January 11, 2013
The year 2012 is past us now, though certainly not forgotten. PAs saw many great changes to the health care arena in the last twelve months thanks to a progressive, forward thinking state legislature and to countless supporters of PAs in the Commonwealth. But the achievements that rang in the New Year for PAs are not quite a reality – not yet anyway. Translating legislative actions into practice doesn’t happen overnight. In fact, even if on paper we are recognized as Primary Care Providers, getting insurers and other payers of care to enact this change in their policies takes time and patience. Even though physicians can now determine the appropriate number of PAs that they can comfortably and legitimately supervise, getting their employer to accept this as true, or even getting the physicians themselves to accept it at all is another story.
In this newsletter, you will read about the advances that Heather Trafton, the MAPA Chair of the Legislative and Regulatory Affairs, has made in translating recent legislative changes for the PA profession to the insurance industry. Her efforts are making huge strides in allowing for acceptance of what has become a significant advancement for PAs in the Commonwealth. I encourage you to read the Legislative Update and determine how you and your practice fit in with the changes that are being made. As always, if after reading this newsletter you have more questions than answers, please contact MAPA through the website at your convenience. We will do the best we can to answer your questions or find the right people to help you.
As we move into 2013, MAPA is shifting focus from the large scale legislative approach utilized last year to one of “house keeping” with regards to regulations and employer practice standards. There are several instances of where the language used in a regulation pertaining to PA practice inhibits or prevents the proper use of the PA. For example, I was recently contacted by a PA who was new to the Commonwealth who was unable to secure state licensure as a Physician Assistant because, though she had a Masters degree from her alma mater, she did not have a Bachelor’s degree as required by the Commonwealth. Ultimately, she received her licensure from a nearby state and accepted a position there. Another loss for the Commonwealth in my eyes – and one that I’d like to prevent in the future. MAPA hopes to identify and correct similar preventive regulations on the State level as well as through employer policies. If you have encountered similar instances of obstructed use of PAs, please let us know. We’ll do our best in 2013 to correct those obstacles so that the January 2014 newsletter can start off as this one did.
State House Visit
Sean T. Robinson, MS, PA-CMAPA Newsletter, January 2013 2
Heather Trafton, MBA, PA-C, Director at Large
Chair of the Legislative and Regulatory Affairs Committee
MAPA leadership has been working diligently since the passage of S2400 “An Act improving the quality of health care and reducing costs through increased transparency, efficiency and innovation” (also referred to as Chapter 224) reaching out to important stakeholders across the state to ensure implementation of key components effecting PA practice. In particular, we are focusing on the section of the statute titled “Consumer Choice of Physician Assistant Services”.
This section mandates that carriers recognize PAs as participating providers include coverage on
a nondiscriminatory basis and requires carriers provide the insured with an opportunity to select
a participating provider PA as a Primary Care Provider (PCP).
In order for these changes to occur insurers will need to set up the infrastructure to credential and contract with PAs. We have met with members of the Division of Insurance, Deputy Commissioner Kevin Beagan and Director of Managed Care Nancy Schwartz. The Division of Insurance is committed to updating the managed care regulations to reflect the legislative changes included in the section of Chapter 224 “Consumer Choice of PA Services”. However, there are non-PA related components of the managed care regulations that need to be updated; as such, the timing of these changes is not clear. The Deputy Commissioner was clear that regardless of when the regulation changes are made, they fully expect insurers to make the necessary changes to comply with the new legislation. The Division will help facilitate this by requiring insurers to report on their progress in complying with the legislative changes for the PA piece as part of their regularly scheduled updates to the Division.
We had a very productive and collaborative meeting with leadership at Blue Cross Blue Shield of Massachusetts (BCBS of MA). They are committed to making the necessary changes in 2013, which will allow PAs to be credentialed and subsequently contract with BCBS of MA. All PAs will have this opportunity. At this time, the plan is to have three categories of PAs:
- “PA-PCP” which will allow PAs to have their own panel of patients and be listed as a primary care provider within the BCBS of MA directory for patients to choose as their PCP.
- “PA (primary care practice)” for PAs that work in primary care but do not have their own panel of patients.
