Legislative Affairs Updates

AAPA PAragon FEDERAL SERVICE AWARD
May 29, 2005

Nominated by the VAPAA, Joseph O. Streff, PA-C, was awarded the coveted PAragon Federal Service PA of the Year for 2005 at the AAPA National CME Conference. The award was presented at a luncheon and Joe and the other award recipients were presented to the audience of over 3,000 PAs at the opening ceremonies of the conference the next morning. The keynote speaker for that opening ceremony even mentioned in his motivational presentation that he "wish I could be like Joe". He noted he was impressed by what he had done for the PAs in the VA and highly respected the job the PAs in the VHA did for their patients. The AAPA reported the presentation in their newsletter.

Thomas A. Zampieri, PA (Ret.)
Executive Director and Legislative Chair

FINAL VAPAA LEGISLATIVE NOTE FROM TOM ZAMPIERI
March 19, 2005

This will be my final VAPAA legislative update on your web site, and my final note as your executive director. In January during many of our busy appointments, I had a chance to be interviewed by the executive director of the Blinded Veterans Association (BVA) for a position as National Director of Government Relations for that veteran’s organization. The BVA is one of the congressionally chartered veteran’s service organizations and has been in existence for sixty years. Well, after my interview they offered me a full time position in the BVA and I have accepted and start work for them on April 18th, 2005.

As Director of Government Relations I will be working with all the major veteran service organizations within Washington DC on many VA health care issues, benefits, compensation and disability programs, education, and VA policy and regulations. I will meet with members of congress, VA officials, Department of Defense officials, and many other non-governmental organizations and associations on issues that affect both the active duty military, and today’s veterans. I already had the experience last week of sitting before the House Veterans Affairs Congressional Committee at the witness table during testimony from our BVA president and vice president. My new position will require me to submit written testimony, and provide information at both Senate and House hearings throughout the year.

For many years I have enjoyed the privilege of being able to serve in many positions within the VAPAA chapter. Since 1987 when I first became involved in legislative issues for VAPAA I have seen major changes brought forth by your organization. Old clinical practice guidelines during those years only allowed PA’s to renew medications, but not write new prescriptions. There was no representation, no history of educational support, no recruiting efforts, and old employment grade levels from the 1978 period. We still now are the only federal agency with GS-13 Chief Grade since 1993; we fought long and hard for prescribing issues, have managed over the years to get various educational funding and loan programs for PA entering the VA system. We had congress include PA’s in overtime title 38 rules, and pass the PA Advisor law to give us formal representation back in 2000. While there have been numerous problems and despite huge obstacles against us, the chapter leaders have succeeded to make the VAPAA one of the best known professional advocacy groups in Washington DC.

But the continued success of VAPAA will depend on each of you to support and work within the VAPAA to reach the goals that you want. The volunteer officers and board members over many years have devoted large amounts of their time away from family, and work to try and be advocates for all the PA’s within the VA system. Our numbers have grown to 1,568 PA’s from slightly over 840 when I first became elected into a VAPAA position back in 1988. The VAPAA needs to have the support and membership of as many of you as possible to continue to have success though. The board wants and needs your involvement and suggestions on what your issues are, and what direction to take the organization in the future.

I will still be able to assist the VAPAA with information about Congress, DOD, and the VA system, and have offered the current board members to feel free to contact me when ever they are in Washington DC working on issues. My network contacts will be extensive, and I know from experience that the various other veteran service organizations are all very supportive of the utilization of PA’s within the VA and are willing to support the VAPAA in efforts to improve veteran’s access to quality health care. But, in my new role, I can not serve on the board as executive director or as legislative chairman for the VAPAA chapter. After a very long run, over a rough road at times, I will always be thankful for the many friends that I have been able to make in my various positions in the VAPAA. It was because of you that I was able to continue to fight, and know that we were in it together for the advancement of PA’s. For those who come to visit for any reason in Washington DC, I hope you will try and find time to contact me and maybe visit my office at the address attached below. In the mean time, best wishes to each of you and for the continued success of this very important association.

