Insights from 2017 Industry Leaders: Patient Assistance and Access ProgramsMelissa Paige
To be recognized this year as an Industry Leader with many other great well known individuals is such an honor. Thank you #CBI!
-Tracy Foster-President Lash Group
-Art Wood-Senior VP, Patient Services, Inc
-Bill Goodson-Director, Market Access and Reimbursement Services, Eisai,Inc.
-Frank Barrett-Executive Director, Patient Support Services, Churchill Pharmaceuticals LLC
-Nicole Hebbert-VP, Patient Access & Engagement, UBC
-Tom Doyle-Executive VP, Commercial Services, Triplefin
-Catherine Blansfield-VP, Access and Outcomes Services, NORD
-Kristina Broadbelt-Director, Global Patient Advocacy, Horizon Pharma
Insights from 2017 Industry Leaders: Patient Assistance and Access ProgramsMelissa Paige
To be recognized this year as an Industry Leader with many other great well known individuals is such an honor. Thank you #CBI!
-Tracy Foster-President Lash Group
-Art Wood-Senior VP, Patient Services, Inc
-Bill Goodson-Director, Market Access and Reimbursement Services, Eisai,Inc.
-Frank Barrett-Executive Director, Patient Support Services, Churchill Pharmaceuticals LLC
-Nicole Hebbert-VP, Patient Access & Engagement, UBC
-Tom Doyle-Executive VP, Commercial Services, Triplefin
-Catherine Blansfield-VP, Access and Outcomes Services, NORD
-Kristina Broadbelt-Director, Global Patient Advocacy, Horizon Pharma
1. T H E L E A D I N G N E W S R E S O U R C E F O R P H YS I C I A N A S S I S TA N T S
J U N E / J U LY 2 0 1 5
NASCAR Medicine
In the Fast Lane With PA Bill Heisel
2. POWER OF YOU PAs GIVING BACK
Congratulations to the first recipients of
the PA Foundation’s new IMPACT grants.
These PAs and PA student are making a
difference for their patients, community and
profession.
Help us empower PAs and PA students who
are improving health in our communities by
making a contribution to the PA Foundation.
The power of one donation. The power of you.
Tameem H. Sabry, PA Student
Touro University Nevada
$10,000 for equipment and supplies for Touro
Nevada Mobile Healthcare Clinic, serving the
homeless in the Las Vegas area
Tameem H. Sabry, PA Student
Touro University Nevada
$10,000 for equipment and supplies for Touro
Nevada Mobile Healthcare Clinic, serving the
homeless in the Las Vegas area
Wilton C. Kennedy, DHSc, PA-C
Jefferson College of Health Sciences, VA
$5,000 to train PAs in overcoming vaccine
hesitancy through motivational interviewing
Wilton C. Kennedy, DHSc, PA-C
Jefferson College of Health Sciences, VA
$5,000 to train PAs in overcoming vaccine
hesitancy through motivational interviewing
Ruth G. Dotson, PA-C,
High Country Community Health, NC
$5,000 to promote treatment of underserved
patients with chronic hepatitis
Contribute Today at pa-foundation.org
3. ContentsJ U N E / J U LY 2 0 1 5 • V O L . 7 , N O . 6
Departments
President’s Letter
Stronger, together
Laws + Legislation
The Annals of Health Law takes a deep dive into
PA scope of practice
STAT
PA among Nepal earthquake victims; New Health
Affairs report on cost-effective care, access and PAs;
New study compares quality of care to CVD patients;
PA educators named Apple Distinguished Educators
Clinical Alert
Diabetes and eye health
Professional Practice
When to sign a contract with your employer
and how to negotiate it
In Print
“Working Stiff: TwoYears, 262 Bodies, and the
Making of a Medical Examiner”by Judy Melinek
Eating Well
Watermelon agua fresca
Reflections
A PA student’s perspective on the AAPA House
of Delegates
4
6
9
39
45
47
42
49
AAPA / Navigating Healthcare
Look for AAPA’s Navigating Healthcare icon to read
stories on the Affordable Care Act and the broader
changes impacting PAs in this rapidly changing
healthcare environment.
Visit our AAPA /Navigating Healthcare page
to see what else we are doing
for you.
Features
C O V E R S T O R Y
NASCAR Medicine
In the Fast Lane With PA Bill Heisel
F E AT U R E S T O R I E S
PA Vision 2010
It’s a Brand New World of Reimbursement
New AAPA Board of Directors
Pagel Elected President-Elect
15
33
25
COVER PHOTO BY CHRISTA L THOMAS
ABOUT THE COVER
PA Bill Heisel examines
a pit crew member
at Michael Waltrip Racing
in North Carolina
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 1
4. Swing For The Fences
PA JobLink has everything you need
to knock your career aspirations out of
the park:
• Search hundreds of jobs
• Get personalized email job alerts
• Upload your resume to easily apply
Step up to the plate at www.healthecareers.com/aapa
PAThe
6. PRESIDENT’SLETTER
President’s Letter
Stronger, together
F
or me, the day-to-day, in the trenches work—talking
with patients and caring for patients—that is what
being a PA is about. In my clinic in Taylorsville, N.C., I
see patients that are“Day 1”to those that are“as old as you
get.”On average, I see 25–40 patients per day—sometimes
more. It’s a tradeoff I am willing to make.
It’s one many PAs make. Our patients’visits run the
gamut. And, if you’re like me, a PA in family medicine, you
get to see multigenerational patients. Truly, that is the best
compliment you can get, isn’t it? When you see the young
child of a patient you once saw.
I was born in the Bronx, N.Y. I grew up in Long Island, N.Y.
You’re probably asking yourself,“How the heck did this
guy from the Bronx end up being a PA in a town of less
than 3,000 below the Mason Dixon line?”It’s simple, actu-
ally. It was love.
Both my twin brother and I fell in love with medicine
when we were in high school, working as paramedics in
Long Beach, N.Y. I saw you could truly affect change and
help people. Eventually, my brother and I made our way
to a Hickory, N.C. program for emergency medicine PAs.
Thirty some odd years later, I’m a PA, part owner of—and
full-time clinician at—a family medicine practice and
president of AAPA.
I’m excited to carry on the great work that has been
done to advance our profession. It’s been quite a year for
PA wins. I’m looking forward to more practice barriers
being shattered, more partnerships being created and
more progress being made for PAs and patients.
Currently, we’re working to expand care by pushing for
federal legislation that would authorize PAs to provide and
manage hospice care for their patients who are Medicare
beneficiaries. (Learn more about how you can help here.)
We also need to engage PA students and early career PAs
by providing them with leadership development opportu-
nities. And we need to continue to bolster the bonds
between AAPA and state PA groups, specialty organiza-
tions, caucuses and special interest groups.
I look forward to working on your behalf, and thank
you for all that you do as PAs for our patients and the
profession.
Jeffrey A. Katz, PA-C, DFAAPA
AAPA President and Chair of the Board
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 4
7. TRUSTED FOR OVER FOUR DECADES.
AHCMedia.com
PA Pricing So Low
We Can’t Even List It!
Ask for Details When
You Call or Email.
Sales@AHCMedia.com
800.688.2421
8. LAWS+LEGISLATION
Prestigious Law Journal Publishes
Perspective on PAs
Analysis of PA Scope of Practice
B Y A A PA S TA F F
T
he PA profession is a true healthcare innovation,
according to an article published earlier this year in
the prestigious Annals of Health Law, The Health
Policy and Law Review of Loyola University Chicago, pub-
lished by Loyola University Chicago School of Law’s Beaz-
ley Institute for Health Law and Policy.
“Access and Innovation in a Time of Rapid Change: Physi-
cian Assistant Scope of Practice”analyzes the evolution of
the profession over its first half century, and looks at the
various legal factors that have contributed to the increas-
ingly vital role PAs play in the delivery of healthcare. It was
written by a team of PAs and AAPA staff headed by lead
author Ann Davis, MS, PA-C, AAPA vice president of con-
stituent organization outreach and advocacy.
Published in March 2015, the 50-page article provides an
in-depth and exhaustive summary of the evolution of the
PA profession to date. The article describes the confluence
of circumstances that led to the profession’s creation,
including the need to expand access to care, and traces in
great detail the legislative and regulatory battles and suc-
cesses that have marked the gradual expansion of PAs’
scope of practice over five decades. It is an excellent
resource for anyone writing or researching about PAs and
a great tool for individuals or constituent organizations
(COs) looking to educate employers or legislators on
PA practice. The Academy has already heard numerous
accounts of COs utilizing the article in their advocacy
and outreach efforts.
The article also covers in some depth the changing roles
of PAs in today’s shifting healthcare world, including their
leadership roles in accountable care organizations and
patient-centered medical homes. The authors note that
PAs can enter the healthcare workforce quickly, and that
their flexibility allows them to adapt to meet workforce
needs across specialties and settings. They also point out
that PAs are well accepted by patients in today’s health-
care climate, and examine how to best increase patient
access to care through expansion of PA scope of practice
in the future. The article concludes that allowing PA scope
of practice to be determined at the practice level by
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 6
10. Your Life. Your Career. Your Partnership.
Caitlin Donahue, PA-C
Northwest Community Hospital
The providers at
CEP America cultivate
a team atmosphere.
We work together.
Everyone is on the
same level.”
“
Find out what makes CEP America different.
Hear Caitlin’s story by visiting: go.cep.com/caitlin
Why choose CME Resources’ PANCE/PANRE
Review Courses?
H 100% Guaranteed to Pass or Money Back**
H 98% Pass Rate
H Most frequently recommended course by Physician Assistants
H On-site practice exams with results broken out by sub-specialty
H The first PANCE/PANRE Review Course to offer Interactive Technology
** - See website for details
The Recognized Leader
in PANCE/PANRE Courses
The Original Chicago Course
Since 1996
CMERESOURCES.COM
• Our CME 5-day program offers
43 hours AAPA Cat 1 CME credits
• CMExpress is a concentrated
3-day - 26 hours Cat1CME credits
For more information or to register go to
www.cmeresources.com or call 800-522-3439.
