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Military Updates:
For more information on what's happening overseas,
visit the DoD's official Website for the War on Terror: http://www.defendamerica.mil/
|
| Administrative
Practice Issue References
Important to Your Practice
NEWLY
UPDATED!!! |
| Joseph
Streff, PA-C
Webmaster, 1995-present |
————————————————————————
READY REFERENCE FOR THE VA PHYSICIAN ASSISTANT
|
|
A CANADIAN VIEW OF THE PHYSICIAN ASSISTANT
http://www.nationalreviewofmedicine.com/issue/2007/12_15/4_patients_practice05_20.html |
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| GRANDFATHERED
PAs:
by Denni Woodmansee, PA Advisor to the USH
With the assistance of the VISN CMOs, I finally have accurate
data on VHA non-certified "grandfathered" PAs.
There are currently 62 non-NCCPA certified PAs
in the system.
15 have indicated that they will retire prior to
1/1/2010.
14 have indicated that they will participate in the Grandfathered
PAs Assistance Program and attempt to regain NCCPA Certification.
This program will fund non-certified VA PAs to attend a
comprehensive certification review course
33 have not responded. Webmaster's note:
if you are one of the 33, why didn't you respond to Mr.
Woodmansee?
I would like present some demographic info. You may
find the following information helpful. The trend clearly
shows that the PA profession is shifting with a majority
of PAs in general being women and the VA rapidly heading
in that direction. - DW
As of November 30, 2007:
1672 PAs were employed by VHA. 55% male,
45% female. AAPA 2007 census shows 64%
of all current PAs are female.
Of all PAs hired in the last 5 years, 21% were veterans,
79% were non-vets. Of all current, VHA
PAs, 36% are veterans.
43% of all VHA PAs hold Bachelor's degrees, 40% with Master's
Degrees, 5 PhDs, actually 24 PAs with nursing degrees.
3,504 NPs are employed by VHA. 10% male,
90% female. 15% of all NPs are veterans
Source: VA PAID Data File
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I have received the FY 2007 2nd QTR stats for VHA PAs
and NPs. These numbers DO NOT include NP positions in VACO.
It also does not include NP/PAs under contract of fee basis.
If the VA is hiring to prepare for the multiple new initiatives,
it isn't PAs or NPs. -dw
| 3/31/07 (FY 07 1st Qtr). |
NPs |
PAs |
| Total |
3228 |
1573 |
| FT |
2972 |
1502 |
| PT/INT |
256 |
71 |
| Grade 5 |
1 |
|
| Grade 4 |
37 |
|
| Grade 3/8 to 3/17 |
2045 (63.4%) |
619 (39.4%) PA Grade 13 |
| |
|
|
| 12/31/06 (FY 06 4th Qtr.) |
NPs |
PAs |
| Total |
3165 (2% increase) |
1570 (0.02% increase) |
| FT |
2904 |
1500 |
| PT/INT |
261 |
70 |
| Grade 5 |
1 |
|
| Grade 4 |
33 |
|
| Grade 3/8 to 3/17 |
1992 (62.9%) |
612 (39%) PA Grade 13 |
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April 11, 2007 |
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| Draft 2008 GS Pay Scales:
The draft of the 2008 Pay Scales has been posted on the
OPM Website. Here is the link:
http://www.opm.gov/oca/08tables/indexGS.asp |
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| Grade/Step Comparisons :
VA Pay information can be found at: http://vaww.appc1.va.gov/ohrm/PAY/PAYRATE1.htm
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|
Retirement Information: Please
use the link provided below to connect to the OPM CSRS and
FERS Handbook for Personnel and Payroll Offices.
http://www.opm.gov/asd/htm/hod.htm |
|
VA Handbook 5007, Part VI, Chapter
3, Retention Incentives (Posted
03Aug2007)
b. Likelihood of Leaving Federal Employment.