On April 18th my new work address will be:

Blinded Veterans Association
477 H Street NW
Washington DC 20001-2694
Phone 202-371-8880

Effective April 18 my email tzampieri@bva.org

VA Physician Assistants Need to take Action
February 20, 2005

During the coming weeks your Congresspersons and Senators will be home. Make it a point to contact them at their local offices and if possible drop by and try to schedule an appointment to discuss your concerns over the VA budgetary cuts in PA spending, the cuts in the PA Advisor budget and the unwillingness of VACO to make that position a Full-Time, VACO (ie, Washsington, DC) based position! Without a PA in the halls of VACO we will NEVER gain the respect and ability to reach out for our own protection within the system. DO IT! Do it for yourself and your fellow PAs! Here is a copy of a letter from Congressman Price of North Carolina to the VA in support of this. The VAPAA has been working hard to insure that this issue is not forgotten! TZ

VA Physician Assistants Included Again in Independent Budget
February 19, 2005

The VA Physician Assistants are again listed in both the Independent Budget and in the Friends of VA Medical Care and Health Research coalition (FOVA). As such, the Board urges you to read the budget proposals and support them in their effort to help us! Go to www.pva.org (go to the link for the Independent Budget from the left hand column) or www.im.org/aaim (public policy pages) for more information on their VA budget recommendations. Additional FOVA article (pdf) can be found here (Word version). ... Exec Dir.

NEW LEGISLATIVE UPDATE FOR VAPAA’s

The VAPAA legislative effort that has been closely following our issues for the past six months since our success with obtaining the new PA Utilization Directive last July, decided that in January we needed to make our rounds in Washington DC. The goals of having VHA appoint the PA advisor to the Under Secretary of Health as a full time FTEE inside of Washington is a priority along with obtaining new Title 38 PA Employment Standards. The VAPAA Legislative Chairman Tom Zampieri, along with the President of VAPAA Bud Shelton, and Vice President John Fields all went to Washington DC for three days January 24th, 25th, and 26th for multiple Senate appointments, Congressional House visits, and to attend the Senate Confirmation Hearing of Mr. Jim Nicholson on Monday the first day of the trip. Mr. Nicholson was questioned by all members of the Senate VA Committee for about two hours, and while he admitted that he would need time to learn more about the internal operations of the VA, he stated he was committed to working to improve VA health care and benefits for those veterans who use the system, and future veterans who are now serving in the war on terrorism.

Along with these visits we had meetings with both key House and Senate staff on the Appropriations Committee and requested them to start making phone calls and send letters of inquiry to VHA about the problem of VHA not funding the PA Advisor as a full time position inside of Washington DC, and the growing problems of VAMC’s preventing PA’s from grade level promotions while other VAMC’s promote several PA’s to the Chief Grade who have the same experience and time in grade. Since our visit last April to the Deputy Secretary of the VA Mr. Mansfield, the PAFAG and the PA Advisor have been working on new Title 38 Employment Standards which should help correct the inconsistency on PA’s being treated differently in the system. Along with this, we have pushed for a VHA Policy or Directive on establishing a VHA PSB for PA promotions that have been denied, as an appeal process. Most medical centers have frustrated local PA’s without giving them an avenue for appealing decisions on their promotions. While appeals were rarely sent into VHA, one person would make the unilateral decision without any advice from a PA. This is wrong. If the medical centers must include a PA on the PSB, then VHA should have a PSB for appeals. VHA did set up a PSB with the Acting PA Advisor and two VHA physicians on the board, but the first case on which they ruled was somehow over-turned at a higher level. This is a point of discussoin we are going to bring forth in future meetings.

