January/February Magazine - 2011 by CA Academy of PAs

News

Official Publication of the California Academy of Physician Assistants

January/February 2011

\The Magazine

CAPA Works to Implement PA Use of Fluoroscopy by Bryce Docherty, CAPA Legislative Advocate

APA continues to regularly meet with the California Department of Public Heath – Radiologic Health Branch (CDPH-RHB) to implement AB 356 (Fletcher) from 2009. As many of you know, even though the legislation was signed into law that provides a pathway for PA use of fluoroscopy, CDPH-RHB has undertaken development of regulations that could delay implementation for up to two more years.

CAPA Legislative Affairs “The purposes of the meetings Coordinator, Beth Grivett were for updates on CDPH-RHB and I met with CDPH-RHB regulatory progress and to on March 3, 2010 and again offer any needed assistance on October 20, 2010. The from CAPA.” purposes of the meetings were for updates on CDPHRHB regulatory progress and to offer any needed assistance from CAPA. At these meetings, CDPHRHB outlined the issues they are addressing with the regulations and why they could take up to two more years. The issues they need to address include: Reconfiguration of internal computer system and IT needs Examine the PA scope of practice

Staffing needs analysis for PA applicants Other funding needs (i.e. establishing the PA permit fee, applications process and workload analysis) Examine whether the existing fluoroscopy RT curriculum is appropriate for PAs CDPH-RHB appears to be addressing all these issues adequately. For example, they have determined that the existing RT curriculum is appropriate for PAs. This is great news; otherwise CDPH-RHB would need to spend much longer developing a PA-specific curriculum. Furthermore, hardly any existing fluoroscopy training programs would accommodate such a new and limited curriculum. CDPH-RHB asked CAPA to assist them in determining the potential number of PAs who would be seeking the fluoroscopy permit. This will directly correlate to whether or not undertaking such a regulatory effort will get approval and what precisely the application fee will be for the permit. For example, the Office of Administrative Law (OAL), which must approve the CDPH-RHB regulations, may not approve staffing resources for this program for only 50 applicants. Furthermore, the application fee needs to sustain the program resources, so the smaller

number of applicants – the higher the application fee. Therefore, CAPA sent out a survey asking if you would potentially seek this fluoroscopy permit. We are pleased with those survey results and will be passing that information on to CDPH-RHB. Thank you for those who responded to that survey! CAPA believes that CDPH-RHB will most likely have regulations published by July 1, 2011. Once the regulations are published, CDPHRHB will have one year to move them through the OAL process. However, CAPA is guardedly optimistic that these regulations could be finalized by the end of 2011. Regardless, Beth Grivett and I will continue to be proactive with CDPH-RHB in hopes of implementing PA use of fluoroscopy as soon as possible. 

6 Hours Cat. I CME

2011 Schedule of

Controlled Substances Education Courses Inside on page 13

News

Editor Gaye Breyman, CAE Managing Editor Denise Werner

Editorial Board Eric Glassman, MHS, PA-C Beth Grivett, PA-C Bob Miller, PA-C Larry Rosen, PA-C Michael Scarano, Jr., Esq.

Proofreaders Paula Meyer, PA-C

CAPA Board Of Directors President Eric Glassman, MHS, PA-C president@capanet.org Vice President Larry Rosen, PA-C vicepresident@capanet.org Secretary Cherri Penne-Myers, PA-C, MSCS secretary@capanet.org Treasurer Bob Miller, PA-C treasurer@capanet.org Directors-At-Large Beth Grivett, PA-C dirbeth@capanet.org

Program Cuts Red Tape for Volunteer Health Professionals Based on a press release from the HHS, October 2010

he U.S. Department of Health and Human Services (HHS) has launched a national Web site for the Emergency System for Advance Registration of Volunteer Health Professionals (ESARVHP) to make volunteering in an emergency faster and easier for health professionals. The ESAR-VHP is a federal program developed after complications arose in the use of medical volunteers following 9/11. The program establishes and implements standard guidelines for registering, verifying and deploying medical professionals in the event of a large-scale national emergency.

The new Web site provides a single point of entry for potential volunteers, quickly connecting them to each state’s ESAR-VHP program. According to the HHS, the new process can shave off hours, even minutes, from the time volunteers used to wait to have their credentials verified. The HHS encourages health professionals to visit the Web site (www.phe.gov/esarvhp) and follow the steps to register with their state system. Registering with ESAR-VHP does not mean that health professionals are obligated to serve. Registered participants can opt in or out when contacted to volunteer. Currently, ESAR-VHP has 49 state programs in place and almost 150,000 volunteers registered. HHS notes that state coordinators are eager to add to the number of volunteers willing to serve in case of a disaster. 

Matthew Keane, MS, PA-C dirmatt@capanet.org Adam Marks, MPA, PA-C diradam@capanet.org Greg Mennie, PA-C, MSed dirgreg@capanet.org

“Mr. Sachs Goes to Sacramento”

Student Representative Jenn Baltazar, PA-S studentrep@capanet.org

Committee from 1993 to 2008 and as Chairman for 11 years. He currently practices at USC Cardiovascular Thoracic Institute of the Keck School of Medicine since 1995. He served as Clinical Instructor at Keck School of Medicine from 2002 to 2010 in Cardiothoracic Surgery. He is a Past President of the California Academy of Physician Assistants (1988) and received our highest award, the “Pride of the Profession Award” in 2008. He serves as a member of the advisory committees at USC, Riverside, and San Joaquin Valley PA Programs.

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: 3100 W. Warner Ave., Suite 3 Santa Ana, CA 92704-5331 Office: (714) 427-0321 Fax: (714) 427-0324 Email: CAPA@capanet.org Internet: www.capanet.org ©2011 California Academy of Physician Assistants

CAPA NEWS

ormer Governor Arnold Schwarzenegger appointed Robert Sachs, PA-C to the Physician Assistant Committee of the Medical Board of California on January 2, 2011. Mr. Sachs had previously served on the

He is an Honorary Founding Member of the California Academy of Physician Assistants and is a Distinguished Fellow of The American Academy of Physician Assistants. 

Now’s The Time by Eric Glassman, MHS, PA-C, President

now ’s

t seems like you can’t have a conversation anymore without bringing up “the future of health care.” It’s a hugely important topic and so much uncertainty exists that cannot be predicted. I think health care is the most important social topic currently in the United States. We have a rapidly growing retired and aging population who will demand much more health care than we are accustomed to providing now. We are already aware that we have a shortage of primary care providers, but this number is only going to get bigger in the coming years. This is an excellent opportunity for PAs to take a big step forward and help with this potential health care crisis.

time e h t

When the Health Care Reform Bill was passed several months ago, you couldn’t go a day without this coming up

in conversation in the work place or a gathering amongst friends. This topic is not just popular with health care professionals, but rather everyone with, or without insurance. This will essentially be affecting all of us to some degree. Even on a recent trip traveling through Thailand, Europeans I met were asking me about our new Health Care Reform Bill. It’s a huge topic with huge potential changes on the way. When the Health Care Reform Bill was signed, it gave the potential for millions of uninsured individuals to now have insurance. This is great news! Many more Americans can seek medical care when they are injured or sick. But, if we already have a shortage of providers, how will we possibly accommodate all these new patients? It’s not an easy problem to fix. It can make the ability to schedule an appointment with a provider even longer than it is now, it can make ERs more crowded with longer wait times. The obvious answer is the need for more providers to see these patients.

By providing more PAs in the workplace, we can effectively see more patients. This is an obvious statement that PAs are very aware of. Unfortunately we can’t just snap our fingers, double the size of PA schools in this country and find rotation sites for all these new students. But, when the great minds in Washington, DC get together and are looking at ways to now provide care for these patients, I hope they get the idea of what PAs can do to help with this problem. We know that the AAPA is working to make sure we have a voice in this matter. Another current issue is that as of January 2011, Department of Managed Care implemented something called, Timely Access. This requires health plans licensed by the Department of Managed Care to see patients within a certain amount of time for urgent visits, non-urgent visits, new consultations as well as patient call backs. Imagine a practice that is already busy enough and now Continued on page 5

Inside This Issue Program Cuts Red Tape for Volunteer Health Professional.......2

Timely Access Regulations...................................................13

How to Help Patients With Nicotine Addiction.......................21

Mr. Sachs Goes to Sacramento...............................................2

Heard Any Great Speakers Lately?......................................14

Facebook: Implications for PA Students and

Now’s The Time.....................................................................3

2011 CAPA Conference!......................................................14

the Job Market...................................................................22

Medi-Cal & Medicare ... A Quick Review.................................4

Controlled Substances Education Course...............................15

Congratulations to the 2011 CAPA Scholarship Winners!!!....23

L.A.’s Half Marathon Was One Whole Wonderful Experience......6

Embracing Change..............................................................16

2011…A New Year of Student Opportunities with CAPA......24

A Fine Man...........................................................................8

What Your Docs are Reading in the

What’s Going On At…USC

The Model Medical Home....................................................10

Medical Board of California Newsletter................................17

Faculty Profile: Anne Walsh.................................................25

Regional Extension Centers Assist PAs Transition to

The Third, New and EXPANDED Edition of the California

The First White Coat............................................................26

Electronic Health Records....................................................11

Physician Assistant’s and Supervising Physician’s Legal

Welcome New Members......................................................27

What’s a PA ... So you think you know your profession?.......12

Handbook..........................................................................18

Local Groups......................................................................27 JANUARY/FEBRUARY 2011

