________________________________________________________________________________________

 $25.00  $50.00  $100.00  $200.00  $____________

Address ________________________________________City___________________________ State______ Zip_______________ Phone _______________________________________ Email ______________________________________________________ Amount of cash/check/credit card donation: $_______________________

If donation is $100 or more, please list employer_________________________________________________________________________________________ Please make checks payable to CAPA PAC. You may also pay by credit card. All contributions are voluntary. PAC ID # 981553 



Exp. Date______________________

Signature______________________________________________________________________________________ CVV#________________________

JULY/AUGUST 2013

One Common Goal: PA Education in California by Christy Eskes, DHSc, MPA, PA-C, PA Program Relations Committee Chair

am so pleased to be joining the CAPA leadership team as the PA Program Relations Committee Chair. I have been involved in PA education for several years and have been the director of the PA program at Loma Linda University for over three years. I have spent my PA career in primary care and continue to see patients one day per week at a local community clinic for the underserved. I completed my PA training at Loma Linda 10 years ago and earned my doctorate in Health Sciences last year with a concentration in Advanced Physician Assistant Studies through A.T. Still University. I appreciate the service of the immediate past chair, Michael DeRosa from Samuel Merritt University, and his committee, who worked with CAPA and the PA programs to

support PA education in California. I look forward to continuing to work with CAPA and our state’s established and upcoming PA programs. As the liaison between CAPA and our PA programs across the state, I wanted to begin by providing our CAPA membership and stakeholders with a current overview of the programs in California and where PA education in our state is headed. We currently have nine PA programs in California with five additional programs in various phases of development. Of the established programs, four are located in Northern California, one is in the central region, and four are in Southern California. The five programs in development all reside in Southern California. Each of our programs must follow a comprehensive set of standards

provided by our accrediting body, the Accreditation Review Commission on Education for the Physician Assistant, Inc. (ARC-PA). We all meet these standards and prepare our students for the certification examination in diverse ways, from varying program lengths from 21 to 33 months to unique curricula highlighting various aspects of medicine. Even with these variances, we all have one common goal: to educate and graduate quality PAs who will serve their patients in California and beyond. Especially with Covered California and other changes coming to health care due to the Affordable Care Act, we need quality PAs now more than ever, especially in primary care and in underserved areas. Our established and developing PA programs are poised to meet these challenges and help expand access to care in California.

Established PA Programs (alphabetical by region): Northern California

Central California

Samuel Merritt University Oakland, CA 510-869-6623 Deaglin@samuelmerritt.edu

San Joaquin Valley College Visalia, CA 559-622-1973 MonicaU@sjvc.edu

Stanford University School of Medicine Palo Alto, CA 650-725-6959 pcap-information@lists.stanford.edu Touro University California Vallejo, CA 707-638-5809 tucpa@tu.edu University of California Davis Sacramento, CA 916-734-3551 fnppa@ucdavis.edu

CAPA NEWS

Southern California Loma Linda University Loma Linda, CA 909-558-7295 pa@llu.edu Riverside County Regional Medical Center/Riverside Community College District Moreno Valley, CA 951-571-6166 pa@mvc.edu

University of Southern California – Keck School of Medicine Alhambra, CA 626-457-4250 jtramel@med.usc.edu Western University of Health Sciences Pomona, CA 909-469-5378 admissions@westernu.edu As developing programs move closer to accreditation and need preceptors for clinical rotations, we will provide their contact information here in the CAPA News – stay tuned!

Pharmacogenetics: Moving Toward Personalized Medicine Continued from page 6

We cannot do this alone, however – each of our programs needs the support of our fellow PAs to be successful. New PA educators who are willing to step out of a primary role of patient care into formal faculty positions are needed to help train the next generation of PAs. PAs willing to share what they have learned in practice by providing guest lectures and demonstrations to students in a classroom setting are also needed. Most critically, we need PAs who can precept our students in their clinical settings, allowing them to learn from their expertise as part of their clinical rotations. Based on accreditation standards, all students need exposure to patients in a variety of settings, including family medicine, internal medicine, pediatrics, emergency medicine, women’s health, general surgery, and behavioral medicine. These can occur in inpatient or outpatient settings. Students also need to have

s 6 Hour I . t a C CME

supervised clinical practice experiences in emergency departments and operating rooms. Some programs offer additional elective rotations in subspecialties such as orthopedic medicine, dermatology and other subspecialties. With the growth of programs in California and expansion of existing programs, we need more preceptors from all areas of medicine to meet the needs of our students so they can graduate as proficient providers, ready to fill the health care gap for Californians. For those currently serving in these ways, thank you for your dedication and commitment to the future of the profession! If you are not currently working with a PA program and are interested in getting involved with PA education in any capacity, please contact your local PA program and ask how you can get started! 

Another exciting area for pharmacogenetics is in psychiatry. Certain antidepressants, such as venlafaxine, have been shown to have a poor clinical effect and increased toxicity in patients who are poor CYP2D6 metabolizers. How many weeks do we try one antidepressant after the other, waiting for a patient’s depression to resolve? The ability to prospectively select medications which have a high chance of success and lower chance of toxicity is very appealing. Other areas of medicine are moving into pharmacogenetic testing as well, such as cardiology with testing for warfarin metabolism. One might think the cost of pharmacogenetic testing is high and poorly covered by payors. In fact, the opposite is true, payors generally cover testing. It has been suggested that up to 35% of every dollar spent on health care ends up funding ineffective or intolerable therapies. Methods to reduce reliance on the trial and error method hold a lot of promise in improving care and reducing costs. If the idea of personalized medicine has not entered your current practice, it will likely be coming soon. In many ways, patients are learning about testing and requesting that it be done. Also, patients may be presenting to you with results obtained from other providers, so an understanding of pharmacogenetics is a must. 

Controlled Substances Education Course A Course Which Upon Successful Completion Will Allow You To Write For Controlled Substances Without Patient Specific Approval* Wednesday, October 2, 2013 Renaissance Palm Springs (preceding the CAPA Conference) 888 E Tahquitz Canyon Way Palm Springs, CA 92262 (760) 322-6000

Sunday, February 23, 2014 Napa Valley Marriott 3425 Solano Ave Napa, CA 94558 (707) 253-8600

*California Code of Regulations Sections: 1399.541(h), 1399.610 and 1399.612. A PA may administer, provide, or issue a drug order for Schedule II through V controlled substances without patient specific approval if the PA completes specified educational requirements and if his/ her Supervising Physician delegates the authority to them. Courses will be canceled if minimum number of registrants is not met.

JULY/AUGUST 2013

NeedyMeds Prescription Drug Discount Card to Help Californians Access/Afford High Quality Health Care

n November of 2011, CAPA partnered with NeedyMeds, a national non-profit organization, to launch a prescription drug discount card that will help Californians lower the costs of their medications and other health care services. The discount card is free and can be used by all California families to save up to 80% off the cost of prescription medications. In the past year and a half, CAPA has distributed over 60,000 NeedyMeds cards to California PAs who provide the cards to their patients. The CAPA prescription drug discount cards have been presented over 31,000 times with a savings of over $662,000. Why is CAPA providing a prescription drug discount card? Part of CAPA’s core mission is to expand access to highquality and cost-effective care for all Californians. The CAPA drug discount card helps reduce outof-pocket costs for California consumers, helps patients stay healthy, and reduces long-term health costs for California families. At a time when all California families are trying to stretch their budget dollars, every little bit helps. The CAPA drug discount card helps keep costs manageable while also helping to ensure that Californians stay on their doctor-prescribed treatment regimes. CAPA hopes that all Californians, 12

CAPA NEWS

there is a high deductible, there is a low medicine cap that has been met, there is a high co-pay and the card offers a better price, or if a consumer is in the Medicare Part D “donut hole.”