- “PA (specialty practice)” for all PAs not working in primary care practice.
BCBS of MA will have documents for us to review in January with plans to continue to work collaboratively throughout the entire process. BCBS of MA will mirror the physician and Advanced Practice Nursing (APN) credentialing process as much as possible including the ability to use the HCAS System. (http://www.hcasma.org) There will be on-going communication between BCBS of MA and MAPA. The fee schedule for services provided by PAs will be a focus as the process moves forward. We will continue to keep you up-to-date on our progress. BCBS of MA will notify every PA when they are ready to begin credentialing and contracting with PAs. BCBS of MA recently sent out an alert to all members notifying them of these upcoming changes.
MAPA Newsletter, January 2013
MAPA leadership had the opportunity to meet with Harvard Pilgrim Health Plan (HPHP) in early January. HPHP is currently credentialing and contracting with PAs working in primary care who would like to be designated as a PCP. We are working closely with them to evaluate the process of credentialing and contracting with PAs practicing in non-primary care settings. If you would like to be credentialed with HPHP please visit HCAS and file an application online.
Tufts Health Plan is currently credentialing and contracting with PAs in primary care and all other specialties. Please visit the Tufts website to get started.
Health New England is currently credentialing and contracting with PAs working primary care and with PAs practicing in other areas.
We are in the process of communicating and meeting with other insurers throughout the state and will continue to communicate with all of you. Many of you and your administrators have contacted us with concerns that insurers are not ready to credential and contract with PAs. We understand your concerns and are working diligently with insurers. Please continue to communicate with us on your experience with credentialing by and contracting with insurers. If you are NOT a member, please strongly consider joining our organization. MAPA is the only organization working on your behalf in Massachusetts. To all of our current members, thank you!
|Insurer||Credentialing & Contracting||Status|
|BCBS of MA||Credentialing and contracting with all PAs||Drafting contracts, 6-9 months|
|Tufts||Credentialing and contracting with all PAs||Available now|
|HPHP||Credentialing and contracting with PAs that want to be PCPs||Available now for PCP status; reviewing policies for other PAs|
|Health New England||Credentialing and contracting with all PAs||Available now|
|GIC||Credentialing and contracting with all PAs||Available now|
End of Life Care Training for PAs Available Online
PAs in Massachusetts who care for patients nearing the end of life due to illness should be aware of the DPH-supported Massachusetts Medical Orders for Life Sustaining Treatment (MOLST).
MOLST is a standardized process that allows Massachusetts Physician Assistants (as well as Physicians and Nurse Practitioners) to convert patient preferences about life-sustaining treatments into medical orders to be honored across health care settings and within the patient’s home. Using MOLST is a voluntary decision for seriously ill patients under a clinician’s care.
Please contact the MOLST Expansion Director, Christine McCluskey if you would like further information about this program. There is more information about MOLST and free on-line MOLST training for health providers at the MOLST website.
Commonwealth Care Now Covers Tobacco Cessation Medications and Counseling
Cathy Hamel, PA-C
Director at Large, Chair of the Newsletter Committee
Beginning July 1, 2012, Commonwealth Care covers all FDA-approved smoking-cessation medications and counseling support. Evidence-based studies have shown that a combination of behavioral counseling and pharmacotherapy gives smokers the greatest chance of success in quitting.
The benefit is basically the same as MassHealth’s tobacco cessation benefit:
- Two 90-day treatment regimens per year with FDA-approved medication, including nicotine replacement therapies (patch, gum, and lozenge), bupropion, and Chantix (varenicline).
- Up to 16 face-to-face counseling sessions per 12-month cycle. These 16 sessions can include any combination of two 45-minute intake/assessment sessions per year and 14 sessions of individual or group counseling.
A fact sheet detailing the Commonwealth Care and MassHealth tobacco cessation benefits can be ordered or downloaded at the Massachusetts Health and Human Services website.
Detailed information about the benefit and counseling reimbursement rates are available by contacting the individual Commonwealth Care plans. Commonwealth Care plans also vary slightly in their prior authorization requirements and benefit limits.