Medi-Cal & Medicare ... A Quick Review By Bob Miller, PA-C, Professional Practice Committee Chair The billing for covered medical services by a PA is submitted under the (Medi-Cal enrolled) physician’s name and identifier with a modifier “U7”. This modifier is used to indicate the service was provided by a PA. Other modifiers may additionally be required for a particular service. Before 2009, PA billing was severely limited to a short list of CPT codes thereby restricting what services could be reimbursed. CAPA’s legislative f the many calls I get each week, the majority efforts resulted in the elimination of that restrictive list continue to involve questions about reimbursement, and the manual now states: mainly concerning Med-Cal and Medicare. Most inquiries are from new grads – but many are not. So Covered services for PAs include services performed by a PA it seems worthwhile, from time-to-time, to review the within the scope of practice when the services would be a basics about how PAs fit into these two enormous covered benefit if performed by a physician and surgeon. reimbursement systems. For PAs who provide first-assistant at surgery services, the Both Medicare and Medicaid are administered under same Manual, under the section “Surgery: Billing With the federal Centers for Medicare & Medicaid Services Modifiers”, explains how to use modifiers “99 = U7 + 80” (CMS). Medi-Cal, as you know, is California’s version along with the appropriate surgical procedure codes when of Medicaid. Be aware that although Medicare and billing under the physician. Medi-Cal fall under the administration of CMS, the rules and regulations for billing under these two Note: When reading this Manual, pay attention to the payers are very different. Medicare recognizes a PA date in the right lower corner which indicates the last as a “provider” and is enrolled as such, while Medidate when any changes were made to the page. Cal requires PAs to enroll - but without “provider” status. This contrast results in allowing the PA to bill Medicare for Medicare covered services either using their name Medicare is the nation’s largest health insurance program. and identifier OR that of the physician (“incident It provides coverage for more than 40 million people to” billing – more on this later). However, Medi-Cal who are age 65 or older or disabled. Even if your practice requires that covered services provided by a PA may does not include Medicare patients, the insurance payers be billed only under the physician (reasoning drawn that you do work with are, and have been, influenced by from the “dependant provider” concept). So let’s do a the rules and regulations and philosophies derived from quick review in hope that this exercise will be useful – Medicare decision making. In many areas of healthcare especially for the new grads. insurance, Medicare has set the standards which in many cases have become adopted as the benchmark for other Medi-Cal companies in the industry to follow. The Medi-Cal billing manual, under a section titled Nonphysician Medical Practitioners (NMP), clearly recognizes Medicare is a federal program under the Centers for the services of PAs and explains that reimbursement for Medicare and Medicaid Services (CMS). However, rules physician services provided by PAs is at 100% of what a regarding billing for physician services provided by PAs physician would receive for covered services. This manual are very different between Medicaid (called Medi-Cal in also describes enrollment criteria and rules for allowable CA) and Medicare. Medicare Part B covers professional reimbursement for PAs. In addition, you will find services such as those provided by physicians and physician information regarding the enrollment process with the assistants. In California Medicare Part B is administered by current forms to be used. Enrolled PAs must work with a Palmetto GBA: Medicare, Jurisdiction 1, Part B. Palmetto physician who is an enrolled Medi-Cal provider. The PA GBA is the “Medicare carrier” for our state. is not considered an independent Medi-Cal provider and must therefore, bill under the supervising physician. Find The Balanced Budget Act of 1997 clarified and simplified this manual by placing “Medi-Cal Provider Manual” into Medicare regulations and reimbursement for PAs. It Google then scroll down to “Medical Services” : “General expanded the areas of coverage for PA provided services and Medicine”; then scroll to the NMP section. eliminated restrictive requirements. PAs in California should

CAPA NEWS

Now’s The Time Continued from page 3

enroll as Medicare providers through Palmetto GBA. When an appropriate bill is submitted using their own name and identifier, covered medical services which are provided by PAs are reimbursed at 85% of the physician fee schedule. Reimbursement is paid to the employer or supervising physician and not directly to the PA. Medicare also reimburses for PAs who are the first assistant at surgery when all appropriate criteria and regulations are met. Medicare reimburses a physician first assistant at 16% of the primary surgeon’s fee and a PA receives 85% of the 16% (13.6%). Medicare also allows for “incident to” billing for covered services provided by PAs. Services billed as “incident to” are reimbursed at 100% of the physician fee schedule and the bill is submitted using the physician’s name and identifier. There are significant restrictions regarding this type of billing and there is some confusion as to how this is applied in various situations. You should not use this billing option unless you are certain that you are complying with all of the regulations and you have adequate documentation. “Incident to” billing requires that the following criteria are met:

Can only be used for services provided in an office / clinic setting. It cannot be applied to hospital or ED services.

The service is one that is typically provided in a physician’s office.

The physician must be in the suite of offices when the PA provides the service.

The service is within the PA’s scope of practice under state law.

The physician must personally treat and diagnose the patient on the first visit to the practice and when there is a new medical problem / diagnosis.

(These above “incident to” restrictions do not apply when billing under the PA’s name and identifier) Medicare limits PA practice in a few other areas of healthcare delivery. PAs cannot order/certify hospice care and cannot yet certify skilled nursing facility care. And although a PA may provide services in the home, the PA cannot order/certify home health services. The AAPA has been working on these issues at the federal level. We will continue to watch for needed changes in healthcare legislation. 

trying to comply with these new regulations. Not an easy task. But there may be an easier solution. Hire a PA. Share the workload and get patients seen quicker while allowing more time with each patient. CAPA has sent out postcards to managed care organizations throughout “Unfortunately we can’t just California promoting PAs for this main reason. Having patients snap our fingers, double seen in a timelier manner is better for both patient satisfaction and the size of PA schools in this quality of care.

country and find rotation sites

Health care will always be evolving and changing. Evidence based for all these new students.” medicine and the “best practice” model will always prove to help benefit our patients. I know with time as the changes with Health Care Reform come to fruition, we will see PAs being used more prominently and efficiently. This is a great time to be a PA and we can help mold the future of medicine. 

CAPA FACT Did You Know?

35 Years Ago… Rod Moser, PA called the first CAPA meeting to order on June 26, 1976 in Fresno, California. JANUARY/FEBRUARY 2011

L.A.’s Half Marathon Was One Whole Wonderful Experience by Larry Rosen, PA-C, Vice President and Public Relations Committee Chair

he closest I ever came to a marathon was last March when my wife, Joyce, and I hosted a CAPA board member and her 12-year-old daughter at our Culver City home after they had completed the Los Angeles Marathon. We had the fun of providing them with warm showers, post-run food and drink and a place to put their feet up for a few hours and share the excitement of what they had experienced together.

The ROCK N ROLL ½ MARATHON series is nation-wide and was coming to Los Angeles for the first time. Proceeds from the event would supply funding for the American Cancer Society, the Leukemia & Lymphoma Society and the unique, L.A. “Grove of Hope” organization. CAPA was happy to oblige Dr. Maharam and we got the word out.

This mother and daughter duo had accomplished something extraordinary; a 26.2 mile run and they both finished standing! So exciting. But the more they talked, the farther I distanced myself from this phenomena. I remember gasping my way through a 10K in Las Vegas about nine years ago. I would never run a marathon and was perfectly OK with knowing that I could deny myself that life experience; like free falling from an airplane; exciting to watch but not on my bucket list.

“I assured the “Running Doc”

Then, last June, I received a call from Dr. Lewis G. Maharam, aka the “Running Doc.” Dr. Maharam is the Medical Director of the Competitor Group’s Rock ‘N’ Roll Marathon Series and Team In Training Chairman, Board of Governors, of the International Marathon Medical Directors Association. Blessedly, he was not inviting me to run. He was looking for physician assistants to act as Medical Captains during the first running of the L.A. ROCK N ROLL ½ MARATHON, Sunday, October 24, 2010. 6

CAPA NEWS

More than a dozen PAs volunteered. Our job was to staff medical relief stations along the race course, providing first aid, medical triage and support to the more than 13,000 runners participating.

that CAPA would again seek out PAs to support this event next October. My team was committed to coming back.” Pre-race meetings included lectures by Dr. Maharam on the sports medicine of racing. He takes pride in being at the forefront of a paradigm shift regarding exercise induced hyponatremia and dehydration. Historically, it was felt that hypotonic fluid losses from sweating would produce a rise in serum sodium. Yet, research showed that the development of hyponatremia following such events was attributed to hypotonic fluid replacement greatly exceeding the fluid losses experienced by sweating. Fascinating data and enormously important in gauging the health status of a runner in distress. (For more information on this subject, see the article in the May 2010 issue of Clinician Reviews:

http://www.clinicianreviews.com/ index.asp?page=courses/106744/ disclaimer.htm&lsn_id=106744). Sunday, October 24th, 4:00 a.m. is a time for dreaming in soft, toasty beds, not driving to downtown LA to meet colleagues in the cold, predawn darkness. But there we were, me and my CAPA buddies huddled over steaming coffee mugs on the USC medical campus, studying maps, figuring out where we were all stationed along the 13 mile half marathon course. Impressive from the get-go was the meticulous organization of the event. Tents and supplies showed up on time. Workers helped us put our stations together in short order. Communication with the main medical tent at the finish line was easy and constant. There were cheerleader teams and bands everywhere. The atmosphere was festive, alive and charged with excitement. My station was at the halfway point. We waited, staring down the empty street that paralleled the Silver Lake Reservoir. We waited and waited and then they came. First in small groups, the lead runners, looking strong. These runners were cruising; smiling, waving, confident. Next, they came in larger groups and then in thousands. Waves of runners rolling by. Men and women in their 70’s, kids in their teens. Some faces in pain, all faces full of hope, this river of runners thick with pride and well deserved self-satisfaction. I’d seen this on TV but never this close. I remembered as a kid going with my dad to see Joe Louis fight and being impressed by the skin tones of the battered fighters and the noises in the arena. You didn’t see or hear this the same way on TV. This was thrilling.

By noon, the last runner had passed Two of the PAs I worked with had our station. My team ultimately both run marathons. They knew disbanded but with the help of my these runners and what they needed medical staff auto identification and even before they asked; Vaseline the generosity of police along the on tongue depressors for chafing, route, I was able to navigate to the bandages for blisters, Tylenol for finish line to greet Dr. Maharam. aches and pain (we had to mark More than 13,000 runners had their badge number if we gave them turned out and Dr. Maharam was Tylenol, only one dose per runner.) very pleased. Most importantly, there Lots of muscle spasms and joint were very few serious injuries and no pain. Sometimes a quick calf massage got them going again. More hyponatremia. He would have liked to have had more medical volunteers. often an ACE wrap would bring There are never enough. I assured the relief as would ice packs strapped “Running Doc” that CAPA would to aching joints with plastic. Only again seek out PAs to support this one runner was done. He’d pulled a event next October. My team was hamstring and was unable to even committed to coming back. walk to the finish line. We called one of a convoy of ambulances that So, circle October on your 2011 was at the ready all along the race course that led from Griffith Park to calendar for the ROCK N ROLL ½ downtown Los Angeles. MARATHON in Los Angeles. CAPA

will be promoting it on the web page and at conference. Don’t miss out next year. The causes are worthy and your skills are needed. It makes for an exciting day and the work is fun. For me, being at the finish line was its own reward. Those prideful, weary faces were a treat to see; making it across the line, cheered on by thousands of spectators, bands, greeters who highfived them as they passed by.

Larry Rosen, PA-C and Marathon participant

Almost made me want to be one of them. Almost. 

E-8858-111_E-8858-111 12/14/10 11:09 AM Page 1

A physician assistant’s story… My child is home sick. Barely get to the office on time. Waiting room is packed. The office manager is out on vacation. Meet with supervising physician to discuss patients. Grab stethoscope. In first room is 3-yearold Emma. Pink eyes, a cough and ear infection. “Gifts” from daycare. Record on chart. Next room. A pleasant 55-year-old woman in no acute distress. She describes a new cough and onset of chest pain. Order EKG, chest x-ray and labs. Minor emergency of the day – 16-year-old Sammy fell off his skateboard while ‘performing an Ollie.’ Suture knee and write prescription for the pain. Fifteen minute break spent getting caught up on paperwork. Supervising physician e-mailed an article titled, “In a courtroom, your documentation can be your best friend or worst enemy.” Good thing I have HPSO!

Make sure your story has a happy ending.