CAPA Ships Over 60,000 Prescription Drug Discount Cards to CAPA Members!

but particularly those from vulnerable or low-income communities, will use the discount card to help afford treatment and stay healthy. Who can use the CAPA drug discount card? Anyone. The CAPA drug discount card is free and open to all Californians. There are no income, insurance or residency requirements, and no fees or registration process is needed to use the card. One card can be shared with friends and family members, or patients can print their own from www.capanet.org. Where can patients use the CAPA drug discount card? The drug discount card is accepted at over 60,000 pharmacies nationwide, including Walmart, CVS, Walgreens, Rite Aid, and other regional chains and local stores. To locate pharmacies in your area that will accept the CAPA/NeedyMeds card, please visit the NeedyMeds website and search for participating pharmacies by zip code. Can patients use the CAPA drug discount card in conjunction with insurance? No, patients cannot combine the card with insurance. The card can, however, be used instead of insurance if the insurance has no drug coverage,

How do consumers use the CAPA drug discount card? To use the CAPA drug discount card, a California consumer simply presents the discount card to his or her pharmacist along with the desired prescription, at which point the pharmacist will tell the consumer how much can be saved using the card. How do I order cards for my practice? If you would like cards sent to you so you may distribute them to your patients, please contact the CAPA office. We are happy to ship you up to 500 cards. You may email your request for NeedyMeds card to capa@capanet.org. Be sure to mention how many cards you would like and include the address to which you would like them sent. You may also download a copy of the card on the CAPA website, www.capanet.org. Or, you may call the CAPA office at (714) 427-0321.  For more information about medical assistance programs, please visit www. needymeds.org.

Looking Back: Meeting the Needs of a Population by Michael Estrada, PA-C, MS, DHSc, Committee on Diversity Chair

ccording to the Office of Statewide Health Planning and Development (OSHPD, 2012) there are 8,104 currently practicing Physician Assistants (PAs) in California. The Migration Policy Institute (MPI Data Hub Migration Facts, Stats and Maps, 2011) has identified the primary five languages that were spoken by limited English proficient individuals (LEP) were Spanish, Chinese, Vietnamese, Korean and Tagalog. Earlier this year the article titled “The Language Gap of Healing” (Estrada, “In our growth as a global 2013) addressed concern that 23 community, the views that the million American people are at risk we share with each other for receiving poor quality health care and those we teach can because they are not influence a change that proficient in English and that too many nurtures unity and respect health care facilities and clinicians often for those differences that use untrained, nonprofessional interpretmake us unique.” ers such as friends and family members, as a “go-between” health care providers and patients. This practice, while seemingly helpful and harmless, can be detrimental in a case where lack of training and understanding of the interpreter of medical concepts and language can create poor patient compliance and recovery because vital information might be lost in translation. Not to mention, the patient privacy issues and concerns that might breach current laws and regulations as they relate to patient care. The answer to this dilemma is to recognize that there is a large language disparity in health care and that it is important to be able to provide first-hand, accurate information in the primary language spoken the patient population being

served, as well as to understand there are resources available to aid in developing and providing professional interpretation services in health care settings. Furthermore, it might prove helpful through future data collection in California to understand the language proficiency of physician assistants in practice settings so that resources can also be made available to help complement and improve patient care outcomes in non-English speaking populations. Utilizing and building upon the fundamental foundation of communication and the importance of it there also has to be a basic knowledge of culture and ethnicity. “The Poverty of Health Care” (Estrada, 2012), recognized that the lack of health care for specific populations and the stigma of certain diseases encountered in the clinical setting such as mental health, HIV and TB can create a lack of societal acceptance and inclusion. Poverty is most commonly defined and recognized as a lack of material possessions. But in health care it is defined as a lack of access to the most basic of health care and preventive services necessary to maintain human identity, life and dignity. By recognizing that we have differences in ethnicity, cultural customs and views on health, we will better serve ourselves and provide treatment for culturally diverse populations with greater care and understanding. Statistically, California has the highest numbers of PAs nationwide working with vulnerable populations. Rural, urban and diverse patient groups are where PAs tend to gravitate and practice almost instinctively true to the core commitment of the PA professional working in medically and culturally diverse areas of need. In “Building a Pipeline” the article suggests that the answer to

eliminating health disparities is to train well qualified health care professionals that share similar attributes, customs, beliefs and language with the communities that are in need of health care and social services. The Institute of Medicine (IOM) has gathered much data on this concept and continues to provide insight on improving care to disadvantaged populations. But in order to do so, the challenges a minority student might encounter while pursuing a health professions career, such as PA, will have to be better understood and addressed in the years to come as we work towards creating a viable and strong health care workforce in California. With the emergence of changing health care competencies such as oral health and mental health, I believe that the PA profession is well suited and well adapted to meet the needs of the population in California as long as we continue to keep diversity and inclusion at the forefront of clinical practice. In our growth as a global community, the views that we share with each other and those we teach can influence a change that nurtures unity and respect for those differences that make us unique.  Works Cited

MPI Data Hub Migration Facts, Stats and Maps. (2011, December). Retrieved from Migration Information: http://www.migrationinformation.org/integration/LEPdatabrief.pdf OSHPD. (2102, September). Fact Sheets Physician Assistant. Retrieved from Healthcare Workforce Development Division: http:// www.oshpd.ca.gov/HWDD/HWC/FactSheets/ PhysicianAssistant.pdf Estrada, M (2013 ) The Language Gap of Healing, CAPA News Magazine Estrada, M. (2012) The Poverty of Health Care. CAPA News Magazine Estrada, M ( 2013) Building a Pipeline. CAPA News Magazine

JULY/AUGUST 2013

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2013 CAPA CONFERENCE IN PALM SPRINGS

by Eric Glassman, MHS, PA-C, CME Committee Chair In case you haven’t heard, CAPA’s Annual Conference in Palm Springs is just around the corner. This is one of the best, if not the best, state run conference in the country. Many of you began attending the Conference when you were PA students and continue to come every year to earn your CME hours. For those of you who have never had the opportunity to attend one of our annual conferences, this is the year to attend! The Conference schedule is set and registration has already begun. You DO NOT want to miss out on CAPA’s fun in the sun conference in Palm Springs. This year’s Conference will be offering 23 hours of CME credit over four days from Thursday to Sunday, October 3-6. We are also offering a pre-conference day of CME on Wednesday, October 2nd, which includes the Controlled Substances Education Course (CSEC) and, back by popular demand, Jen Carlquist PA-C and her EKG Boot Camp. For those who attended last year, your reviews for the EKG Boot Camp were so impressive we had to bring it back for another year for those that missed it. Seats will be limited for this special program so don’t delay, sign up now. Our Conference is once again packed with amazing speakers from start to finish. Many of you remember PA Rod Moser’s lecture last year and it will be even more impressive this year. Mark your schedule to attend his lecture, it promises not to disappoint. Notable returning top lecturers include: Dr. John Beurele speaking on Emergency Medicine, Dr. Phillip O’Carroll and his dynamic presentations on Neurology, Dr. Anita Nelson and all the experience she brings from the world of Women’s Health. We also have Greg Mennie, PA-C with Primary Care pearls; Greg Thomas, PA from the NCCPA; and John Notabartolo, PA-C speaking on Dermatology to name just a few notable PA speakers that will be back this year. We also have new and innovative speakers that you will not want to miss. Dr. Robert Kopel, anesthesiologist, will be speaking on PreOperative Evaluations and Clearances. Dr. Ronnie I. Mimran will be speaking on Sports Concussions and Evaluations. The list goes on. You will have to see them all for yourself and be amazed by the quality speakers chosen by our Conference Planning Committee. We also offer optional workshops on Thursday and Saturday at the Conference. Some of the topics include: Slit Lamp in the Emergency Room, Joint Injections and Joint Examinations, Orthopedic Examinations, Suturing,

