Week 1 (History) Flashcards
What is the last US territory to authorize PA practice?
Puerto Rico (2019)
In __________, ____________ University’s first PA class matriculates with four students
1965; Duke
The first PA Graduating Class graduated when?
(Know this)
Oct 6, 1967 (National PA day)
What report recommends that State Medical Practice Acts be amended to permit PA practice under physician supervision?
NIH
The AMA endorses the ___________________ concept in 1970
Physician Associate
___________ Governor Ronald Reagan signs Assembly Bill 2109 into law making his state the first to enact enabling legislation for PAs
California
Mississippi becomes the last state to enact PA legislation in what year?
1999
What does TAPA do for us?
Advocacy, legal advice, state laws, networking, discounts
(part time attorney + 2 lobbyists)
1) What is our state professional organization?
2) What is its mission?
1) TAPA
2) Promote quality, cost-effective and accessible healthcare, and to promote the professional and personal development of physician assistants.
Who can answer your practice questions and give you professional guidance?
TAPA
What do the 2 lobbyists employed by TAPA do?
1) Both lobbyists (John Williams and Katherine Moffat) attend legislative hearings throughout the session to monitor activity and advocate for PAs.
2) Each January, 1,500-2,000 bills are filed in the General Assembly; John Williams reviews each of these bills to determine if they affect PA practice
What does TAPA monitor and push for?
1) Monitors legislative and regulatory developments that could affect the PA scope of practice in Tennessee.
2) Pushes for passage of legislation that allows PAs to practice at the highest level of their training.
1) TAPA has a Student Affairs Committee made up of representatives from each PA Program. This committee elects what?
2) TAPA is divided into six ______________ regions. Each region has a director who serves on the Board of Directors.
1) the Student Representative to TAPA’s Board of Directors.
2) geographical
What is optimal team practice (OTP) (2017)?
PAs working together with physicians and others healthcare professionals w/o administrative constraints
What are the 3 goals of OTP 2017?
1) Elimination of legal requirement for a specific relationship bet PA and MD (SP) for PA to practice
to full extent of their education, training and experience
2) Create a majority-PA board to regulate PAs or add PAs/MDs who work with PAs
3) Authorize PAs to be eligible for direct payment by all public and private insurers
Describe the goals of optimal team practice (2017; don’t need to know all details)
1) Elimination of legal requirement for a specific relationship bet PA and MD (SP) for PA to practice
to full extent of their education, training and experience
-need collaboration tho
2) Create a majority-PA board to regulate PAs or add PAs/MDs who work with PAs
3) Authorize PAs to be eligible for direct payment by all public and private insurers
What are 2 other bills recently passed/proposed? (in TN)
1) Telemedicine
2) PA compact licensure
What do the following do?
Telemedicine-HB 0498 (B.Martin)/SB 0721 (Massey)
PA Compact-HB 1862 (Faison)/SB 1727 (Jackson)
1) Allowing collaborating physicians in practices which provide services solely through telemedicine to conduct all 12 of the required monthly visits per year remotely. (Telemedicine)
2) Proving for an exemption to the 16-month-in-person encounter and relationship requirement when a pt is receiving an initial encounter/evaluation for behavioral health treatment. (Telemedicine; don’t really need to know)
3) Ease application for multiple state license for PA telemedicine providers (PA Compact)
PA Practice Act-HB 1272(Cochran)/SB 1171 (Swann): What did it do?
Modernized the oversight and regulation of PAs which has not been updated in TN since 1999.
PA Practice Act-HB 1272(Cochran)/SB 1171 (Swann)
1) New grads- 3 years or 6,000 hrs post-graduate clinical practice
2) <6,000 change to new specialty: 6 months supervision practices to determine oversight, (including chart review: blocked), visits to remote locations, training, assessment
3) limits on surgical procedures
4) limits on use of medical specialty titles
5) no changes to prescribing, including opioids
What parts of PA Practice Act-HB 1272(Cochran)/SB 1171 (Swann) was blocked?
1) Including chart review
2) Scope of PA practice may differ from physician
1) The National Professional Society of PAs is what?
2) Where was it established/ when?
3) Who were the first members?