Professional Liability Insurance for Physician Assistants

888.273.4686 • www.hpso.com/capa This program is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA Company. Healthcare Providers Service Organization is a division of Affinity Insurance Services, Inc.; in CA (License #0795465), MN and OK, AIS Affinity Insurance Agency, Inc.; and in NY, AIS Affinity Insurance Agency. ©2011 Affinity Insurance Services, Inc. E-8858-111

JANUARY/FEBRUARY 2011

A Fine Man by Rodney Moser, PA, Ph.D, CAPA Founding President the PA Advisory Committee (which did not include any PAs). The most technical of the tasks allowed by the State was the removal of cerumen, if you can believe it.

L to R: Harvey Fine, PA, Rod Moser, Ph.D., PA, and Juan Baltierra, PA

n November 26, 2010, my friend and colleague, Harvey Fine, one of the first licensed PAs in California, lost his battle with lung cancer. Harvey was candidly open about his years as a chain smoker and was not surprised when he was diagnosed. He knew it was his fault and told me he had expected it. He died peacefully in his sleep under the compassionate hands of Hospice. For those of you who attended the CAPA conference this year, you may have seen him walking by with his portable oxygen tank, fighting for each breath. Even though he moved to Arkansas a few years ago, he continued to attend this annual event. As far as I know (myself included), Harvey Fine is the only PA who has attended every CAPA conference since the first one in Fresno in 1976. I am honored to be considered the Father of CAPA, but I can tell you that CAPA had more than one parent. I came to California after graduating from PA school in 1973 at a time when there were only a handful of PAs, tactfully hiding in clinics and doctor’s offices across the state. Why? PAs were not licensed, but we were tolerated…to a point. The Department of Consumer Affairs knew we were here, so we were being carefully watched to make sure we were not doing anything beyond the laundry list of tasks assigned by

CAPA NEWS

CAPA did not exist. As a matter of fact, no one was really sure where these unlicensed PAs were hiding. It took over a year for me to smoke them out, and one of the first ones that surfaced was Harvey Fine. At that time, I was living in San Anselmo (Marin Co), and working in San Francisco. Harvey was living with his wife, Ginny, in a little, onebedroom beach house in Marshall, CA, about thirty miles away. PA jobs nearly non-existent, Harvey was working for a weight-control specialist in San Jose, just a little 2.5 hour, one-way commute. This was not his first choice of jobs. He was supposed to work with a physician in the nearby town of Petaluma, but the doctor died before Harvey graduated. Harvey was born in San Jose in 1932, so he knew his way around. Among his many PA duties, was the counting of pills – a demeaning position for a PA who had served his country as a Navy corpsman in Korea, and was a graduate of the first class from the Stanford PA Program (1973). At age 39, Harvey was the oldest student. Borne out of our growing frustrations with PA regulations, Harvey joined our rag-tag, five-member team – The Organizational Committee of the California Academy of Physician Assistants. With Harvey’s help, CAPA was born. A nurse practitioner friend of mine joined the Navy during the Vietnam era, trying to avoid being put in harm’s way as a ground soldier. Once in the Navy, it sounded like a good idea to become a Navy Corpsman. He looked at me and said, “As God

is my witness, I had no idea that Navy Corpsmen were assigned to Marine ground units.” When Harvey became a Navy Corpsman, he knew this in advance. He was assigned to Baker Company, Fifth Marines, First Battalion in 1950, a year before I was born. Harvey spent two years of active duty in Korea on the 38th Parallel, shivering most of the time at 40 below zero. When I was learning how to walk, Harvey participated in numerous ground assaults and saved countless lives of soldiers under his care. CAPA’s office was my home in San Anselmo. Since Harvey was elected Secretary/Treasurer, running unopposed, I might add, it seemed only fitting that the home office should be in his home in Marshall. Harvey’s wife, Ginny, was hired for about a $100 a month to help. CAPA dues were only about $30 a year, so her salary required that we have at least 40 members. Ginny maintained our books and knew our bottom line, so she rarely was paid and seldom complained. When the Fines moved to Stockton, they took CAPA and their two Doberman Pinchers with them. As a side note, I was once bitten in the ass by one of them (one of the dogs!) while leaving a meeting. In 1984, Harvey Fine, having served CAPA as Secretary/Treasurer since the beginning, was elected President during a very turbulent period for our fledgling organization. It was really his turn. Ginny died a few years before Harvey. A few of the old CAPA dinosaurs all met in Marshall, rented a boat, and spread Ginny’s ashes in Tomales Bay just off-shore of their former home. Sometime this year,

we will do this for Harvey. I last saw Harvey at the last CAPA conference in Palm Springs. When I suggested that his ashes be mailed to me to be scattered at Marshall, he cried and two men hugged. We both knew this would be the last time that we would see each other. Harvey’s PA career included a string of jobs that very few of us would even consider today. PA jobs were few and far-between, so decisions were often more economical than logical. If there was a “borderline” physician out there looking for a PA to be his scut-puppy, Harvey somehow ended up working for them. He often felt that being older was a growing

disadvantage in a competitive job market. Sadly, I don’t think he ever found a PA job that he truly loved. He never looked for trouble, but trouble often found him. Having lost his PA license for a few years for prescribing Tylenol with codeine without a “patient-specific order,” he spent his entire savings to try and defend his case to no avail. He was able to work as a PA in Saudi Arabia for a few stressful years, relegated to brewing his own beer as a geographic consequence. Harvey loved his beer. I thought he would never retire, but he finally hung up his stethoscope and moved to Arkansas to be close to his brother. He spent his remaining

years active in the local VFW, planning Navy reunions, and taking a few cruises. You just can’t get Navy boys off of the water. I called him often to see how he was feeling, and he always said, “Fine.”He was a fine man. He was my friend and a friend of CAPA’s. He bravely served his country and served his profession to the end. We will miss him. 

CAPA’s first office in Harvey’s home in San Anselmo.

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JANUARY/FEBRUARY 2011

The Model Medical Home by Adam Marks, MPA, PA-C, Director-At-Large

rimary care clinics, especially those in rural areas, are fluid entities. These clinics are continually conforming to current legislation and patient demands with the goal of increasing access to quality health care. As the new health care legislation gets under way, the primary care world is looking at a push in the development of medical homes. Some clinics have begun to restructure their foundation with the goal of creating a working medical home, while others a simply “What was once a clinical remodeling to better-fit health practice has transformed into a care legislation.

clinic, resource center, birthing

Rachel Farrell is a physician center and a flourishing set of assistant and mid-wife in social businesses.” the small town of Linda, California. A graduate of the Stanford PA Program in 1989, Rachel has dedicated her professional career to her community within Yuba County; she has done so through Harmony Health Medical Clinic. Rachel founded Harmony Health in 1999, but her medical home was not transformed overnight. Throughout the day and late into the night, since Harmony’s inception, Rachel has had bursts of inspiration that slowly have become reality. What was once a clinical practice has transformed into a clinic, resource center, birthing center and a flourishing set of social businesses. Harmony Health Medical Clinic includes four physician assistants, a nurse practitioner, and a pediatric and infectious disease doctor who see patients on a regular basis. The clinic 10

CAPA NEWS

sees roughly 1,500 patients a month; ranging from private insurance to sliding scale patients. Along with the medical providers is an assortment of ancillary staff including behavioral health specialist, licensed clinical social workers and even lactation specialists. Rachel has developed a wide array of medical resources in one medical home in order to meet a diverse patient population. Apart from her clinic, Harmony Health Medical Center has a family resource center. The Center provides education on community resources, intervention programs and a variety of medically relevant classes. The family resource center is where community education becomes the focal point. The Center reaches out to kids of all ages with their program called “R Spot.” This program is a youth group that the organization has created to help educate children within the community. Children participate in outings, like camping or social events hosted by Harmony. Harmony’s Family Resource Center is available to anyone despite their financial status and its funding is as innovative as the services it provides. The Harmony Health Center derives part of its funding from what Rachel calls “Social Businesses.” Rachel has gradually developed these businesses over the life of the clinic, all of which help fund the programs, educational courses and the community outreach that the Resource Center performs. Along with creating a source of funding, they also integrate the community into the business. For example, Yuba County has a large number of teen mothers. Rachel has developed classes that she brings in the mothers and teaches them how to cook healthy and cost effective foods. The Eating Well Café opens as a soup like kitchen providing food

to the needy within the community. Recently the clinic obtained a small strip mall that includes laundry facilities. Rachel uses this not only for its monetary value, but gives the attendees of her classes a token that they can redeem for laundry services. She is able to reward class participants by improving their health along with helping their socioeconomic needs. While Rachel’s social businesses are dependent on the medical staff and community activist, they are very effective ways of generating services for those in need. While it can be difficult to find funding, Rachel and Harmony Medical clinic are finding innovative ways to make their medical homework. Harmony Medical Health Center has derived its success from looking at the needs of the community, assessing those needs and finding ways in which they can expand their services. Rachel’s “grassroots” approach to medicine has created a strong following. Rachel’s ability to take on different roles and find ways to make her organization successful is evident through its success and ambitious future projects. Harmony Medical’s goal is to become a Federally Qualified Health Center (FHQC) that would allow for further funding and increased patient access. They have plans in the works to build a birthing center and Rachel is actively pursuing UC Davis students whom she would like to rotate through her facility with the hope that they will become active and passionate members of her medical home. Yuba County’s socioeconomic problems will not disappear Continued on page 11

Regional Extension Centers Assist PAs Transition to Electronic Health Records by Reena Samantaray, M.P.A., Director of Outreach and Education, California Health Information Partnership and Services Organizations (CalHIPSO)

hree federally funded Regional Extension Centers (RECs) opened in California last year to assist provider’s in implementing and using Electronic Health Record (EHR) systems. LA County is served by HITEC LA, Orange County is served by CalOptima REC, and the rest of California is served by The California Health Information Partnership and Services Organization (CalHIPSO).

funding made available from the federal Office of the National Coordinator for Health Information Technology to support the ability of 100,000 “Priority Primary Care Providers” nationwide to adopt EHRs by the year 2014.

RECs are nonprofit, vendor-neutral, support centers that offer a variety of programs and services designed to help clinical providers transition from a paper-based practice to one that successfully uses EHRs. All three RECs have extensive products and services designed to help providers navigate through the complicated world of EHR implementation.

1) Private practice of 10 providers or less 2) Non-profit primary care clinics including community health centers 3) Ambulatory care clinics associated with public, rural, and critical access hospitals 4) Other medically underserved settings

The three RECs in California are primarily supported through stimulus

Membership benefits of RECs can vary, but generally include:

PAs practicing in a primary care field are eligible to receive subsidized REC services if they work in one of the following practice care settings:

• • • • • •

Access to group purchasing discounts for EHR products Assistance locating qualified EHR vendors Project management services Readiness and workflow assessment Access to extensive training and education Assistance with demonstrating meaningful use in order to begin receiving federal incentive payments, for eligible providers

If you are interested in learning more about CalHIPSO, visit the CalHIPSO website at www.calhipso. org and click on “Join Now.” If you are located in Los Angeles County and would like more information about HITEC LA, please visit www. hitecla.org. For more information about REC services for Orange County, please e-mail CalOptima REC at COREC@caloptima.org. 