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Radiology and Neurology Examinations. These are small group workshops that offer hands-on training to help sharpen your clinical skills. The workshops will definitely sell out as seats are limited. So, make sure to register early. In addition to the CME lectures being offered, there is so much more at this year’s and every year’s CAPA Conference. A few highlights at this year’s conference – Friday: the Dance and All-Star American Idol competition. Saturday: the PArty by the pool which features CAPA’s All-Star Band, with Greg Mennie, PA-C on drums and the Student Medical Challenge Bowl where PA Programs compete for the coveted trophy and bragging rights for an entire year. Sunday: back this year – relax in your Scrubs and Slippers, if you choose, for breakfast and lectures. There are great networking opportunities with your peers and time to catch up with your old classmates at one of the PA Program’s Alumni Receptions. Whatever brings you to Palm Springs this year, we are so happy and thrilled for you to be a part of the experience. This is an exciting time to be a PA. With all the changes occurring in medicine it is so important to stay current, and what better way than to do it with CAPA in Palm Springs. And, of course Sunday, the last day of the Conference, October 6th is PA Day so we invite you to cap off PA Week with your fellow California PAs. See you in Palm Springs!

A Special Thank You! Special thanks to those who have and who will make it all happen in Palm Springs on October 3-6, 2013.

CME Committee Members:

Chair - Eric Glassman, MHS, PA-C Jennifer Carlquist, PA-C Shelby Edwards, PA-C, MPAS Michelle Lim Serrao, PA-C Adam Marks, MPA, PA-C Kevin Robertson, MHS, PA-C Saloni Swarup, PA Timothy Wood, MS, PA-C

Conference Planning Committee Members: Chair - Timothy Wood, MS, PA-C Tracey DelNero, PA-C Shelby Edwards, PA-C, MPAS Eric Glassman, MHS, PA-C Ghina Katrib, PA-C Anne Walsh, PA-C, MMSc Robin Wempe, PA-C

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C URES AT CAPA

Free Service at the CAPA Conference This Year, Add a Few Important Documents to Your List of Things To Pack For the CAPA Conference!

APA is committed to providing PAs with education and tools to help you provide the best care possible to your patients. At last year’s CAPA Conference we provided a free service to allow attendees to sign up for California’s Prescription Drug Monitoring Program (CURES). Many people see the value of registering with CURES, especially after taking the Controlled Substances Education Course and hearing Jeremy Adler talk about the important and practical use of the Patient Activity Report. That report is an invaluable tool in developing a risk assessment in patients taking controlled substances. PAs leave the CSEC geared up and ready to register with CURES. They get back to their office, log on to the site and promptly fill out the CURES paperwork. They even print it and then often the paperwork sits on their desk because the next step is to have the form notarized. We are all very busy and often we just don’t get to finding a notary public, going to their location and paying the notary fee. And, sometimes we do all of that and still find that the notarized paperwork and accompanying documents never make it into an envelope with postage and to the US Post Office. CAPA is here to serve!

with us at the conference and he/she will accept and later process all of your paperwork, free of charge. We have made it easy, but you will still need to have 3 documents with you and/or copies of them. Without them, you can’t register on-site at the CAPA Conference for CURES. Come to the conference with copies of the following to be included in the envelope with the CURES application: 1) Your PA license, 2) your DEA Registration Certificate and 3) a government issued identification (e.g. your driver’s license). Make copies before you come to Palm Springs (and remember to BRING THEM with you) or we will have a scanner and we can scan them for you. Your life and ours will be easier if you bring the copies. This is all about making it easy for you!

CURES at CAPA is a program which will allow you to do it all in just a few moments at the CAPA Conference. We will have a representative from the Department of Justice

3) A copy of a government issued identification (e.g. your driver’s license).

Documents Needed to Complete the CURES Registration at the CAPA Conference: 1) A copy of your PA license 2) A copy of your DEA Registration Certificate

On Sunday morning, join us for breakfast and an exceptional line up of speakers who requested they speak on Sunday!

Scrubs and Slippers

Come on down for breakfast wearing your wildest (and/or most stylish) scrubs and pump up the volume with your craziest slippers! Relax and enjoy some of our best speakers on Sunday morning and show off your personal style starting with a delicious breakfast and coffee. It doesn’t get any better than attending high quality CME combined with a splash of fun and color. Stay until the last lecture ends and you could win one of two sets of scrubs and a beautifully tailored lab coat (one men’s and one women’s) from Medelita, sponsors of Scrubs and Slippers!

www.medelita.com

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PAs TRENDING What Is Trending In Your Life? Your Work Life, Your Private Life,

fter almost 50 years of hard work and thousands of important milestones, it seems PAs are an overnight success!! At the CAPA Conference we will be celebrating our acclaim! We know that success happens with consistent preparation and planning. Thanks to the work of CAPA and AAPA and decades of PAs providing exceptional care to patients, PAs are Trending! We did it together and we will continue to work together to strengthen California PAs’ role in health care. CAPA’s Vision: Fully integrate PAs into every aspect of California’s health care.

Adam Marks, MPH, PA-C: The only thing that could beat a sunset in Bora Bora...being there with my wife on our honeymoon.

Joy Dugan, MSPAS, MSPH, PA-C: As a child, I wanted to be a superhero. As a PA, I strive to be a superhero for my patients.

Chelsea Hemming, PA-S: My mother and I at my White Coat Ceremony for Western University of Health Sciences this last year.

Eric Glassman, MHS, PA-C: On June 8th, 2013 at the Montage Resort in Laguna Beach, CA, I proposed to my girlfriend and now the crazy business of wedding planning begins!!

Ana Maldonado, MPH, DHSc, PA-C: I am with two of our Touro students in DC during the AAPA Conference. We are lobbying for legislation that involves PA education and practice.

Bob Miller, PA; CAPA Professional Practice Committee Chair and Treasurer: Retirement is good!

What Milestone Are You Celebrating? You didn’t arrive where you are today without hard work, dedication and sacrifice. What is trending in your life? New job, new baby, new role at work, going back to school, getting into PA school, first clinical rotation, last clinical rotation, a volunteer role, anniversary, graduation, marriage, amazing vacation, grandchild, retirement, overcoming a health issue, etc. At the CAPA Conference we would love to share your photo depiction of what is trending for you. We will put all of the photos into PowerPoint and do a slideshow each day as people enter the grand ballroom for meal presentations.

Tell Us, What Is Trending In Your Life? Please submit your digital photo to capa@capanet.org along with a caption of no more than 25 words to let us know a bit about the photo and how it illustrates what is trending in your life.

Photos must be received before September 20, 2013.

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Your Extracurricular Life!

Saloni Swarup, PA: My family = my success. At graduation from Western PA Program in June 2013.

Roy Guizado, MS, PA-C: Bicycling has reminded me that life needs to be tempered with activities to ensure overall productivity and health.