2015 Dates & Locations
5-Day Course
Chicago June 1-5
August 3-7
August 19-23
December 7-11
Atlantic City June 15-19
Los Angeles July 15-19
Houston August 16-20
Philadelphia Aug. 29-Sept. 2
Las Vegas September 15-19
Boston Sept. 30-Oct. 4
Atlanta October 24-28
Washington, D.C. November 11-15
3-Day CMExpress
Chicago July 31-Aug. 2
Orlando June 12-14
Charlotte July 10-12
Las Vegas September 17-19
Boston October 2-4
Cleveland November 6-8
Las Vegas December 3-5
11. STAT | Industry News
AAPA REVISES MODEL STATE LEGISLATION FOR PAs
AAPA’s Advocacy Commission recently approved an update to the Academy’s Model State
Legislation for PAs (Model Law). The revisions were drafted by a diverse seven-member workgroup
of PA volunteers over the course of several months. Generally, the updates modernize the language
used to describe the profession and PA practice. Revisions include replacing the term“supervision”
with“collaboration.”
The improved Model Law can be viewed in full here, and will serve as a guide for states looking
to update PA laws and regulations. For more information, contact Ann Davis, MS, PA-C, AAPA vice
president of constituent organization outreach and advocacy.
PA EARNS INTERNATIONAL AWARD FOR WORK WITH FIRST RESPONDERS
Sue Swank-Caschera, MMS, PA-C, recently received
a national award at the International Critical
Incident Stress Foundation (ICISF) World Congress
on Stress, Trauma & Coping. She is the first PA to
earn the ICISF’s Susan E. Hamilton Award.
While working as a PA in psychiatry at
Geisinger Medical Center, Swank-Caschera
helped create a critical incident stress manage-
ment (CISM) team to assist hospital personnel in
times of stress. CISM teams work with individu-
als or groups in the public safety arena as well as
hospitals, schools, and other community organi-
zations.“CISM is a peer-driven process of support
and normalization of the stress response that
includes multiple forms of intervention,”
she said.
Swank-Caschera has led CISM teams in
Pennsylvania for more than 15 years. She was
actively involved with the response to the
TWA Flight 800 crash, and, along with the
Susquehanna CISM team, also provided support
at the 9/11 site in New York.
An assistant professor with the Pennsylvania
College of Technology PA program, Swank-
Caschera is a graduate of the Pennsylvania State
University PA program.
PA Sue Swank-Caschera
PA AMONG NEPAL EARTHQUAKE
VICTIMS
Our condolences and thoughts go out to the peo-
ple of Nepal and the family and friends of Marisa
Eve Girawong, PA-C. According to media reports,
she was climbing Mount Everest as the base camp
medic for a mountaineering company in April
when she was killed in an avalanche caused by the
massive earthquake that devastated the country.
She was 28.
She had participated in wilderness medicine in
the Everest region since 2014. Prior to that, she
was a PA in emergency medicine at East Orange
General Hospital in East Orange, N.J. A native of
Edison, N.J., she graduated from the Saint Francis
University Master of Medical Science Program in
collaboration with the John H. Stroger Hospital of
Cook County/Malcolm X PA program in Chicago.
PA Marisa Eve Girawong
PHOTOCOURTESYOFSUESWANK-CASCHERA
PHOTO:MADISONMOUNTAINEERING
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 9
12. STAT | continued
PA Elias Villarreal Jr. PA Sabba Quidwai
COST-EFFECTIVE
CARE, ACCESS
AND PAs
A new Health Affairs
report says fully inte-
grating PAs into the
delivery system can
help ensure access to cost-effective care across
the nation.
NEW GUIDELINES ON SMOKING
CESSATION RELEASED
The U.S. Preventive Services Task Force (USPSTF)
has posted a draft recommendation statement and
draft evidence review on behavioral and pharmaco-
therapeutic interventions for tobacco smoking ces-
sation in adults, including pregnant women.
FIRST SURVEY RELEASED ON PAs
AND NPs IN CRITICAL CARE UNITS
The first national survey on PAs and nurse prac-
titioners (NPs) in critical care units indicates that
several factors need to be considered when deter-
mining the optimal provider-to-patient ratio for
NPs or PAs in the ICU, reports an article published in
the American Journal of Critical Care. Researchers
believe survey results have implications for hospital
administrators and others on PA and NP utiliza-
tion, specifically staffing ratios for NPs and PAs that
affect the continuity of care.
PA EDUCATORS NAMED APPLE
DISTINGUISHED EDUCATORS
Elias Villarreal Jr., MPAS, PA-C, clinical associate profes-
sor and academic coordinator with the University of
Texas–Pan American PA program, and Sabba Quidwai,
MA, director of innovative education for the University
of Southern California PA program, were recently named
2015 Apple Distinguished Educators (ADEs).
Apple created the international distinction to recognize
educators for doing amazing things with Apple technol-
ogy in and out of the classroom. Out of thousands of
applicants worldwide, Villarreal and Quidwai were among
only 646 educators selected to receive the honor this year.
According to Apple, ADEs explore new ideas, seek new
paths and embrace new opportunities. They work with
each other—and with Apple—to bring innovative ideas
to students everywhere.
ADEs advise Apple on integrating technology into
learning environments—and share their expertise with
other educators and policy makers.
PAEA PRESIDENT ASKS
CONGRESS FOR $12 MILLION
FOR PA EDUCATION
PAEA President Stephane
VanderMeulen, MPAS, PA-C, testified
on Capitol Hill about the importance
of continued support for Title VII pro-
grams, which are the only source of funding that directly
supports PA programs. She specifically asked Congress to
increase funding to help strengthen PA education curricu-
lar innovation as well as faculty recruitment, development
and training. VanderMeulen is an assistant professor and
academic director at the University of Nebraska PA pro-
gram in Omaha, Neb.
PAs DELIVER SIMILAR QUALITY OF CARE
TO CVD PATIENTS AS MDs
Patients with chronic heart disease receive the same
quality of care from a PA or an NP as they would from a
physician, reports a new study published in the journal
Circulation: Cardiovascular Quality and Outcomes.
PAHX TOOLKIT FOR PA EDUCATORS
Teaching PA students about the PA profession’s history
just became easier. The PA History Society (PAHx) recently
released an educational toolkit for PA program faculty.
Designed to provide maximum flexibility in various for-
mats, from traditional lectures to individual study, the tool-
kit includes five modules and an instructor’s handbook.
For more information, contact the PAHx.
PHOTOSCOURTESYOFELIASVILLARREALJR.ANDSABBAQUIDWAI
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 10
13. STAT | continued
HAWAII PAs OBTAIN FULL
PRESCRIPTIVE AUTHORITY
Hawaii Gov. David Ige in April signed a rule autho-
rizing PAs to prescribe Schedule II controlled sub-
stances, giving Hawaii PAs full prescriptive author-
ity. The Hawaii Academy of Physician Assistants
(HAPA) worked closely with the Hawaii Medical
Board to achieve this measure and was persistent
in getting the rule adoption expedited after the
U.S. Drug Enforcement Administration’s reclassifica-
tion of hydrocodone combination products from
Schedule III to Schedule II.
Full prescriptive authority for PAs is consistent
with national standards and best practices and
brings Hawaii to having four of AAPA’s Six Key
Elements of a Modern PA Practice Act. Forty states
and the District of Columbia have full prescriptive
authority for PAs. The rule also increases the physi-
cian/PA ratio from two to four PAs at any one time.
AAPA applauds HAPA’s diligent work in achieving
these great improvements for PAs in Hawaii.
A PA who has been delegated the authority to
prescribe Schedule II–V medications must register
with the state’s Narcotics Enforcement Division.The
rule revisions became effective April 16. For more
information, please contact Keisha Pitts, JD, AAPA
director of constituent organization outreach and
advocacy.
IOWA GOVERNOR SIGNS PA
EMERGENCY COMMITMENT
Iowa Gov. Terry Branstad signed Senate File 201 into
law on April 17. The new law, a joint effort of the
Iowa Society of PAs and AAPA, is a giant leap for-
ward as it will allow PAs to communicate without
delay with a magistrate when a patient is a danger
to himself or others, and needs emergency invol-
untary hospitalization.
For years, PAs in Iowa were required by law to
obtain the consent of a“supervising physician
before ... [communicating] with the nearest avail-
able magistrate”concerning a patient in need of
emergency involuntary hospitalization. This extra
step, which is not required of psychiatric nurse
practitioners, is unnecessary for several reasons: PA
training and education include didactic and clinical
education in psychiatry; PAs must pass a national
certification exam covering a wide variety of medi-
cal subjects, including psychiatry; and psychiatric
emergencies deserve the same prompt treatment
as other emergencies.
ARMY SURGEON GENERAL’S 2015
PA RECOGNITION AWARD
Maj. John B. Robinson, U.S. Army, PA-C, is the recipient of the
Surgeon General’s 2015 Physician Assistant Recognition Award.
The award is presented to a PA who has made a significant con-
tribution to military medicine.
Robinson is assigned to the Combat Medicine Department,
Defense Medical Readiness Training Institute, under the
Education and Training Directorate, Defense Health Agency.
He received the honor for recognizing and addressing gaps in
medical care that have saved the lives of U.S. service members
and coalition partners.
Lt. Col. Jeffrey Oliver,
U.S. Army, PA-C, con-
sultant to the Army
Surgeon General,
(left) and Maj. John
Robinson, U.S. Army,
PA-C, (right).
PHOTOCOURTESYOFU.S.ARMY
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 11
14. STAT | continued
OKLAHOMA IMPROVES PA PRACTICE
Oklahoma took an important step to address the
health provider shortage when Gov. Mary Fallin
signed Senate Bill 753 into law in April. Under the
new law, PAs and physicians will be expressly
authorized to collaborate electronically. Under
current law, a physician is required to be on site
at least a half day per week.
Working together, the Oklahoma Academy of PAs
and the American Academy of PAs drafted legisla-
tion that eliminates this requirement and allows
practices to determine the extent of onsite super-
vision. Eliminating this requirement adds an addi-
tional key element to Oklahoma PA law that will
help increase the time PAs and physicians spend
treating patients. This brings Oklahoma’s total to
two Key Elements of a Modern PA Practice Act. The
new Oklahoma act also includes these provisions
that strengthen the PA-physician team:
• Allows frequency of chart review to be deter-
mined at the practice level (as approved by the
medical board)
• Establishes guidelines on how a PA may dispense
medications
• Allows what qualifies as a newly diagnosed com-
plex illness to be determined at the practice level
• Removes the requirement that PAs obtain certain
approval before practicing in remote settings.
