Colorado Academy of Physician Associates

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June 2020 Newsletter

June 2020

CAPA stands with you, we kneel with you, we will work to hear and amplify your voices. The healthcare dimension of racism is one that needs attention and collective acknowledgement in order to be changed. We strive to be a resource for support, an outlet for suggestions and advice, and a force that will help drive the change we need in our communities and healthcare systems.

We believe in access to and delivery of quality medical care for Coloradans and promote a commitment to team – based care to enhance the health and wellness of the people of Colorado. CAPA pledges to embrace an individual’s right to be heard regardless of race, color, social class, status, sex, ethnicity, sexual orientation, physical ability, or religious belief. Diverse voices are needed to meet the challenges and find solutions. CAPA supports diversity, equity, multiculturalism and promotion of justice in our PA education, our PA profession and our healthcare community.

During this time of unprecedented change, “new normals” and ever-evolving information, we thank you for your efforts taking care of your patients, co-workers, family, friends and your community. We’ve seen so many examples of how PAs are compassionately adapting and pivoting to provide care, education and advocate where it is needed most. This is just what PAs were built to do.

We have also heard from PAs who are facing difficulty in finding work positions or are experiencing furlough in current jobs. Know that we hear you too. CAPA recognizes the actions taken on behalf of Executive Orders to expand the available healthcare workforce in Colorado through temporary suspension of certain regulations related to PA practice; however, the regulatory barriers that prevent PAs from practicing at the top of their scope have been amplified during this time, both locally and nationally. CAPA has a finger on the pulse, has taken action to support the ability for PAs to practice where needed during this pandemic, and is looking ahead towards opportunities to affect meaningful change. Check out more of what the Governmental Affairs Committee has been working on below.

CAPA has also gone through recent management restructuring, and is looking forward to strengthening our service to members through opportunities for networking, obtaining CME and providing meaningful involvement in advocacy. As we look ahead to our strategic planning session in July, we as a Board have also been thoughtful about recent events, and the impact that is felt on behalf of PAs, patients and our communities. We are looking forward to a robust conversation around these topics. CAPA represents you and exists to serve you as a PA, and thus, we want to hear from you! As is done annually, CAPA will be conducting a member survey over the next month, and ask for your candid responses in helping us understand what is important to you and your community. Keep your eyes open for this survey in the next couple days!

As my term as President concludes at the end of June, it has been a privilege to serve and represent the Colorado PA community this past year. With a year full of transitions and adaptations, I have been grateful for an inspiring and supportive Board of Directors, and am encouraged by the individuals who will be leading the organization moving forward.

We invite you to join us, whether through continued membership support or becoming more involved in committee or outreach activities. Look for more opportunities to get involved and support PA practice in Colorado!

Peggy Walsh, President

Thank you to all those who voted in the

CAPA Election!

We are honored to present the 2020-2021

Board of Directors. The leadership year starts July 1, 2020:

Board of Directors (voting):

President: Kandace Shepherd

President-Elect: Alyn Whelchel *

Immediate Past President: Peggy Walsh

Secretary: Samantha DeYoung *

Treasurer: Kellie Lyons

Chief Delegate: Alysia Wiley

Student Director: Annalise Grammerstorf *

Directors At Large:

Josh Borgstadt

Amy Bronson

Kendra Glassman *

Joe Jones *

AAPA House of Delegates, Colorado Delegates:

Chief Delegate: Alysia Wiley

Chief Delegate-Elect: Rachel Weinzimmer *

Delegates:

Rebecca Bohl *

Cooper Couch *

Steve Kudebeh *

Kirsten Kuhn *

Peggy Walsh *

* elected during the 2020 CAPA Elections

Has your membership lapsed? Be sure to keep your membership active and keep receiving CAPA correspondence, supporting PA advocacy in the state and have access to CAPA events and CME opportunities!

Visit the Membership Page to renew or log-in to your CAPA account.

Legislative Update

Alyn Whelchel, Governmental Affairs Committee Co-Chair

The CAPA Governmental Affairs Committee (GAC) had another successful legislative season. We wrote, testified for and passed HB20-1041 Physician Assistants Financial Responsibility Requirements. This important legislation allows PAs to continue to utilize the shared malpractice policies many of us currently have with our employer organizations and physicians. As we all know, based on legislation passed by CAPA in 2019, HB19-1095 Physician Assistants Supervision and Liability, PAs with more than three years of experience are now solely liable for the care they provide. HB20-1041 clarifies malpractice coverage questions related to this legislation.

In addition, CAPA has responded to the current COVID-19 crisis by contacting Governor Polis with several letters to address the specific needs of PAs in Colorado to help us care for patients. Like many state chapters and with the support of AAPA we requested temporary suspension of the Physician: PA supervision ratios and easing liability for care outside a specific provider’s area of specialty. Governor Polis responded by releasing an Executive Order expanding the scope of practice for medical providers and lifting other requirements. PAs are specifically mentioned in this order.

