Exam 4 Flashcards
HIPAA
Health Insurance Portability and Accountability Act of 1996
-protection of sensitive patient health information
Medical record
collection of data recorded when a pt seeks medical treatment
1. required by licensing authorities to track/document
2. provide documentation of continuing health (birth-> death)
3. foundation for managing pt’s health
4. serve as legal documents
5. clinical data for education, research, data
meaningful use - safety, coordination of care, privacy, reduce disparity
Benefits to EMR
-better utilization
-organization
-better tracking
-shared records amongst providers (EHR)
-access to other providers’ notes
Mandated EMR
January 1, 2014 - part of American Recovery and Reinvestment Act
-maintains Medicaid and Medicare reimbursement
EMR
digital version of paper charts
EHR
built to share information with other healthcare providers
Consent for records, photos, videos
sign release for their own medical records due to doctrine of professional discretions
-cannot be released to third party without written permission by patient or guardian
Medical info about a pt often released due to:
- insurance claims
- transfer to another physician
- use in court of law
Federal Statute of Confidentiality of Alcohol and Drug Abuse Patient Records
protects patients with hx of substance abuse regarding release of into about treatment without written consent from pt
Health information technology (HIT)
electronic systems that healthcare professionals + pts use to store, share and analyze health information
-meaningful use:
1. adoption of EHR by providers
2. focuses on interoperability, health info exchange and pt portals
3. improve pt access to EHR
Social media in healthcare
widely used; need consent from pt to post anything
Telemedicine
remote delivery of healthcare services and clinical information using telecommunications and technology
-advanced form of care
Credentialing
systematic process of collecting and verifying qualifications for professionals
-purpose: to ensure that the individuals and companies are qualified to perform services offered
-PA student are also credentialed by PA programs
-PA-C credentialed by taking PANCE/applying for licensure
-required by work site
-maintained by Joint Commission on Accreditation of Hospitals + National Commission on Quality Assurance
-further step = privileging (administered by medical staff) that documents training/experience w/ specific procedures before granted privilege of performing activities (need proof)
PA Program Accreditation
official approval that program maintains standards that qualify that graduates can sit for PANCE exam
-voluntary process ensuring program requirements are met
ARC-PA
Accreditation Review Committee on Education for PA
body that completes that accreditation process
-works w/ other organizations to stay within guidelines
-standards recently revised in 2020
-began in 1970s w/ AMA -> own governing body in 1990s
-left AMA in 2000
-only accreditation body for PA/PA post grad programs
ARC-PA Mission
protects interests of students, public and PA profession by defining standards for PA education, evaluate programs and ensure compliance w/ standards
ARC-PA and Profession
-standards allow PAs to be academically and clinicaly prepared to practice medicine as members of patient-centered medical care teams
-collaborative team relationships is fundamental to PA profession and enhances delivery of care
-diagnostic, therpeutic, preventitive, and health maintenance services
ARC-PA Standards
establish minmum requirements for PA education in terms of resources, operations, curriculum, evaulation and assessment
-5th edition of standards released in 2020 + update to manual in Oct 2022
Clinical Role of PA’s
primary and specialty care in medical and surgical practice settings
-centered on pt care
-educational, research and administrative activities
Role of ARC-PA
-establish educational standards using broad based input
-define/administer process for competitive review of applicants
-define/administer process for accreditation decision making
-determine whether PA education programs are in compliance with standards
-work cooperatively w/ collab organziations
-define/admiinster appeal of accreditation decisions
Professional curriculum of PA education
medical, behavioral and social sciences
-ensures functionality in all fields upon completion of program
PA Program Standards
-administrative: instiutional responsibilities, resources and support
-curriculum: student based outcomes
-evaluation: self assessment for weakness/strengths
ARC-PA Commissioners
take part in decision making responsibilities of ARC-PA
-serve for 3 years and renewable upon ARC-PA recommendation
-nominated by members of AAPA and PAEA
Accreditation-Provisional
(step 1)