FIRST CDC STUDY ON LATINO HEALTH
RISKS RELEASED
The Centers for Disease Control and Prevention
(CDC) released the first national study on Latino
health risks and leading causes of death in the
United States. The study showed that similar to
whites, the two leading causes of death in Latinos
are heart disease and cancer. Fewer Latinos than
whites die from the 10 leading causes of death,
but Latinos had higher death rates than whites
from diabetes, chronic liver disease and cirrhosis.
They have similar death rates from kidney diseases,
according to the new Vital Signs.
HHS ISSUES FINAL RECOMMENDATION FOR
COMMUNITY WATER FLUORIDATION
The U.S. Department of Health and Human Services
released the final recommendation for the optimal fluoride
level in drinking water to prevent tooth decay. The new
recommendation is for a single level of 0.7 milligrams of
fluoride per liter of water. It updates and replaces the pre-
vious recommended range (0.7 to 1.2 milligrams per liter)
issued in 1962.
INGIMAGE.COM
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 12
May 2015
www www.cdc.gov/vitalsigns
Hispanic Health
¡A la Buena Salud! – To Good Health!
See page 4
Want to learn more? Visit
Hispanics or Latinos are the largest racial/ethnic
minority population in the US. Heart disease and
cancer in Hispanics are the two leading causes of death,
accounting for about 2 of 5 deaths, which is about the
same for whites. Hispanics have lower deaths than
whites from most of the 10 leading causes of death
with three exceptions—more deaths from diabetes and
chronic liver disease, and similar numbers of deaths
from kidney diseases. Health risk can vary by Hispanic
subgroup—for example, 66% more Puerto Ricans smoke
than Mexicans. Health risk also depends partly on
whether you were born in the US or another country.
Hispanics are almost 3 times as likely to be uninsured
as whites. Hispanics in the US are on average nearly 15
years younger than whites, so steps Hispanics take now
to prevent disease can go a long way.
Doctors and other healthcare professionals can:
◊ Work with interpreters to eliminate language
barriers, when patient prefers to speak Spanish.
◊ Counsel patients on weight control and diet if they
have or are at high risk for high blood pressure,
diabetes, or cancer.
◊ Ask patients if they smoke and if they do, help
them quit.
◊ Engage community health workers (promotores
de salud) to educate and link people to free or
low-cost services.
About 1 in 6 people living in
the US are Hispanic (almost
57 million). By 2035, this
could be nearly 1 in 4.
1in6
Centers for Disease Control and Prevention
Office of Minority Health and Health Equity
Hispanics are about 50%
more likely to die from
diabetes or liver disease
than whites.
50%
Hispanic death rate is
24% lower than whites
(“non-Hispanic whites”).
24%
15. STAT | continuedPHOTOS:NORBERTVONDEGROEBEN
2015 AAPA Outreach and Advocacy Awards
The 2015 Outreach and Advocacy Award recipients were announced during the Constituent Organization
Leadership Forum at AAPA Conference 2015 in San Francisco on Sunday, May 24. AAPA President John
McGinnity, MS, PA-C, DFAAPA, presented the constituent organizations below with the awards and recog-
nized them for their outstanding achievements:
Oregon Society of Physician Assistants (OSPA)
2015 Award for Fostering PA Excellence
PROJECT:
Outreach and legislative advocacy with passage of SB1548
American Academy of Nephrology Physician
Assistants (AANPA)
2015 Award for Optimizing PA Practice
PROJECT:
Creating“Kidneys in a Box”PI-CME tool
Society of Dermatology Physician Assistants (SDPA)
2015 Award for Growing the PA Profession
PROJECT:
Melanoma awareness and advocacy for prevention
16. STAY ON THE ROAD TO
ICD-10
OCT 1, 2015
Official CMS Industry Resources for the ICD-10 Transition
www.cms.gov/ICD10
The ICD-10 transition will affect every part of your practice, from software upgrades, to patient
registration and referrals, to clinical documentation and billing.
CMS can help you prepare. Visit www.cms.gov/ICD10 to find out how to:
• Make a Plan—Look at the codes you use, develop a budget, and prepare your staff
• Train Your Staff—Find options and resources to help your staff get ready for the transition
• Update Your Processes—Review your policies, procedures, forms, and templates
• Talk to Your Vendors and Payers—Talk to your software vendors, clearinghouses, and billing services
• Test Your Systems and Processes—Test within your practice and with your vendors and payers
STEPS TO HELP YOU TRANSITION
Now is the time to get ready.
www.cms.gov/ICD10
So what are NCCPA exams really like?
Get an idea of what types of questions you’ll see on
PANCE, PANRE and the CAQ exams.
Learn more, and register for a practice exam!
www.nccpa.net/PracticeExams
National Commission on Certification of Physician Assistants | www.nccpa.net | 678-417-8100
PANCE and PANRE Practice
Exams (120 questions)
Practice questions for all exams are
taken directly from the actual test question
banks. These exams can help you:
• Assess your strengths and weaknesses
• Direct your study efforts towards
the areas that really need your time
and attention
• Put anxieties to rest
At just $35, the practice exams are preparation tools
you can’t afford to miss out on!
CAQ Practice Exams (60 questions)
Prepare for a CAQ Specialty Exam by
taking a practice exam offered in the
following specialties:
• Cardiovascular and thoracic surgery
• Emergency medicine
• Hospital medicine
• Nephrology
• Orthopaedic surgery
• Pediatrics
(Psychiatry available later this year)
NEW!
17. COVER STORY
NASCAR
MedicineIn the Fast Lane With PA Bill Heisel
BY NICHELE HOSKINS
PA Bill Heisel
PHOTOBYCHRISTAL.THOMAS
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 15
18. COVER STORY | continued
IT’S RACE DAY AT TALLADEGA and temperatures are in the mid-80s, sur-
prisingly warm for October. Bill Heisel, PA-C, stays hydrated and keeps up a
snappy pace alongside pit road.
Like the NASCAR fans, drivers and pit crews, he’s swept up in the Chase
for the NASCAR Sprint Cup, which is essentially the playoffs of stock car
racing. And since, next to football, NASCAR is the most popular spectator
sport in the United States, this is a big deal—the race results will determine
which eight cars will move on to the Eliminator Round.
So Heisel, wearing comfortable shoes and a red polo-style shirt embroi-
dered with an OrthoCarolina Motorsports logo, keeps moving from pit box
to pit box, looking for a thumbs-up or a wave-in to check on an injured pit
crew member.
Heisel’s an important contributor to the race scene. But he doesn’t
spend Sunday afternoon driving stock cars at nearly 200 miles an hour.
He’s not one of the guys jacking up cars, changing tires and pumping
fuel in the graceful, muscular car-eography that animates pit road.
Heisel’s the guy who takes care of the guys who take care of the cars.
A PA in orthopaedic surgery with a background in sports medicine, he
was working for OrthoCarolina in Charlotte when Ricky Hendrick, son of
Hendrick Motorsports owner Rick Hendrick, crashed in a race in Las Vegas
PHOTOBYCHRISTAL.THOMAS
PA Bill Heisel checks in with
a Joe Gibbs Racing pit crew.
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 16
19. COVER STORY | continued
and injured his shoulder. Heisel assisted in surgery and later collaborated with NASCAR
on altering the design of the seat inside the car to prevent similar injuries.
OrthoCarolina is the official provider of healthcare to the Carolina Panthers, the Char-
lotte Knights, the Chicago White Sox’Triple-A team, and about two-thirds of NASCAR’s
racing teams, including Joe Gibbs Racing, Hendrick Motorsports, Stewart Haas Racing,
Roush Fenway Racing and Richard Petty Motorsports.
And a good part of that is due to Heisel.
He came up with the idea to start OrthoCarolina Motorsports nine years ago, after he
proposed becoming the medical liaison between OrthoCarolina and the NASCAR
nurses who attend Camping World Truck Series, Xfinity and top-level Sprint Cup events.
He has run the growing, profitable specialty service line ever since.
“I didn’t start off with a passion for racing,”Heisel said.“I started off with the idea that
you can take sports medicine principles usually applied to stick-and-ball sports and
apply them to caring for pit crews and race teams. I went from knowing little to nothing
about NASCAR to basically drinking from a fire hydrant and learning a lot about the
engineering, the positions and basically learning how to speak the language.”
In July 2014 he went from spending 12 to 14 hours a day in other OrthoCarolina
duties, then working with the pit crews after hours, to being available to the crews all
day—every day.
The NASCAR season is the longest in all of sports and 38 racing weekends take a toll
on everyone, from the drivers and coaches to the pit crews. Couple that with the fact
that motorsports technology has evolved rapidly, and the physical demand it puts on
pit crews and drivers has increased significantly.
The injuries Heisel sees among the NASCAR patient population would be familiar to
anyone who specializes in orthopaedics or sports medicine. But with his generalist edu-
cation as a PA, Heisel also does a fair amount of preventive and family medicine.
“To maintain peak performance all season long, especially for our over-the-wall ath-
letes, it is critical to have proper recovery and preventative care, as well as access to
quick, efficient medical treatment,”said Michael Waltrip, founder of Michael Waltrip
Due in large part to
Heisel, OrthoCarolina
Motorsports now
provides care to
about two-thirds
of NASCAR’s racing
teams.
PHOTOBYCHRISTAL.THOMAS
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 17
20. “… You can take sports
medicine principles usually
applied to stick-and-ball
sports and apply them to
caring for pit crews and
race teams.”
—Bill Heisel, PA-C
Racing (MWR) and a two-time Daytona 500 champion.“OrthoCarolina Motorsports and Bill Heisel have pro-
vided MWR the perfect solution.”
OrthoCarolina has proven itself to NASCAR. But“most importantly, they are trusted by our employees,
which is what everyone needs when it comes to personalized care,”Waltrip added.