Each supervisor shall make a separate certification that an
employee, or for group authorizations, a significant number
of employees in the group, is likely to leave Federal service
in the absence of an incentive (see appendix VI-E). This certification
will only be made when the supervisor is reasonably convinced
that the employee is likely to leave Federal service. Such
a certification may be based on:
(1) Receipt by an employee, or for group authorizations,
a significant number of employees, of one or more bona fide
offers of employment, as evidenced by a formal written job
offer or affidavit signed by the employee or employees providing
the position and salary being offered, the name and location
of the organization, and the prospective date of employment;
or
(2) Evidence of high demand in the private sector for
the knowledge and skills possessed by the employee or group
of employees and significant pay disparities between Federal
and non-Federal salaries; or
(3) A discussion with the employee of the employee’s
career plans. |
|
| VHA Directive 2007-015 Interfacility
Transfer Policy (Posted 26
May 2007) This
Directive was just released. I have posted sections that
may pertain to Physician Assistants.
<<VHA Directive 2007-015 Inter-Facility Transfer Policy.DOC>>
(4) No patient is transferred to the VA facility or from
the VA facility to a non-VA facility, without the prior
approval by an appropriately-credentialed, privileged, and
responsible VA staff physician, or designee.
(a) No patient may be transferred from a VA facility to
a non-VA facility without the prior approval from an accepting
physician, or designee, at the receiving non-VA facility.
(b) The accepting physician, or designee, must speak directly
with the referring physician, or designee, regarding the
care of the patient. NOTE: A nurse to nurse contact is essential.
These verbal communications need to allow for questions
and answers from both transferring and receiving facilities.
This is irrespective of whether the transferring facility
is VA or non-VA.
) An assigned designee, involved in any decisions or actions
related to transfers, is a credentialed provider.
(a) The designee cannot be an individual who is at the
VA as a post graduate trainee (intern, resident, or fellow).
If the designee is not a physician, the designee must be
a qualified medical person as determined by the facility’s
by-laws or rules and regulations.
(b) Transfer-related decisions by a non-physician designee
may be made only after a physician is consulted and agrees
with the action. Signatures of any transfer-related documentation
by the non-physician designee must subsequently be counter
signed by the physician consulted.
(6) Only the Emergency Department or Urgent Care Unit
physician, or designee on duty and in charge, accepts patients
for evaluation in the Emergency Department or Urgent Care
Unit. NOTE: Responsibility for accepting direct admissions
to inpatient units is determined by local policy. |
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| VHA Directives
Links: (Posted 20
May 2007) Special Awards
Some confusion exists about the difference between Special
Awards for Achievement versus those for Performance. Here
are the latest copies of the regs for you to download and
keep in your files:
Physician_Assistant_Criteria_for_Special_Advancement_for_Performance.doc
(30k)
Physician_Assistant_Criteria_of_Special_Advancement_for_Achievment.doc
(33k)
Special Advancements (Originally
Posted 25 Feb 2007)
Q. What are the rules on Special Advancements?
A: VA Handbook 5017, Part V authorizes Special
Advancement for Performance and Special Advancement for
Achievement. These provisions may be used to recognize a
PA who exhibits superior performance or sustains professional
achievements. Requests for SAPs and SAAs must be submitted
to the PA Professional Standards Board for review and approved
by the Director. Step increases awarded under SAP and SAA
do not take the place of the regular periodic step increase
and does not reset the waiting period for the next step
increase. They also do not effect eligibility for grade
promotion. One could receive a step increase for SAP, a
regular periodic within grade step increase, followed by
a grade promotion in the same year. SAP are limited to one
occurrence in 52 weeks. Step increases may not exceed the
maximum step in the grade.
Special Advancement for Performance (SAP)
- Allows for a one step increase.Criteria
d. Physician Assistants. The employee must have demonstrated
a sustained high level of performance and ability over and
above that normally expected of employees in the particular
grade and profession or there must have been noted contributions
in some aspect of health care. Criteria for one-step advancement
will be demonstrated superior performance as evidenced by:
(1) Assumption of a major responsibility in administering
a major patient care program.
