Nevada Academy of Physician Assistants August 2015 Nevada Academy of Physician Assistants is dedicated to the promotion of our profession in Nevada. Like Us on Facebook! Issue 1, August 2015 O ur 2015-2016 Board of
Directors
President: Ben Prohaska President Elect: Cameron Byers Immediate Past President: Jay Somers Secretary/Treasurer: Elizabeth Kang Northern Director at Large: Julie Thomas Southern Director at Large: Brian Sady Southern Director at Large: Steve Engelberg Rural Director at Large: Bart Anderson Delegate to the HOD: Brian Lauf Delegate to the HOD: Gerry Jones Student Representatives: Allie MacAdams and Samiyah Hoodbhoy Opening a Frontier Medical Clinic; would I do it again? You bet! Ann Miles PA-­‐C Funny how life works out sometimes. About 3 years ago I left a “perfect” job because my employer pushed me into an unethical dilemma. I had to walk; unemployed but my integrity (and license) intact. Sometimes events put you on a path that you wouldn’t otherwise take. Like endeavoring to open a medical clinic in frontier Nevada. With my reputation intact, I dreamed the dream: Be a medical provider for my community and live in the frontier. I have always had a passion for medicine and taking care of people. It fills my cup and makes me feel good about being part of a community. I loved where I lived and didn’t want to live away from my husband, so the only solution was to create a (cont. pg. 4) Spotlight on a PA: Ann Miles PA-­‐C Ann Miles has been a practicing PA for 15 years. She graduated from the California PA School in 2000. She was born and raised in Carson City, NV. She practices in the Frontier of Nevada, Kingston, NV and lives with her husband John and dog Zee. More of her story continued on pg. 4 1
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Nevada Academy of Physician Assistants August 2015 From the desk of the President A letter from our outgoing President, Jay Somers PA-­‐C Greetings fellow PA colleagues! I first took over the presidency in January 2014 and it has been an amazing 18 months! During this time I have witnessed unprecedented PA leadership participating from North and South and several parts in between! W e have tackled NUMEROUS significant regulatory and legislative issues affecting, and sometimes trying to limit, PAs scope of practice and critical access to care for our most needy populations. If you have been a member of NAPA, or even if you have been a non-­‐
member PA in this state, we have reached out to you to ask questions about what is important to you, your supervising physician, and the patients you care for regarding: chart review and co-­‐signature, supervision requirements, oversight, licensing obstacles and m any others issues. We have worked VERY hard at building important relationships with key physician and regulatory contacts. I am proud to say that I, and m any on our Board, are on a first name basis with the executive staff and physician leadership of the Clark County Medical society, The Washoe County Medical Society, the Nevada State Medical Association and the 2 main regulatory licensing Boards: NSBME and NSOMB. We have worked with them and with ALL Nevada PAs, to spread the PA message of TEAMWORK and b etter access to high quality, cost effective healthcare. To be honest, at times we have hit walls that looked like they were made of reinforced concrete! However, the ability to remain focused on what we knew was right, along with lots of help from our parent organization AAPA, has pulled us through the fire many times. On too many occasions to count we have sat across the table explaining the PA message to State Senators and Congress m en and women, to physician leadership and staff on county medical associations boards and have testified numerous times at regulatory Board meetings codifying, and clearing up misperceptions, about the mission of PAs and the power of using them to the fullest extent of their license, experience and ability, in partnership with our physician colleagues. I am proud to say that I believe I move out of my presidency with a far stronger N APA than it had been 18 months ago. W e have a great executive leadership team starting in July headed by our new President Ben Prohaska, b ased in Reno. I feel very good about the leadership we have at the helm right now. from over, but right now many have abated for a while possibly building up strength on the horizon. We will need greater involvement from ALL PAs in Nevada. W e are a small state but we are a GREAT state. However we can only continue to be great if we stand together and share information so that we can all benefit from the power of unity and singular focus on a set of core principles. I cannot tell you how important a united voice is when we stand in front of physician groups, administrators or legislators, who are struggling to fully appreciate the PA message. Will you join us? I has been m y honor to be your President, Jay C. Somers, PA-­‐C, NAPA Immediate Past President With that being said, we have some daunting challenges ahead, both internal and external. The storms facing N evada PAs are far www.nevadapa.com 2 6
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Nevada Academy of Physician Assistants August 2015 Government Affairs Update: 2015 Nevada Legislative Session This year began with NAPA
embroiled in discussions
regarding Senate Bill 116. The
Government Affairs
Committee expended a great
deal of time and effort
speaking with the authors of
the bill, discussing motivations
behind it, and ultimately
working to defeat it. We
reached out to our constituents,
the AAPA, local and
government agencies and
officials and finally
successfully lobbied the
Nevada State Senate
Committee for Labor,
Commerce and Energy. As
you are all aware, a bill that
was unanimously felt to
represent many steps in the
wrong direction for access to
care, PA jobs in the state, and
reasonable forward movement
in the relationship between
physicians and PAs never
made it out off
committee. This is a classic
example of your state
organization working for you.