The Human Factor
The green flag whips over Talladega Superspeedway. The cars take their first laps, rumbling deep and loud
around the 2.66-mile oval. This is NASCAR’s longest track.
Stock car racing is a sport of highly visible technology and hardware, so it’s surprising how primal it is to
feel the almost tectonic rumblings of the speeding cars move up from your feet to your gut.
With these machines and their drivers in such prominent roles, pit crews could be easy to overlook, if
there weren’t so amazing to watch and if doing their jobs well weren’t sometimes pivotal to the outcome of
a race.
“The human element in racing is absolutely crucial,”Heisel said.“The average speed for a four-tire stop
four years ago was 14 seconds. Now it’s in the low 11s or high 10s. We have to keep guys as healthy as we
can. Human performance in pit crews buys positions on the track.”
The right crew can move a car up in the rankings while it’s standing still.
It was in the 1990s that NASCAR teams began to embrace the idea that races aren’t won
and lost on the racetrack alone. So they started moving away from training mechanics to pit
the car on race day and began teaching athletes—football players, baseball players, wres-
tlers—to pit a car.
Here’s a scenario: You’re a front tire changer. At your fastest and most accurate, you can
loosen five lug nuts in a single second; before one lug nut hits the floor, you’ve put a mean
air-gun spin on the next. Your car has a slight lead in a pack of the 10 cars. The driver and
several others in the top ten screech onto pit road for a four-tire change and fuel. You and
the rest of the crew are ready.
Your adrenaline is pumping. You hop over the wall, executing the steps you and the rest
of the crew have worked to perfect. But a few things go wrong: It takes the jack man an
STEPHANIECHESSONPHOTOGRAPHY
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 18
21. COVER STORY | continued
extra second to crank the car far enough off the ground for
you to change the tire. Despite your training, you miss the
fifth lug nut on the first tire. It slows your flow and the flow
of the rest of the crew, costing the team about two seconds.
“If you were first, you could fall to 20th on the basis of a
two-second mistake,”Heisel said. And if you were trailing,
someone else’s pit road error could move you closer to
the lead.
It’s a personnel sport, even though they’re driving a car,
said Donald D’Alessandro, MD, who practices in collaboration
with Heisel at OrthoCarolina.
“It’s always interesting to think about how critical a second
or a couple seconds is in the outcome of a race, and how
precisely they have to do it,”D’Alessandro said.“There’s so
much parity in the car themselves … that a lot of the difference in winning
and losing a race comes down to the person behind the wheel, the coach-
ing staff and the pit crew guys.”
According to Heisel’s bio, he works“under the supervision of”
D’Alessandro. But D’Alessandro, who says they’ve been friends and col-
leagues for 23 years, characterizes their working relationship as one of
cooperation and mutual respect.
“You think of a physician assistant as assisting the physician. But essen-
tially, I’m his backup,”D’Alessandro said.“He has earned everybody’s trust.
He also knows he has my support.”
Heisel assists in some surgeries, many of which are scheduled in the
brief off-season between November and February.
The Mayor of Pit Road
Each racing shop is a bit like its own ward or borough: proud, protective and
insular by design and competitive necessity. There are no guards or gates,
but folks are sensitive about the possibility of unauthorized images of the
cars in various states of repair and revision getting out onto social media
and into the wrong hands. Each shop is“very proprietary,”Heisel said.
But Heisel is one of the few people who can walk into Stewart-Haas
Racing in the morning, Joe Gibbs Racing in the afternoon and several oth-
ers in between—more evidence of the trust he’s earned.
“Moving between shops this easily is pretty rare,”he said.
He gets around easily among pit boxes on race day, too. Each box is the
pit road command center for each car. Nearby, the haulers—massive trail-
ers used to move tools, cars and other equipment from Charlotte to the
PHOTOBYCHRISTAL.THOMAS
From racing, PA Bill Heisel says OrthoCarolilna has had 1,700 paid office visits,
handled by 25 different PAs and 57 physicians.
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 19
22. FUELER
Lifts the 90-pound mobile fuel tank to the race
car and fits the nozzle into the fuel tank opening
on the inboard side of the car. Hands off or
tosses first of two cans back over the pit wall
and empties in a second can full of fuel. Each
can contains 12 gallons of fuel.
Compatible athletic types: Teams seek the
tallest fuelers. The taller the fueler, the sharper
the angle of the fuel tank and, presumably, the
faster the fuel will flow.
Common injuries: Lifting injuries to the back
and shoulders, as well as over-heating illnesses,
since fuelers’ fire suits and helmets are heavier
that those of other pit crew members.
AnatomyofaNASCARPitCrew
TIRE CARRIER
Carries 70-pound tires over the wall to tire
changers and hangs tire and wheel assembly
on studs attached to the brake rotor. The tire
carrier rolls the used tires back to the pit wall,
and then runs around to the other side of the
car to possibly make changes to the track
bar with a wrench inserted into the car’s rear
window. Also prepares new tires for use and
records tread wear and other data on tires
removed from the vehicle. There is a carrier in
the front and rear of the car.
Compatible athletic attributes: Agility, flex-
ibility and speed.
Common injuries: Hand and elbow injuries;
fingers crushed or snagged in tires
JACK MAN
Places the manual jack at the jack pin
screwed into the mid-point frame rail
of the car to raise each side of the car
for a tire change. May be called on to
help make handling changes to the car
or pull a rear tire.
Compatible athletic types: Upper
body strength and power
Common injuries: Back and upper
body injuries
TIRE CHANGER
Squats or kneels low to remove five lug
nuts with an impact gun, take off spent
tires and install fresh tires, then quickly
repeats on the other side of the car. For
stock cars, there is a changer in the front
and the rear of the car.
Compatible athletic attributes: Agility,
flexibility, speed, hand-eye coordination
and accuracy.
Common injuries: Hand and elbow inju-
ries; getting hit by the front of the car;
leg injuries
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 20
23. COVER STORY | continued
racetrack du jour—serve as another
communication center. Each pit box
has two levels: a viewing stand for
crew, guests and families on the
upper level and monitoring screens
and tools below.
The fire lane behind the pit boxes
is where fans bearing“hot passes”can
watch the race, and where crew
members roll dollies back and forth,
moving used tires and empty fuel
tanks and bringing in fresh supplies.
Between stops, a pit crew member
hands out pairs of earplugs to fans
nearby.
As part of his race-day rounds,
Heisel walks up and down pit road chatting with pit crews. Before the race he
gently palpates a tire carrier’s recovering wrist to test for pain. He steps up his
pace after each pit stop, which is when most injuries happen. Once the
cars pull away, he’ll catch the attention of a designated crew member in
the pit, looking for a thumbs-up indicating that all’s well or a sign that
someone needs medical attention.
At Talladega he stops to talk to Mark Armstrong, a tire changer for
BK Racing. He had been recovering from injuries to the latissimus dorsi
and serratus anterior muscles of his upper back. As with all but the
most serious injuries, Armstrong’s injuries had been managed with
meds and intense physical therapy.“Two stops under his belt and no
pain,”Heisel said.
High-Speed Healthcare
The Monday morning after race day comes fast, too. Moments after the race
ends, Heisel takes fast strides to get to his medical bag—a black, soft-sided car-
rier originally designed to carry fire suits. Inside, plastic containers with dividers
hold bandages and meds. He and the rest of the team members sprint to get to
a team plane, private but reportedly not glamorous, then fly back to Charlotte,
arriving late that night or, in the case of West Coast races, early in the morning.
After a few hours of sleep Heisel makes Monday rounds at the race shops at
Stewart-Haas Racing, Hendrick Motorsports, Joe Gibbs Motorsports, Roush Fen-
way and other team headquarters. He treats new injuries and attends to old one
that may have been aggravated.
Monday is recovery day for the pit crews, which can include stretching, ther-
apy and even yoga. Those who need it get checked, diagnosed, treated or
referred to specialists. Tuesday and Wednesday are spent reviewing tape, prac-
ticing and training. On Thursday the team flies to the speedway. There’s a day or
two of practice, race prep and interaction with fans—then Sunday is race day.
“You think of a physician
assistant as assisting the
physician. But essentially,
I’m his backup. He has
earned everybody’s trust.
He also knows he has my
support.”
—Donald D’Alessandro, MD
STEPHANIECHESSONPHOTOGRAPHY
PA Bill Heisel works on
Michael Waltrip Racing pit
crews on preventative
therapy, as well as post-
injury rehabilitation.
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 21
24. COVER STORY | continued
Whatever day it is, Heisel is there to manage whatever health issues might
slow down the pit crew. He sees plenty of hernias and kidney stones.“We get
our fair share,”he said.“This is the kidney stone belt,”citing the South’s love for
sweet tea and ice cream.
And because crews work, practice and travel in close quarters, a bad gut bug
can spread fast.
“You can have a GI virus and it can spread very quickly through an airplane,
airborne or from hand to mouth,”Heisel said.“These guys are walking down the
same aisles, patting each other on the back. Hand sanitizers help, but they’re no
match for three minutes at a sink with warm water, scrubbing.”
As team healthcare provider for six of the nine larger NASCAR teams, he also
provides care to all their employees. Heisel is the healthcare point person for
everyone from custodians to the drivers to team
CEOs to the 3-year-old son of an accounting man-
ager who fractures an arm during a weekend soc-
cer game.
He focuses on his orthopaedic specialty and can
treat most general complaints, but refers to spe-
cialists when needed.“I draw the line at cardiac
issues,”he said.“I don’t treat hypertension and
heart murmurs in race shops.”
Joe Gibbs Racing, the first team OrthoCarolina
Motorsports took on as a client, has about 250 employees, and another 350
dependents, Heisel said. Multiply that by six for each of teams the group works
for, give or take, and that’ll give you an idea of the scope of his practice.
Heisel is always on call. Always.
The Friday before the fall 2014 Talladega race, he got a call from a driver who
admitted to“doing something stupid.”He’d been riding on a parade float, yuck-
ing it up with fans, when he slipped and fell, aggravating the knee that had
recently been operated on.
“Most of them have my cell phone number. If they have a problem, they’ll
call. They know how to find me.”