(2) Significant accomplishments associated with an academic
program conducted in affiliation with the facility where
the physician assistant is employed.
Special Advancement for Achievement (SAA)
- Allows for one to five step increase. The number of steps
awarded will depend on the level of achievement. The average
award is a 2-3 step increase. A 5 step increase is extremely
rare and usually involves significant achievements that
are national in scope. Note: Those holding faculty appointments
with a university based PA training program may be eligible
for a SAA.
d. Physician Assistants. Full-time, part-time
and intermittent physician assistants may be advanced within
the grade from one to five steps on the basis of professional
achievement above that expected for the grade level or assignment
provided they have demonstrated excellence in performance
and potential for assumption of greater responsibility.
Examples of such achievements include, but are not limited
to:
(1) A graduate level degree in a field related to the
Department’s health care mission;
(2) Appointment to a university faculty position;
(3) Significant contributions to the Department’s
health care mission. Such accomplishments may result from
leadership or exceptional efforts on facility, regional
or national task forces or committees, or by serving as
a consultant on matters relating to education research,
health care management, or quality of care issues;
(4) Recognition of outstanding and exceptional achievement
by a professional or academic organization;
Election to office in a professional organization
at the State or national level
Independently producing or serving as a principal assistant
or major contributing member on research producing publishable
results that advance patient care or medical science; or
(7) Attainment of specialty certification
within the occupation. This does not include certification
as a physician assistant by the National Commission on Certification
of Physician’s Assistants, which is a condition of
employment as a physician assistant in VHA.
----- -----
All the MP-5s were converted to Handbooks. I have found
the links listed below to be very helpful. That last one
on the list includes any updates or changes.
http://www1.va.gov/vapubs/
http://www1.va.gov/vhapublications/
http://vaww.appc1.va.gov/ohrm/Directives-Handbooks/Direct_Hand.htm |
|
| VHA Directives Links:
(Posted 13 May
2007)
As discussed at the VAPAA Conference, the link to most
of the relevant VHA Directives effecting PAs is provided
below. This site incorporates changes to the directives
as they occur so this reference is the most up to date.
(These are VA Intranet links and not available from outside
the VA realm.)
http://vaww.appc1.va.gov/ohrm/Directives-Handbooks/Direct_Hand.htm
Also included is a index of VA Handbooks 5001 - 5027 (HRMS
Directives) that enables you to more easily find which handbook
addresses a particular topic.
http://vaww.appc1.va.gov/ohrm/Directives-Handbooks/Documents/TerryKguide.doc
Denni
J. Woodmansee, PA-C
PA Advisor to the Under Secretary for Health
Department of Veterans Affairs
(774) 826-2035
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AAPA Reimbursement
Policy Template Available (posted
01May2007)
The AAPA’s Reimbursement Policy Staff developed a
template of reimbursement policy information to add to your
organization’s website. The link below will take you
to information on Medicare, Private Payer, Medicaid, and
Workers’ Compensation reimbursement policy that will
help your members answer their reimbursement questions and
will direct them to the AAPA’s reimbursement policy
staff members to solve more difficult reimbursement problems.
http://www.aapa.org/cor/WebResources.htm
The web page can also be located by going through the Constituent
Organization Services section of our website at: http://www.aapa.org/cor/index.html
We encourage you to review this information and add it
to your organization’s website. If you have additional
questions about reimbursement policy, or need assistance
customizing the Medicaid and Workers’ Compensation
sections for your state, please contact Gwen Gordon (ggordon@aapa.org)
in the AAPA’s Reimbursement Policy Department at 703/836-2272
ext. 3219.
Sincerely,
Gwen Gordon
Manager, Reimbursement Policy
American Academy of Physician Assistants
950 N. Washington Street
Alexandria, VA 22314-1552
The following message was sent on behalf of the AAPA Reimbursement
Department. All e-mail replies should be directed toward
ggordon@aapa.org.
