Board of Directors  2007-2008
President:                       Justin Brinkerhoff
Past President               David Anderson
President Elect:             Jared Spackman
Vice President:              Tom Bean
Treasurer:                        Brad Pace  
Secretary:                        Raun Child  
Student Representative:         Olivier Mulyangote
                                                   Scott Bramble
Chief Delegate:             Shari Combe 
Senior Delegate:           Kelly Wood
Jr. Delegate:                  Rod Grogan
Member at Large:         Jennie Coombs
Member at Large:         John Powell
Executive Director:        Bob Bunnell

Attending:
Tom Bean, John Powell, Jared Spackman, Olivier Mulyangote, Gary Nelson, Rod Grogan, Dave Anderson, Justin Brinkerhoff, Dave Keahey, Jennie Coombs, Bob Bunnell
AAPA: Roger Wells and Sherry Stolberg

AGENDA

Welcome:                                Justin Brinkerhoff

1.  Review and approval of 8/07 BOD minutes        Justin Brinkerhoff
Minutes approved as presented.
   
2.  Leadership training                        Justin Brinkerhoff
AAPA will conduct leadership training tomorrow starting at 8:30 am.  Justin refers to the AAPA Constituent Academy Leadership Handbook – recommends leaders review and use in their functions.  Justin encouraged use to refine our efforts and to promote smooth transitions for new leaders.  Justin recognizes work done by committee chairs.  Encourages continual informational reports to go to membership to foster interest in the Academy.

3.  Radiology PAs                            Rod Grogan
Rod presents handout.  Don Pedersen has spoken with WSU RPA educators; they told him they would not use the PA moniker.  Scott Frischknecht will be submitting an opinion.  They are not licensed with DOPL.  Rod asks what liability risks we take if they read our x-rays.  WSU has not told Rod how many RPAs there are in the state.  (See Radiology PA handout written by Rod.)  Rod met with AAPA 6 months ago – told to deal with it on an Academy level.  Jared: 2 issues:  1. Radiology Assistant does not have clinical training.  2.  Title confusion. 

Dave: Currently, legislation exists to protect the PA name.  RPA means Radiology Practitioner Assistant.  Suggest that when we hear them referring to themselves as PA, report to DOPL.  Jared: if they are performing a billable action, they are practicing medicine without a license.  Justin suggests UAPA write a formal letter to DOPL to indicate we wish clarity and notification that this exists.  Dave quotes 58-54-2 Radiology practical technician.  Defines qualified practitioners.  MDs, DOs, Chiropractors and PAs may supervise a radiology practitioner assistant.  Discussion about Heather Hatch in St. George who works as RPA.  Issue then is what is WSU producing?  What are they calling themselves?  Dave Keahey suggests we report those who are loose with using the name.  Also suggests DOPL write letter to WSU program leaders.  They may go to the program and investigate.  Dave Keahey asks to have Don Pedersen meet with them again. 
Plan:
1. Report infractions to DOPL.
2. Don Pedersen to meet with WSU leaders.
3. UAPA send letter to DOPL outlining concerns and ask for their assistance in managing this issue.

4.  Committee Reports
   
Legislative                            Dave Keahey
Dave submits copies of the legislative report.  See below. Issues:  Randy Steed, PA-C 100% co-signing change.  Bob to give feedback to Randy on this issue.  Suggest Jared’s mechanism for chart review.  Jared will email details to Dave.
Reimbursement:  Mandate to force insurers to pay full MD rate for PA services.  PINs will make it easy to identify PAs, making it simpler for insurers to cut reimbursement for PA services.  Dave not sure what we can do to influence insurers.  Dave’s submission outlines plan for moving forward with legislative efforts.  He warns the insurance lobby is strong – very rare for changes to be made.  Jared notes the 17 states have passed similar mandates.  Dave reviews 31A-22-618 – cannot discriminate any class of provider.  Dave suggests obtaining legal opinion to investigate if this clause covers PAs.  To start the process: Reimbursement committee to investigate which insurers pay at different rates.  Consider review with insurance commissioner to interpret law.  Dave submits this report:


Legislative Chair Report
11/9/07
St. George Utah

New Issues for 2007

1.  Randy Steed, PA-C requested an initial investigation into the possibility of reducing physician co-signature of Schedule 2-3 controlled substances in the “medical chart record”.  The 100% co-signature is perceived as a burden in his practice of chronic pain management.  This would require ‘opening’ the PA act.

58-70a-501. Scope of practice.
     (2)
(c) the supervising physician cosigns any medical chart record of a
prescription of a Schedule 2 or Schedule 3 controlled substance made by
the physician assistant.