Jay Williamson, MS, PA-C: “Be the voice to those we elect, protecting the future of those we LOVE, improving health care one physician assistant at a time.”

Michael Estrada, PA-C, MS, DHSc: PAs and Panthers teaming to develop an innovative PA program at Chapman University in Orange, CA

Christy Eskes, DHSc, PA-C, PA Program Relations Committee Chair: Celebrating our daughter’s first birthday and my first 10 years of being a PA-C!

Kevin Robertson, MHS, PA-C: Switching practices after almost 10 years taught me more than I ever thought. A definite trending of my new perspective on patient care!

Cherri Penne-Myers, PA-C: Health and Wellness Committee members at my church. We do health events each month. This was for our June 27th blood drive.

Teresa Thetford, PA-C, MS: Moved 3000 miles from Connecticut to California for the opportunity to be a part of the first PA Program in Orange County at Marshall B. Ketchum University.

Tracey DelNero, PA-C: Taking a break from teaching by cruising the Caribbean with sons (Tyler and Kyle).

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CONFERENCE HIGHLIGHTS

CAPA Student Medical Challenge Bowl – Aqua CME We’re back poolside for the Student Medical Challenge Bowl. On Saturday afternoon, just as the sun begins to set behind the mountains, the game begins. You won’t want to miss this fun, light-hearted, Jeopardy-style game show format event. PA students answer questions in order to vie for the championship title, the coveted Student Challenge Bowl Trophy and cash prize for the winning program’s Student Society. It has become a highlight of the CAPA Conference and so much fun to watch (and learn). So, bring your sunglasses, have a beer or soft drink, grab a lounge chair and see who will win this year’s CAPA Student Medical Challenge Bowl.

Back This Year 4-Hour Course: EKG Boot Camp CURES Registration - Free Service Complimentary Cyber Café sponsored by CEP America The CAPA Dance and All-Star American PA Idol Competition CAPA Student Medical Challenge Bowl Live Band on the Pool Deck on Saturday – CAPA All-Star Band 7 Conference Meals – Medical Providers Only

Hands-on Workshops • Beginning Suturing • Orthopedic Exam • Secrets of Splinting • Expert Suturing • Neurology Exam: Not Just Fun With Reflex Hammers • ACLS Recertification • Basic Radiology: Chest X-Ray • Joint Injection • Slit Lamp in the Emergency Room Setting • Wound Care 101

PA Program Alumni Receptions Students! Sign your teams up today for the Student Medical Challenge Bowl at www.capanet.org.

If you graduated from a California PA Program, contact your school and see if they will be hosting an alumni reception on Friday or Saturday evenings. Several schools have already started to plan their alumni event at the CAPA Conference. Check with your school to see what you can do to make this year’s alumni reception even better.

Legal and Legislative Update - Session I & II Robert Miller, PA; Michael Scarano, Jr., Esq.; Teresa Anderson, MPH Session I - Friday, 2:15 p.m. - 3:15 p.m. Session II - Friday, 5:30 p.m. - 6:30 p.m.

TOURO UNIVERSITY

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Friday Evening at the CAPA Conference

PArty At The Pool – 5:00 p.m. - Saturday

9:00 P.M.

The Dance and All-Star American PA Idol Competition The nightclubs of Palm Springs can’t compete with the PA PArty of the Year. It is the place to be on Friday night. We transform the beautiful lobby of the Convention Center into PArty Central with music that will please everyone. At 10:00 p.m. our All-Star American PA Idol show begins. The PArty continues as PAs compete and the audience votes to name the next American PA Idol. The Dance and All-Star American PA Idol competition are included with your registration and guests are welcome to attend at no charge. There will be a cash bar. This really is an event you won’t want to miss!

Trending - Student Track on Saturday, Including Speed Mentoring Students, don’t miss this year’s special series of lectures just for you. You will want to hear Mitzi D’Aquila’s lecture entitled: How To Be A Great Student At Your Clinical Site. She is back this year by popular demand. After Ms. D’Aquila’s lecture, you will join everyone in the grand ballroom for a lunch talk. Then back to the student track for a chance to network and win some fabulous prizes! New this year: Speed Mentoring! A special and unique opportunity to spend some quality time with 6-8 hand-picked leaders of our profession. After the Student Track, we will see you on the pool deck for the CAPA Student Medical Challenge Bowl.

PA Program Faculty Recognition and Special Reception

The PA profession is trending, and we want to honor our PA Program faculty! Without faculty, there would be no PAs. At the conference, look for the special PA Program Faculty ribbons on badges. When you see them, thank them for their dedication to the profession. If you are faculty at a PA program, please let us know when registering so we can give you a special badge ribbon. And, please be sure to join us on Saturday at 3:30 p.m. for a reception before the Student Challenge Bowl to recognize your accomplishments and network with colleagues from other California programs.

All-Star Band

This year, the CAPA All-Star Band will rock the house – actually the pool deck! All will enjoy an incredible concert before, during and after the Student Challenge Bowl. Just in case you don’t get enough dancing and music on Friday night at the CAPA Dance and American PA Idol competition, we have more fun in store on the pool deck on Saturday afternoon – a live band with PA, Greg Mennie on drums! Our special thanks to Greg Mennie, PA-C and the band for making this performance at the CAPA Conference possible. The Conference program and activities are subject to change without notice.

EKG Boot Camp Wednesday, October 2, 2013 2:00 - 6:00 p.m. Jennifer Carlquist, PA-C

$150 for CAPA Members $275 for Non-Members

To Screen or Not To Screen by Joy Dugan, MSPH, PA-C, Secretary

n medicine, we use screening to identify potentially harmful disease states in asymptomatic patients with an increased risk. The goal of screening is earlier intervention to reduce morbidity and mortality. The purpose of this article is to present the United States Preventative Services Task Force (USPSTF) screening recommendations as a guide to evidence-based clinical practice.

screening PSA for prostate cancer has been so widely debated recently. We also avoid screening when the outcomes of treatment in asymptomatic stages are no different from treatment after symptoms are present. In doing so, we would simply lengthen the treatment time, which may have little benefit. Screening for certain cancers including ovarian and pancreatic is given a “D” grade.

Why is this important? Health care providers need to recognize the preventive benefits covered under the Patient Protection and Affordable Care Act (PPACA). Under PPACA, preventative services with a USPSTF grade of A or B are covered with no cost sharing1.

New Updates (2013) to USPSTF Grade A and B Recommendations for Adults2 Alcohol Misuse: screening and counseling Grade B: recommendation for all patients 18 years or older who misuse alcohol. Patients identified should be offered counseling intervention to reduce alcohol misuse. Consider using the CAGE questionnaire for the majority of your patients or TWEAK questionnaire in pregnant women (to access: http://www.ccjm.org/content/78/10/649.full).

What do the USPSTF Grades mean? According to the USPSTF2, screening exams with “A” and “B” recommendations should be performed on patients. Grades “C” and “I” should be carefully considered at an individual basis. Helping patients understand the risk to benefit surrounding screening is important for “C” and “I” recommendations. Services with a “D” should be discouraged unless another clinical indication exists. Why Do the Grades Exist? The USPSTF gives “A” and “B” grades to screening tests that have statistically proven to prevent complications that would develop if treatment had not started until after symptoms are present. This is why our patients are recommended to have colonoscopy screening exams beginning at 50 years old or pap smears at 21 years old. By the same token, we try to avoid screening tests that will increase morbidity or mortality even if they have a positive result. This is why the recommendation against performing

HIV screening3 Grade A: for ages 15 to 65 years. Screen younger and older if increased risk. Grade A: for all pregnant women including those who present untested and are in labor. Intimate partner violence screening: women of childbearing age Grade B: all clinicians should screen for domestic violence and intimate partner violence. The SAFE (Stress and Safety, Abuse, Friends’ & Family’s knowledge of situation, and Emergency plan) questionnaire can help a provider referral as necessary for women that screen positive. For more information on SAFE questionnaire access: http:// domesticabuse.stanford.edu/screening/how.html.