All constituent organization leaders were blind copied on
this message.
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|
| Travel Policy Changes
(Posted 01
Feb 2007)
From: Travel Policy Division (047E3)
Subject: Travel Notice 07-07 – Mileage Rate Reimbursement
Change
To: All VA Administrations and Staff Offices
This is Travel Notice 07-07 to inform all VA Administrations
and Staff Offices of a change to the reimbursement rate
for the use of a privately owned vehicle (POV) for official
travel. This change in the POV rate is effective for travel
on and after February 1, 2007.
1. Reimbursement rates when the use of a POV is authorized
as advantageous to the government:
· privately owned automobile rate increases from
44.5 cents per mile to 48.5 cents per mile.
2. Reimbursement rate for the use of a POV when a government
vehicle is authorized as the mode of transportation:
· rate for use of POV remains at the same at 28.5
cents per mile.
3. Reimbursement rate for the use of a POV when traveler
has signed a commitment statement to use a GOV:
· rate for use of POV remains the same at 12.5 cents
per mile.
Again, please note these changes are effective February
1, 2007.
Questions or concerns regarding this Travel Notice should
be directed to the Travel Policy office on 202-273-9375,
or at travelpolicy@va.gov.
|
Quote of the Week: (Posted
28Jan2007) "Fair
pay is a crucial element in attracting and retaining the talented
employees federal agencies require if they are going to meet
the public's needs and expectations." -- Colleen Kelley,
president of the National Treasury Employees Union, in support
of a call for civilian-military pay parity in 2008. |
| Overtime Pay
(Posted 29 Jan 2007)
Q: What is the policy on overtime pay? A: Physician
Assistants were re-classified by the FLSA as a "learned
profession" which meets the criteria of "exempted"
profession. You may find that the FLSA designation in your
service record in VISTA is Exempt. FLSA, as administered
by the Department of Labor, sets standards for overtime
payment for all employers (public and private) which is
at least 1 1/2 times the basic rate of pay. There is a complicated
formula use to determine which occupations are exempt from
these provisions which means the employer does not have
to pay OT rates. VA addresses this issue in VA Handbook
5007 where FLSA exempt employees have OT pay rates capped
at GS-10 levels.
HOWEVER, VA has a separate policy provision
for Nurses, PAs, and EFDAs concerning OT and OT pay rates.
Therefore, it does not matter if PAs are FLSA exempt or
non-exempt. OT pay rates for VA PAs are not capped. If someone
tries to tell you this, give them a copy of the reference
below.
VHA Handbook 5007/21 - Pay Administration, Part V., Chapter
2, 2. Overtime and Compensatory Time off for Employees Appointed
Under 38 U.S.C 7306, 7401, and 7405
b. Overtime Pay for Nurses, PAs, and EFDAs
(1) Except as provided in paragraph 3a of this chapter,
probational and permanent full-time nurses, PAs, and EFDAs
are employed on the basis of a 40-hour basic workweek, unless
on an alternate work schedule, as indicated in VA Handbook
5011, Hours of Duty and Leave. Computation of regular pay
for employees on the 40-hour basic workweek shall be based
on a basic hourly rate, derived by dividing the employee’s
annual rate of basic pay by 2,080.
(2) General provisions for the payment of overtime pay for
nurses, PAs, and EFDAs
(a) Leave without pay is not included when computing hours
of work for overtime purposes.
(b) Overtime must be at least 15 minutes duration in a calendar
day to be creditable for overtime purposes.