The Model Medical Home Continued from page 10

overnight, yet it is nice to know that a diverse group of medical, professional, and community activists have opened their medical home, inviting those who are in need of any type of assistance. As I finished interviewing Rachel, I had to sit back and really let what she is doing sink in. In my short time as a physician assistant, I have seen some basic medical home models. I am even lucky enough to be in an organization that is making that transition, but I can’t help but marvel at the innovative, comprehensive community based approach that Harmony is taking in Yuba County. PAs like Rachel are

what make our profession so profoundly important in today’s brave new world of medicine. The team-based approach to medicine, which is the foundation of the PA profession, will continue to endure as long as PAs like Rachel continue to exist in the system. I would really enjoy hearing from other health care professionals who have innovative ideas, improved delivery of medical services, or unique patient outreach. Please continue to contact me at diradam@capanet.org.  JANUARY/FEBRUARY 2011

Answers to Quiz 1. The answer is a. 26 mos The average PA program is 26 mos. Currently there are approximately 115 graduate PA programs.

2. The answer is d. Mexico The physician assistant concept was introduced to Australia in 1999. There are two pilot programs underway. Al Forde (PA Faculty from the University of Utah) transplanted to Australia to be a senior lecturer at James Cook University in Townsville, Australia. As of October 2010, three UK universities, Birmingham, St George’s of London and Wolverhampton are currently training Physician Assistants. In June 2003, the Canadian Medical Association recognized the PA as a health professional.

3. The answer is b. William Stanhope A surgical technician in the US Army, Stanhope trained at the Duke University Physician Assistant Program in 1967. During his time at Duke he met one of the original Duke graduate PAs, Richard Scheele, and together they founded the American Association of Physician’s Assistants.

4. The answer is a. The AAPA’s first female president In 1982 Judith Willis became the AAPA’s first female President.

5. The answer is a. June 1976 .....................and still going strong.

6. The answer is c. Alderson Broaddus

CAPA NEWS

Michael Casillas William Stanhope Bob Miller Larry Rosen

Back for more outstanding trivia...

In 1969 William Stanhope was recruited by Dr. Myers to work as a surgical PA and in the PA Program at Alderson Broaddus. As part of his recruitment enticements Dr. Meyers offered Stanhope the opportunity to complete his baccalaureate at the University. The college was the first to offer a degree to PA students.

a. b. c. d.

3. In 1978 the AAPA elected this PA as its first president: a. Australia b. UK c. Canada d. Mexico 2. The PA concept is alive and well across the globe except for: a. 18 b. 22 c. 26 d. 30 1. The average PA Program is how many months in length. I’ve gathered more information from multiple sources (PA Historical Society, AAPA, CAPA, Wikipedia, and Google) and put together a few short quizzes to share with you over the next few editions of the CAPA News. Enjoy and don’t forget to dazzle your friends and colleagues with the incredible knowledge of YOUR profession. Photo property of www.pahx.org Jeff Heinrich and Judith Willis, 1985

a. b. c. d.

June 1976 October 1976 December 1971 June 1980

5. CAPA was founded in:

See answers to quiz below. 

a. The AAPA’s first female president b. Founder of the PA education Association c. CAPA’s first President d. The first PA Ph.D. candidate 4. Who is Judith Willis:

a. USC b. Washington Medex c. Alderson Broaddus d. Duke University 6. This University was the first to offer PAs a degree.

by Greg Mennie, PA-C, MSed, Director-At-Large

What’s a PA ... So you think you know your profession? Part 3

Timely Access Regulations Reprinted from the State of California Website

As of January 17, 2011, Health Plans Licensed by the Department of Managed Care Must Fully Implement the Policies, Procedures and Systems Necessary To Comply With Rule 1300.67.2.2

Timely Access to Care California law requires health plans to provide health care appointments and telephone advice in appropriate time frames. Appointment Wait Times Beginning January 17, 2011 health plan members have the right to appointments within the following time frames: Within 48 hours of a request for an urgent care appointment for services that do not require prior authorization, Within 96 hours of a request for an urgent appointment for services that do require prior authorization, Within ten (10) business days of a request for non-urgent primary care appointments, Within fifteen (15) business days of a request for an appointment with a specialist, Within ten (10) business days of a request for an appointment with non-physician mental health care providers, and Within fifteen (15) business days of a request for a nonurgent appointment for ancillary services for the diagnosis or treatment of injury, illness, or other health condition. Telephone Wait Times Beginning January 17, 2011 health plan members have the right to the following telephone services within the following time frames: Triage or screening services by a qualified health professional to decide the urgency of a health

condition: 24 hours a day, 7 days a week. If a call-back to the member is required, it must be within 30 minutes. Speak to a plan’s customer service representative within 10 minutes during normal business hours. While the law sets these time frames, health care providers can be flexible in scheduling appointments if a longer time frame is appropriate for the member’s health. It must be noted in the member’s record that a longer waiting time will not be harmful to the health of the member.

In geographic areas with provider shortages, if timely appointments are not available, a health plan must refer members to, or, in the case of a preferred provider network, assist members in locating appropriate contracted providers in neighboring service areas. For More Information visit: http://www.hmohelp.ca.gov Mailing Address: Department of Managed Health Care California Help Center 980 9th Street, Suite 500 Sacramento, CA 95814-2725 

PAs = Excellent, Cost-Effective and TIMELY Access to Health Care

n December of last year, CAPA sent out a large postcard to 500+ Medical Directors and Medical Group Administrators letting them know that hiring a PA or more effectively utilizing the PAs they currently employ could help with implementation of the Timely Access Regulations. Timely Access Regulations Non-Urgent Primary Care Appointment 10 Business Days

After Hours Call Back 30 Minutes

Non-Urgent Appointment for Ancillary Services 15 Business Days

Urgent Care Appointment Needing Pre-Authorization 96 Hours

Urgent Care Appointment Not Needing PreAuthorization 48 Hours

Call Backs During Business Hours 10 Minutes

Health Plans Licensed by the Department of Managed Care Have Until January 17, 2011 To Fully Implement The Policies, Procedures and Systems Necessary To Comply With Rule 1300.67.2.2.

PARTNERS IN MEDICINE

Timely Access Regulations –PAs Can Help! Physician assistants work in a physician-led team practice model within any specialty of medicine to diagnose, treat, educate, refer and write drug orders for your patients. Instead of considering how you might have to work harder and longer hours, think about how adding a PA to your practice could increase productivity, decrease patient wait times and increase patient access to timely care.

Call CAPA to set up a phone consultation for further information and/or consider being a preceptor for a physician assistant student.

California Academy of Physician Assistants 3100 W. Warner Avenue, Suite 3 Santa Ana, CA 92704-5331

Address Service Requested

Website: www.capanet.org Phone: (714) 427-0321 Contact: scott@capanet.org

PRSRT STD US POSTAGE PAID SANTA ANA, CA PERMIT NO 949

Post A Job

California Academy of Physician Assistants 3100 W. Warner Avenue, Suite 3, Santa Ana, CA 92704

JANUARY/FEBRUARY 2011

d Hear eat r Any G ers k Spea ? ly Late

If You Can Only Attend One CME Conference in the West This Year – It Should Be the

2011 CAPA Conference!

very year at the CAPA Conference in Palm Springs we hear it said: “You guys have the best speakers. How do you do it?” The answer is we hand pick them based on referrals, feedback and firsthand experiences. Please help us identify the great speakers out there. Keep your ears open for interesting topics and excellent speakers. Please let us know what/who they are. You can email us, call us and/or fax us the information. We have a new Conference Planning Committee comprised of CAPA members who help us identify gaps in medical knowledge of PAs working in various practices/specialties. Once we identify the needs of our potential audience, we will come up with lecture topics. We will then need to find exceptional speakers to address those topics. We are very discerning in our speaker selection which makes for an excellent program and ensures a quality conference for those who attend. This is no easy task, but with the help of every CAPA member, it is manageable. If you know of an exceptional speaker; one who is knowledgeable, entertaining and engaging, please let us know. We will add them and their lecture topic to our list. Once our conference program topic “wish list” is developed, we can start to match speakers with topics. Your help is invaluable. We hope you will take a moment, throughout the year as you hear speakers to let us know the names of the ones you enjoyed and learned the most from.

Please give us a call or send us an e-mail! Email: capa@capanet.org Phone: (714) 427-0321 Fax: (800) 480-2272

Thank you and we hope to see you at the CAPA Conference on September 22-25, 2011 14

CAPA NEWS

• Attending the CAPA Conference helps to support the only organization working solely to promote and protect California PAs. • The CAPA Conference is exactly the right size. Big enough to take over the entire Renaissance Hotel and, small and friendly enough to allow you to feel at home and part of this wonderful California Community of PAs. • The CAPA Conference is the right price. If you reserve your hotel room early, you can stay at the Renaissance or the Palm Springs Hilton for just $169 a night. Compare that to the room rates for other conferences. Save about $100 a night! • The CAPA Conference includes 5 or more meals with no waiting in line for a seat. This is your conference and our goal is to make you feel welcome. • The CAPA Conference has the best speakers, handpicked by PAs for PAs. We listen to what you want and bring back your favorites.

“Great course!” “Good course. Good pace. Good facility. Food was excellent!”

urs 6 Ho I Cat. CME

“Great class!! Great examples from Dr. Lowe’s personal experience. He knows my patients.” “This was an excellent presentation on behalf of both speakers. Thank you.”

Controlled Substances Education Course A Course Which Upon Successful Completion Will Allow You To Write For Controlled Substances Without Patient Specific Approval* Saturday, March 19, 2011

Saturday, April 23, 2011

Wednesday, September 21, 2011

Lecture Hall 1 309 E Second St Pomona, CA 91766

Fontaine Auditorium, Health Education Center 450 30th St Oakland, CA 94609

888 Tahquitz Canyon Way Palm Springs, CA 92262 (Prior to the 2011 CAPA Conference)

Western University of Health Sciences

Samuel Merritt University

Renaissance Palm Springs Hotel

*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.