Resolution:
Bob Bunnell presented the idea from the Physician Assistant Practice Act to the members of the PA Licensing Board.  Physician members of the committee responded negatively to the idea.

It was suggested that PAs facing this obstacle develop creative ways of complying with the law through use of electronic or NCR paper records that could be co-signed and placed in the medical chart record on a regular basis.  Note that no time frame is mentioned in statute.

2.  Members of the UAPA BOD heard complaints from members that third party payers were refusing to pay for PA-generated inpatient charges or surgical first assisting.  Assignments were made to explore the situation in other states.  Bob Bunnell recommended:

“ . . .  we formalize our strategy and establish a unified, coherent group that can march this forward without undue delay.  Dave, Jim, Scott, Jared, Justin and Bob will comprise the primary work group”.  

The chair made the following recommendation for a course of action for 2007-2008:

-Outline exactly what is happening, who is affected (and their docs), what the policies are for each insurer
-Educate our selves thoroughly about the issues from our side as well as the insurers side
-Consult with AAPA
-Consult with UMA to see if they are aware of the problem and if any of their constituents are affected; ask if they would look favorably on specific action we might take
-Obtain a legal opinion regarding Utah Code 31A-22-618
-Consider a meeting with each insurer who is problematic and perhaps some who are not
-Consider asking Scott Bramble to outline the problem to his father for his input about whether or not legislation is feasible or advisable

If non-legislative efforts fail and legislation is contemplated:

-Hire attorney with legislative experience in health insurance to draft language
-Explore bill sponsorship
-Consider boosting EDs compensated time with UAPA to increase lobbying efforts for 2008 session

Ongoing activities for chair:

Continue to monitor Utah Legislature website for any bills/committee activities that might affect PA practice in Utah.

31A-22-618.   Nondiscrimination among health care professionals.
     (1) Except as provided under Section 31A-22-617, and except as to insurers licensed under Chapter 8, no insurer may unfairly discriminate against any licensed class of health care providers by structuring contract exclusions which exclude payment of benefits for the treatment of any illness, injury, or condition by any licensed class of health care providers when the treatment is within the scope of the licensee's practice and the illness, injury, or condition falls within the coverage of the contract. Upon the written request of an insured alleging an insurer has violated this section, the commissioner shall hold a hearing to determine if the violation exists. The commissioner may consolidate two or more related alleged violations into a single hearing.
     (2) This section does not apply to catastrophic mental health coverage provided in accordance with Section 31A-22-625.

Submitted 11/6/07
D. Keahey

Jenny suggests we ask AAPA for legal opinion.  Board reviews Dave’s submission.  BOD to communicate with UAPA membership regarding impact to date.  Jim Meeks to accumulate information and prepare a report for the legislative committee.  Consensus: move forward with plan as outlined. 
Dave shows Utah State Legislative update website and demonstrates how to track bills/committee work.  He reviews how to find bills and progress of specific bills in the legislative process.   Web address: www.le.state.ut.us

Sherry Stolberg and Roger Wells report on national progress.  
Justin reviews CCOW plans for legislative visits in winter.  Benefits of attending similar leadership opportunities are outlined.  Justin leads discussion with optimistic approach to making this work.

CME                                Dave Anderson
Dave presents check for $11,000 for Mesquite meeting!  DMG is now working on grants for our conference in April.  Dave has confidence in their ability to double our income from this conference.  Dave with discuss with DMG.  Chuck at DMG reports we should increase our fees for tables at the conference.  He suggests we expand offered CME hours.  Rod reports about attending AFPPA and reviewing CME with Chuck and Jim – most speakers were PAs.  Rod presents handout on the AFPPA conference setup and presentations.  Jared suggests a drug enforcement speaker present at our next conference.  Gary proposes wilderness medicine topic to generate participation from associated merchandisers.  These suppliers are not bound by the same rules as pharmaceutical companies.  Rod suggests workshops to generate more participation.  Dave replies the space at the hotel limits this option.  The hotel is now building a conference center that will accommodate this option.  Could be available in 2009.  Jared suggests we forward any personal contacts to Dave and Alan for further marketing efforts.
The UAPA BOD congratulates Dave on outstanding service in the difficult work of putting on a conference. 
   