GAC also hosted CAPA at the Capital February 26^th this year. Many PAs attended and had the opportunity to meet and educate our lawmakers about what we can do for the citizens of Colorado. We also experienced the legislative process and gained a greater understanding about how to affect positive change for our profession at the state level.

The CAPA Governmental Affairs Committee continues to have a very active presence in the Colorado legislature and the Colorado Board of Medicine. We continue to work closely with CAPA’s lobbyist to ensure legislation pertaining to PAs is reviewed by CAPA. We are proud to represent Colorado PAs and plan to continue the work we need to positively promote our profession and support our fellow PAs.

This is an unprecedented time in our country and in our profession. PAs are uniquely poised to provide care where needed. Our training and ability to adapt to different practice situations and specialties is unlike any other. Please know GAC is aware of how incredible PAs are in our community and how vital we are to the sustained and successful provision of excellent patient care in Colorado. Please share your stories with us! We want to know how we can help support and improve your practice in our state.

“Our professional organizations are the voice, but we as PAs are the megaphone."

CAPA Goes to Washington D.C. to Advocate for Colorado PAs!

Leadership and Advocacy Summit, March 2020 Kandace Shepherd, President-Elect

Colorado leaders joined PAs across the nation at the LAS, sponsored by the national organization, the American Academy of Physician Assistants (AAPA) to lobby legislators in the U.S. House of Representatives and the U.S. Senate on the most important issues for PA practice.
The CAPA leaders addressed two important issues affecting PA practice at the federal level:
1. Physician Assistant Direct Payment Act: Change in legislation that would allow PAs to receive direct payment from the Center of Medicare and Medicaid Services (CMS), which would align PAs with the other non-physician practitioner’s ability to receive direct payment. This inability to receive direct payment inhibits PAs ability to secure clinical positions by deterring employers due to increased complexity of insurance collections.
2. Home Healthcare Planning Improvement Act: Change in legislation that would allow CMS to update its rules to allow PAs to order, manage and oversee home health care (HHC) treatments and supports for their patients. The inability for non-physician practitioners to order and manage HHC for patients inhibits efficient and appropriate patient care, adds to the paperwork burden for physicians, clinics and PAs, and inhibits patient’s ability to receive these services timely.
During this summit, CAPA BOD members met with Senators, Representatives or their Staffers in person in order to promote these changes to improve PA practice and best support patient healthcare services:
Senators Cory Gardner, [R-CO] and Michael Bennet [D-CO]; Representatives Ken Buck [R-CO, district 4], Jason Crow [D-CO, district 6], Scott Tipton [R-CO district 3], Diana DeGette [D-CO, district 1] and Joe Neguse [D-CO district 2]. Colorado co-sponsors of the Home Healthcare Planning Improvement Act are Senators Gardner and Bennet, and Representative Neguse; Colorado co-sponsor of the Physician Assistant Direct Payment Act is Representative Neguse.

NOTE: In March, the CARES Act was passed in response to the national emergency declaration due to the COVID-19 pandemic. Within the CARES Act is emergency legislation allowing non-physicians to order and manage Home Healthcare services for patients without physician co-signature! While this change is within the CARES Act at this time, we are legislating to continue this change by making permanent and passing the Home Healthcare Improvement Act.

Thanks to our representatives and senators who identified this crucial need for patient care – but we need to make this permanent!

Thank you to all who attended the February 2020

Annual CAPA CME Winter Conference in Breckenridge, Colorado!

We hope to see you at future CAPA events!

Congratulations to the CAPA 2020 Award Winners!

PA of the Year:
Kari Schoenwald

PA Educator of the Year:
Dayna Jaynstein

Student Scholarships:

Katie Gansar
Lauren Norheim

Check out the inspiring stories of these awardees here.

Reimbursement Pearls

Josh Borgstadt, Reimbursement Committee Chair

Are PA’s cost effective?

At 40% reduced salary on average compared to physician salaries, even at 85% rate of physician rate paid by Medicare, PAs lower cost and increase profit to organization, compared to physicians.

Click on the links below for additional resources related to PA reimbursement:

Advanced Practice Providers Optimize Efficiency and Improve Financial Performance (Healthcare Financial Management Association Forums)
Non-Physician providers boost revenue, practice productivity (Healthcare Finance)
How Adding Physician Assistants Improves Hospital Revenue Cycle (RevCycle Intelligence)
The Effects of Expanded NP and PA Scope of Practice on the Cost of Medicaid Patient Care (Health Policy)
15% Payment Differential in Reality (PowerPoint Presentation)

COPIC Corner

WHAT’S WRONG WITH THIS EHR SCREEN?