Controlled Substances Education Course Registration Form Please select ONE seminar location:  Western University of Health Sciences, Saturday, March 19, 2011  Samuel Merritt University, Saturday, April 23, 2011  Renaissance Palm Springs Hotel, Wednesday, September 21, 2011 Name_____________________________________________________ PA-C_  PA  Other PA License #____________ Address_________________________________________ City_______________________State______ Zip Code_____________ Phone (____) __________________________________ Email____________________________________________________

 CAPA Member - $110

 Non CAPA Member - $200

 Late Registration Fee after 3/11/11 for Pomona location - Add $20  Late Registration Fee after 4/15/11 for Oakland location - Add $20  Late Registration Fee after 9/14/11 for the Palm Springs location - Add $20  Check enclosed (make check payable to CAPA)



Total Amount Due: $________________

   

Name on Card__________________________________ Signature______________________________ Exp. Date___________

 In accordance with the Americans with Disabilities Act, please check here if you have any special needs. You will be contacted by CAPA. Mail completed Registration Form and make checks payable to: California Academy of Physician Assistants, 3100 W. Warner Ave., Suite 3, Santa Ana, CA 92704-5331. Phone: (714) 427-0321 . Fax: (714) 427-0324 . Toll Free Fax: (800) 480-2272

JANUARY/FEBRUARY 2011

Embracing Change by Matthew Keane, PA-C, Director-At-Large

hat would you think if you were a PA looking for a new job and part of the job description and requirements were to take out the trash every day at the end of your shift? Would you do it? To my knowledge, PA job descriptions have not yet started asking PAs to perform such tasks. However, more and more jobs are asking PAs to take on more administrative and clerical duties as part of their conditions of employment. As the number of insured patients increases and the number of primary care physicians continues to decline PAs are going to be needed more than ever to help carry the patient load. Part of the carrying may be performing administrative work. One of my colleagues who has worked in Orthopedics for over 15 years recently told me that in his opinion, our jobs as PAs are to do whatever is necessary to keep as much of the patient burden off of our surgeons. As a new PA, I wasn’t quite sure what to make of that statement when I first heard it. I always assumed that we would see the patients assigned to us, and our supervising physicians would do the same, and also be available and willing to address all of our questions and uncertainties. The longer I have worked as a PA in a hospital based specialty clinic, the more dynamic I have found my true job as a PA to really be. In school we learn how to treat diseases and do physical exams. We were not taught how to fill out a referral, schedule a surgery, or complete a Workers’ Comp. form, etc. As a PA there are a ton of things we learn on the job, and these things vary from office to office, and provider to provider. In the clinic there is much more 16

CAPA NEWS

than just patients to be seen and prescriptions to be written. The administrative duties of a practice can be just as much, if not more, time consuming than actual patient care. I work for an extremely busy orthopedic surgeon who performs up to 25 arthroscopic and joint replacements procedures. That’s a lot of surgery, which can be very mentally and physically draining. Therefore, it is very important that I do everything within my scope and power to protect my surgeon from being burdened with paperwork, administrative tasks and office staff questions, allowing him time to recover and focus his energy on the upcoming surgery schedule. Now don’t get me wrong, I am not left alone on an island to function in isolation, my supervising surgeon is always available and willing to answer questions or discuss a case, but there is an expectation that I be competent to handle most of the day-to-day tasks within the office. As the world of medicine continues to change and evolve, we PAs need to be willing to change and evolve as well. As PAs, we are

not independent practitioners, we are members of a team and must act accordingly. As a member of a team, we must be willing to do whatever is asked of us for the good of the team in order to be as successful as we can. This changing environment may require us to take on more and more administrative responsibilities. We have to embrace change and be flexible when it comes to our role in the PA/Physician model. There will always be jobs that are more clinically based than others. Not all PAs will be asked to do more administrative tasks. Fortunately for PAs, our license and training allows us to choose where we want to work and the type of work we want to do. If at your job you are not asked to do more administrative tasks, you may be asked to take on additional duties like call or see more patients, or assist in surgery and so on. As PAs we will always be expected to fill a role or ease a burden, and we have to be willing to step up for the good of the team and take on these new and evolving roles. 

CAPA FACT Did You Know?

1994: CAPA succeeds in passing SB 1642 allowing PAs to issue written prescription drug orders

What Your Docs are Reading in the Medical Board of California Newsletter

Recent legislative changes to Assistant (PA) scope of pract by Beth Grivett, PA-C, Legislative Aﬀairs Coordinator California Academy of Physician Assistants

Recent legislative changesThe to Physician following information will assist physicians who supervise physician assistants in becoming familiar with Assistant (PA) scope of practice

by Beth Grivett, PA-C, Legislative Aﬀairs Coordinator A California Quarterly Publication Academy of Physician Assistants

The following information will assist physicians who supervise physician assistants in becoming familiar with new legislation, which became law January 1, 2011. These Board-sponsored legislation changes may impact your practice.

nia he on of

Vol. 117, January 2011

• 1069 Order(Pavley/Fletcher), medications andsponsored provide by thethe statement SB California attesting to the need for medications to Academy of Physician Assistants, allows PAs tobedoavailable the following, unlessduring otherwise indicated to a student school hours.in the Delegation of AB 583Agreement (Hayashi, Chapter 436) Services (DSA): Th is bill requires health care practitioners their • Certify the parent’s request to waivetoa disclose school-based • Order durable medical equipment. name, license type,test. and highest level of academic degree to visual acuity their patients in their office or in writing in at least 24-point • Approve, sign, modify, or add to a plan of treatment, •• Perform physical examinations required for and Order medications and provide thephysicians statement type in a specifi ed format. It also requires or plan of care, for home health services (PAs are still participation in interscholastic athletic programs. attesting theosteopathic need medications todisclose be available surgeons, including physicians, to unable totoorder homefor health and hospice care for the nametoof their certifying board or association. a student during school hours. Medicare beneficiaries. Solutions to this problem are

Legislative Update Recent legislative changes to Physician Assistant (PA) AB 1767 (Hill, Chapter 451) scope of practice by Beth Grivett, PA-C, Legislative Aﬀairs Coordinator

ThSB is bill requires the Office ofsponsored the Attorney to provide 1069 (Pavley/Fletcher), by General the California California Academy of Physician Assistants representation to a licensed physician who provides expertise Academy of Physician Assistants, allows PAs to do the Th following information will physicians tofollowing, thee Medical Board (Board) in theassist evaluation thewho conduct unless otherwise indicated in the of Delegation of supervise physician assistants in becoming familiar with ofServices a licensee when, as a result of providing the expertise, the Agreement (DSA): physician is subjectwhich to a disciplinary proceeding undertaken new legislation, became law January 1, 2011. These bychanges a•specialty board of which the physician is a member. It Order durable medical equipment. may impact your practice. also extends the sunset date of the two members of the Health Approve, sign, Foundation modify,sponsored or add a appointed plan of treatment, SB• 1069 (Pavley/Fletcher), the California Professions Education that to areby by the or plan of care, home health (PAs Academy of Physician Assistants, allows PAs to do are the still Board, from January 1, for 2011 to January 1,services 2016. unableunless to order home health and in hospice care for of following, otherwise indicated the Delegation SB 1489 (Sen. B&P Comm., 653) Medicare benefi ciaries. Solutions Chapter to this problem are Services Agreement (DSA): The provisions in this bill relating to the Medical Board were being worked on at the federal level.). sponsored by the Board,medical and do equipment. the following: delete and • Order durable correct obsoletethat references the Board’s Division of • Certify certainrelated schooltodistrict employees, • including Approve, sign, modify, or add to a colleges, planpostgraduate of treatment, Licensing and exams; correct reinstating the educators atbycommunity are orrequirement plan of care, for home health services (PAs are trainingfree for licensure; allow the Board to from communicable diseases for purposesconsider of still unable to order home health and hospice care for good cause or reason, time spent in various training programs, employment. Medicare benefi ciaries.inSolutions to this and current and active practice another state or problem Canadianare • Provide the statement the need of an being on atthe theattesting federalofto level.). province whenworked considering period validity of the to bescores carried by pupils while at school. writtenEpi-pen examination required for licensure; and clarify • Certify that certain schoolrequirements district employees, provisions related to the reporting for licensed including educators at community colleges, are midwives. free from communicable diseases for purposes of Other legislation into law employment. Check your signed physician profile

• Cert visua

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• Certify the needs of an individual who has been this law al being worked on at the federal level.). AB 867 (Nava, Chapter a physician as being deafa school-based or hearing • diagnosed Certify thebyparent’s request to416) waive in that do This• impaired bill authorizes the California State University (CSU), to retain a telecommunications device for visual acuity test. Certify that certain school district employees, to https:// untilthe July 1, 2018, to establish a Doctor of Nursing Practice including at community colleges, are deaf or educators hearing impaired. • Perform examinations required for of by (DNP) degree pilot program at diseases three campuses chosen free fromphysical communicable for purposes Supervising physicians and PAs should update their participation in to interscholastic athletic programs. the Board of Trustees award the DNP degree. This DSA bill if employment. this law allowsthe theDNP PA to do something not already covered distinguishes degree from the doctor of philosophy • Certify Providethe theneeds statement attesting need ofbeen an •that of an individual who Pert degree offered at the of California. Ithas requires the in document. ToUniversity read the bill intoitsthe entirety, please go Epi-pen toby beacarried by pupils while at school. diagnosed physician as being deaf or hearing degree pilot program to be designed to: enable toDNP https://www.capanet.org/pdfs/SB1069Chaptered.pdf. impaired to retain a telecommunications device for (continued on page 5) Finally, the deaf or hearing impaired. that vac

Check address of record with Checkyour your physician profi le

Supervising physicians and PAs should update their DSA if on the the Medical Board's Physician Committee thisthe law allows PA toAssistant do something not already covered Web site in that document. read the bill in its entirety, please go Remember, this To information is(continued available from page 8) www.mbc.ca.gov 2 toPresident's https://www.capanet.org/pdfs/SB1069Chaptered.pdf. to the public.Report . . . . . . . . . . . . . . Finally, health care providers are reminded Legislator proﬁle .tab . and . . "Check . . . . My . . Profi . . le." . . . 3 Click on "Licensees" www.pac.ca.gov that vaccine products have similar names and CURES prescription monitoring update . . . 4 The mandatory physician datatheisto used to update Once you are on the can website, click on Licensees tab at abbreviations that besurvey confusing school staff Pertussis Booster (Tdap) . . . . . . . . . . . your online physician profi le on the Board's Web site. ABon 52 the (Portantino, Chapter 529) the top and then the fifth option will be Verify a License. who will be keeping records for the new law. Be sure8 Medical Board's to the(UC) needtoofdevelop an Enter your name and/or license number and you will This•billProvide requeststhe thestatement Universityattesting of California physicians motivate patients . . see . 10 toHealthier document immunizations clearly accurately. Remember, your address of record is and public. Web site toand be carried by pupils while atCord school. what the public sees. If you would like to change your a plan toEpi-pen establish administer the Umbilical Blood (continued from page 8) Schools reportRecommendations: that immunization records areViral not Screening Chronic www.mbc.ca.gov address, youwhether can do. so. the at the same Licensees link. Collection Program (UCBCP) for the purpose of collecting Signedclear address changes may be. submitted to the Hepatitis . . . . . . . . . . . . . . . Board . . 12 always student received Tdap, which Finally, health care providers are reminded by fax at (916) 263-2944, or by regular mail to: units• ofOrder umbilical cord blood for public use, which is defi ned medications the meets the newproducts requirement, and Td, which New Electronic Health Records that vaccine have similar namesdoes andnot. Clickunits on "Licensees" taband andprovide "Check Mystatement Profile." be Physician Assistant Committee as blood from donors that attesting to genetically the need fordiverse medications to bewill available Incentive Programs . . . . . . . . . . . . staff . . 17 Make sure the patient’s Tdap immunization record Medical Boardthat of California abbreviations can be 1100 confusing to school 2005 Evergreen Street, Suite Check your physician profi le owned by the UC. It increases the fee for birth certifi cate a studentphysician during school hours. The to mandatory survey data is used to update clearly states that Tdaprecords wasofgiven. Licensing Physician supervision allied health Sacramento, CA 95815 who will beProgram keeping for the new law. Be sure copies by $2 to provide funds to implement the UCBCP, and on the Medical Board's your online physician profile on the Board's Web site. 2005 Evergreen Street, Suite 1200 professionals . . . . . . . . . . . and . . .accurately. . . . 18 Telephone: 916 561-8780 to document immunizations clearly requires the UC to implement the plan, contingent on an • Certify the parent’s request to waive a school-based For general information about pertussis disease and Web site Sacramento, CA 95815 Administrative actions . . . . records . . . . are . .not . . 20 FAX: 916 263-2671 Schools report that unspecifi ed amount funds being available in the UCBCP visual acuity test. Remember, yourofwww.mbc.ca.gov address of record is public. immunization, visit immunization www.cdph.ca.gov/HealthInfo/ always clear whether the studentYou received Tdap, which Fund. discond/Pages/Pertussis.aspx. also can contact Medical Board of California Newsletter • Perform physical examinations required Signed address changes submitted to for the meets the new requirement, which not. Click on "Licensees" tabmay andbe"Check My Profi le."Board CDPH Immunization Branchand andTd, your localdoes health JANUARY/FEBRUARY 2011 17 participation in interscholastic athletic by fax at (916) 263-2944, or by regular mailprograms. to: Make sure the patient’s Tdap immunization record department immunization program for additional The mandatory physician survey data is used to update clearly states that Tdap was given. information. The mission the Medical Board of California • Certify the of needs of an individual who hasofbeen Medical Board California