While SB 116 was the “showstopper” for the year, other
bills during the legislative
session were also monitored,
discussed, and in some cases
acted upon. Another such bill
was SB 459 (shown below)
which was the Governor’s
initiative on management of
controlled substances. This
bill passed through both houses
in the NV State Legislature and
was quickly signed into law. It
creates new requirements in the
prescription of controlled
substances, and affects all
practitioners of medicine in the
state.
Please visit our NAPA website,
www.nevadapa.com, to learn
about 11 other bills that passed
this legislative session that
affect PAs.
List of bills passed this
Nevada Legislative
Session that affect PA
practice:
-­‐AB89 -­‐AB158 WHY JOIN NAPA?
The Nevada Academy of
Physician Assistants is a small,
all-volunteer organization. We
are growing! We need every
PA in the state to recognize that
this organization is working for
you. Your representatives have
every desire and intention to
seek feedback on critical issues
that will affect the way we
practice in Nevada. In order to
best serve you, we need your
membership and
support. Please help us to help
you and join today!
-­‐AB227 -­‐AB292 -­‐SB7 -­‐SB68 -­‐SB459 -­‐SB327 -­‐SB292 -­‐LCB R022-­‐15 -­‐LCB R021-­‐15 For more information on these bills, please visit www.nevadapa.com Cameron Byers, PA-C
Chair: Government Affairs
Committee
President Elect, NAPA
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Nevada Academy of Physician Assistants August 2015 PA opens rural Nevada Clinic, cont. “I thought the hardest part was going to be the development of the site and the building. As I found out, that was the easy part.” medical facility in our very small town. Our town has a permanent population of 80, but our remote community, encompassing a 75-­‐miles radius, totals 5000 residents with little or no access to medical care. I thought about it, and talked to locals. Of course they would want a medical clinic in their back yard. As it was, our community had to travel a minimum of 140 miles to reach medical care and most went into the “big city” 200 miles away. One must plan one’s emergencies carefully. As I continued to think about it, I signed up and traveled to classes and seminars on “how to open an Urgent Care.” I down-­‐
loaded and read “how to open a Rural Health Center”. It had everything that was required, except how to sign up payers. If I had to do that, I didn’t think I could get it done. Just too much. I would have to think about that some more. In the meanwhile, I kept talking it up. My 1st beneficiary approached me to offer bare land, at a much reduced price, in the perfect location; by our dirt-­‐runway airport. We made the deal and I was on my way. With the community’s help and connections I was able to make, the septic engineered in record time, 6 months. That was about the time I ran out of money. Being a little bit older, I was pretty sure I didn’t want to take on a great deal of debt, and this clinic was starting to look a lot more expensive than I thought it would be. That’s when my 2nd beneficiary stepped forward with an offer to take my “clinic idea” to the County Hospital’s Board of Trustees. She assured me they would listen politely, and would probably be interested in funding something like this. I met with the CEO and pitched my idea. He agreed that I should pitch it to the Hospital Board. I have never asked for money, from anyone, so I wasn’t very good at it. But I was passionate about my community and my medicine, so I wrote up my idea. I created a business plan, added pictures, dressed nicely, and presented my vision for a frontier health care facility in our remote valley. Yes, they were interested! After 2-­‐3 months, they voted to become my 3rd beneficiary. Every month for nearly a “It has been a challenge and I know I will look back wistfully” www.nevadapa.com 4 4
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Nevada Academy of Physician Assistants August 2015 Continued from pg.1 year, I drove the 240 miles round trip to attend the hospital board meetings. As the planning progressed, it became obvious to me that it could become a problem if I owned the land, and the hospital owned the building. The CEO assured me we could go either way with ownership, but we agreed it should be owned by one entity. The hospital, having more resources than myself, was the obvious choice. I transferred my ownership to the hospital. Now the race was on. We all know how large companies work; slowly and cautiously, and the hospital was no exception. Another 2 years slipped by with more planning, designing, meetings, approvals, disapprovals, re-­‐planning and redesigning. Contracts, Thirty-­‐eight years ago, the few PAs practicing in Nevada formed NAPA. Those PAs needed each other to collectively further and protect their/our profession in its infancy...although you may not think it, more than ever do we need each other! PAs in Nevada continue to face numerous challenges in protecting our abilities to deliver care to our patients, permits, studies and money! With our head down, we continued to trudge on. Finally, the day came when we broke ground for the facility. The community pitched in to help prepare the grounds. Many months later the building was delivered. It was built as a prefab building, which was easier than having materials delivered in 400 miles. It is even more difficult and expensive to get skilled tradesmen out here and put them up. Thus, building had been completed