The Pit and the Pendulum
Last September Stewart-Haas Racing made an unexpected move. The team
swapped the pit crews of Kevin Harvick, who drives the #4 car, and Tony Stew-
art, who drives #14. The idea was to put the best crew together with the best
driver in the building to increase the chances of winning.
Tire changer Ira Jo Hussey, a 19-year pit crew veteran, was one of the men
who made the move to Harvick’s #4 car.
Learn more about
PA Bill Heisel and
NASCAR online:
Local news segment
on PA Bill Heisel
Pit road procedures
Anatomy of a pit stop
Pit fitness
Pit crew in action
PHOTOBYCHRISTAL.THOMAS
PA Bill Heisel got to take the stage with driver Denny Hamlin,
of Joe Gibbs Racing, after he won the Sprint All-Star Race at
Charlotte Motor Speedway.
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 22
25. COVER STORY | continued
“Those guys (who moved to Tony Stewart’s crew) all got put together
last year. We’ve been together 4½ years. It’s definitely an advantage,”
Hussey said. The fastest a crew he’s been on has ever pit a car is 10.9 sec-
onds, he said.“Usually it’s 11.2 or 11.8.”
Hussey went from high school, where he ran cross country and played
football and basketball, to a pit crew. His goal had been to stay in the job
for 20 years but despite the long, 38-week-long seasons with no time to
fully recover, he feels optimistic, in large part because he feels healthy.“I
think I can go another five or six years, depending on how well I take care
of myself. Eventually I’m going to slow down and lose a step.”
It wasn’t too long ago that it was the physical wear and tear that would
dictate when a pit crew member bowed out of the business. Now, with the
help of the wrap-around care OCM provides, Hussey has choices.
Before packing himself up for a race in California, he packed up uniforms
for his daughter’s softball team; he’s a team coach.
“Now I’m thinking 25 years. If I hit 25 … I want to be around for those
weekends when we’re going to (softball) tournaments,”he said.“Besides
that, I don’t like flying.”
Moving the Needle
After Kevin Harvick’s win and the end of the season there was celebration.
Then for a few weeks Heisel pulled in his shingle to recover from the sea-
son, relax and spend time with his wife and daughter.
Although Heisel has worked with race shops for years, he’s only been
working fulltime with OrthoCarolina Motorsports since July 2014. And
being on call at all hours of the day“pisses my wife off to no end,”he said.
“I’ve missed some of my daughter’s events at her school. My family has
sacrificed a lot to make this go.”
But Heisel hopes to spend more time with his family next year—hiring
more staff to join his hard-working and talented team.
From racing, OrthoCarolina has had 1,700 paid office visits, handled by
57 different physicians and 25 PAs.“OrthoCarolina Motorsports is me doing
a lot of work, but also a collective group, a company-wide initiative I spear-
head. The success of the program is a direct reflection on those
professionals.”
The past year, Heisel was able to build infrastructure and experience.“As
next year comes in, and we obtain resources, we’ll be able to do this more
efficiently,”Heisel said.“It will allow me to get back to my family.”
He plans to hire a designated MRI scheduler and an administrative assis-
tant“to allow me to grow the business and provide the level of service
these guys require.”
NICHELE HOSKINS is a freelance writer based in
Washington, D.C. She regularly writes on healthcare
and fitness-related topics.
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 23
26. $350 PA Students
$425Physician Assistants
This program has been reviewed and is pre-approved for a maximum of 32 hours of
AAPA Category 1 CME credit by the PA Review Panel, 26 hours for three conference
days & up to 6 hours for optional workshops. Physician Assistants should claim only
those hours actually spent participating in the CME activity. This program was
planned in accordance with AAPA’s CME standards for live programs and for
commercial support of live programs.
www.CertMedEd.com
100%Guarantee
or your money back!
Chicago’s Original 100% Guaranteed
3-DAY CME & PANCE/PANRE Board Review
2015 3-Day Conferences
April 25 - 27 Orlando, FL
May 15 - 17 Des Moines, IA
May 15 - 17 Chicago, IL
May 18 - 20 State College, PA
June 5 - 7 Seattle, WA
June 8 - 10 Washington, DC
June 27 - 29 Salt Lake City, UT
August 28 - 30 Syracuse, NY
Sept 18 - 22 Chicago, IL (5 - day)
Sept - 18 - 20 Atlanta, GA
Sept 19 - 21 Denver, CO
Oct 12 - 14 Nashville, TN
Nov 21 - 23 Cleveland, OH
Dec 11 - 13 Las Vegas, NV
Conference Benefits
► 100% Money Back Guarantee
► ~ 99% Pass Rate
► Over 1,000 Practice Questions
► Up to 32 hours of Category 1 CME
$50 Discount
See
W
ebsite
Testimonials
“This course is by far the best, most detailed, and
most useful that I have yet attended. ”
- Lina Quan-Aston, PA-C - Family Practice
Very enjoyable 3-day class. It was affordable as
well as extremely informative! The material
covered was well organized and easy to learn!
Absolutely recommend to people recertifying or
first time PANCE takers."
- Nicole Polke, PA, Cheshire, CT
For more information and to REGISTER go to:
“By PAs, For PAs”
Program Director Michael Nowak, MPAS, PA-C, FAPACVS is
a PA Educator and clinician at the Mayo Clinic. His passion
for education has made Certified Medical Educators the
“GOLD STANDARD” in CME & PANCE/PANRE Board Review.
Certified Medical Educators
NEW PHARMACOLOGY CONFERENCES
Denver, Colorado Chicago, Illinois
See website for details
$295$295
NEW PROFESSIONAL
LAB COATS
SLIM FIT, SOPHISTICATED STYLE
AAPA MEMBERS
RECEIVE 15% OFF
ENTER CODE AAPAMEM15
AAT CHECKOUT
To place an order, visit
www.medelita.com
27. It’s a BRAND
NEWWORLDValue-Based Reimbursement Means Opportunities for PAs
BY STEVEN LANE
AMERICAN HEALTHCARE IS IN THE MIDST OF ANOTHER
PROFOUND TRANSITION.The way providers are reimbursed for
their care is changing rapidly, and it seems certain to change even more
in the next two or three years. The transition from fee-for-service to fee-
for-value reimbursement means that providers will increasingly be paid
for their contribution to patients’health outcomes (value), rather than on
how many patients they see or how many tests they order (volume). And
these changing incentives will drive changes in the way they practice
medicine.
A lot of new terms are in the air. Fee for value. Value-based reimburse-
ment. Accountable care organizations (ACOs). Value-based care. Pay for
performance. Bundled payments. Shared savings.
What does it all mean for PAs?
At this point, it seems fair to say there is a great deal of uncertainty out
there, and many unanswered questions. How will quality be measured?
How will budgets be set for bundled payments? How will differences in
patient acuity of illness be taken into account when holding providers
accountable for treating diabetes or congestive heart failure? If your
patient is noncompliant or another provider does something that puts
your patient back in the hospital, will you get dinged under a bundled
payment arrangement?
The first in a four-part series, this article will take a look at the current
status of the transition to value-based reimbursement (VBR) and provide
some thoughts on what to expect from PAs who are already in the thick of it.
While change and uncertainty are always unsettling, the good news is
that the transition seems to offer some genuinely exciting opportunities
for PAs. In fact, in some ways, value-based care seems tailor-made for the
profession. It will reward teamwork and communication, and may allow
many PAs, especially in primary care, to“return to their roots”—to spend
more time with patients and to focus more on education and prevention.
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 25
28. What Is Value-based Reimbursement?
Under value-based reimbursement, providers are reimbursed based on the health out-
comes of their patients, rather than on the volume of patients they see. VBR puts more
of a burden on helping patients get better, and on helping them not get sick in the first
place. A typical arrangement is that an insurance company gives a practice a certain
amount of money per patient per month for the care of a particular patient population.
This gives the practice a financial incentive to keep those patients as healthy as possible
and therefore to maximize their share of the money.
This is similar in many ways to the capitation arrangements that were common in the
1980s and‘90s, but with a new wrinkle: To counteract the incentive to cut corners on
care to save money, VBR puts a new emphasis on quality. This is part of the so-called
“triple aim”: improving the patient experience of care (including quality and satisfaction),
improving the health of populations, and reducing the per capita cost of healthcare.
How to define and measure quality, how to determine the amount of the payment,
how to define patient populations, and how to adjust for the relative risk of populations
with different levels of baseline health are among the many questions that are currently
being explored.
What Is Driving the Change?
Fundamentally, the change is being driven by the rapidly rising costs of healthcare.
While there is disagreement on how to fix it, there is widespread consensus that the
cost of healthcare in the United States is simply becoming unsustainable.
Some quick facts: The United States spent nearly $3 trillion on healthcare in 2014. Per
capita, this comes to nearly $10,000 a head, an amount projected to rise to $14,000 by
2021. America spends more than twice as much per person on healthcare as the aver-
age of other developed Western nations, (as shown in the chart on the next page). And
these expenditures are eating up a larger and larger share of the nation’s resources: the
United States now spends nearly 18 percent of GDP on healthcare, up from 13% as
recently as 2000.
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 26
30. 1 One step at a time.
Not every area of medicine will move immediately to VBR; some proce-
dures and problems lend themselves to this form of reimbursement more read-
ily than others. Procedures like joint or heart valve replacements, which are rela-
tively self-contained and have fairly clear start and end points, are among the
first for which VBR is becoming common. Hospital readmission rates for these
and other procedures are one easily measurable way to hold providers account-
able for quality of care.
Heidi Felix, chief PA for a level 2 trauma center in the Allegheny Health
Network, adds:“There has been a big push toward looking at catheter
line infections and skin breakdowns from pressure sores. We have to fill
out all kinds of forms: Why does the patient still have a central line? Why
does she still have a Foley catheter? How long has the patient been on
a ventilator?”
The other major area in which VBR is being adopted early is in control
of conditions like diabetes or hyperlipidemia at the population level.
Shock describes a typical setup like this:“If I am ABC Healthcare with
10,000 patients, I can enter into a contract with XYZ Insurance to manage
those patients at a lower cost. They say,‘We’ll give you x dollars per
month per patient,’so now I have the resources to hire a dietician to help
me manage this disease and improve diabetic outcomes for my patients.”
