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  • April 01, 2020 12:16 PM | Becca Liebers (Administrator)

    Waiver Temporarily Eliminates Requirement for Medicare Patients in Hospital to be Under Care of Physician | By Michael Powe, Vice President of Reimbursement & Professional Advocacy

    The Centers for Medicare and Medicaid Services (CMS) initiated another round of regulatory relief on March 30 aimed at increasing the ability of PAs, other health professionals and hospitals to deliver needed care to patients during the COVID-19 crisis. These temporary waivers are designed to remove unnecessary administrative and regulatory requirements and provide maximum flexibility to increase access to care for patients.

    The regulations will immediately allow for:

    • Waiving a long-standing provision which requires that Medicare patients in the hospital be under the care of a physician. This allows hospitals to use other practitioners, such as PAs, to the fullest extent possible.
    • The use of telephonic (as opposed to the previous audio-visual requirement) evaluation of management codes;
    • Waiving certain requirements to allow hospitals to hire PAs, physicians and other health professionals to increase workforce capacity and deal with potential patient surges;
    • Health professionals to temporarily enroll in Medicare including those who previously officially opted out of Medicare for the required two-year period;
    • Temporarily permit non-hospital buildings to be used for patient care and quarantine sites, if approved by the state.

    CMS is authorized to waive regulatory requirements for federal programs including Medicare, and for Medicare beneficiaries. However, CMS can’t alter or override existing state laws, hospital policies, such as, bylaws or privileging requirements, or regulations in state Medicaid programs.

    PAs will need to check their individual state laws and workplace policies to determine how they can best utilize the CMS flexibility. AAPA is encouraging Governors to provide maximum flexibility for PAs to practice to the full extent of their education and experience by waiving physician supervision requirements during this crisis.

  • March 31, 2020 12:18 PM | Becca Liebers (Administrator)

    We’re Aggressively Working to Update Laws, Inform the Public | By David E. Mittman, PA, DFAAPA

    What is AAPA doing to respond to the COVID-19 crisis? It’s a question I’ve been asked by many of you in private conversations and emails, and that I have seen consistently on social media and on the Huddle. So, let me answer this question directly. AAPA is aggressively advocating on your behalf during this crisis.

    Over the last couple weeks, in collaboration with state chapters, AAPA’s work to remove supervision requirement for PAs in laws and regulations has intensified considerably. As you know, removal of supervision requirements was a goal solidified by the House of Delegates three years ago when it passed Optimal Team Practice (OTP).

    COVID-19 has underscored why PAs passed this policy. During this national health crisis, policymakers and the public are recognizing the arbitrary nature of laws that require PAs to have an agreement with a specific physician in order to practice, or that require ratio restrictions. In a state where a physician is limited to “supervising” four PAs—what happens when that physician falls ill themselves?  What happens when a PA who practices at a private primary care office wants to help at a hospital that is overwhelmed with COVID-19 patients, yet can’t because they don’t have a “supervising” physician credentialed at that hospital? Those policies don’t serve our patients well.

    AAPA is working on both short-term and longer-range strategies to ensure PAs can fully contribute not only to COVID-19 patient needs, but to the broader healthcare system in general:

    • In the short-term, AAPA is calling on governors to immediately remove supervision requirements by issuing executive orders as five states have done at this time. In fact, we issued this press release today. We continue to support our state chapters in making these requests and have prepared sample executive order language. I recently authored an op-ed that clearly presents both the urgency and argument for why this action is critical to the COVID-19 response: “More physician assistants are ready to help with COVID-19—now governors must empower them.”
    • AAPA’s longer-range advocacy strategy requires permanent legislative change to the restrictive and archaic barriers that preclude PAs from delivering to patients the medical care they are trained to provide. These changes take time, and are often incremental in nature as we’ve seen in the last week with victories in KentuckyWashingtonMaine, and Iowa, to name a few.