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The Third, New and EXPANDED Edition of the California Physician As by Bob Miller, PA-C, Professional Practice Committee Chair and Gaye Breyman, CAE, Chief Operating Officer

Hot Off The Presses and Available Now!

he first edition of the Legal Handbook was published in 2007 and was intended to meet a pressing need among PAs and their supervising physicians. While physician assistants emerge from their academic programs and preceptorships well equipped for the clinical challenges they will face, many are not as knowledgeable regarding the laws and nia Califor tant’s regulations n Assis Physicia ing Physician’s that govern PA pervis u k S o d o practice. Many n b a and Legal H supervising physicians also lack information regarding the rules applicable to the physician-PA relationship. Failure to know and understand these rules can have dangerous, even career ending consequences, particularly as licensing agencies and government reimbursement programs become increasingly vigilant in policing professional misconduct.

RNIA ALIFO

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The second edition was authored in 2008 to incorporate changes in the law resulting from AB 3. AB 3 expanded Medi-Cal coverage for PA services to make it commensurate with the coverage of physician and nurse practitioner services; eliminated the requirement for patient-specific authority for a PA to write drug orders for controlled substances if the PA has met certain educational requirements; doubled the number 18

CAPA NEWS

of PAs a supervising physician may supervise from two to four; and reduced the percentage of charts a supervising physician must review when a PA functions pursuant to protocols from 10% to 5%. This Third Edition of the Legal Handbook was published in January of this year to cover new legislation sponsored and passed by CAPA in 2009 and 2010 and other new legal developments of interest to PAs. To summarize, the new information in this Third Edition covers the following:

telecommunications equipment by disabled individuals. Updated information regarding the requirements for PAs to receive reimbursement from Medicare and Medi-Cal. Information about reports of adverse peer review actions and insurance payments to the National Practitioner Data Bank. An expanded discussion of how a PA obtains a DEA number.

A new law that will permit PAs to obtain fluoroscopy permits and to perform fluoroscopy procedures by taking a course and passing an exam to be administered by the California Department of Public Health.

Updated information regarding the HIPAA patient privacy requirements, and new state laws that make it illegal to “snoop” into the records of patients for whom a practitioner has no clinical responsibility.

Amendments to the Education Code permitting PAs to examine and certify school district and community college district employees as being free form Tuberculosis and otherwise fit for duty, and to examine and certify students as being fit for participation in school athletics.

Case studies intended to illustrate how the laws governing PA practice work in “real life” have also been added at the end or each chapter, at the suggestion of PA educators.

The impact on PAs of the medical marijuana law. An amendment to the Physician Assistant Practice Act permitting PAs to order durable medical equipment and make arrangements for home health and personal care services. An amendment to the Public Utility Code authorizing PAs to certify the need for special

The Legal Handbook helps CAPA perform its mission, which includes keeping PAs and their supervising physicians up to date and educated in legal as well as clinical matters. CAPA has performed that role over the last thirty years by responding to countless questions from PAs on a wide range of issues, such as: What risk do my supervising physician and I face if he/ she does not comply with the requirements for delegating services, establishing protocols, reviewing charts, etc.?

ssistant’s and Supervising Physician’s Legal Handbook Can PAs own, or share ownership of, a medical practice?

What kind of insurance should I have?

What should be included in an employment agreement?

How do I protect myself from malpractice claims?

What are the requirements to bill Medicare for “incident to” services?

In answering these and other questions, for twenty five years CAPA and its members have often looked to attorney Mike Scarano, CAPA’s general counsel. Mike has not only provided CAPA and its members with guidance on a myriad of issues, he has helped shape the legal face of the PA profession by writing most of the statutes that CAPA has sponsored over the years to enhance PAs’ ability to treat their patients. Mike has authored issues and position

Are PAs exempt employees, or do they have to be paid overtime? Does the supervising physician have to be present when I “close” a surgical patient? Can PAs give orders to nurses or medical assistants?

papers for the American Academy of Physician Assistants, as well as for CAPA, and is nationally recognized in the area of physician assistant law. As PAs have grown in number, and the laws governing the profession have become increasingly complex, there is a need for a “one stop” authoritative source for legal information regarding the PA profession and other basic health law concepts every PA should know. This Legal Handbook meets that need. 

3rd Edition

Order Form California Physician Assistant’s and Supervising Physician’s Legal Handbook:  CAPA Member - $29.95 or  Non-Member - $49.95

Name_________________________________________________________________________________________________  PA-C  PA  PA-S  MD  DO

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Mail completed Order Form and make checks payable to: CAPA California Academy of Physician Assistants 3100 W. Warner Ave., Suite 3 . Santa Ana, CA 92704-5331 Phone: (714) 427-0321 . Fax: (714) 427-0324 . Toll Free Fax: (800) 480-2272

JANUARY/FEBRUARY 2011

How to Help Patients With Nicotine Addiction by Gary Tedeschi, Ph.D., Clinical Director, California Smokers’ Helpline, UCSD Moores Cancer Center

Ask. Advise. Refer. Three Minutes or Less Can Save Lives

espite reductions in smoking in recent decades, tobacco use remains the leading cause of premature death among Americans. Not surprisingly, many patients seen by health care providers are tobacco users suffering from tobacco-related illness. This fact “Every patient interaction is presents both a challenge and an a teachable moment in which opportunity. The challenge is to patients may realize the provide adequate treatment for connection between quitting the presenting concerns of so and improved health…” many tobaccousing patients. The opportunity is to help them make healthy choices to prevent such illnesses in the future. Recognizing the tremendous value of this opportunity, the California Smokers’ Helpline recommends that health care providers follow the Ask, Advise, Refer intervention at every patient visit: •

Ask all patients if they use tobacco

•

Advise those who do to quit

•

Refer them to cessation resources such as the California Smokers’ Helpline (1-800-NO-BUTTS)

Providers who consistently follow these steps can have a dramatic

impact on the prevalence of tobacco use among their patients. The Helpline has been scientifically proven by UCSD researchers to double a smoker’s chance of quitting successfully. Together, the provider and the Helpline ensure that patients have the best possible chance of success. To make referral easy, providers can simply hand their patients a gold Take Charge card. These durable plastic cards look like credit cards and list the Helpline’s toll-free number on the front and a brief description of services on the back. Providers can order Gold Cards and other patient materials free of charge at www.nobutts.org. Every patient interaction is a teachable moment in which patients

may realize the connection between quitting and improved health, and all health care providers--not just physicians--can help them reach this point. The California Smokers’ Helpline (1-800-NO-BUTTS) is a free evidence-based telephone counseling service available to California residents wanting to quit tobacco. Services are available in six different languages (English, Spanish, Cantonese, Mandarin, Korean, and Vietnamese) and specialized services are also available for teens, pregnant women, and tobacco chewers. The Helpline is funded by the California Department of Public Health and First 5 California. To order free patient materials, visit www.nobutts.org. 

CAPA FACT Did You Know?

2002: CAPA succeeds in revising the California Labor Code to clarify that PAs may treat Workers’ Comp patients JANUARY/FEBRUARY 2011

Students Students Students Students Students Students Facebook: Implications for PA Students and the Job Market by Roy Guizado, MS, PA-C, Student Affairs Committee Chair

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

acebook, LinkedIn, My Space and Twitter are some common social media sites. One of the most used, Facebook, was founded in 2004 and currently boasts of over 500 million users, and still growing. Users of Facebook create personal profiles that can include photos, personal Table 1 interests, References to drug abuse contact Extreme/Intolerant views information, including racism, sexism, and and other homophobia types of Criminal activity personal data. Evidence of excessive alcohol use Facebook Inappropriate pictures – with or appeals to without nudity many age Foul language groups, but Links to unsuitable websites the main Lewd jokes market is the Silly email addresses Millennial Members of silly or pointless Generation groups (those born Display of poor communication in the years skills 1978-2000). Bad-mouthing previous Everyone employers, co-workers, or clients is getting onboard with the Facebook train. For example, my son, a high school freshman, is a member of his school’s Student Government Association (SGA). The preferred and main method of communication for the forty SGA representatives is Facebook. Undoubtedly, many of you hold Facebook accounts and have

CAPA NEWS

discovered the joys of finding old friends or connecting with geographically distant friends. Facebook also provides various types of connectedness outside social events, such as dissemination of articles, news events and professional grouping. Facebook is a valuable communication and network resource in which you can advertise yourself. This is especially attractive to students who will be hitting the job market in the near future. Not all that glitters is gold. Facebook and other social media sites are now frequently being used by universities and employers to screen potential applicants. Research has indicated that between 40 to 70 percent of recruiters access information about applicants through programs like Google or media sites such as Facebook, Twitter or LinkedIn (1) (2) (3). Up to 79% of authorized hiring personnel have used information to better assess a candidate (1). Sometimes the assessment is not good for the applicant. Employers disregard candidates when they find certain “red flags” in the online sources (4). Some of the red flags may be obvious, some others not as obvious. Table 1 lists items that have negatively swayed a potential employer/school (5). One of the not so obvious items that have caused an applicant to be

disregarded has been the use of “emoticons” e.g., smiley face and text language such as w8 (wait) or b4 (before) in an e-mail or job application. Studies have shown that potential employers have begun using social media sources as a determination if a candidate is a good fit for the position/ practice. One way they have used social media is by checking on applicants to make sure they have not misrepresented himself/ herself or their qualifications. Employers may also feel that if an applicant posts something that is inappropriate, that action displays poor judgment. Today’s employers look for other qualities in applicants such as loyalty and discretion. Posting inflammatory information about a company, person, instructor, or physician on the Internet can be construed as poor judgment. Is it fair for an employer to use social media to further assess an applicant? Currently there are no specific laws that prohibit employers from checking applicants on the Internet, Facebook, Twitter or LinkedIn. There is some protection, however. State and federal laws do discuss “too much information.” How does an employer explain the knowledge of a medical condition that was not presented in the