2 Information technology will be crucial.
IT will be central to VBR because showing“value”requires
tracking enormous amounts of data and being able to demonstrate
outcomes.
“Technology is key,”says Lori Beane, a PA in primary care at Corner-
stone, a multispecialty group in North Carolina.“You have to know where
you stand on the metrics.”The IT system at Beane’s practice, along with
the efforts of a team of patient care advocates, allows her to greatly
reduce the number of patients lost to follow-up—the system reminds her what
to go over with a patient on each visit: to make sure vaccines are up to date, that
diabetics are getting their eye and foot exams—and to reduce duplication of
tests.“They’re not going to have another mammogram if they don’t need it
because we will know they’ve already had one,”she says. And the system can
generate hundreds of different reports, which allow providers to document
health outcomes and quality of care.
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 28
31. 3 IT and other costs will drive practice integration.
The move to VBR is driving integration at the practice and health sys-
tem level, where the investment required to set up the IT and electronic medical
records (EMR) infrastructure needed to successfully adapt to the VBR world will
require deeper pockets than most smaller practices have. The McKesson report
notes that“without the appropriate investments in contemporary health IT that
enables value-based care, existing systems will be pushed beyond the breaking
point, and administration of these models will exceed the human capacity to
fund and manage them.”And these investments can typically only be made by
larger practices and health systems, part of the reason for the huge numbers of
healthcare mergers witnessed in recent years.
“Small and medium-sized practices will increasingly join together or be pur-
chased by hospitals or regional healthcare systems,”Powe says.“We expect to
see a lot more consolidation and integration.”
4 Teamwork will be more important than ever.
Integration will also be happening on the team level, where a broader
range of professionals may be involved in a patient’s care, including dieticians,
counselors, patient care advocates and scribes. And this will help relieve the
burden on PAs, according to Shock:“The team can shoulder the administrative
responsibility together, rather than putting it all on the provider. As a primary
care provider, I’ve been asked to do more and more in that 15-minute visit. In a
value world the reimbursement is different. You might be able to put resources
in to a dietician or a mental health counselor. In the fee-for-service world, you
might have had all that on your plate. Now you can share the load.”
“Our practice is definitely much more integrated,”adds PA Alisha DeTroye,
director of transitional and supportive care at Wake Forest Baptist Health.
“Patient care is being delivered by a multi-disciplinary team of physicians, PAs,
NPs, nurse navigators, social workers, community health workers, dietitians and
pharmacists. There is also greater emphasis on relationships with community
partners, such as home health agencies, skilled nursing facilities and other post
acute care providers.”
5 Using data to your advantage will be key.
The pervasiveness of IT systems, and the need to document quality and
metrics, will empower those who know how to collect and use data. PAs and
other providers will need to learn the systems and procedures put in place by
hospitals and health systems, of course. But they will also need to know how to
gather and use data to make the case for their roles in the system.
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 29
32. PAs need to be able to go to administration with data in hand, says Felix.
“You need to be able to say,‘Since we’ve added PAs, length of stay has gone
down, line infections have gone down, patient satisfaction scores have
gone up.’We need to get this data. There is a really good opportunity for
PAs to forge a leadership role.”
Felix recommends seeking out partners to help you make the best use
of data you can.“Talk to service line administrators, who are repositories for
data,”she says.“Seek out individuals in Academy. If you are in an academic
medical center, there will probably be statisticians and researchers around.
Partner with PA programs and academic faculty; they might be trying to
figure out what the research opportunities are.”
6 Providers will be able to spend more time
with patients.
For many PAs, the move to VBR, and the expanded teams that it requires,
will allow them to go back to spending more time with patients. Scribes,
patient care advocates and other support staff can take care of much of
the administrative work that many providers now do. DeTroye notes that
“there are a lot of advantages to value-based healthcare. In the past we’ve
been expected to see a certain number of patients per day; now, because
we will be paid on value rather than productivity, there is an opportunity
to be more patient centered. PAs can focus on educating patients and their
families as well as relationship building.”
Shock agrees:“We should be able to enjoy the practice of medicine and
take back some of the reason we went to school in the first place, by lever-
aging all the members of the team. By spending less time on the nonreim-
burseable tasks, we will have more time to enjoy direct patient care.”
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 30
33. PA Vision 2020 | continued
STEVEN LANE is a senior writer for AAPA
and managing editor of PA Professional.
7 VBR presents a real opportunity for PAs.
The PAs interviewed for this story all agreed that the transition
presents a golden opportunity for PAs.“I live it every day,”says Shock.“And
I see this as a time of tremendous opportunity for PAs. We’ve been saying
for years that PAs practice coordinated, team-based, cost-effective care. So
now its time to show what we can do in a system that will truly value these
things.”
“PAs are going to be a major part of the solution to the problem,”adds
DeTroye.“There should be increased job opportunities for PAs, especially in
primary care settings. PAs need to continue our advocacy efforts to make
sure we are included in all appropriate legislative decisions that expand
our practice in this changing healthcare environment.”
8 PAs need to help shape the new system.
So much aboutVBR is still“to be determined”and, as DeTroye notes,
PAs need to seize the opportunity to be at the table when key decisions are
being made and rules being written. Felix, Shock and others encourage PAs
to find ways to get involved in their institutions, get themselves on commit-
tees, do research, take on leadership roles.“As we transition into more team-
based care we need data to show what PAs are doing,”says Felix.“We need
to pinpoint the highly functioning PAs that can take on the leadership roles.
And we need to help write the rules that will affect how we all work in the
next few years.”
While there is still plenty of uncertainty about what the healthcare land-
scape will look like in a few years, and while fee-for-service reimbursement
will likely never go away entirely, it seems clear that the move towards
value-based reimbursement is past the point of no return, and that it
represents a tremendous opportunity for PAs.
Join the Discussion
AAPA members interested in discussing this healthcare trend, and how
it affects PAs, are encouraged to join the discussion in our new mem-
bers-only online community, the Huddle. This new resource is for PAs
and PA students to share ideas, discuss challenges, post questions,
search for other PAs, and more.
The Huddle officially launches later this month, but you can get an
early start by logging in with the same username/AAPA ID and pass-
word that you use for aapa.org.
From now through October, you can weigh in on separate discussions
on each trend. The discussions will be summarized and provided to the
AAPA Board of Directors for consideration in developing the Academy’s
2016-2020 Strategic Plan.
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 31
34. What else
could be
going on?
Using the Isabel Diagnosis
Decision Support tool assists
in answering this question.
Isabel helps broaden your differential and provides access to evidence-based reference
material to get to the right diagnosis and treatment sooner. Whether on a desktop or
your mobile device- Isabel is available where and when you want it.
To learn more about Isabel click here: www.isabelhealthcare.com
Isabel is offered to AAPA members at a discount! To receive the discount visit the
member’s only section and click the Isabel link
MPAS Degree Advancement Option
Division of Physician Assistant Education
Requirements
§ Graduate of accredited PA program and possess
a baccalaureate degree
§ Current or prior NCCPA certification
§ Physician/Mentor who agrees to be your preceptor
Learn more and apply at:
unmc.edu/alliedhealth/padao.htm | 402-559-6673
Program Highlights
§ Over 30 years of proven success granting
master’s degrees to nearly 2000 practicing PAs
§ 36 semester credit hours of courses including
a clinical or education track
§ Affordable program with no required resident
time on the UNMC campus
§ Graduate in 5 semesters with up to 5 years to
complete studies
35. Katz Leads AAPA’S 2015-16 Board of Directors
A
APA’s 2015-16 Board of Directors began their new term on July 1. The
14-member leadership team, led by Jeffrey A. Katz, PA-C, DFAAPA,
includes both new and veteran members from a variety of practice set-
tings and geographic locations. Katz, a family practice PA from Taylorsville, N.C.,
will serve as chairman of the Board of Directors as well as president of AAPA. As
the volunteer leader of the Academy, Katz serves as AAPA’s spokesperson.
Josanne Pagel, of North Ridgeville, Ohio, was recently elected AAPA
president-elect. Pagel will serve as president-elect for one year before assuming
the duties of AAPA president and chair of the Board. She previously held the
position of secretary-treasurer.
Laurie Benton of Temple, Texas, and Dave Mittman of Boynton Beach, Fla., are
newly elected directors-at-large. Diane Bruessow, of Middle Village, N.Y., was
re-elected to a second term as director-at-large. The directors-at-large will serve
a two-year term ending June 30, 2017.
L. Gail Curtis (vice president and Speaker of the House of Delegates), David
Jackson (first vice speaker), and Bill Reynolds (second vice speaker) were all re-
elected to their positions at the May 2015 House of Delegates (HOD) meeting in
San Francisco. Each will serve a one-year term.
Elizabeth Prevou, currently residing in Washington, D.C., also joins the Board
of Directors for a one-year term as student director.
Get to know your Board better through the brief bios provided below. For
more detailed information, visit the Board page of the AAPA website.
President and Chair of the Board
Jeffrey A. Katz, PA-C, DFAAPA,
assumes the leadership reins after
serving in the House of Delegates and
on the Board as director-at-large. He
sits on the Board’s Executive, Finance,
Internal Affairs and Executive Compen-
sation committees. Katz is a practicing
PA at the Family Care Center in Taylors-
ville, N.C., a certified rural health clinic
of which he is part owner. Prior to his
family practice, Katz was a clinician in both urology and emer-
gency medicine. He has been a practicing PA for 35 years.
During his tenure as president, Katz intends to continue the
focus on three key areas of AAPA’s Strategic Plan:
■ Removing PA practice barriers, particularly those involving
Medicare patients
■ Positioning PAs to lead team-based, patient-centered positive
outcomes in the rapidly changing healthcare environment
■ Enhancing student and early career engagement to support
the next generation of Academy and clinical leaders.