Table 1: USPSTF Recommendations Grading2 Grade

Definition

The USPSTF recommends the service. There is high certainty that the net benefit is substantial.

The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

The USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small.

The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

CAPA NEWS

Hepatitis C This recommendation is likely to be updated in the coming weeks. Currently published recommendation is Grade I for high-risk patients. However, the CDC recommends all adults born from 1945-1965 get a one-time screening4. In the coming months, a decision is likely to be made by the USPSTF with clarification of the screening recommendation grade.

Grade I: asymptomatic adults with sustained blood pressures lower than 135/80 mm Hg.

USPSTF Grade A and B Recommendations for Adults (prior to 2013)2 Aortic Aneurysm Grade B: recommendation for screening all men ages 65-75 years who smoked greater than 100 cigarettes in a personâ&#x20AC;&#x2122;s lifetime with ultrasonography. Remember to include in your ICD-9 coding the code V15.82 (personal history of smoking) or 305.1 (nicotine dependence) as your diagnosis code.

Fall prevention in older adults: Vitamin D supplementation. Grade B: supplementation to prevent falls in communitydwelling adults age 65 years and older who are at increased risk for falls.

Aspirin Grade A: recommendation for all men 45-79 years old and women 55-79 years old to take an aspirin 81mg daily as long as the disease benefit (prevention of myocardial infarctions in men and cerebrovascular accident in women) outweighs potential harm of gastrointestinal hemorrhage. Consider calculating the 10-year cardiovascular disease risk according to ATP-3 guidelines for male patients (http://hp2010.nhlbihin.net/atpiii/calculator.asp) or calculating stroke risk for female patients (http://www. westernstroke.org/index.php?header_name=stroke_tools. gif&main=stroke_tools.php). Colon Cancer Grade A: recommendation to screen all adults age 50-75 with annual high sensitivity fecal occult blood testing (FOBT), sigmoidoscopy every 5 years, or colonoscopy every 10 years. Note: Grade D recommendation to screen in for colon cancer adults older than 85. Depression Grade B when staff-assisted depression care supports are in place for effective treatment and follow-up. Please reference my previous article in the Jan/Feb 2013 CAPA News entitled â&#x20AC;&#x153;Mental Health in the U.S.â&#x20AC;? for more information on screening for depression. Diabetes Mellitus Type 2 Grade B: asymptomatic adults with sustained blood pressure greater than 135/80mm Hg should be screened for diabetes.

Fall prevention in older adults: Exercise or physical therapy. Grade B: exercise or physical therapy in communitydwelling adults age 65 years and older who are at increased risk of falls.

Healthy diet counseling Grade B if patient has known cardiovascular, hyperlipidemia, and diet-related chronic disease. A provider or nutritionist/dietician can perform this counseling. Hyperlipidemia Grade A: screening men age 35 and older and women age 45 years and older for lipid disorders if they are at increased risk for coronary heart disease. Grade B: screening men and women ages 20 to 35 years for lipid disorders if they are at increased risk for coronary heart disease. Note: if the patient is not at an increased risk of heart disease in women age 20 years and older or men ages 20 to 35 years no recommendation for or against screening (Grade C). Hypertension Grade A: recommendation for all adults 18 and older every 1-2 years. Obesity screening and counseling Grade B: for all patients with BMI 30kg/m2 or higher should be referred to a multicomponent behavioral program. Sexually transmitted infections counseling Grade B: in all sexually active adolescents and adults at increased risk for STIs. Skin cancer behavioral counseling Grade B: for young adults ages 10 to 24 years who have fair skin about minimizing their exposure to ultraviolet radiation to reduce skin cancer. Continued on page 22

JULY/AUGUST 2013

To Screen or Not To Screen (continued) Continued from page 21

Syphilis screening Grade A: for syphilis screening in all persons at increased risk for syphilis infection. The two-step process that involves an initial nontreponemal test (Venereal Disease Research Laboratory or Rapid Plasma Reagin), followed by a confirmatory treponemal test (fluorescent treponemal antibody absorbed or T. pallidum particle agglutination) should be performed. Tobacco use counseling Grade A: recommendation for all adults to be questioned about tobacco use and provide tobacco cessation interventions for those that use tobacco products. If patient is pregnant, the smoking cessation counseling should be pregnancy-specific. In California, consider using the resource 1-800-NO-BUTTS. USPSTF Grade A and B Recommendations for Women’s Health2 Grade A • Bacteriuria screening in all pregnant women (at 12-16 weeks gestation). •

Cervical cancer screen with cytology every 3 years in women ages 21-65 or for women ages 30-65 co-test (cytology with HPV) every 5 years. Note: Grade D recommendation to screen women younger than 21 years old or in women post-hysterectomy without history of high grade precancer or cancer.

•

Chlamydial infections in nonpregnant women under 24 years and younger and for older nonpregnant women who are at increased risk. This is a Grade B recommendation if the patient is pregnant.

•

Folic Acid supplementation in all pregnant women at doses of 0.4 to 0.8 mg of folic acid.

• Syphilis screening in all pregnant women. Grade B • Anemia screening in pregnant women.

CAPA NEWS

•

Breastfeeding counseling during and after birth to promote and support breastfeeding.

•

Gonorrhea screening in all sexually active women, including those who are pregnant.

•

Osteoporosis screening in women age 65 years and older and in younger women whose fracture risk is equal to or greater than that of a 65 year old white woman with no additional factors. The FRAX fracture risk assessment tool, available at http://www. shef.ac.uk/FRAX/ can help guide treatment.

Caveats to Preventive Screening Certain services can have both preventive and diagnostic indications. Only when a test is performed for preventive screening is the test covered under the preventive services benefit. It is important to discuss with the patient their screening history. If the patient has symptoms or previous abnormal screening studies, the tests become diagnostic tests. In some patient insurance plans, diagnostic tests often include a share-of-cost. If the preventive service results in a therapeutic service at the same encounter as the initial screening exam, then the therapeutic service is still preventive. However, all subsequent screening will be diagnostic. For example, if an initial colonoscopy screening has a large polyp removed, that colonoscopy would be preventive but all subsequent colonoscopies would become diagnostic. This has important implications for the cost a patient may incur. Free Resources For those of you that like applications on your smart phone or iPad, check out: http://epss.ahrq.gov/PDA/index.jsp. The ePSS is an application designed for primary care clinicians to identify clinical preventive services using USPSTF recommendations that are age and gender appropriate for their patients.  References

1. The Guide to Clinical Preventive Services (2012). Accessed: http:// www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/guide-clinical-preventive-services.pdf.

•

BRCA screening and counseling for women whose family history is positive for breast cancer associated with BRCA1 or BRCA2 genes.

2. United States Preventative Services Task Force A & B Recommendations. (2013, June). Accessed: http://www.uspreventiveservicestaskforce.org/.

•

Breast cancer preventive medication for women at high risk for breast cancer and low risk for adverse effects of chemoprotection.

3. USPSTF Grade A Recommendation Finalized (2013, April). National Network of Prevention Training Centers. Accessed: http://nnptc.org/ spotlight/uspstf-grade-a-recommendation-for-hiv-testing-finalized/.