Students Students Students Students Students Students application or interview? The employer must demonstrate how they did not use that piece of information when disregarding the applicant. Some employers use a third party to conduct searches on an applicant’s background. Usually an applicant provides written consent for someone to perform a background check, which provides time for applicants to remedy their social site. The catch is consent needed if a third party performs the search; no consent may be needed if the search is performed directly by the employer. Finally, some states have mandated that offduty conduct is exempt from consideration for hiring a candidate, especially if the offduty conduct is legal, such as drinking. However, if a direct link can be demonstrated to a job’s formal responsibilities, then that information can be used to deny hiring, i.e., drinking to excess frequently when the job requires the employee to be on call or ready to serve at a moment’s notice, as a function of the job (6). With this new found knowledge of employer Facebook fishing, subscribers have tried to change their names on Facebook. Many have found this too cumbersome and revert back to their original name in a few months. All is not lost if you use common sense and take the following advice. Check your privacy settings by limiting who has access to information. If you are in networks, consider the real need – you must weigh the potential of job contacts versus social contacts. Clean

up your profile, checking for the information listed in the Table. It is important to “untag” all questionable photos. Keep your profile clean especially in commenting of other people’s photos, walls, etc. This information is provided to assist you in maximizing the use of Facebook and other social media programs to your advantage. Facebook can be a great tool for networking, job and school communications. A well thought out social site can support an applicant’s professional qualities, attributes and creativity. The crafted site can highlight solid communication skills and well-roundedness (2). Use of common sense and the realization that anyone can check Facebook should be the guide when posting information. Now go and update your Facebook profile and security settings. 

Works Cited 1. Goldberg, Stephanie. Young job-seekers hiding their Facebook pages. CNN Tech. [Online] March 29, 2010. http://articles.cnn. com/2010-03-29/tech/facebook.job-seekers_1_facebook-hiringonline-reputation/2?_s=PM:TECH. 2. 45% Employers use Facebook-Twitter to screen job candidates. Oregon Business News. [Online] August 24, 2009. http://oregonbusinessreport.com/2009/08/45-employers-use-facebook-twitterto-screen-job-candidates/. 3. Skinner, Carrie-Ann. Half of employers check Facebook. Macworld Business Center. [Online] January 2010. http://www. macworld.com/article/145719/2010/01/facebook_jobs.html. 4. Finder, Alan. For Some, Online Persona Undermines a Resume. The New York Times. June 11, 2006. 5. Make Sure Your Facebook Profile Doesn’t Lose You A Job. Dumb Little Men. [Online] February 2009. http://www.dumblittleman.com/2009/02/make-sure-your-facebook-profile-doesnt. html. 6. Ford, Jackie. Why employers should reconsider Facebook fishing. Market Watch. [Online] February 11, 2009. http://www. marketwatch.com/story/story/print?guid=885560B4-7672-481CAE84-9AFE18AF9F70.

Congratulations to the 2011 CAPA Scholarship Winners!!! Community Outreach Scholarship Alan Valenzuela, PA-S San Joaquin Valley College Ray Dale Memorial Scholarship Joy Dugan, PA-S Touro University Ruth Webb Minority Scholarship Christina Guzman, PA-S San Joaquin Valley College JANUARY/FEBRUARY 2011

Students Students Students Students Students Students 2011… A New Year of Student Opportunities with CAPA by Jennifer Baltazar, PA-S, Student Representative

very year around this time I find myself making a list of “Personal New Year’s Resolutions.” To be honest, some years are better than others for meeting the goals I have set out to achieve. This concept got me thinking, “what if I could make a New Year’s Resolution list specifically for the new career that I will be officially entering in 2011.” As a PA-S finishing up my first year of school at Western University of Health Sciences, it would be very easy to bury myself in the books, rotations, and a thesis…not to surface until the PANCE is over and my license number is issued. But, as with any great career, success depends on many factors above and beyond test grades. So my article this month is not only for me, but also for all my fellow CAPA students. It is a “Physician Assistant 2011 New Year’s Resolution List” that can actually be completed with confidence and the help of CAPA student-wide resources: “Top Ten List of Physician Assistant Resolutions 1. Statewide Physician Assistant Laws, Legislation and Regulations. Stay up-to-date and current about my career via CAPA’s Facebook page, eNews updates, and CAPA News 2, Physician Assistant Networking. Attend CAPA’s Annual Conferences in Palm Springs and Napa. These are great opportunities to network with PA students and graduate PAs statewide for educational and future job opportunities 24

CAPA NEWS

3. PANCE Study Advice and Resource. Read archived CAPA News July/ August 2008 article accessed from CAPA’s website, “Surviving Clinical Rotations Workshop” 4. Great Clinical Preceptors Relationships. Putting your best foot forward in this area is key. Read the archived CAPA News May/June 2010 article accessed from CAPA’s website, “Taming the Clinical Monster” 5. Lessen My Financial Debt. Decrease the financial burden of PA school by applying for one of the three $1,000 scholarships available through CAPA. There are other financial aid programs listed on the CAPA website. Links can be found at: http:// www.capanet.org/student_ otherfinancial.cfm Deadline to apply for CAPA Scholarships is December 31 each year.

7. Electronic/PDA PA Software. It’s so important to stay upto-date with current medical knowledge from prescription medications to anatomy to treatment guidelines. A great jumping off point to decide what programs are best can be accessed at CAPA News July/August 2008 Archive found on the web titled, “Surviving Clinical Rotations Workshop” 8. Hands-On Training Workshops. CAPA’s Annual Conference in Palm Springs offers hands-on training with top professors, physicians, and other expert PAs in a variety of fields to practice the skills I will need for whatever PA career field I enter 9. Controlled Substance Education Course. For graduates, multiple locations and dates are offered throughout the year at a discounted rate for all CAPA members

• Ruth Webb Minority Scholarship $1000

10. Post Graduation Job Search. CAPA’s website offers great job listings for recent graduates to search for new opportunities at: http://www.capanet.org/ joblistings.cfm

• Community Outreach Scholarship $1000

Happy 2011 and good luck with your future career.

• The Ray Dale Memorial Scholarship $1000

6. Volunteer Opportunities Statewide: This is a great way to stretch my legs and practice my school knowledge on actual patients while bettering my community. These opportunities are listed at: http://www.capanet.org/index.cfm

Jenn Baltazar, PA-S Student Prepresentative studentrep@capanet.org 

www.capanet.org

Students Students Students Students Students Students What’s Going On At…USC Faculty Profile: Anne Walsh by Michael De Rosa, MPH, Ph.D, PA-C, PA Program Relations Committee Chair

had an opportunity to catch up with Anne Walsh, Interim Director of the PA Program at the University of Southern California, at the recent Physician Assistant Education Association meeting in Baltimore, Maryland. “Catch up” is an apt term. Anne continues Anne Walsh, PA-C to work long clinical hours in a gastroenterology practice while taking the reins of the program from which she was graduated in 2000. But leadership is not new, Anne was co-president of a PA class voted Outstanding “USC is in the midst of a SAAAPA chapter. Not number of exciting changes, surprisingly, she got into PA including Kevin C. Lohenry, education “by default.” She MPAS, PA-C becoming the PA was first hired to teach medical Program Director in March students, then recruited into 2011.” the PA program where she now teaches GI modules to first year students and laboratory skills, a topic which came naturally to her based on her pre-PA experience as a cytotechnologist. Still glowing (and gloating) about USC’s victory in the CAPA Student Challenge Bowl at the October CAPA Conference, Anne took time to reflect on the future of PA education. Like many PA faculty, she feels the changing face of the profession, reflected in the changing population of PA students, will dictate where PA education goes over the coming years. She spoke

of the challenges educators face in imparting practical information to an ever younger, less experienced student population. She believes, “[The] strength of the profession has been in the maturity and experience of our students, the commitment to previous experience and an emphasis on clinical skills.” Less seasoned students means taking the time to provide training PA programs once took for granted. She also expressed concerns about the effects of changing degrees, and the emphasis masters level PA training programs place on the baccalaureate degree relative to previous clinical experience. The issue of younger students with less professional experience also came up when I asked about CAPA and its relationship to PA training programs. Anne stated that she feels CAPA will need to focus on advocacy more than it ever has in order to impress upon new PAs the professional obligation to support and expand

the profession. Additionally, CAPA plays an important role in providing a venue for PA educators in the state to meet, share ideas and, hopefully, identify more graduate PAs interested in a role in education. USC is in the midst of a number of exciting changes, including Kevin C. Lohenry, MPAS, PA-C becoming the PA Program Director in March 2011. The Department is also adjusting to its new home – a 22,000 square foot, $1.5 million training facility custom designed by program faculty. The new facility contains dedicated state-of-the-art classroom space for all three classes, library, wireless internet, student lounge and study space, and 10 rooms dedicated to clinical scenario examination (OSCE). USC is also currently seeking a new faculty member. With another accreditation cycle on the horizon, the USC PA program has much to celebrate and a dedicated leader to help guide them through this exciting time. 

Attention: PA Program Directors, Class Presidents, Student Society Leaders, Faculty and Students

et CAPA know what you are doing by submitting an article and include a photo if possible. Or, you may simply send a photo with a descriptive caption. We want to let our readers know the wonderful things that are happening at our PA programs. We will print submissions on a space available basis. Send your article/photos, etc. to capa@capanet.org. Thank you!!

JANUARY/FEBRUARY 2011

Students Students Students Students Students Students The First White Coat by Stacy L. Frazer, PA-S, Constituent Chapter Student Representative of the 2011 Student Society, UC Davis FNP/PA Program

he UC Davis FNP/PA Program, of Sacramento, CA, hosted its first annual White Coat Ceremony on December 8, 2010. The White Coat Ceremony is a tradition among many programs that marks the studentâ&#x20AC;&#x2122;s transition from didactic studies into the clinical portion of their training. The ceremony was coordinated by the 2011 Class Student Society and faculty members: Kris Himmerick, MS, MPAS, PA-C, Ceremony Coordinator and Marcia Ceesay-Slater, MPH PA-C, Student Society Faculty Advisor. The event began with two amazing Keynote Speakers, Sonny Cline, PA-C and Beth Grivett, PA-C.