Information about the specifics of MassHealth’s tobacco cessation benefit is available through MassHealth Provider Services at (800) 841-2900, and on the MassHealth website. Further details regarding MassHealth’s pharmacotherapy benefit for tobacco cessation can be found at the MassHealth Drug List website.
Look-Alike Website Address Attracts MAPA Attention
Sean T. Robinson, MS, PA-C
President of MAPA
Thanks to email notification from several members, it has come to the attention of the MAPA Board of Directors that a continuing medical education (CME) company has created a website advertising their pharmacology CME offerings that contains the abbreviated version of our organization (“mapa”). Please be advised that MAPA does not endorse the use of our abbreviation within this company’s web address nor do we participate in or endorse the product(s) they offer. All of the CME opportunities offered by MAPA are listed on the MAPA website (https://www.mass-pa.com). Organizations that use the letters “mapa” in their web address are not necessarily related to the Massachusetts Association of Physician Assistants
(MAPA). Thank you to the members who have notified us of their discovery.
Bay Path College Update
Being Bay Path College’s first PA class, students decided to promote their new program while helping the community at the same time. While PA week lasts only seven days, the PA students at Bay Path stretched the festivities throughout the month of October. Prizes were raffled off and donations collected for the Bay State Medical Center Ray of Hope – a “Walk Toward the Cure of Breast Cancer”. Additional funds were raised to help support student attendance at the annual AAPA conference in being held this May in Washington D.C.
The inaugural white coat ceremony took place on Thursday October 4th, 2012. The white coats were given during the second didactic semester before going out into the community to participate in flu shot clinics and a cardiac clinic catering to teenage athletes. Congratulations on these great inaugural activities!
MCPHS University Update
Congratulations to PA Students Hayley Chestnut and Rachel Harris, who will be 2 of the 51 students selected nationally to serve in the SAAAPA House of Delegates for the 2013 AAPA conference in Washington, D.C.
MCPHS-Boston in conjunction with Brigham and Women’s Hospital held its largest annual blood drive to date. There were 75 donors who gave a combined 52 units of blood, including a male with the rare AB blood type whose unit of donated blood was walked back to the hospital for immediate processing.
Also, PA students volunteered on a monthly basis cooking meals for the children and families who stayed at the Devon
Nicole House at Children’s Hospital and led a workshop teaching high school students about vital signs and cranial nerve testing as an exposure to occupations in medicine.
Northeastern University Update
Nicole Hanbury, PA-S, organized a very successful bone marrow drive through the National Marrow Donor Program called “Be the Match”. Approximately 100 potential donors were identified.
Student Paige Landry was selected as a member of the Student Academy delegation to the AAPA House of Delegates. Paige will join Hayley and Rachel from the MCP program at this year’s conference in Washington DC. Congratulations!
Julie Purcell, PA-C
Immediate Past President, Chair of the Membership Committee
We continue to grow as an organization and our committees are very active promoting the profession and working closely with the legislature on vital issues to our profession. We can anticipate many changes to our daily practice in the next few years, and your colleagues at MAPA are working hard to make your voice heard. Thanks to our members for supporting these activities and please join or renew your membership today!
Meredith Johnson, PA-C
MAPA is “in the black” with resources in place to promote our profession at the state level and support our CME activities. Your membership dues and attendance at our CME activities are the primary source of revenue. Thanks for your support! We hope to see you at the Spring Pharmacology CME event and please bring a colleague so they can see what a strong organization we have here in Massachusetts.
MAPA’s Spring Pharmacology CME Event
Jay Chamberlain, PA-C
Chair of CME Committee
Please join us for the upcoming Spring Pharmacology CME event being held at the Lahey Clinic in Burlington, MA on Saturday, March 16, 2013. Details about this event and registration options can be found on the MAPA website. An annual tradition, the Spring CME event affords all who attend the opportunity to satisfy the Massachusetts Board of Registration regulation that PAs must earn six hours of pharmacology and controlled substance related CME every recertification
cycle. Earn your pharmacology CME in one sitting this March while surrounded by your PA colleagues from across the Commonwealth. We hope to see you there.