UNFORESEEN CONSEQUENCES WITH TEMPLATED CLINICAL ENCOUNTERS

The following is a screenshot of a physical assessment as recorded in an EHR template. Can you spot any areas of concern?

While this record, if it is an accurate reflection, serves as valid documentation of the exam, it also invites the following issues of concern:

Credibility—If it is not an accurate representation of all the elements it documents as being completed, then it greatly reduces the credibility of the authors of the note. This reduced credibility can harm defensibility in subsequent review of the care for professional review and quality purposes, in medical board complaints, in legal proceedings, and in billing fraud allegations.

Fraud—If the documentation is inaccurate and overstates the level of examination, it triggers significant potential for claims of fraudulent representation for billing and financial purposes. When combined with claims of professional negligence, plaintiffs can exert pressure on the record's author to settle those claims that are covered by insurance by threatening the fraud or criminal claims that are not covered by insurance policies.

Burying positive findings—Increasing extraneous data or noise to the system can cloud the positive significant findings. While this documentation does provide a summary impression of the positive clinical findings and the pertinent negatives, some systems can induce clinical errors by burying the important signals of positive findings in the noise of all of the templated “normal” in the exam.

EHR fatigue—Perhaps the greatest concerning issue is that each of these negative/normal entries required a corresponding click by the author. A 2017 Annals of Family Medicine¹ article noted that primary care physicians spend more than one-half of their workday, nearly 6 hours, interacting with the EHR during and after clinic hours. Such “clicktation” burden is likely the single largest contributing factor in the reported high levels of burnout.

Telling the patient’s story—Lastly and probably subtler is that in many instances the resulting chart created by positive and negative clicking of a template fails to tell the story of the patient’s history, exam, and your medical decision-making. Such “pixelation” changes the image of the encounter. Subsequent clinicians have a limited idea of what you heard, saw, and thought about a given encounter.

¹ Ann Fam Med September/October 2017 vol. 15 no. 5 419-426

Save the date! Registration details coming soon!

Rocky Vista University PA Program

By Ashleigh Mueller and Barbara “Blair” Feldhaus

Like many programs across the country, Rocky Vista University has made substantial changes to the school year in response to COVID-19 in order to prioritize the health and safety of the students and faculty. This has been a difficult challenge for all the students and the faculty, but we have been able to maintain our close-knit sense of community and continue our education despite these changes.

During spring break in the second week of March, first year PA students were notified that we would not be coming back to campus for a few weeks and would instead continue our studies online. Many of our classmates who had gone back home for spring break decided to stay with family instead of returning to Colorado scattering our class across the country. Most of our lectures are now recorded, but we do have several live lectures over Zoom each week, where we get to see everyone’s faces again! Around the same time, the second year PA students were also temporarily relieved from their rotations during the COVID crisis and are instead continuing their learning with online modules. We are fortunate that RVU has some extra time built into the program for elective rotations, so graduation will not be pushed back for the moment and our staff is working tirelessly to make sure we are all still learning during this unpredictable time.

As many of us have personally experienced in the past few weeks, working and learning from home can be a challenge. However, having such wonderful classmates and faculty have been so helpful through these adjustments. Our faculty advisors meet with us weekly over zoom to check in and our class is still meeting virtually to continue studying together. This was definitely not how RVU envisioned their students ending their rotations and didactic year, but we are happy to help flatten the curve and provide aid where we can. We are so proud of all our spouses, friends, family members, and neighbors that have stepped up during this time of fear and uncertainty and applaud them for their efforts!

Colorado Mesa University PA Program

By Danielle Pelletier, PA-S1 and Tyler Anderson, PA-S1

Greetings from the Colorado Mesa University PA Class of 2022!

As the inaugural class of 2021 approaches the eve of their clinical year, we would like to introduce you to the second class at the CMU MPAS Program. We would like to begin by offering a profile of our new group of PA students! We are 22 students and our homes range from California to Massachusetts to right here in Mesa County. Our backgrounds span across a broad spectrum and have truly created an eclectic group of students with unique experiences. Jason, one of our students, worked in law enforcement for 18 years before making the switch to healthcare. Whereas, Mita, a student from local Grand Junction, has a background in teaching clinical Pilates. Many of us were student athletes, scribes, EMTs, and research coordinators. In this first semester of classes our multifaceted group has brought many unique perspectives that we look forward to sharing and building upon during our education.