Sonny has worked in family, emergency, and psychiatric medicine for over 10 years and has also been a guest lecturer for UC Davis as well 26

CAPA NEWS

as Stanford. He delivered a very memorable and sobering speech, driving home both the privilege and responsibility the white coat symbolizes. Beth, who currently practices family medicine, has held many positions of leadership within our profession including President of CAPA 20022003. She has worked tirelessly as the Chair of the Legislative Affairs Committee for CAPA for the last 10 years. Beth gave a very motivational speech about becoming an active member within our profession, remembering those who have come before us and helped carve the path we now travel, as well as the importance of paying it forward with our participation and future leadership. First Year and Second Year FNP/PA Students and the faculty attended

Faculty: White Coat Ceremony Coordinator: Kris Himmerick, MS, MPAS, PA-C Student Society Faculty Advisor: Marcia Cessay-Slater, MPH, PA-C Student Society 2011 President: Chris Davis, PA-S Vice President: China Milligan, PA-S Treasurer: Neda Raheen, PA-S

the Ceremony. Together, both classes participated in reciting the Physician Assistant Processional Oath, lead by Student Society President Chris Davis, PA-S. The ceremony was completed by the second year FNP/ PA students, already having been in their clinic setting for some time, placing the white coats on the First Year Students, who begin their clinical rotations in January 2011. This is the beginning of a wonderful tradition for UC Davis! The symbolic meaning of white coat will be remembered by all and carried forward throughout the years at UC Davis and in the careers of its students. Thank you to those who organized and attended this event and congratulations to the Classes of 2011 and 2012. ď Ž

Secretary: Sharon Perez, PA-S AOR Representative: Fallon Lopez, PA-S Constituent Chapter Student Representative: Stacy Frazer, PA-S Diversity Chair Committee Representative: Kim Harris, PA-S Student Society Historian: Martin Ceballos, PA-S External Affairs Committee: Suzy Choi, PA-S

Welcome New Members

Local Groups

November 11, 2010 through February 1, 2011 Candice Abdou, PA-C Gabriel Aguilar, PA-S Maria Aguilar H., PA-C Jamie Ahner, PA-C Anne Alexis, PA-C, MS Carlos Alvarez, PA-C Krupa Andalkar, PA-S George Anderson, PA Lisa Asfahani, PA-S Adela Ashraf, PA-C Brynn Bailey, PA-C Kelly Baldwin, PA-S Stephanie Baron, PA-C Bret Batchelor, MD Mandi Battles, PA-C Michelle Bauer, PA-S Rodney Beaty, PA-C Amy Becerra, PA-C Lisa Beedle Verenisse Bejarano, PA-C Gilbert Benitez, PA-C Arnie Bergula, PA-C Maria Betancourt, PA Brigette Beyer, PA-S Rakhi Bhatia, PA-C Asbel Bolado, PA-C Randy Bonds, PA-S Rolando Bonilla, PA-C Tricia Borchers, PA-C Richard Bowling, PA-C Christa Bradley, PA-C Julia Brenta, PA-S Linda Broussard, PA-C Leah Burnett, PA-C Emily Bush, PA-S Tiffany Butler, PA-S Kelly Calkins, PA-C Robert Carleton, PA-C Charlotte Carlson, PA-S Leo Carpenter, PA-C Chuah Cha, MA Brenda Chandler Lissette Chao, PA-C Mark Christiansen, PA-C John Clark, PA-C Molly Cobb, PA-S Donna Colobong, PA-S Lara Conovaloff Crystal Cox, PA Jenna Curtis, PA-S Lauren Cypert, PA-C Elena Da Silva, PA-S Jacqualine Dancy, PA-C, MPAS Jason Daughety, PA-S Tiffany Day-Neutill, PA-S Robert deBos, PA Nina DeWeese, PA-C Erin Dean, PA-C Mari Jo Dedeker, PA-C Anne Denslow, PA-C Lisa Deppmeier, PA-C Trung Dinh Thomas Dowell, PA-C Matthew Dowell, PA-S Andrew Duncan, PA-C Chris Ediss, PA-C Irene Edmunson, PA Terri Edwards, PA Mikhail Esfandier, PA-C Celia Espinoza, PA-C Sudi Fahim, PA-C Marlene Farronan, PA-C Brandi Fleischmann, PA-C Jorge Flores, PA-S Robert Fonseca, PA-C Vera Fonseca, PA-C

Anthony Fraser, PA-C Jason Frazer, PA-C Alexis Fruge, PA-C Margaret Galileo-Rojas, PA-C Meghan Galloway, PA-C Heather Gerstl, PA-C Jennifer Gerwick, PA-S Kirsten Gipson, PA-C Maria Glover, PA-S Elida Gonzalez, NP Kellie Goudreau, PA-S Geoffrey Green, PA-C Steve Gruer, PA-C Victor Gunn Liv Hagstrom, PA-C Wesley Hardin, PA-S Kristin Harrington, PA-C Kristin Harris, PA-S Janet Hendrickson, PA-S Daliya Heng, PA-S Long Her, PA-S Joshua Hess, PA-C Rachel Himelstein, PA-S Coleman Ho, PA-S Danny Ho Candie Hochnadel, PA-C Elizabeth Hollo, PA-S Joy Horstman, PA-S Chase Hungerford Rie Inaba, PA-S Karl Inbody, PA-C Dina Jackson, PA-C Marvin Jones, PA-C, FNP Navjot Kaur, PA-C Ashkan Kaviani, PA-S Sarah Khan, PA-C Esther Kishimoto, PA-S Jennifer Kokesh, PA-C Steve Kotarek, PA-C Erasmus Kotey, PA-C Vitaley Kovalev, PA-S Petra Krupp, PA-C Michelle Lancaster, PA-C Teresa Latham-Kockinis, PA-C Katherine Lauchaire, PA-C Sheila Lederer, PA-C Jessica Lee, PA-S Shane Leininger, PA-S Brandon Lew Tina Lewis, MMSc, PA-C Emily Liao, PA-S Bethany Lindstrom, PA-C Amelia Lopez, PA-C Jacob Loya, PA-S Gabriel Maalouf, PA-C Jessica MacDonald, PA-S Megan Maddock, PA-C Sirintorn Mann, PA-C Alison Marcus, PA-S Monique Mariscal, PA-S Stephanie Mayberg Matthew McCartt, PA-S Libbey Michelini, PA-S Rafael Miranda, PA-C Erin Montgomery, PA-S Brianna Morris, PA-C Glenn Morrison, PA-C Corinna Morton, PA Yvonne Muro, PA-C Angela Nguyen, PA-S Matthew Nothern, PA-C Allison O’Boynick, PA-S Francisca Obiora, PA-C Ambar Oregel, PA-S Angela Passanisi, PA-C Yana Pechenik, PA-C

David Pena, PA-C Larisa Petrison, PA-C Arineh Petrosian, PA-C Anthony Pinner, PA=C Laura Pittenger, PA-S Ghazal Pooya, PA-C Terence Potter, MS, PA-S Wing Kay Pui, PA-C Alison Quammen, PA-C Alfonso Quant, PA Reynaldo Quinonez, PA-C Daniel Ramos, PA-C Shannon Rathbun, PA-C Amber Richter Romulo Romero, PA-C Rafael Romero, PA-C Ragna Rostad-Ruffner, PA Hamid Sakhi, PA-S Samuel Samalin, PA-C Tony Sanchez, PA-C Sarah Schrader, PA-S Jennifer Schroeder, PA-C Judith Seargeant, PA-C Adam Shiffman, PA-C Brett Sibley, PA-S Joseph Silverstein, FNP, PA-C Deborah Smallwood, PA-C Vance Snyder, PA-C Jim Spears, PA-C Jenny Spencer, PA-C Irina Spivak, PA-C Julie Stackhouse, PA-C James Stafford, PA Emily Stuhr, PA-S Christine Szafranic, PA-C Howard Taliercio, PA-C Emily Talmich, PA-S Victoria Tang, PA-S Gloria Taylor, PA-C Bonnie Taylor, PA-S Jaroslava Teet, PA-C Dania Tenorio, PA-S July Torres, PA-S Jacie Touart, PA-C Joseph Trajano Eric Travis, PA-C John Trent, PA Miguel Trujillo, PA-C Sandy Valle, PA-C Linda Van Horn, PA-C Erika Van Hulzen, PA-C Valerie Venghiattis, PA-C Anthony Vennik, PA-C Lauren Vento, PA-C Ivan Ventura, PA-C Kimberly Veres, PA-C Shilpa Vichare, PA-C Renee Vinyard, PA-C Connie Volpi, PA-C Anne Wadham, PA-C Heidi Wang, PA-C Agnes Warhover-Kotarek, PA-C Susie Wegner, PA-C Charles Wetter, PA-C Steven White, PA-C Bart White, PA-S Tessa Whiteley, PA-C Kellie Williams, PA-C Jason Williford, PA-S Patrick Wong, PA-C Samantha Wood, PA-C Alfred Yang, PA-C Albert Yun, PA-S Sahar Yusufi, PA-S Robert Zapotosky, EMT Jason Zartman, PA-C

1. Redding Area PA/NP Alliance Summer Ross, PA-C; (530) 275-5747 summerross@hughes.net 2. Physician Assistant Society of Sacramento (PASS) Carlos De Villa, PA-C, PASS President; (916) 973-6185, pasocietyofsac@yahoo.com Atul Sharma, PA-C, MMS, MPH, CHES; (916) 397-6035, pasocietyofsac@yahoo.com 3. Contra Costa Clinicians Association Brian Costello, PA-C; (707) 651-2705, brianc510@comcast.net 4. San Francisco Bay Area Physician Assistants (SFBAPA) www.sfbapa.com, PO Box 14096, San Francisco, CA 94114-0096 Martin Kramer, PA-C; (415) 433-5359, Fax: (415) 397-6805, 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 Emma Calvert, PA-C; stocktonmidlevels@gmail.com NEW

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. Tulare/Kings NP/PA Association Steve Henry, PA-C; Pager: (559) 749-4348, msh649@sbcglobal.net 12. Central Coast Nurse Practitioners & Physician Assistants Kris Dillworth, NP; ccnppa@yahoo.com 13. So Cal PAs Linda Aghakhanian, PA-C; want2heal@hotmail.com 14. Orange County Hung Nguyen, PA-C; (714) 846-8178; nhy52@yahoo.com 15. San Gabriel Valley Local Group M. Rachel DuBria, PA-C; (818) 744-6159, racheldca@aol.com 16. San Fernando/Santa Clarita Valley Group Jonah Tan, MPT, PA-C; (818) 634-0007, jotptpa@yahoo.com

NEW

17. Coachella Valley Physician Assistant Group Matthew Keane, MS, PA-C; mkeanepas@gmail.com 18. San Diego Area Jeremy Adler, MS, PA-C; (619) 829-1430, jadler@simplyweb.net

JANUARY/FEBRUARY 2011

California Academy of Physician Assistants 3100 W. Warner Avenue, Suite 3 Santa Ana, CA 92704-5331

PRSRT STD US POSTAGE PAID SANTA ANA, CA PERMIT NO 949

Address Service Requested

CAPA’s 35th Annual Conference

September 22-25, 2011

Optional Workshops, September 22 and 24

Controlled Substances Education Course

September 21, 2011 – Prior to the CAPA Conference

APA’s home away from home is looking a bit more like a palace! The renovation is complete and the Wyndham Palm Springs is no more. A new and very much improved CAPA Conference experience awaits you at the Renaissance Palm Springs. And, the special CAPA Conference Rate is just $169! You may reserve your room today.