1) AAPA
2) North Carolina in 1968
3) Military corpsmen from Duke University, the first graduating class
NCCPA Code of Conduct (National level): list the first 11 points
1) shall not engage in cheating or other dishonest behavior that violates exam security
2) shall not engage in irregular behavior
3) shall not employ deceptive means, in obtaining or maintaining an NCCPA credential.
4) shall not manufacture, modify, reproduce, distribute or use a fraudulent or otherwise unauthorized NCCPA certificate.
5) shall not falsely represent themselves in any way to be a Physician Assistant-Certified (PA-C) designee, aCertificate of Added Qualification (CAQ) recipient, or a PA-C Emeritus
6) shall promptly inform NCCPA when possessing knowledge or evidence cheating on or misuse of questions from an NCCPA examination
7) fraudulent use/ misrepresentation of NCCPA certification status by a physician assistant or any other individual
8) professional boundaries in their interactions with patients and others.
9) shall avoid behavior that would pose a threat patient’s interest during the delivery of health care.
10) shall not disclose patient confidential information
11) shall recognize and understand their professional and personal limitations.
NCCPA Code of Conduct (National level): list the rest of it
12) shall practice without impairment from substance abuse/cognitive deficiency or mental illness
13) demonstrate the ability to engage in the practice of medicine within their chosen areas of practice safely and competently.
14) shall behave in a manner that is lawful and ethical, during and outside the practice of medicine, that upholds accepted standards of professional practice and conduct.
must report to the NCCPA any adverse regulatory or credentialing action within 30 days of issuance
15) must report to NCCPA within 30 days of convictions, guilty pleas or no contest pleas to felonies and certain misdemeanors, as described more fully in thePolicies and Procedures forPA Disciplinary Matters.
16) must cooperate with and respond to inquiries from NCCPA certification-related matters or disciplinary proceedings.
17) must comply with conditions set forth by NCCPA, unless due to circumstances beyond the PA’s control.
PA Practice Act is at what level?
State
Describe the PA practice act
The protocol must be reviewed and updated biennially – signed and dated by both the PA and the physician
The protocol must be maintained at the PA’s practice site and made immediately available upon request to inspectors from the Tennessee Department of Health (written or digital)
TAPA has a template for purchase on the TAPA website
Describe the current scope of practice
The physician must have experience or expertise in the same area of medicine as the PA working with them.
The PA may only perform those tasks which are within the PA’s range of skills and competence, and which are within the usual scope of practice of the collaborating physician.
The range of services which may be provided by the PA must be set forth in a written protocol, jointly developed by the PA and physician. Make sure you know how to perform skills. (exceptions)
1&2
- Licensure-state the term (dates, etc)
- Full prescriptive authority (DEA license Controlled Substances II-V)*
II. Methamphetamines, Adderall, Vicodin/Norco
III. Tylenol with codeine, Testosterone
IV. Xanax, Ambien,Valium
V. Robitussin AC, Lomotil (contain opioid/codeine)
*state specific
Scope
1) The PA profession is moving away from what?
2) A collaborating physician must possess what?
3) What physician may not perform this function?
1) The PA profession is moving away from using the term “supervision” and using “collaboration”
2) A current, unencumbered license to practice medicine in Tennessee (or state of practice)
3) A physician who does not normally provide patient care
-In Tennessee, a collaborating physician must be an MD, DO; Podiatrist under certain conditions
4.& 5. Describe how co-signing is determined at practice level
1) Generally, acollaborating physicianmust review at least 20% of charts monitored or written by a PA/APRN
And
2) make at least one visit to every remote site at least every 30 days
What are some newly approved things within our scope of practice in TN as of 2025
(Don’t memorize this)
a. order Durable medical equipment (DME)
b. nutrition
c. blood and blood products
d. diagnostic support services: Home health, hospice, PT, OT
e. sign death certificates
Upon graduation from PA school, you will be faced with what steps?
1) Passing the PANCE/NCCPA certification
2) Obtaining licensure
3) Defining your role in your new practice with your collaborating physician
4) Gaining insurance and/or hospital credentials
5) Practicing medicine as a PA-C
6) Life-long learning/continuing medical education (CME)
Describe passing the PANCE
1) A PA graduate must pass the Physician Assistant National Certifying Exam (PANCE) to be eligible for licensure. (can take 7d after graduation; if fail, wait 90d to retest)
2) max 3x/yr; max 6x in 6 years (or lifetime); $500
Describe what happens after passing the PANCE
-After passing the PANCE, a PA receives NCCPA certification and can add the “-C” behind “PA”.