occurs when a program has provided all necessary steps to having their first cohort (6-12 months before enrollment of students)
Provisional Monitoring Visit
(step 2)
occurs as the first cohort is preparing to graduate
Final Provisional Visit
(step 3)
occurs 18-24 months after initial accreditation provisional is granted
-will receive accreditation-continued if all standards are met
Accreditation-Probation
given to an established program that has failed to keep up the standards
-temp 2 year status
Accreditation-Continued
validation visits every 10 years +/-
Accreditation-Withheld
seeking accreditation-provisional but does not comply w/ standards
Accreditation-Withdrawn
loss of accreditation
-may pose risk to graduates of the program by not being able to gain licensure depending on the state
NCCPA
National Committee of Certification for PA’s
PA profession certification body that provides reliable indicator that those certified have demonstrated/possess/maintain knowledge and skill to practice safely/effectively
-over 20 years
-PA cert, re-cert and CME records (previously done by AAPA)
NCCPA Cert Process
National Certifying Committee for PA
certifies all states and DC
-must attend accredited school
-must pass PANCE
-100 CME hours every 2 years
-PANRE every 10 years
-certified w/in 6 years of graduation
-up to 6 attempts on PANCE
-maintenance of certification is digital
8 States w/ own PA regulatory body
Arizona, California, Texas, Iowa, Massachusetts, Rhode Island, Utah
Temporary licensure
allows new grads to work prior to sitting for their PANCE exam
-much more restrictive than full license
Patient centered EMR use
-let pt know your are going to log on
-computer can enhance provider-pt relationship
-maintain eye contact throughout computer use
10 tips to enhance pt-cnetered EMR use
“HUMAN LEVEL”
- Honor golden minute: remain technoology free the first minute
- Use triangle of trust: allow u and pt to see screen
- Maximize pt interaction: encourage pt to interact w/ graphs + trending tools
- Acquaint yourself w/ chart: before entering pt room
- Nix the screen: disengage from compiuter when discussing sensitive pt issues
- Let the pt look on: see screen and follow actions
- Eye contact: maintain as much eye contact as possible
- Value the computer: discuss its benefits
- Explain what you’re doing: avoid long periods of silence
- Log off: to ensure medical info is secure
Typical PA Program Length
27 months
-24 months before integration of master’s
Typical PA student applicant
-2,000 PCE hours
-GPA = 3.56
-25 years old
PAEA
Physician Assistant Education Association
-advocacy for PA education
-founded in 1972
-oversight for CASPA
PANCE
360 multiple choice questions that assess medical and surgical knowledge
-6 attemps to pass within 6 years (3x in one year)
-need 350 score out of 800 to pass
-wait 90 days to retake if failed exam
PANRE
recert after 10 years
-computer based exam
-240 multiple choice questions from NCCPA blueprint
-passing score of 379 out of 800
PANRE-LA
administered over 12 quarters in years 7-9
-added in 2022 to start Jan 2023
-final score based on best 8 quarters
-25 questions each quarter w/ 5 minutes to answer each question
-can use printed/online references
-3 attempts to pass PANRE in year 10 if failed PANRE-LA
-still need CME requirements
CME
100 hours every 2 years w/ NCCPA
-50 category 1 credits (medical conferences, training, journal reading w/ questions, grand rounds meeting)
-remaining 50 credits can be category 1 or 2
-NCCPA fee of $180 to log CME
Issues related to PA practice
subcommittee of medical board formed ot deal w PA practice or state medical board that includes seats for PA representation
PA licensing boards
states are trying to create PA licensing boards as a result of new PA practice acts that replace intial delegation amendments to medical practice acts
-composed of practicing PAs and physicians who employ/work with PAs
-typically advisory to governmental agency (ultimate authority)
Delivering bad news
-communication
-knowledgeable about diagnosis, prognosis and treatment
-supportive space
-speak without medical jargon
-allow pt to process info (silence)
-evaluate your reaction to pt’s diagnosis
Palliative care
hospice
-formal symptom assessment and treatment regarding disease processes shortening a pt’s life
-aid w/ decision making and goals of care
-practical/moral support for pt/caregivers
-collaborative models of care (team) for terminal illnesses
pts in U.S. spend < 1 week on hospice
Healthcare Proxy
legally designated person to make decisions for a pt when they are unable to state their own wishes regarding medical treatment
-executes wishes via living will for resuscitation, antibiotics, feedings and other life sustaining treatment
Living will
legal document stating pt’s wishes regarding treatment if unable to speak
-resuscitation instructions