During our first week of the semester, we enjoyed getting to know our classmates and professors both inside and outside of the classroom. As a program, we organized an after-school program for foster kids where we did arts and crafts, science experiments, obstacle courses, and even facilitated conversations about healthy eating. It was a wonderful way to get to know our community that we now call home. We also participated in healthy cooking classes at the local community college and a scavenger hunt to familiarize ourselves to campus and get to know our classmates. In our research and evidence-based medicine class, we have been developing our capstone projects. Our interests vary from quality improvement projects surrounding biking to campus, sauna use as a mimicking agent for exercise, and creating educational tools for fall prevention, skin cancer detection and substance abuse. We also had the opportunity for some interprofessional education with the CMU BSN students, where we collaborated in a public health outbreak activity with Mesa County Public Health (how relevant to our current situation!).

As the class of 2022 approaches the end of our first semester of PA school, things are looking a little different than expected. Our classes have been completely online since we have returned from spring break and will be until at least April 27th, 2020. While online learning has created some challenges, especially in developing our hands-on physical exam skills, we have all risen to the challenge, and continue to build relationships with our classmates from a distance. We are excited to continue growing as a class through the challenges of COVID-19 and we look forward to sharing our journey with the members of CAPA!

We hope this message finds you all well and we wish you health and safety in this difficult time.

University of Colorado PA Program

By Annalise Grammerstorf, PA-S1

As the University of Colorado has transitioned classes online, students from the CHA/PA have sought ways that they can help their neighbors and communities non-clinically during this uncertain time. While 8 students have helped ease the burden on local shelters by fostering and adopting dogs and kittens, others are volunteering with food banks to deliver supplies to community members or grocery shopping for immunocompromised and elderly neighbors. Colin Jenks, a second-year student, and his wife, Corey Jenks, collected gloves, N-95 masks, hand sanitizer, and disinfectant wipes from schools, classmates, and their own home to donate to Denver Health.

The students at CU have found no shortage of ways to help while continuing to succeed in their coursework so that the next time our healthcare system needs assistance, they can be on the front lines. Katie Ganser, a second-year PA student, has been volunteering with the Colorado Hospital Association to help get masks to rural hospitals and using her position within AAPA to help coordinate the student response and ensure needs are met. Katie and her boyfriend Jim Bauer (a PA and CAPA member!) sought inspiration from the COVID-19 USA Physician/APP group on Facebook to develop their own UV box from scratch that will allow local hospitals to decontaminate N-95s in a few minutes. Along with others in the program, Katie has also helped pass around legislation that would allow the nation to maximally utilize PAs throughout this crisis.

Lauren Norheim, a first-year PA student, is helping to connect those who need assistance with those who want to help. She created flyers for her neighborhood that included information about local resources like free counseling, employment services, food pantries, and emotional support lines. The flyers also list the current needs of the local food pantry, and instructions for contributing to the community food drive that Lauren and her family organized themselves. Lauren commented, “it only took about an hour to make a flyer and distribute them, so anyone could do it in their own neighborhood”!

Thank you to all our students who have been going above and beyond as always to serve their communities, and to those who have been doing their best to take care of themselves and their own families who are staying home. As Brooke Weinberger, a PA-S1 and mom says perfectly, “I have been taking care of two wild boys. Does that count?”

Red Rocks Community College PA Program

By Eric Meiklejohn, PA-S1

CLASS OF 2021

The class of 2021 is still hard at work wrapping up the didactic portion of their education. With the end in sight, they only have to complete their module in women’s health before taking final exams. The global COVID-19 pandemic has closed all the schools in Colorado, but the Red Rocks Community College students press on. They have migrated their classes online and continue to prepare for their future roles.

CLASS OF 2020

The class of 2020 was hit hard due to COVID-19 among the many other schools with students in clinical rotations. Some students in rural healthcare settings have been able to maintain their rotation, but many others have transitioned from clinical rotation to at home learning modules. On the bright side, this is offering the class of 2020 time to focus on their capstone research projects.

RRCC Students as a Whole

All of the students want to express their gratitude to our professors, and every healthcare worker, working on the frontlines of the COVID-19 pandemic. Whether working with COVID patients directly, or getting a crash course in tele-health care in their clinics, our professors have continued to work hard to keep us students on track as we all try to navigate this new territory.

Announcements

Check out our new changes

CAPA has undergone some recent changes. Check out our updated website and new contact info:

Colorado Academy of PAs

PO Box 100356

Denver, CO 80250

720-515-4480

info@coloradopas.org

www.coloradopas.org

Apply for a Committee

Committee work is the operational foundation of the work of CAPA. Are you interested in getting involved? Do you have a background or particular set of skills you think would be helpful in advancing CAPA's mission and vision? We'd love to have you join us!

Check out the different committees and fill out an application here.

CAPA Surveys

CAPA sends out an annual survey to collect opinions of members. You should receive an invitation to complete the survey in the next week.

CAPA wants to hear from you!

Upon completion of the survey, you may choose to be entered into a drawing for a free year of CAPA membership. Please take a few minutes to let us know how we can better serve you!