-In Tennessee, maintenance of NCCPA certification is not required in order to renew a license.*; However, NCCPA certification may be required by hospital and insurance credentialing boards, as well as by employers.
Differentiate between a regular license and a temporary license
1) A graduate who has passed the PANCE can apply for full licensure.
2) Graduates waiting to take or pass the PANCE exam can apply for temporary licensure in Tennessee.
In Tennessee, an individual must meet what qualifications for licensure?
1) Graduate from a PA program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA)
2) Successfully complete the examination of the National Commission on the Certification of Physician Assistants (NCCPA) = PANCE
3) 3 letters of recommendation
Describe state licensure renewal
1) In Tennessee, the renewal due date is the last day of your birth month (Q 2yrs)
2) DO NOT LET YOUR LICENSE LAPSE! This could result in fines and other disciplinary procedures.
3) It is the PA’s responsibility to renew his or her license – not the practice manager; not your collaborating physician.
What are the limitations of a temporary license?
1) The physician must be on site at all times
2) The physician must co-sign 100% of patient charts
1) Can a PA can apply for a DEA license with a temporary license?
2) How long can temporary licenses be held?
1) Yes; $888-valid 3 years
-[your practice should pay for that]
2) Fifteen (15) months; can be renewed for an additional year.
1) PAs are professionally and legally obligated to keep abreast of changes in medicine. This is primarily done through what?
2) Give examples of this
1) continuing medical education (CME).
2) CME can take various forms – medical journals, live instruction and online learning.
1) What is CME required for? When must it be completed??
2) What CME does the NCCPA require?
1) CME is also required for licensure renewal.
2) According to the Board on PAs, required CME must be completed during the 24 months preceding the submission of an application for renewal.
3) The NCCPA requires 100 hours of CME every two (2) years.
Tennessee state laws mirrors this requirement.
50 must be from Category 1.
4) A PA’s license renewal cycle and NCCPA certification cycle may differ greatly.
-Pay attention to deadlines for both.
1) PANCE/PANRE LA is taken when?
2) When is CME done?
3) What is the difference between CAT 1 and 2?
1) Every 10 years
2) Q 2 years-100hrs
5 cycles every 10 years
3) CAT 1: 50hrs (always need at least 50)
-PI-CME; Self-assessment
-CAT 2 (teaching medicine, reading journal, etc)
TOTAL=100
Give examples of CAQ-Certificate of Added Qualifications (12)
Cardiovascular & Thoracic surgery (CVTS)
Orthopedic surgery
Emergency Medicine
Hospital Medicine
Nephrology
Pediatrics
Psychiatry
Dermatology
OBGYN
Palliative/Hospice
Occupational Medicine
What is a PA-C Emeritus?
1) PA-C retired from clinical practice
2) Certified by NCCPA a minimum of 20 cumulative years or disabled
3) No reportable actions in their NCCPA disciplinary history/no disciplinary actions
4) One time fee
5) Maintain designation Q two years
6) NOT considered certified
Once you begin practicing, you will go through two types of credentialing, which are what?
1) Hospital credentialing (if you work in a hospital setting or a surgical practice)
2) Insurance credentialing
[Typically, the practice’s office manager or administrator will assist PAs and other clinicians with the credentialing process.]
Differentiate between credentialing and privileging
1) Credentialing is the verification of a healthcare practitioner’s education, training, work experience, licensure, etc.
2) Privileging is granting approval for an individual to perform a specific procedure or specific set of privileges based on documented competence in the specialty in which privileges are requested.
True or false: Providers cannot work in the hospital setting until they are credentialed and granted privileges.
True
1) What is insurance credentialing?
2) What does it vary by?
3) What cannot happen until you’re credentialed?
1) As with hospital credentialing, insurance credentialing is a process for verifying the provider’s education, training, experience, licensure and competency.
2) Insurance credentialing varies from carrier to carrier – some will credential a PA independently; others will credential under the collaborating physician or practice.
3) Providers are not eligible for reimbursement until they are credentialed.
You will likely submit insurance credentialing through the Council for Affordable Quality Healthcare(CAQH). CAQH is a nonprofit alliance of America’s leading health plans.