Membership                            Jared Spackman
Jared reports on efforts to increase membership.  Several membership lists have been merged with others to produce a tight list of PAs.  Very few bad addresses now exist.  First-year PA students met for a night of phone calling.  Phone numbers were not available, but found about ½ of Utah PA non-members.  Approx. 20 new memberships generated.  Annual repeat is planned.  On-line memberships working well. 2-year memberships now allowed.  Memberships are now from date of payment to same date one year later.  Reminders to be sent as memberships expire.  Approx. 45% of Utah PAs are members, a good number compared to other states.  Goal: 80% of all Utah PAs to be members of UAPA.   Justin reports Gordon Day’s feedback about generating memberships for national dermatology PAs.  Membership fee included 40 hours of CME sponsored by drug companies which generated a marked increase in memberships.  A similar educational CME effort could be generated for UAPA.  Would category I CME take away the option to generate participation at Mesquite/Snowbird?  Challenge: identifying PAs who are not members.

Reimbursement                        Jim Meeks
     
Website                            Kyle Harmer

Emergency     Preparedness Committee        Gary Nelson
New committee formed at request of UAPA.  Gary recruited by Wayne Crawford.  Gary presents handout on goals for his committee.  New committee name is discussed.  Jared suggests coordinating with state agencies.  IHC has contacted Gary to coordinate with them as he directs PA efforts.  IHC goal is to help direct areas where PAs will be needed.  Jared suggests we decide which agencies UAPA will respond to when called upon.  Gary to review who will have the first draw on PA services.  UAPA may be able to draw attention and stimulate membership by soliciting PAs to help with these efforts.  Gary and Justin propose using mailings to generate interest. Funds for mailing may be available from Utah State.

5.  UPAP Student report                        Olivier Mulyangote
Reports enjoying participating in the membership drive.  Students participated in PA week by assisting with the Special Olympics. A successful golf tournament will be repeated this year.  Students are willing to be involved in UAPA activities.  Approaches to UPAP to allow students to attend have been initiated.  Discussion directed at encouraging student participation at the CME events.  Dave K. reports it is difficult to take a Friday off, impacting the Friday Clinics program.  Bob reports he has written to Dan Crouse to request the Program allow students to attend.  Jennie will also speak with Dan. 

6.   Elections/Awards                        Tom Bean
Awards:  Recognition for UAPA board members reviewed.  Tom to present a plan for recognizing UAPA Board members when they leave the board.  Jared discusses plan to nominate awardees to give more time for them to plan to attend the conference.  Suggest that early-bird registration notify PAs of awards nominations. 
Elections: It is suggested that Academy members have more notice of offices to be elected well before the Mesquite meeting.  Publishing job descriptions prior to the meeting is also encouraged to promote improved understanding of offices and duties.  John Powell relates his desire to serve, but unsure of opportunities and duties.  Member Kathy Pedersen also recommends obtaining personal statements from candidates for publication before the election deadline.

7. Treasurers report                        Bob Bunnell
    $7,049.48 Checking now $18,049.48 (Thanks to Dave Anderson’s CME work!)
    $15,393,01 Savings

8.  Roundtable                            All
Rod Grogan recommends UAPA members join UMA.  Many benefits from membership – including financial planning and supporting the relationship between PAs and MDs.  Currently 10 PAs are UMA members.

Rod suggests producing a workbook with basic leadership information for all board members.  Rod will provide an outline for the workbook.  Jared suggests the information be filed on the website.  Leaders could download to make their own handbook.  John communicates need for training for new BOD members.  Suggest retreat for new leaders – and previous leaders to transition.  
     
9.  Next Meeting                            Justin Brinkerhoff

To Do: 
Everyone: review Constituent Chapter Leadership Handbook.
Rod: Craft a letter for DOPL regarding RPAs.  Discuss issues with Don about contacting WSU about concerns.  Send letters to Bob for inclusion into minutes.  Submit outline for workbook to be given to board members. 
Gary: Submit handouts to Bob for inclusion in minutes.  Compose a name for his committee for BOD approval. 
Bob: Produce copy of hard drive with UAPA data for holding elsewhere in case of loss or damage to UAPA computer.  Convert Rod’s information for a handbook into a document for the UAPA website.  Present Legislative Committee directives to UMA, insurers when prepared. Bob to give feedback to Randy Steed on Rx co-signing issue.
Dave Keahey:  Initiate coordination with Reimbursement Committee chair, Jim Meeks.  Contact Anne Davis @ AAPA for legal opinion/direction. 
Jared: Craft letter for membership to solicit impact of insurance cuts. Review with Jim Meeks.
Jim: Contact Michael Poe at AAPA for direction.  Jim to accumulate information about the impact of reimbursement cuts and prepare a report for the legislative committee.
Tom:  Submit ideas for recognizing UAPA board members when they leave the board.  Produce plans for elections with time-lines for distributing information to UAPA members before elections.  Start process for nominations for UAPA awards prior to Mesquite conference with enough time to invite awardees to attend the conference.