    As you know, while governors can temporarily suspend supervision requirements for PAs, only state legislatures have full control over these permanent decisions. And, while the White House and federal agencies have recommended supervision requirements be eased, they have no authority in these state decisions. Nurse practitioners have worked more than 30 years to make progress on this issue. We can build on what they have done.

    Among AAPA’s immediate federal priorities are requesting that the White House remove supervision requirements for federally employed PAs, such as those who work for the U.S. Department of Veterans Affairs or the Bureau of Prisons; and, advocating for personal protection equipment for PAs, signing on to this letter to Vice President Pence along with Congressional leaders.

    One of AAPA’s federal priorities became a reality on March 27 when the President signed emergency legislation, the Coronavirus Aid, Relief, and Economic Security Act or the “CARES Act” (H.R. 748) that included the Home Health Care Planning Improvement Act (S. 296/H.R. 2150). AAPA had to act swiftly to attach our legislation to this larger vehicle, which was no easy feat. AAPA worked on home healthcare for over a decade and now, PAs can finally order home healthcare services for Medicare patients, freeing up beds for potential COVID-19 patients and others, and preventing the further spread of the virus.

    AAPA is also providing valuable resources to our members, whether you are on the front lines providing clinical care, an educator retooling your curriculum for e-learning, or a student adapting to online classes. You can find tools and information on AAPA’s COVID-19 Resource Page, including shareable graphics for PAs to show their professional pride and deliver an important public health message.

    We are also aggressively reaching out to national, state, and local media, correcting misinformation, and raising awareness of the contributions of PAs during this national crisis. AAPA has engaged a global public relations agency to assist to specifically leverage their national media contacts.

    Now, back to the crisis at hand.

    Over the coming days, more and more states will likely issue executive orders removing physician supervision requirements temporarily. PAs will have the opportunity, free from burdensome administrative constraints, to prove ourselves, to fully contribute to the healthcare team and to practice according to our training, education, and experience.

    This is an occasion we can all rise to—and one that will pave the way for permanent change in the very near future, once the nation experiences what PAs are truly capable of accomplishing: saving lives.

    Finally,  I would ask that you take a moment to tell us your story and how you’re contributing to the COVID-19 response. The more PA stories we have, the stronger case AAPA can make in our advocacy and media relations strategies. Take some pictures also (not of patients) of what you do best: contributing to the health of our nation. We will need to document this.

    Also, be sure to check out this list of Frequently Asked Questions regarding the COVID-19 response and how AAPA is helping our members navigate this strange new world.

    Stay healthy and safe, my friends. AAPA is by your side, and we have your back.

    David E. Mittman, PA, DFAAPA, is AAPA president and chair of the Board. Contact him at dmittman@aapa.org.

  • March 17, 2020 12:15 PM | Becca Liebers (Administrator)

    Indiana University Health Ready to Meet Community Needs

    Like all medical facilities around the country, Indiana University Health (IU Health) is responding to coronavirus (COVID-19). In the midst of this pandemic, patients are relying on PAs and other healthcare providers more than ever to diagnose, treat, and care for their symptoms.

    Since COVID-19 spreads so easily, telemedicine is quickly becoming an ideal way for patients and providers to communicate. Lindsey Kocher, PA-C, has experience in both primary care and emergency medicine and recently joined IU Health’s Virtual Care Division. She talked to AAPA about how IU Health is dealing with the COVID-19 pandemic, and how telemedicine is integral to the future of healthcare.

    AAPATell us about your role at IU Health.

    Lindsey Kocher (LK): I worked for IU Health initially through the IU Health Bloomington Hospital emergency room in 2008. For the last four years I have worked in primary care and very recently accepted a position in the Virtual Care Division to head up a program focused on targeting our Accountable Care Organization patients who struggle to be seen in an outpatient setting due to physical and/or social barriers.

    Can you tell us about the IU Health Virtual Visit app?

    LK: The IU Health Virtual Visit app has been used as an on-demand service for patients seeking evaluation for various symptoms and concerns. We decided as the coronavirus was emerging in the U.S. that we could also utilize this service to offer patients free virtual coronavirus screenings that could be conducted in the safety and comfort of their own homes.