approximately 9 months earlier and had been “sitting and waiting for us.” The hospital was generous in supplying equipment, computers, furnishings, and supplies. Everything was the best quality. The hospital wanted the structure to look developing financial and clinical situations were self-­‐determination is encouraged and protected; and most importantly, having a seat at the table where our voices are heard and respected when decisions affecting our profession are made. How can you help? I thought you would never ask! Joining good over a long period of time and give the community something to be proud of. We are very proud and grateful. I thought the hardest part was going to be the development of the site and the building. As I found out, that was the easy part. We had our staff hired, full of good intention and enthusiasm but a little lacking in experience. We set our date to open, planned our advertising strategy, sent out mailers, hung up flyers and posters and got a phone to take appointments for our opening week. After many emergency last minute trips to the State Capital for this license, that permit, those HIPAA compliant windows and window coverings, this sign, that poster, and a precursory RHC evaluation; NAPA is the first step. The $75 per year membership fee will cost you just over $0.20 a day; however, presenting a high participation rate of Nevada PAs to the public and alike, will speak inspiring volumes when your NAPA volunteers represent you—
the Nevada PA! -­‐-­‐cont. pg.6 www.nevadapa.com 5 7
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Nevada Academy of Physician Assistants August 2015 Continued from pg. 1 NAPA volunteers spent numerous hours away from their workplace, families, and personal time, speaking to legislatures and other governing bodies, advancing and posting job opportunities, facilitating regional meetings/dinners, voting on your behalf at AAPA HOD, developing and promoting corporate sponsorship for student scholarships...and much more. For instances, saying, “NAPA represents 85% of the practicing PAs instead of 60 or so people” (students make up about half of our 110 members) advances a wiliness for additional conversations and active engagement in our common challenges here in Nevada. -­‐Brian Lauf, PA-­‐C, HOD NAPA www.nevadapa.com the opening day came. With onsite help and guidance from the hospital’s supportive management, we started seeing patients. There were a few things that had slipped through the cracks; phones, licensing, training. We weren’t going to let the little stuff stop us, we were on a roll now. The first week we saw 18 people followed by the official Grand Opening that weekend. If anything will bring people to an event; its free food. We had 75 valley residents attend the opening, along with an emergency transport helicopter, and our local volunteer fire department! It was a GRAND opening, with everyone ogling and praising our new building, new facility, new everything! We cut the ribbon with the giant scissors, just like in the movies. Everyone clapped and cheered, the helicopter took off and buzzed us. And then we started our second week. Clinic Helipad after 1 ½ weeks we figured out the phone system wasn’t working properly. Well, that only took us another 1½ weeks to get repaired. Today they are reasonably reliable. We are now going over the charts from the last month and fixing everything that we did wrong (coding, dictating, and transcribing). It has been a challenge, and I know I will look back wistfully to these quieter times. The dream has come true, but only with help from far and near, big and small, and many, many friends and supporters that also believed in the dream. -­‐Ann Miles PA-­‐C The second week was quiet, our phones were frustrating and the insurmountable amount of paperwork was overwhelming. By the 3rd week, we started wondering “Where are all our patients?” “Why aren’t they calling?” Finally, www.nevadapa.com 6 Nevada Academy of Physician Assistants August 2015 Welcome to our new NAPA President, Ben Prohaska PA-­‐C I would like to thank my colleagues, members, and constituents of NAPA for the opportunity to serve you as President over the next year. I would like to welcome any new members to NAPA, and thank all retaining members for continuing to support NAPA. I will do my best to represent Physician Assistants in the state of Nevada and continue to promote our profession. It is a humbling experience and I am excited to serve Physician Assistants of Nevada as we all continue to work together to better our profession. My goals include continuing to work with the Nevada State Board of Medical Examiners, as well as the need to create a closer relationship with the Nevada State Medical Association. We will look at adjustments to the bylaws of NAPA, and we will continue to work closely with the AAPA to promote our PA/Physician relationships. We are in an uncharted unique time in history with respect to healthcare in Nevada, and it’s ever changing medical system as it continues to evolve. The NAPA Board and I will be as proactive as we can to create a better understanding of our role in this ever changing landscape of medical practice. Please feel free to contact me or any of the NAPA Board members with questions, concerns, or items you feel we need to address. -­‐Ben Prohaska PA-­‐C, NAPA President Nevada Academy of Physician Assistants www.nevadapa.com PO Box 98381 Las Vegas, NV 89193-­‐8381 [Recipient] Address Line 1 Address Line 2 Address Line 3 Address Line 4