-intubattion/mechanical vent instructions
-treatment guidelines
-future hospitalization and transfer
-artificially administered fluids and nutrition
-antibiotics
-etc
MOLST
Medical Orders for Life Sustaining Treatment
form used for pts who want to avoid or receive any or all life sustaining treatment; only authorized form in NYS documenting both nonhospital DNR/DNI orders
-pt who reside in long term care facility and/or may die within. a year
-used in a variety of healthcare settings
-legal checklists required concerning life-sustaining tretament
-no checklist used = alternative method assuring strict adherance to legal requirements
-witnesses to consent
-renewed/discontinued after 90 days
bright pink paper
Deciding on MOLST
conservations w pt, family and qualified health professional
-provider defines goals for care, reviews treatment options and ensures shared/informed medical decision making
-provider MUST consult w/ all of the above personnel about diagnosis, prognosis, goals, treatment preferences, gain consent and sign orders derived from discussion
MOLST Sections
-Page 1 (section A+B): resuscitation; pt/proxy/witnesses sign
-Section C: signatures of physician
-Section D: advanced directives
-Section E: treatment guidelines, ventilation, future hospitalization/transfer, fluids, nutrition, antibiotics
-“Other” section: dialysis, transfusion
Pain Management
obtain good hx and physical exam
-pain: nociceptive, neuropathic, mixed-pain, psychosocially based pain
Pain mgmt in elderly
-underreporting of pain
-multiple co-morbidities
-side effects of meds to treat pain
-changes in metabolism of meds due to age
Treating mild pain
NSAIDS, cognitive behacorial training, complementary modalities
Treating moderate pain
low dose/low potency opioids, +/- NSAID, complementary modalities
Treating Severe Pain
potent opioids, PCA, neural blockage, spinal anesthesia, complementary modalities
PA Education facts
- 300 accredited programs as of Nov 2022
- terminal degree = masters
- average program length = 27 months
- “minds on hands on” - short training
- didactice + clinical phases
- clincial experience during didactic
- service in 1/3 programs to expose population health issues and cultural diversity
PA student debt upon graduation
PAEA Survey
-21.9% 100k-125k
-20.8% 75k-100k
-14.5% 50k-75k
OTP
Optimal Team Practice
May 2017 by AAPA
-direct reimbursement for all PA services
-PA representation on state medical boards or separate PA regulatory boards
-elimination of the requirement for written practice agreement to supervisory physician
-PA scope of practice determined at the practice level (even though AAPA does not advocate for independent practice)
Collab Organizations of ARC-PA
-AAPA
-PAEA
-NCCPA
Informed Consent Law
Code of Medical Ethics Opinion 2.1.1
-pts have right to receive information and ask questions about treatments to make well educated decisions
-communication between pt and provider
To obtain informed consent, provider must
-assess patient’s ability to understand
-pt’s independent and voluntary decision
-discuss diagnosis, purpose, risks/benefits, options, outcomes of refusal
-documentation
Medical billing and coding
process of converting pt charts and clinical data to medical claims (submitted for reimbursement)
-data entered through EMR
-applying procedure codes
-ICD-10
Coding requirements for outpatient documentation and coding
January 1, 2021- outpatient E/M CPT 99202-99215 office visits have new guidelines to follow for assigning CPT code
2022 changes to coding requirements
-elimination of hx/PE as elements for code selection
-providers choose to base documentation on medical decision making (MDM) or total time spent on encounter [office setting]
-MDM or time (not both)
MDM vs. time E/M 2022 changes
- time: prep for visit, documentation, face to face time
- MDM: 4 levels (straightforward, low, moderate, high), number and complexity of problems/data (tests, orders, review), risk of complications
MDM vs. time E/M 2022 changes
- time: prep for visit, documentation, face to face time
- MDM: 4 levels (straightforward, low, moderate, high), number and complexity of problems/data (tests, orders, review), risk of complications
ICD-10
-3-7 characters in length
-68,000 codes
-first digit = letter
-digits 2+3 = number
-digits 4-7 = aplha or numeric
-flexible for adding new codes
-very specific
-up to 12 codes on claim form
Golden rules of coding
-bill for what you actually do
-do not up code
-do not commit fraud (medicare/medicaid investigation)
-review / understand before clinical year
CMS (center for medicare/medicaid services)
federal Medicare/Medicaid agency that oversees HIPAA administration
-creates safety guidelines for facilities
-penalizes facilities falling below standards by lowering reimbursement
-monitors 30 day risk for unplanned readmissions
-decubitus ulcers