    [Rush University PAs Integral to Coronavirus Response]

    How does telemedicine specifically show promise for treating infectious disease/COVID-19?

    LK: First and foremost, I believe we have the ability to improve containment efforts since we are able to properly educate patients on when and how to care for themselves and their family. We have been able to identify at-risk individuals and facilitate their safe transport to a health facility with proper infection prevention protocols already in place. Regarding infectious disease, telehealth can certainly expand our antibiotic stewardship by preventing or limiting unnecessary exposure of many viral illnesses in outpatient settings where there is a much higher risk of serious infection transmission among our most fragile patients.


    Read the full article here.

  • March 03, 2020 7:58 AM | Becca Liebers (Administrator)

    MedPage Today

    Study details aspirin nonadherence impacts on obstetric complications

    Greater aspirin adherence was associated with better preeclampsia prevention in high-risk pregnancies, according to an observational cohort study.

    Inadequate adherence, seen in 63 of 145 women prescribed prophylactic aspirin in the study from Australia, was linked to a higher incidence of:

    Early-onset preeclampsia (17% vs 2% with adequate adherence, OR 1.9, 95% CI 1.1-8.7)

    Late-onset preeclampsia (41% vs 5%, OR 4.2, 95% CI 1.4-19.8)

    Intrauterine growth restriction (29% vs 5%, OR 5.8, 95% CI 1.2-8.3)

    Preterm delivery (27% vs 10%, OR 5.2, 95% CI 1.5-8.7)

    Increase in antihypertensive use antenatally (60% vs 10%, OR 4.6, 95% CI 1.2-10.5)

    Good aspirin compliance was linked to lower odds of premature delivery -- the only treatment for preeclampsia -- on Kaplan-Meier analysis (HR 0.3, 95% CI 0.2-0.5), a study team led by Renuka Shanmugalingam, MBBS, of Liverpool Hospital in Australia, reported online in the Hypertension journal.

    With an absolute risk reduction of 51% and number needed to treat of just two when adherence is ≥90%, the authors concluded that aspirin is "an effective prophylactic agent" for the prevention of preeclampsia.

    "Therefore, suggesting adequate adherence with aspirin is essential and that nonadherence with aspirin among high-risk pregnant women may result in preventable obstetric complications," they urged.

    They acknowledged, however, that aspirin for preeclampsia prophylaxis "remains controversial" because of conflicting data.

    Read more.

  • February 19, 2020 7:43 AM | Becca Liebers (Administrator)

    ACOG Today's Headline / Chicago Tribune

    Less than 5% of pregnant women have good heart health, according to Northwestern study. Experts say doctors need to do more in response.

    Cardiovascular disease is the leading cause of death during pregnancy and the postpartum period, and U.S. health experts are working to better understand why so many moms are dying.

    But many women might be unaware of their heart risks while pregnant — and the importance of taking steps to improve heart health is becoming more clear in light of a new study.

    On Monday, Northwestern Medicine researchers published what they say is the first study to examine the cardiovascular health of pregnant women in the United States.

    Using 15 years of data from the Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey, the Journal of the American Heart Association article analyzed records of 1,117 pregnant and 8,200 nonpregnant women, assessing key factors including diet, exercise and blood pressure.

    Read more.

  • February 16, 2020 8:24 AM | Becca Liebers (Administrator)

    Medium / Surabhi Verma

    "My name is Kristy Goodman and I’m the Co-founder & CEO of PreConception, the first and only direct-to-consumer preconception testing platform for women planning a pregnancy. My background is in medicine and I worked as a women’s health PA for several years before starting PreConception. Working in Ob/Gyn I realized how few women were receiving appropriate preconception testing and education before pregnancy and decided to leave clinical practice to start PreConception and bring preconception testing to women across the country through an online platform."

    Read the full article here!