(c) Overtime is payable for service performed in excess
of 40 hours in an administrative workweek, or in excess
of 8 hours in a day, whichever is greater, at a rate of
one and one-half times the employee’s basic hourly
rate of pay. NOTE: [For a full-time employee on a compressed
work schedule, overtime is pay-able for hours of work in
excess of the basic work requirement. For a part-time employee
on a compressed work schedule, overtime is payable for hours
of work in excess of the basic work requirement for a day
(but must be in excess of 8 hours) or for a week (but must
be in excess of 40 hours)]. |
PAY AND BENEFITS WATCH (Posted
25 Jan 2007) Rating
Benefits By Karen Rutzick
How do your 1.8 million federal co-workers feel about their
pay and benefits? The Office of Personnel Management surveyed
220,000 of them to get an idea. Some of the results released
last week could have been expected. But there were some
surprises, too.
This column is published at http://www.govexec.com/dailyfed/0107/012507pb.htm |
| DEA Exemption Letter
December 8, 2006
A recent email discussed that the
VA will need to require DEA registration for all PAs. After
further discussion, it was clarified that a PA may be licensed
in any state. However, personal DEA registration requires
licensure in the state in which the facility of employment
is located. Those not licensed in their state of practice
may use the facilities DEA number. This may seem to avoid
a problem but VA Pharmacy is pushing to implement a new
tracking system that requires every practitioner have their
own DEA number. So… we may have a reprieve for now
but there will be problems down the road. The best permanent
solution is to exempt VA practitioners from DEA registration
in the first place.
21 CFR 1300.01(b)(28) - "The term mid-level practitioner
means an individual practitioner, other than a physician,
dentist, veterinarian, or podiatrist, who is licensed, registered,
or otherwise permitted by the United States or the jurisdiction
in which he/she practices to dispense a controlled substance
in the course of professional practice."
Since VA practitioners are "agents" of the United
States and states recognize they do not have jurisdiction
over federal facilities, VA should use it's authority and
authorize ALL prescribing authority irrespective of state
licensure status. DOD did it. We just need someone with
enough chutzpa in the VA to override VA General Counsel
to make it happen.
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Health
care employees benefit from retention bonuses
By Karen Rutzick (of GOVEXEC.com)
Health care workers are reaping the benefits of federal agencies'
efforts to use cash incentives to keep stellar employees on
the job, the Office of Personnel Management reported Monday.
Based on data from every agency that awarded retention
bonuses in 2005, OPM calculated that five of the top 10
occupations to receive retention incentives were in health
care: nurse, medical officer, pharmacology, physician's
assistant and practical nurse.
One reason for the health care emphasis is the disproportionate
use of retention incentives by the Health and Human Services
Department. HHS, which employs less than 70,000 people,
doled out more than a third of the 3,000 retention bonuses
throughout government 2005. The agency spent about $12 million
on the incentives to keep high-performing employees at risk
of leaving the agency.
Full story: http://www.govexec.com/story_page.cfm?articleid=35110&dcn=e_gvet
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| Military
PAs - Recently Mobilized National Guard PAs Need To Read
This:
You have been identified as a Soldier that has served on
Title 10 Mobilization orders on or after September 11, 2001.
You may be eligible for educational benefits under the Reserve
Educational Assistance Program (REAP), Chapter 1607, Title
10, U.S. Code, as established by the Ronald Reagan National
Defense Authorization Act of 2005.
In accordance with this provision of the law, it is a requirement
that you be notified of these benefits.
To obtain your Eligibility for Mobilized Soldier (EMS),
or receive further instructions, please click on the following
link.
https://www.nationalguardbenefits.com/MGIBWeb/CH_1607_Notification.aspx?SessionID=bd9332fa-bc8f-4365-be0e-efcd21ec8a5f
Alternatively you can follow these steps to obtain your
Eligibility for Mobilized Soldier (EMS) notification -
Go to https://www.nationalguardbenefits.com/
Logon using your AKO username and password
Review and print your Eligibility for Mobilized Soldier
(EMS) notification
POC for this email message is the ARNG GI Bill Support
Team.