•

Breast cancer screening in women with or without a clinical breast exam every 1 to 2 years for women age 40 and older.

4. Hepatitis C: Testing Baby Boomers Saves Lives (2013, May). Center for Disease Control. Accessed: http://www.cdc.gov/features/vitalsigns/ hepatitisc/.

MICRA: The Basics by Lisa Maas, Executive Director of Californians Allied for Patient Protection

rial lawyers and their allies have filed a proposed ballot measure that will make it easier for lawyers to file meritless lawsuits against doctors and other health care providers and to generate more in legal fees for themselves. The initiative would change California’s landmark Medical Injury Compensation Reform Act (MICRA) to increase the cap on speculative, “non-economic” damages from the current $250,000 to nearly $1.1 million. While the measure contains other “window “Unless we defeat trial dressing” provisions, including mandatory lawyer efforts, their doctor drug testing and a mandated prescription changes would increase drug database, there is no doubt that the main health care costs for goal of the trial lawyers is the MICRA change.

doctors and consumers

A higher limit on noneconomic damages gives trial lawyers incentive to per year while reducing take on non-meritorious cases against doctors and patient access to health health care providers because they can reap care providers.” more in legal fees and the possibility of an out of court settlement is more likely. More lawsuits against doctors mean higher liability insurance costs and, ultimately, higher costs for patients and reduced access to health care services.

by billions of dollars

The California Academy of Physician Assistants is a member of Californians Allied for Patient Protection (CAPP), a coalition of more than 800 organizations representing physician assistants, community clinics, nurses, physicians, hospitals, EMTs, labor unions, local governments, employers, taxpayer groups and others that support MICRA and are actively opposing

the trial lawyer ballot measure. CAPP will be providing support toward the effort to defeat the proposition or any legislative changes. Since inception, MICRA has proven to be an effective way of ensuring injured patients are fairly compensated, while limiting meritless lawsuits against dentists, physicians, nurses, hospitals, community clinics and other health care providers. MICRA fairly compensates patients by awarding unlimited economic compensation for all past and future medical care, past and future lost wages, and unlimited punitive damages. MICRA’s reasonable cap of up to $250,000 for speculative, non-economic damages helps reduce incentives by lawyers to file meritless lawsuits which drive up health care costs. Under MICRA, payments to patients are going up at more than twice the rate of inflation. Filing a measure with the Attorney General is just a first step in

qualifying a measure for the ballot. The trial lawyers would have to collect signatures over the fall and winter if they intend to qualify the measure. CAPP coalition members are also prepared to fight any end of session attempt by the trial lawyers to change MICRA in the Legislature. Unless we defeat trial lawyer efforts, their changes would increase health care costs for doctors and consumers by billions of dollars per year while reducing patient access to health care providers. This could be disastrous, coming at a time when California is experiencing a growing shortage of physicians and access to care issues related to federal health care reform. For more information about CAPP and MICRA, visit www.micra.org and sign up to receive e-mail updates about efforts to protect MICRA and follow CAPP on Twitter: @ MICRAWorks. 

Dear CAPA, Becoming a PA was the best thing to happen to me. I LOVED IT, I LIVED IT. I am retired now but use my skills as a volunteer with the Red Cross, especially with the deploying troops that take off from Camp Roberts. I support CAPA and give thanks daily to the Almighty that He steered me into the most worthwhile thing I ever did in my life. Best Regards, Lynne S. Newhouse, PA-C, RN A note from long-time CAPA member, Lynne Newhouse, PA-C. Her love of the profession is evident as she enters this new phase of her life/career. Lynne, we wish you all the best. Thank you for the thousands of patients you cared for and continue to serve. JULY/AUGUST 2013

Students Students Students Students Students Students Make Each Rotation Count by Roy Guizado, MS, PA-C, Director-At-Large and Student Affairs Committee Chair Many PA students will be starting their clinical rotations fairly soon. Here is some advice that will make you stand out to your preceptor. Pre-Rotation: Be sure to contact your preceptor before the first day of rotation. Your PA Program will dictate the contact timeframe, which can vary from one to two weeks prior to the start of your rotations. The purpose of the contact will allow you to: • confirm your rotation;

“Enjoy the environment and the clinic. The experience in a clinical rotation is as good as the student’s attitude for that rotation. If it is a less-than-ideal rotation, a positive attitude will allow you to gain more positive experiences from that rotation.

• verify if you need to get an ID work badge; • determine if you need to complete an institution-specific HIPAA certification; • see if you need training or specific passwords for the electronic medical record; • confirm the preceptor operating days and hours; • determine the type of dress code expected in the office; and • provide any information the site might need from you, such as verification of malpractice insurance, immunization status and completion of any rotation specific information. (All programs send this information

CAPA NEWS

to the preceptors, but it is very common for the information to get misplaced.) After contacting the office and before the rotation starts, review your Program learning objectives for that rotation. Be ready to discuss these objectives with the preceptor. First Rotation Day: Be early, not just on time, and be sure to stay late without having to be asked. The student should verify the rotation schedule, especially making sure it reflects any days that your PA Program requires you back on campus. The student should let the preceptor know of any daily scheduling issues such as daycare, but the student should be as flexible as possible so as to have more time to gain clinical knowledge. This is also the time to discuss the learning objectives with the preceptor. Share the information so that the preceptor can assign patients that will help your educational process. Again, all preceptors get the objectives from the PA Program, but not all will review it. It is best to be proactive in this case, but not pushy. Observe your surroundings and know the locations of the exits for your safety, as well as your patient’s. Ask your preceptor where you can learn the site’s safety procedures. Learn the patient flow from start to finish, i.e., front desk sign in, room assignments, vitals assessment routine, examination by preceptor/ student and patient discharge

process. Once you know the basic procedures, you can be ready to help out at any point. Throughout the Rotation: Be professional at all times, which means being appropriately groomed and wearing a clean, pressed coat. When you are on rotation, remember you are working. Unless you are on an official break, it is always inappropriate to text, check email, Facebook, Twitter, or use your cell phone when in the clinic. Keep a positive demeanor. Always practice empathy with patients, which includes being nice to the patients that do not seem especially nice to you. Know your limits; if you do not know something, admit it to the patient or preceptor. Be sure to look up any questions that you may have from a patient encounter and report back to the patient or preceptor. Remember to practice patient confidentiality as guaranteed in HIPAA. Be sure to chart on all your patients while you are in the clinic. It is best to complete your charting as soon as possible after you see them, as your history and physical data are fresher in your mind. It is acceptable to use electronic resources such as the Internet to assist with information for patients. Try not to use electronic resources for every patient, as you must commit information to memory to become an effective PA. If you use the Internet for every patient you may become the “Google Guy” or the “Google Girl,” which is not meant to be complimentary.

Students Students Students Students Students Students Saturday, October 5, 2013 – Student Track For Those Students Registered for the Conference Be attentive to the teachings and information the preceptor provides to you. If the preceptor gives you articles to read, be sure to read them that night at home and be ready to discuss them. You may not discuss them the next day, but there will be a time that the preceptor will assess your knowledge. Some preceptors will assign topics for you to report on during the rotation. Prepare the topic and be ready to present and discuss.

Last Day of Rotation Finish your rotation with professionalism, class and a positive attitude. Be sure to get your final evaluation from your preceptor. If the evaluation is less than what you expected, listen to the preceptor to check for validity. If you disagree with the evaluation, do not argue with the preceptor. Instead, speak with your PA Program clinical coordinator who may be able to get additional information.