What does CAQH allow for?
Providers to submit one application to meet the needs of all the health plans and hospitals participating in the CAQH effort.
-eliminates the need for providers to submit the same information to multiple organizations.
What do you get after you’re credentialed?
1) National Provider Identifier (NPI; Same number throughout career)
2) TheHealth Insurance Portability and Accountability Act of 1996 (HIPAA)mandated the adoption of standard unique identifiers for healthcare providers and health plans
What are 3 parts of the Hippocratic oath?
1) Medical confidentiality
2) Nonmaleficence
3) Beneficence
What oath do PAs follow?
The Physician AssistantProfessional Oath
What are the 6 PA core competencies?
1) Medical Knowledge
2) Interpersonal & Communications Skills
3) Patient Care
4) Professionalism
5) Practice-based Learning & Improvement
6) Systems-based Practice
Describe the medical knowledge core competency
-Evidence-based medicine
-Scientific principles r/t pt care
-Etiologies, risk factors, underlying pathologies, epidemiology for medical conditions
-s/sx of medical and surgical conditions
-Appropriate diagnostic studies
-Mgmt of general medical and surgical conditions, including pharmacologic and other tx
-Interventions for prevention of dz and health promotion/maintenance
-Screening methods to detect conditions in an asymptomatic pt
-Hx and PE findings and diagnostic studies to formulate ddx
Describe the interpersonal and communication skills core competency
-create and sustain a therapeutic and ethically sound relationship with patients
-use effective communication skills to elicit and provide information
-adapt communication style and messages to the context of the interaction
-work effectively with physicians and other health care professionals as a member or leader of a health care team or other professional group
-demonstrate emotional resilience and stability, adaptability, flexibility, and tolerance of ambiguity and anxiety
-accurately and adequately document information regarding care for medical, legal, quality, and financial purposes
Describe the patient care core competency
-work effectively with physicians and other health care professionals to provide patient centered care
-demonstrate compassionate and respectful behaviors when interacting with patients and their families
-obtain essential and accurate information about their patients
-make decisions about diagnostic and therapeutic interventions based on patient information and preferences, current scientific evidence, and informed clinical judgment
-develop and implement patient management plans
counsel and educate patients and their families
-perform medical and surgical procedures essential to their area of practice
-provide health care services and education aimed at disease prevention and health maintenance
-use information technology to support patient care decisions and patient education
Describe the Practice-based Learning & Improvement core competency
1) analyze practice experience and perform practice-based improvement activities using a systematic methodology in concert with other members of the health care delivery team
2) locate, appraise, and integrate evidence from scientific studies related to their patients’ health
3) apply knowledge of study designs and statistical methods to the appraisal of clinical literature and other information on diagnostic and therapeutic effectiveness
4) utilize information technology to manage information, access medical information, and support their own education
5) recognize and appropriately address personal biases, gaps in medical knowledge, and physical limitations in themselves and others
Describe the professionalism core competency
1) understanding of legal and regulatory requirements, as well as the appropriate role of the physician assistant
professional relationships with physician supervisors and other health care providers
2) respect, compassion, and integrity
3) accountability to patients, society, and the profession
4) commitment to excellence and on-going professional development
5) commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices sensitivity and responsiveness to patients’ culture, age, gender, and abilities
6) self-reflection, critical curiosity, and initiative
7) healthy behaviors and life balance
8) commitment to the education of students and other health care professionals
Give the pt 1 of systems-based practice core competency
1) effectively interact with different types of medical practice and delivery systems
2) understand the funding sources and payment systems that provide coverage for patient care and use the systems effectively
3) practice cost-effective health care and resource allocation that does not compromise quality of care
4) advocate for quality patient care and assist patients in dealing with system complexities
5) partner with supervising physicians, health care managers, and other health care providers to assess, coordinate, and improve the delivery and effectiveness of health care and patient outcomes
Give the pt 2 of systems-based practice core competency
6) accept responsibility for promoting a safe environment for patient care and recognizing and correcting systems-based factors that negatively impact patient care
7) apply medical information and clinical data systems to provide effective, efficient patient care
8) recognize and appropriately address system biases that contribute to health care disparities
9) apply the concepts of population health to patient care