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 33
36. New BOD | continued
Immediate Past President
John G. McGinnity, MS,
PA-C, DFAAPA, has served
AAPA in various leadership
capacities over the past two
decades, including as a mem-
ber of the Board of Directors,
the House of Delegates and
the Conference Education and
Planning Committee. McGinnity currently serves on
the Editorial Board of JAAPA, the Executive, External
Affairs and Executive Compensation committees of
the Board and the Commission on the Health of the
Public. Based in Attica, Michigan, McGinnity is the
program director of the Department of Physician
Assistant Studies at Wayne State University in
Detroit. Clinical areas of expertise include cardiology
and home health care.
President-elect Josanne K.
Pagel, MPAS, PA-C, Karuna
RMT®, DFAAPA, was twice
elected as the Academy’s
secretary-treasurer prior to
her recent election as presi-
dent-elect. She serves on the
Board’s Executive, Finance,
External Affairs and Executive
Compensation committees. Pagel is a long-time
volunteer leader in both the national organization
and the Ohio Academy of Physician Assistants.
Based in North Ridgeville, Ohio, Pagel is the execu-
tive director of physician assistants at the Cleveland
Clinic Health System. She has worked in various
medical disciplines, including CT surgery, family
practice, psychiatry and addiction medicine.
Vice President and Speaker
of the House of Delegates L.
Gail Curtis, MPAS, PA-C,
DFAAPA, has been elected by
the members of the HOD as
Speaker for three consecutive
years. She serves on the
Board’s Executive, Finance,
Internal Affairs and Executive
Compensation committees. Based in Winston
Salem, N.C., Curtis is vice chair and associate profes-
sor in the Department of PA Studies at the Wake
Forest University School of Medicine. Her clinical
areas of expertise include substance use disorder,
otolaryngology, weight management and PA pro-
fessional regulations.
First Vice Speaker David I.
Jackson, DHSc, PA-C,
DFAAPA, has served for many
years on the Board and in the
HOD where he chaired the
Reference Committee and the
House Standing Rules Com-
mittee. Jackson serves on the
Board Internal Affairs Commit-
tee and was recently appointed to the PA Founda-
tion Board of Trustees. Based in Huntington Station,
N.Y., Jackson is associate professor, clinical coordina-
tor, director of admissions and student society fac-
ulty advisor at the New York Institute of Technology
Department of Physician Assistant Studies. He is also
part of the adjunct faculty of the Pace University
and the Long Island University PA programs. Jack-
sons’clinical experience includes primary care, occu-
pational health and emergency medicine.
Second Vice Speaker William
T. Reynolds Jr., MPAS, PA-C,
DFAAPA, has served in a vari-
ety of leadership positions at
both the Pennsylvania Acad-
emy and AAPA. Previously he
chaired the House Reference
and Standing Rules commit-
tees. He serves on the Board’s
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 34
37. New BOD | continued
External Affairs Committee. Reynolds is the clinical
director and an associate clinical professor in the
Department of Physician Assistant Studies at King’s
College in Wilkes-Barre, Pa. Reynolds has practiced
in general pediatrics and family medicine at the
Rural Health Corporation of Northeastern Pennsyl-
vania for 20 years.
Director-at-Large Laurie E.
Benton, PhD, MPAS, PA-C,
RN, DFAAPA, was elected to
the Board in the 2015 general
election. She is a recognized
leader through her volunteer
positions at the state and
national level with organiza-
tions such as the National
Kidney Foundation and the American College of
Surgery’s Task Force on Patient Safety Education.
Benton serves on the Board’s Internal Affairs Com-
mittee and the Research and Strategic Initiatives
Commission. Based in Temple, Texas, Benton over-
sees nearly 400 PAs and NPs as System Director of
Advanced Practice Professionals at Baylor Scott and
White Health, the largest nonprofit healthcare sys-
tem in Texas. Clinically, she has practiced in nephrol-
ogy and in cardiovascular surgery.
Director-at-Large Diane M.
Bruessow, PA-C, DFAAPA,
was recently re-elected for a
second term as director-at-
large. Bruessow has held
multiple appointed and
elected positions in AAPA and
its constituent organizations.
She currently chairs the
Board’s External Affairs Committee and serves on
the Finance Committee. Based in Middle Village,
N.Y., Bruessow has long advocated for improving
health outcomes for medically underserved popula-
tions by expanding healthcare access through effec-
tive utilization of PAs.
Director-at-Large David E.
Mittman, PA, DFAAPA, was
elected to the Board in the
2015 general election. He
previously served on the
AAPA Board in the early 1980s.
Mittman serves on the Board’s
External Affairs Committee
and the Advocacy Commis-
sion. He practiced in primary care in Brooklyn for
nearly a decade before moving into a career in med-
ical publishing and writing, including the founding
of Clinician Reviews. He is currently the editor-in-
chief of Clinician1.com and is a certified life coach.
Director-at-Large Lauren G.
Dobbs, MMS, PA-C, served in
the House of Delegates and
on various AAPA work groups
before her election to the
Board in 2014. She serves on
the Board’s Internal Affairs
Committee and the Commis-
sion on Continuing Profes-
sional Development and Education. Based in Fort
Worth, Texas, Dobbs is an assistant professor at the
University of North Texas Health Science Center.
In addition to her clinical and academic work in
pediatric medicine, Dobbs is an active champion
of childhood literacy and the Reach Out and Read
Program.
Director-at-Large Michael C.
Doll, MPAS, PA-C, DFAAPA,
FAPACVS, has served the
Academy and the Association
of Physician Assistants in Car-
diovascular Surgery in numer-
ous leadership positions over
the past two decades. He is
currently serving his second
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 35
38. New BOD | continued
term on the BOD and chairs the Internal Affairs
Committee. Based in Berwick, Pennsylvania, Doll is
the Chief PA of Cardiothoracic Surgery at the Geis-
inger Medical Center. He is a strong proponent of PA
education at every level. He has extensive experi-
ence as a preceptor, university professor and CME
program chair, and lectures at both national and
international conferences.
Student Director Elizabeth
R. Prevou, MPH, MSHS, PA-C,
also serves as the president of
the Student Academy of AAPA
(SAAAPA). She serves on the
AAPA Board’s Internal Affairs
Committee. Prevou is a recent
graduate of the PA/MPH pro-
gram at The George Washing-
ton University, in Washington, D.C. Growing up in a
military family fostered a love a travel, which has
shaped her aspirations to couple cultural diversity
with hands-on medical practice. She works in com-
munity-oriented primary care in Washington, D.C.
CEO Jennifer L. Dorn, MPA,
joined the AAPA in 2011, brin-
ing 30 years of management
experience to the Academy’s
leadership team. Dorn has led
multi-billion dollar federal
agencies, start-ups and well-
established nonprofit organi-
zations. She has served as the
U.S. representative on the Board of Directors of the
World Bank, administrator of the Federal Transit
Administration, assistant secretary for policy at the
Department of Labor and associate deputy secre-
tary of transportation. Her nonprofit leadership
posts include senior vice president of the American
Red Cross, president of the National Health
Museum, and service on a number of boards.
NOTE: At the time of publication, the secretary-
treasurer vacancy has not been filled.
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 36
39. Protect your pets!
Veterinary Pet Insurance® provides affordable
pet health coverage from preventive care to
significant medical incidents.
Veterinary Pet
Insurance®
The #1 choice in
America for pet
insurance
You Support. You Save. | www.aapa.org/memberhome
Plans to fit your needs and your budget, 10-day,
100% money-back guarantee
Save 5% on coverage for your pet, plus
additional savings for multiple pets
Visit any veterinarian - even specialists and
emergency providers
Neurosurgery Advanced Practitioner Opportunity
Charlotte Metro Area
Outstanding opportunity for an experienced Advanced Practitioner to join an established single specialty
Neurosurgery practice in Gastonia, NC, located just outside of Charlotte, one of the fastest growing cities
in the country. This opportunity will involve primarily outpatient responsibilities with limited inpatient
responsibilities and call coverage at the hospital will be one in four. Caromont Regional Medical Center is a
435-bed comprehensive and progressive hospital with state of the art ORs and Cath labs and an active medical
staff of over 350 physicians representing all medical subspecialties including established surgicalist and
intensivist practices. This will be an employed opportunity and will offer a competitive compensation package
including salary guarantee, paid time off, generous benefits and CME and relocation allowance.
Located just minutes from an international airport and uptown Charlotte, the area offers amenities of any large
metropolitancityincludingtheperformingarts,professionalsportsandupscaleshoppinganddiningwhileproviding
residents of Gastonia the benefits of living in a small, family oriented community with lovely neighborhoods and
good choice of public and private schools. If interested in being considered for this opportunity, please complete
online application @ www.caromonthealth.org or send CV to Celia.Billings@caromonthealth.org.
Advertise with us!
40. Now every issue of PA Professional can be found
in one convenient library. Locate that helpful
reimbursement article you read in last month’s
edition in a matter of seconds.
And because PA Pro is digital, it’s even easier to
access and share!
It’s easier than ever to find career
and practice news just for PAs.
App
I n t r o d u c i n g t h e n e w
EverEvolving,
EverEducating
WhatPAEducation
LooksLikeNow
THELEADINGNEWSRESOURCEFORPHYSICIANASSISTANTS
APRIL2014
Bookmark articles.
Download them
to your device.
Share on social media.
Read your PA Pro
anywhere, anytime
– even offline.
41. CLINICALALERT
NEYAL J. AMMARY-RISCH, MPH,
MCHES, is the director of the
National Eye Health Education
Program at the National Eye
Institute at the National Institutes
of Health.
Helping Patients With Diabetes
Keep Their Eye Health on TRACK
What PAs Can Do to Prevent Vision Loss and Blindness
B Y N E YA L J . A M M A R Y - R I S C H , M P H , M C H E S
P
atients with diabetes are at risk of developing dia-
betic eye disease—a group of eye complications
that include diabetic retinopathy, glaucoma and
cataract—all of which can lead to vision loss or blindness.
All people with diabetes, whether type 1, type 2 or gesta-
tional, are at risk. The longer a person has diabetes, the
more likely he or she is to develop diabetic eye disease.
Controlling glucose levels, blood pressure and cholesterol
are among the best things patients can do to delay the
onset or progression of diabetic eye disease, especially
diabetic retinopathy, the most common form, which dam-
ages the blood vessels in the retina.