ARNG GI Bill Support Team
Email.: esc@PEC.NGB.army.mil
Phone: 1-866-628-5999
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Proficiency Guidelines for Physician
Assistant Rating / Evaluation
HTML Document PA-Rate
Document
Proficiency Rating
System: (MP-5,
Part II, Chapter 6)
http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1042
ANNUAL LEAVE ACCRUAL
FOR PAs:
Handbook
5011 (Moved to OHRM Web Site)
Creditable
Service for Annual Leave:
http://www1.va.gov/ohrm/WorkLife/Leave/Flyer06-15.doc
Provider
Credential Information:
PAs are included in the VHA Directive
2001-013, Maintaining Provider Credential Information in
the VistA NewPerson File has been approved for distribution;
it may be found on the following web sites:
Internet http://www.va.gov/publ/direc/health/
Intranet http://vaww.va.gov/publ/direc/health/
Assignments,
Staff Adjustments, and Furloughs:
http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1428
Comp Time for Travel:
Compensation Time For Travel - VA
Handbook 5007, Part VIII, Chapter 15.doc
(2) Under the authority
of 38 U.S.C. 7421(a), the Secretary has extended provisions
of 5 U.S.C. 5550b, Compensatory Time Off for Travel, to
nurses, physician assistants, expanded function dental auxiliaries
and title 38 hybrid employees entitled to overtime under
38 U.S.C. 7453 and to part-time physicians, dentists, podiatrists,
chiropractors and optometrists appointed under 38 U.S.C
7306, 7401 or 7405. [Latest complete version is on VA website
dated July 20, 2005]
http://www1.va.gov/ohrm/Directives-Handbooks/Documents/5007-19.DOC
Other Directives (some
with Handbooks attached):
http://www1.va.gov/vhapublications/publications.
or http://www1.va.gov/ohrm/Directives-Handbooks/Direct_Hand.htm
(Human Resources HBs)
Other Handbooks:
http://www1.va.gov/vhapublications/publications
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VA
HANDBOOK 5011/6, PART III, CHAPTER 3, 6.
ACCRUALS OF ANNUAL AND SICK LEAVE
f. Maximum Leave Accumulation,
(1) Annual Leave
(a) Full-Time Physicians, Dentists, Podiatrists , Chiropractors,
or Optometrists. A full-time physician, dentist, podiatrist
or optometrist may carry forward not more than [86] days
of accumulated annual leave at the end of any leave year.
(b) Full-Time Nurses, PAs or EFDAs. A
full-time nurse, PA, or
EFDA may carry forward not more than 685
hours of accumulated annual leave at the end of any leave
year.
(c) Part-Time Employees. A part-time employee may carry
forward not more than 240 hours of accumulated
annual leave at the end of any leave year except that an
employee converted to part-time from full-time may carry
forward more hours of unused annual leave as indicated in
subparagraphs 1 and 2.
http://vaww.appc1.va.gov/ohrm/Directives-Handbooks/Direct_Hand.htm
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Code of Federal Regulations
You can find the specific regulations at the DEA website:
http://www.deadiversion.usdoj.gov/
Also please check these specific pages; http://www.deadiversion.usdoj.gov/drugreg/index.html
It is so unique for VHA not to be requesting an exemption
for registration. See 1301.23. There are no PAs in the DOD,
Military or PHS required to have DEA registration (or state
license) to prescribe scheduled medications.
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| ————————————————————————
July 1, 2006 Urgent Information from AAPA
About FOR-PROFIT Specialty Exam Company
House of Delegates policies concerning specialty certification
(http://www.aapa.org/policy/against-spec-cert.html).
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June 6, 2002
Texas Allows PAs to Submit for Reimbursement Without License!
Texas now has a law that allows PAs without licensure to
submit for insurance reimbursement for services if they
use the hospital or clinic's provider number. It is hoped
that more states will follow suit, so that federally employed
PAs, who due to their unique relationship with their supervising
physician in the federal system, cannot qualify for licensure
in most states, can have their services reimbursed. This
will help PAs become more widely acceptable, within the
federal system, we hope. |
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