Appreciate the front office and back office staff. They are instrumental in your education. The staff will look at you as a bonus if you can help with patient tasks, like taking vital signs, etc. You have to balance working with the staff and seeing patients. Patients take priority, but take advantage of times when you can assist the staff.

Thank the preceptor for his or her time and for contributing to your education. Remember to thank the staff, as well.

Check your rotation learning objectives to be sure you are on task. Be sure to include any specific tasks/benchmarks that you need to complete. Discuss your clinical performance and needs with your preceptor. The frequency of the intervals for evaluation may change from preceptor to preceptor, but you should consider a weekly conference, not lasting any longer than 10-15 minutes. Enjoy the environment and the clinic. The experience in a clinical rotation is as good as the student’s attitude for that rotation. If it is a less-than-ideal rotation, a positive attitude will allow you to gain more positive experiences from that rotation.

After the Rotation Within one week of completing the rotation, send a hand-written thank you note to the preceptor and a separate note to the staff (if appropriate). This common courtesy is an appreciated gesture. Each rotation can provide you with a unique and invaluable learning experience. As you go from rotation to rotation, take all the bits of information you have gleaned and use them to make yourself a star PA student. Who knows, one of your preceptors could become your future employer! 

10:30 a.m. – 11:30 a.m. How to Be a Great Student At Your Clinical Site – Mitzi D’Aquila, PA-C 11:30 a.m. – 1:00 p.m.

Exhibit Hall

1:00 p.m.

Lunch in the Grand Ballroom

2:15 p.m. – 2:55 p.m.

Networking & Prize Drawings

3:00 p.m. – 3:15 p.m.

CAPA – Your California PA Advocate

3:15 p.m.

Ice Cream Break

3:30 p.m. – 4:30 p.m.

Speed Mentoring – Spend Quality Time With PA Leaders

Student Medical Challenge Bowl Sign Up Now

he 17th Annual CAPA Student Medical Challenge Bowl will be held Saturday, October 5, 2013, poolside at the Renaissance Palm Springs from 5:45 p.m. – 7:15 p.m. There will be a cash prize for the winning team: $250 for their Student Society. The winning team will also be able to display the official Challenge Bowl Trophy at their PA program. To sign up, go to the student section of the CAPA website (www.capanet.org). We look forward to seeing you there. 

JULY/AUGUST 2013

How Did I Make That Mistake?

sing an electronic prescription system, a physician assistant (PA) orders penicillamine for a 9-year-old patient with a positive test for Streptococcus. The PA meant to order penicillin, the antibiotic, not penicillamine, the chelating agent. The error wasn’t caught for 2 days. A likely contributing factor might have been “inattentional blindness,” which refers to the failure to see something that is unexpected. The PA wasn’t expecting an incorrect drug name, so didn’t see it. The “invisible gorilla” In the classic 1999 experiment of inattentional blindness, researchers asked students to watch a video of two teams passing basketballs. The students had to silently count the number of passes made by members of the team dressed in white shirts and ignore the number of passes made by those in black shirts. Halfway

through the 1-minute video, a student wearing a gorilla suit walks into the scene, stops in the middle of the players, faces the camera, and thumps her chest before walking off. Amazingly, about half of the students failed to see the gorilla. They were totally concentrating on their task—to count the number of passes made by those in white shirts—that they missed the unexpected appearance of a gorilla. Furthermore, the students couldn’t believe they missed the gorilla, expressing amazement when they saw the video again. (To see the invisible gorilla video, visit www. theinvisiblegorilla.com/videos.html.) What happened to the students? The gorilla study illustrates what researchers Christopher Chabris and Daniel Simons call the “illusion of attention.” In essence, we see what we expect to see. Researchers who focus on the impact of human factors on errors point to

four factors: capacity, conspicuity, expectation, and mental workload. Avoiding invisible gorillas The problem of inattentional blindness still occurs even when people are cognizant of it, but by taking these actions, based on contributing factors, you can help protect yourself and your patient: • Be alert for drug labels that look similar. • Lower the noise level to reduce distractions. • Consider putting a system in place to avoid interruptions during medication preparation. • Take special care with what you consider “routine” procedures. Keep in mind that errors tend to occur when new or unusual combinations Continued on page 27

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Physician Assistants Professional Liability Insurance 888.273.4686 | www.hpso.com/oncall This program is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company, and is offered through the Healthcare Providers Service Organization Purchasing Group. Coverages, rates and limits may differ or may not be available in all states. All products and services are subject to change without notice. This material is for illustrative purposes only and is not a contract. It is intended to provide a general overview of the products and services offered. Only the policy can provide the actual terms, coverages, amounts, conditions and exclusions. CNA is a registered trademark of CNA Financial Corporation. Copyright © 2012 CNA. All rights reserved. Healthcare Providers Service Organization is a registered trade name of Affinity Insurance Services, Inc.; (AR 244489); in CA, MN & OK, AIS Affinity Insurance Agency, Inc. (CA 0795465); in CA, Aon Affinity Insurance Services, Inc., (0G94493), Aon Direct Insurance Administrator and Berkely Insurance Agency and in NY and NH, AIS Affinity Insurance Agency. ©2012 Affinity Insurance Services, Inc. CAPA112

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Welcome New Members

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May 21, 2013 through August 2, 2013 Erik Abernethy, PA-C Patricia Achay, PA-S Marisa Ayers, RN, PA-C Jennifer Babich, PA-S Nicole Banegas Melissa Barlis, PA-S William Bartoli, PA-S Julia Bates, PA-S Jeanette Bear, PA-C Toni Bell Brittany Berguin, PA-S Emily Boriack, PA-S Theresa Brady, PA-C Kayla Bratton Melanie Brzozka, PA-C Yi Bu, PA-S Simona Byk, PA-S Aaron Campbell, MS MPH PA Phillip Campos James Carnahan, PA-C Elana Carvalho, PA-S Vicki Chen, PA-S Stephanie Chen, PA Maggie Ching, PA-S Jonathan Choi, PA Elaine Choy, PA-C Ahyana Clark, PA-C Lindsey Clyde, PA-S Erin Coakley, PA-C Stefani Comerford, PA-C Corinne Corrier, PA-S Anthony Cramer, PA-S Randall Crew, PA-S Kara Danneberger, PA-C Kathleen Davies, PA-C Glenn de Guzman, PA-C Weston DeBry, PA-S, EMT-P Alex DeTrana, PA-C Elise Diner, PA-S Marc Dobson, PA-C Laura Desiree Dougherty, PA-C Amanda Duncan, PA-S

Heather Elledge, PA-C Kimberly Ely, PA-S Cristina Evans, PA-C Aaron Farmer, PA-S Gary Felix, PA-S Michael Fisher, PA-S Martha Fisic, PA-S William Fuller, PA-S Meaghan Gagnon, PA-S Brittany Gansar, PA-S Sarah Garrett, PA-S Mia Gatti, PA-S Azniv Gevorkyan, MPH Leanna Gonzales, PA-C MariJo Goodsite, PA Kirsten Griffin, PA Ann Marie Hedrick, PA-S Luz Herrera, PA-C Brett Heslop, PA-S Spencer Hill, PA-C Christopher Jankly, PA-C Melissa Javaheri, RD CDN Alyssa Jensen, PA-S Kellie Johnson, PA-S Autumn Johnson, PA Christopher Johnson, PA-C Kathryn Johnson, PA-S Kimberly Kasperek, PA-C Kimberly Kasten, PA-S William Kerr, PA-S Matt Kiddle, PA-S Daniel Kim Karri Knodel, MS Jaideep Kochhar, PA-C Kylie Kumasaka, PA-S Michael Lam, PA-S Helen Lam Gage Lambert Marisa Leal, PA-S Michelle Lee, PA-S Jennifer Lind, PA-C Shonna Lindo