  • February 10, 2020 8:45 AM | Becca Liebers (Administrator)

    ACOG Today's Headlines / MedPage Today

    MedPage Today (2/7, D'Ambrosio) reported research based on CDC data from 2003 to 2016 revealed a decrease in maternal deaths in medical facilities. However, over the same period, “the rate of pregnancy-related deaths in the home nearly doubled.” Moreover, “increases in pregnancy-related death rates during this period were most dramatic in women age 45 and older,” according to a presentation at the Society for Maternal-Fetal Medicine annual meeting.

    Read more.

  • February 07, 2020 8:42 AM | Becca Liebers (Administrator)

    ACOG Today's Headline / CBS NEWS

    CBS News (2/7) reported “heart disease is known to kill nearly 420,000 women in the U.S. each year, and is the leading cause of maternal deaths.” Moreover, “We’re seeing that there’s actually an increase in the number of heart attacks during pregnancy, and that number is going up in the United States,” one cardiologist told CBS news. In addition, research published in the National Vital Statistics Report “found that about one in four pregnancy or postpartum deaths are caused by cardiovascular complications – hypertensive disorders in particular affect as many as one in 10 women and cause increased risk of heart failure, heart attack, and stroke.” 

    Read more.

  • December 02, 2019 12:34 PM | Becca Liebers (Administrator)

    Journal of the American Academy of Physician Assistants: December 2019 - Volume 32 - Issue 12 - p 11–12

    Gajarawala, Shilpa N. DMSc, MPAS, PA-C; Wood, Tiffany A. BSHS; Stanton, Amanda P. MHS, PA-C

    ABSTRACT In small clinical trials, dehydroepiandrosterone (DHEA) has been found to relieve symptoms associated with postmenopausal conditions and infertility in women. DHEA may provide a cost-effective alternative to typical hormone therapies. Because of a lack of long-term and large-scale studies, only intravaginal DHEA supplementation is approved and recommended for treatment. Further investigation of DHEA supplementation is needed and encouraged to determine its safety and effectiveness.

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  • November 21, 2019 1:30 PM | Becca Liebers (Administrator)

    Washington, D.C. – Ted L. Anderson, MD, PhD, president of the American College of Obstetricians and Gynecologists (ACOG), issued the following statement regarding the vote out of the House Energy and Commerce Committee on H.R. 4995 and H.R. 4996: 

    “ACOG applauds the House Energy and Commerce Committee for advancing H.R. 4995 and H.R. 4996. The committee took a giant step toward eliminating preventable maternal deaths with these two critically important bills that will improve maternal health outcomes and build upon legislation passed last year.

    “These bills include ACOG’s top legislative priorities in the “Momnibus,” a collection of U.S. House and Senate bills aimed at addressing the maternal mortality crisis. Specifically, H.R. 4995 and H.R. 4996 will 

    • help hospitals and maternity care providers implement clinically proven best practices,
    • incentivize states to continue Medicaid or CHIP coverage for women for one year after delivery,
    • increase access to maternity care in rural and underserved areas,
    • work to eliminate racial and ethnic disparities in maternal health, and
    • provide support for perinatal quality collaboratives.

    “Typically, women lose Medicaid coverage 60 days after delivery. This legislation would help ensure that moms receive care beyond that period for serious health conditions, including cardiovascular disease, postpartum depression, and opioid use, and close a huge gap in women’s health coverage during a time in which the Centers for Disease Control and Prevention show one-third of preventable maternal deaths occur.

    "ACOG is very appreciative of House Energy and Commerce Chairman Frank Pallone and Ranking Member Greg Walden; Health Subcommittee Chairwoman Anna Eshoo and Ranking Member Michael Burgess, MD, FACOG; and Representatives Robin Kelly, Larry Bucshon, MD, Eliot Engel, and many more. It’s notable that the committee members are working across the aisle to deliver solutions to the nation’s maternal mortality crisis. We applaud their work and look forward to collaborating with all members of Congress to bring these bills to the floor of the House and Senate.”

    To learn more about recent state action to extend Medicaid coverage to pregnant women for a year after delivery, view ACOG’s map.

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