Living with vision loss or blindness can dramatically
impact a person’s quality of life and ability to self-manage
his or her disease. With the prevalence of diabetes con-
tinuing to rise, rates of vision loss from diabetic eye dis-
ease also continue to increase, causing a major concern
for public health. In fact, diabetes is the leading cause of
new cases of blindness among adults ages 20–74 years,
with diabetic retinopathy causing 12,000 to 24,000 new
cases of blindness each year, according to the National
Diabetes Statistics Report.
Early Diagnosis Can Prevent Loss of Sight
Diabetic eye disease often has no symptoms in its early
stages. Most people do not experience vision problems
until the disease reaches an advanced stage. Since people
often seek eye care only when they begin to notice vision
problems—and do not have an annual comprehensive
dilated eye exam as recommended in healthcare guide-
lines—many are diagnosed when it is too late for treat-
ment to be effective and vision loss often cannot be
restored.
But there is good news: Early diagnosis, treatment and
appropriate follow-up care can prevent or delay severe
vision loss in more than 95 percent of patients with dia-
betic eye disease. You can be instrumental in helping
patients with diabetes protect their sight by asking them
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 39
42. CLINICAL ALERT | continued
during appointments if they’ve had their yearly comprehensive dilated eye
exam and making referrals to an eye care provider as appropriate.
PAs Play a Powerful Role in Patients Seeking Eye Care
Your patients rely on you for information to help them manage all aspects
of their health. As a PA, you are in a unique position to talk with patients
with diabetes about their visual health and make recommendations to get
a comprehensive dilated eye exam at least once a year. A nationwide survey
conducted by the National Eye Institute (NEI) and the Lions Clubs Interna-
tional Foundation underscored the value of a health practitioner’s recom-
mendation. The survey found that 96 percent of U.S. adults would be
somewhat or very likely to have their eyes examined if a primary care pro-
vider suggested they do so.Even without specialized training in ophthal-
mic care, you can positively affect your patients’eye health by encouraging
them to get a yearly comprehensive dilated eye exam and to engage in
other healthy behaviors that can keep their diabetes in control and pre-
vent or slow the progression of diabetic eye disease.
Five Steps to Help Patients with Diabetes Stay on TRACK
In addition to talking to patients about getting an eye exam each year, you
can also remind them to keep their eye health on TRACK by: Taking their
medications; Reaching and maintaining a healthy weight; Adding physical
activity to their daily routine; Controlling their ABCs—A1C, blood pressure
and cholesterol; and Kicking the smoking habit.
Resources to Keep You Focused on Eye Health
The NEI’s National Eye Health Education Program (NEHEP) has a variety
of science-based educational resources you can use with patients in
your practice and in your community. The brochure Eye Disease Facts for
Physician Assistants provides at-a-glance information about major eye dis-
eases and how to identify patients at higher risk. Teaching tools, such as
the Diabetes and Healthy Eyes Toolkit and Diabetic Eye Disease: An Educator’s
Guide, can help you provide information to patients about the eye compli-
cations of diabetes and the importance of comprehensive dilated eye
exams. NEHEP also has a new dilated eye exam animation that shows a
patient what a doctor sees during an exam. Additionally, brochures, tip
sheets, infocards and infographics are available, as well as live-read scripts
that can be recorded for phones when patients are on hold and a patient
education website that can be linked to at www.nei.nih.gov/diabetes.
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 40
43. Connect with top employers from around the country looking to hire
physician assistants from the comfort of your home or office.
Network, make contacts and find the job that’s right for you!
AAPA Virtual Career Fair
Wednesday October 7, 2015
12:00pm - 3:00pm EDT
Register Here
www.peptools.com
44. PROFESSIONALPRACTICE
JENNIFER ANNE HOHMAN is
founder and principal of PA Career
Coach, a service dedicated to
helping PAs create rewarding,
healthy and patient-centered
careers.
To Sign or Not to Sign
When to Sign a Contract With Your Employer and How to Negotiate It
J E N N I F E R A N N E H O H M A N
I
s it always in a PA’s interest to have an employment
contract? Are there some situations in which it is bet-
ter to go without one?
The answer to this question depends on the contract
itself. Contracts create a blueprint for the terms of an
employment relationship, and can do so to your benefit
or detriment. Depending on what a contract stipulates, it
can help secure fair compensation and a livable sched-
ule—or the opposite.
I’ve spoken to many PAs over the years who regretted
signing contracts that included elements contrary to
their professional well-being: career-limiting restrictive
covenants or unrealistic schedules being common prob-
lem areas. At the same time, I have also spoken with
many who accepted a position with a handshake and no
written agreement who discovered that important pro-
fessional benefits they were promised never materialized
and in some cases were denied having been offered. So
how do you tell if it is better to sign or not to sign?
Why it generally pays to have a written,
negotiated contract
Key word: negotiated. A contract is only as helpful to
your career as your interests have been negotiated into
it. Contracts are conduits of power in an employment
relationship, and it’s essential that your point of view be
strongly represented in the contract, to help keep it
mutually beneficial. My recent PA Professional article,
“Contracting for a Healthy Career,”explores some of the
reasons I advocate for carefully negotiated and signed
contracts.
Once you’ve ensured appropriate compensation, a
sustainable schedule and essential benefits in writing, it’s
much easier to focus on your patients. Professional issues
left unaddressed in an employment contract have a way
of cropping up and bleeding into work life, creating anxi-
ety and tension and ultimately compromising the
employment relationship.
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 42
45. PROFESSIONAL PRACTICE | continued
The Case for Going Without a Contract
There are some situations in which it may be beneficial to go without a
contract. Doing so allows you to take a job on a trial basis and wait to see if
the position ripens into a good one. Perhaps the partnering physician is
new to team practice, or you have questions about whether a new spe-
cialty or some other aspect of the position will prove a good fit. Starting
practice on an easy come, easy go, no-strings-attached basis can be a boon
in these instances: Both parties can agree to a 90-day trial period, after
which they are free to dissolve the employment relationship if either
wishes to do so. If the trial period goes well, I endorse negotiating a con-
tract. You’ll have the benefit of several months of real-life experience with
this employer to bring to the negotiations, which could be very helpful in
shaping your job description, schedule and other contract elements.
In the absence of an employment contract, clarity about liability cover-
age is crucial. How are you covered, and who is paying for the policy? And,
critically, who is responsible for tail coverage when you move on? Having
your own policy affords both security and flexibility: The policy follows you
and allows you to avoid tail coverage disputes. If you opt for employer
coverage but are not signing a contract with them, ensure that you are
covered: Ask for policy details and make a copy for your records.
Another reason to consider going without a contract: When an employer
offers one (or an update to an existing one) that contains“poison pills”
you’d be better off not agreeing to. Typical deal breakers include harsh
financial penalties if you leave the employer within the first six months or
year of practice,“non-competition”clauses that would radically restrict
your ability to practice in your specialty (or worst case, in your profession)
after departing from a job, and tail coverage being incumbent upon you
regardless of the reasons you separate from the employer.
In many cases, negotiation can remedy the worst contract offences. In
my experience, the majority of employers will modify noncompetition
clauses, unequal tail coverage obligations or unrealistic departure notice
requirements. What if they will not? Assume that anything you sign, an
employer will seek to enforce. Sometimes it’s just better to not sign and
keep your professional options and autonomy intact.
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 43
46. Earn CME From Our Top Live Events
Convenient, 24/7 online access to comprehensive
multimedia libraries from our most
popular live conferences.
Save with our bundle packages and maximize your learning! Or,
just choose the sessions you need. Take advantage of exclusive
AAPA member pricing on all of our CME on Demand products.
Get started at aapa.org/ondemand
AAPA
MEMBERS
ONLY
Making your best career move just got easier.
These member tools will get you where you
want to go – at every stage of your career.
Learn about all of the career resources your
membership offers at aapa.org/makeyourmove
Simplify your job
search!
Search thousands of PA
positions in all states
and specialties with
this easy-to-use online
resource.
Prepare for your
new position.
Get details on contracts,
liability insurance,
interviewing, and more
with your free Contacts
and Contracts guide.
Get personalized
career advocacy.
Save up to 25%
on services from
PA Career Coach,
an expert who has
helped thousands of
PAs navigate career
transitions.
PAThe
47. INPRINT
MICHAEL C. DOLL, MPAS, PA-C,
DFAAPA, FAPACVS, is Geisinger
Medical Center’s director of
physician assistants for the
cardiothoracic surgery service line.
He holds teaching positions with
The George Washington University
and Lock Haven University PA
programs. He is a director-at-large
for AAPA.
Forensic Pathology
and How It Helps the Living
From the Death Scene to the Autopsy Table
B Y M I C H A E L C . D O L L , M PA S , PA - C , D FA A PA , FA PA C V S
A
s someone who can watch hour upon hour
of police investigation shows like“Law &
Order,”I was eager to review Judy Melinek’s
memoir“Working Stiff: Two Years, 262 Bodies, and the
Making of a Medical Examiner.”Melinek, a graduate
of the UCLA medical school, started her medical
career with the goal of becoming a surgeon, only to
find that the brutality of a five-year surgical resi-
dency, followed by the life of an attending surgeon,
did not agree with her career plan to be a physician
with a family. Struggling with what to do next in
medicine, she remembered that her happiest days as
a medical student were during her rotation in pathol-
ogy. Melinek was fascinated by the science of pathol-
ogy and observed that pathologists“seemed to have
stable lives.”
That“stability”points up how different pathology is
from most other specialties. In other areas of both
medicine and surgery, providers work to investigate
ongoing and“alive”diseases, attempt
to correct their downstream affects
and to prevent reoccurrence if pos-
sible. On an everyday basis, healthcare
providers work diligently to prevent
death. Forensic pathologists do not
prevent death. Whether they are
investigating the death scene or
examining the patient on the
autopsy table, death has already
occurred. Their jobs are to investi-
gate the cause of death (natural,
accidental, suicide, overdose, mur-
der, etc.), perform autopsies and
collect evidence that may be used
in court.
The majority of this well-written
memoir is Melinek’s detailed and
riveting accounts of the various
PA PROFESSIONAL | JUNE/JULY 2015 | AAPA.ORG | 45