Christopher Littmann, PA Jesirey Locquiao, PA-S Jason Lomheim Nina Luong, PA-S Jenny Luong, PA-C Alison Marcus, PA-C Lisa Mark, PA-C Teresa Marsoobian, PA-C Tim Martinez, PA Jeremiah Martinez, PA-S Brianna McCann, PA-S Sean McGovern, PA Alexandra Mead, PA-C Christine Mikhael, PA Sara Minsavage, PA Eric Montoya, PA-C Sarah Moore Christopher Morales, PA-S lindsay moran, PA-S Priscilla Narain, PA-C Jennifer Nessenson, PA Tran Nguyen, PA-C Surjit Nijjar, PA-C Grace O’Brien, PA-C Elizabeth O’Connor, PA-C Katherine Osaki, PA-C Jonathan Pagano, PA-S2 Bindi Patel, PA-C Jennifer Pence, PA-S Katherine Pocock, MA, PA-S Goodwill Princewill, PA-C Amena Rahman, PA-S Gunbir Rana, PA-S Dan Raphael, PA-C Ashley Ratner, PA-S Paterson Rene, PA-S Rita Reyes, PA-C Jim Richmond, PA-C Shawncey Rider Jared Robertson, PA-S Megan Robinson, PA-C Marissa Rogers, PA-S

Bryan Rupley Lorne Sachs, PA-S Sabina Sampath, PA-C Zondree Scott, PA-C Sepideh Shahri, PA-C Biqi Shi, PA-S Stacey Shoop, PA-S Michael Sicat, RPA-C Matthew Slater, PA-C Ashley Smith, PA-S Maggie Smith, PA-S Christine Son Chad Spears, PA-C, ATC Erin Spiro Laura Striffler, PA Bridget Stringer, PA-C, MPAS Jeffrey Susila Jennifer Swisher, PA-S Travis Taggart, PA-S Lynn Tai, PA-S Jessica Tannous, PA-S Sarah Tanquary, PA-C Sean Therien, PA Caroline Tran Christopher Traut, PA-S Colleen Trimlett, PA-S Josepha Valdez, PA-S Erica Ventrella, PA-S Amanda Vigil Brianna Vincent, PA-S Amanda Watkins, PA-S Kelly Whitmire, PA-S William Wilson, PA-S Luwam Wolana, PA Laura Yee, PA-S Justin Yong Hana Yoshikawa, PA-C Lia Yuen, PA Jesse Zablan, PA-S Sergio Zambrano, EMT

Continued from page 26

of circumstances occur in a familiar setting. • Increase your critical thinking skills by taking a class or reading about it. • Don’t ignore technology such as automatic warnings on documentation systems, but don’t over-rely on technology, either.  Resources:

Chabris C, Simons D. The Invisible Gorilla: How Our Intuitions Deceive Us. New York: Three Rivers Press; 2011. Green M. Inattentional blindness & conspicuity. 2011. http://www.visualexpert. com/Resources/inattentionalblindness.html Grissinger M. Inattentional blindness: What captures your attention? P&T. 2012;37(10):584-585.

Hughes V. When experts go blind. National Geographic. 2013. http://phenomena. nationalgeographic.com/2013/01/31/whenexperts-go-blind. McGann E. Medication error prevention: a shared responsibility. Medscape Medical News. Jun 14, 2011. http://www.medscape.com/ viewarticle/744546. This risk management information was provided by Healthcare Providers Service Organization (HPSO), the #1 provider of professional liability insurance for over 1 million healthcare professionals, and is now offering the same quality coverage, financial strength and level of service to Physician Assistants. The professional liability insurance policy is administered through HPSO and underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an email to service@hpso.com or call 1-800-9829491. www.hpso.com.

1. Redding Area PA/NP Alliance P.O. Box 993515, Redding, CA 960-3515 Summer Ross, PA-C; (530) 225-6194 summerlynn712@gmail.com 2. Physician Assistant Society of Sacramento (PASS) Judi Price, PA, MPAS, PASS President; (916) 952-8327 pasocietyofsac@yahoo.com 3. Contra Costa Clinicians Association Brian Costello, PA-C; (925) 852-8706 contracostapas.com 4. San Francisco Bay Area Physician Assistants (SFBAPA) www.sfbapa.com, Martin Kramer, PA-C; (415) 433-5359 220 Lombard St., Apt. 118, San Francisco, CA 94111-1155 mkramersf@hotmail.com 5. Bay Area Mid-Level Practitioners Rose Abendroth, PA-C; (650) 697-3583, Fax: (650) 692-6251 rosepard@aol.com Matt Dillon, PA-C; (650) 591-6601, mattdillon42@hotmail.com 6. Bay Area Non-Docs Linda O’Keeffe, PA-C; (650) 366-2050, lindapac@aol.com 7. Northcoast Association of Advanced Practice Clinicians John Coleman, PA-C; (707) 845-6008, streetdrag49@sbcglobal.net 8. Stanislaus County NP/PA Network Brian Cormier, PA-C; (209) 605-4966, briancor@verizon.net www.nppanetwork.org 9. Stockton Midlevels Roy Blanco, PA-C; (209) 623-8580 stocktonmidlevels@gmail.com 10. Journal Club for PAs and NPs (Fresno area) Cristina Lopez, PA-C; (559) 875-4060; Fax: (559) 875-3434 clopez875@aol.com; 2134 10th St, Sanger, CA 93657 11. Central Coast Nurse Practitioners & Physician Assistants Kris Dillworth, NP; ccnppa@yahoo.com Sharon Girard, PA-C; (305) 803-1560; ccnppa@yahoo.com 12. So Cal PAs Linda Aghakhanian, PA-C; want2heal@hotmail.com 13. Orange County Hung Nguyen, PA-C; (714) 846-8178; nhy52@yahoo.com 14. San Gabriel Valley Local Group M. Rachel DuBria, PA-C; (818) 744-6159, racheldca@aol.com 15. San Fernando/Santa Clarita Valley Group Jonah Tan, MPT, PA-C; (818) 634-0007, jotptpa@yahoo.com 16. Coachella Valley Physician Assistant Group Matthew Keane, MS, PA-C; mkeanepas@gmail.com 17. San Diego Area Patrick Astourian MS PA-C; pastourian@gmail.com www.SDPASOCIETY.com.

JULY/AUGUST 2013

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OPTIONAL WORKSHOPS October 3 and October 5, 2013

What Is Trending In Your Life? Your Work Life, Your Private Life, Your Extracurricular Life!

Anne Walsh, PA-C, MMSc: PA Life is busy! Hubby and I just celebrated my first vacation in 6 YEARS in the Galapagos, with giant tortoises, iguanas, & blue-footed boobies!

Jeremy Adler, MS, PA-C: 2013 has been an exciting year, elected as President-Elect of CAPA and made a partner with Bob Wailes, MD in my practice at Pacific Pain Medicine Consultants.

Michelle Lim-Serrao, PA-C: Chad and I, both PA-Cs, went from a family of 3 to 4 last year. Learning to navigate life with 2 kids!

Jennifer Carlquist, PA-C: As a long time EKG lover I finally got my dream job as a full time cardiology PA!