In our meetings last week we spoke with many new members of Congress, their committee staff, and high level VHA officials. We educated them to the fact that PA’s in over 41 states have representation on their state medical boards, and we pointed out that all the other federal agencies have PA Consultants working full time for their respective Surgeons General. We also indicated that the model should be akin to that of the DOD. Therefore, the PA Advisor should be utilized in many instances to not be limited to work on PA issues and barriers that prevent effective utilization of PA’s, but also should work on other new VHA policies or directives with regard to the planning of national health care programs, staffing for new CBOC clinics, and joint sharing agreements between VA/ DOD and other federal agencies. We stressed that VHA for four years only viewed the role of the PA Advisor as a PA task specific issue job, and has rarely allowed the PA Advisor to become part of the overall VA health care planning process, one in which other occupations fully participate.

The "Washington Gang" Tom, John and Bud in the House: it was taken actually with us sitting in the House Veterans Affairs Committee Hearing Room with us sitting in chairs usually reserved for the Congressmen. We did have over 12 Senate appointments, four veteran service organization national staff meetings, and six House congressional appointments, one with a Congressman face to face lasting over 25 minutes!

During this process, the Acting PA Advisor Mr. Denni Woodmansee PA-C in Boston has done an outstanding job of constantly working with members of the PA Field Advisory Group, Dr. Gerald Cross, and working with VAPAA to attempt to resolve problems, and create new Title 38 Employment Standards that will address the issues surrounding PA’s in the VA system regarding their difficulty with obtaining promotions. We all agree that the entry grade should be no less than GS-9 and we would prefer GS-11, with the GS-12, GS-13 grades being for all clinical PA’s and not restricted to research, education, or administrative positions which many PA’s can not participate in with heavy out-patient clinic loads. We hope though to have the GS-14 grade level added, which would be restricted for PA’s who have major roles in medical center and VISN level programs or who have advanced into high level administrative/clinical executive positions like other occupations. As pointed out before, Denni Woodmansee is now well respected inside VHA, and has opened many doors to which we had no previous access. Doing so as a part-time, field-based Acting PA Advisor is not easy!
While VAPAA did convince Dr. Perlin and Dr. Kussman to extend his time as Acting PA Advisor to ¾ FTEE time from last October through March 1st 2005, he only this past week received word that his FY 2005 travel funding would be $10,000, but half of this will be spent for the PAFAG meeting later this summer. The net result is that he has only about $5,000 for nine months of travel to Washington DC. VAPAA is still working very hard on increasing the position to full time, and to make it inside of Washington DC. We had success in 2001, and in 2002 in having the Senate Appropriations Committee language include that they recommended that this be a full time position inside Washington. VHA ignored the Senate language, and while the previous Senate staff failed to follow-up on this, we had meetings with new committee staff who were extremely upset over this. Failure of VHA to comply with directions in Senate language and failing to report back on language included in an appropriations bill is like not complying with a law. No less than five Senator’s have agreed to send over questions about this, and several will make phone calls demanding that this be resolved soon. The Senate VA/HUD Subcommittee may send over a letter to the new Secretary with a request for this PA Advisor to be full time and inside of VHA within sixty days.
While we work on these issues, and keep our presence in front of those in Washington who have the power to make changes, we need your support by becoming members if you already are not a member, and by getting friends to join. We are one of the most active federal chapters in lobbying in history, and our efforts have brought many successes in the past, and we expect more in the future. But, we really need you all to help support us. We need those letters sent to the key Chairmen of the House and Senate VA Committee’s as soon as possible. The Acting PA Advisor is going to Washington DC in two weeks to work on the new PA Employment Standards and we will keep you all updated on this issue and our effort to get the PA Advisor in to VHA full time.
-TZ, your Legislative Chair
Printable Copy of Article

VAPAA OBTAINS INTERESTING VA STATISTICS
January 20, 2005

VAPAA has found some very interesting numbers inside VHA.
FACTS:
The VA employ's 15,200 physicians, some part time, some full time FTEE.
They all have of course speciality representatives within VHA system, even if Field based, they all have the VHA physician representatives.

Point: Podiatry has 507 positions total
Optometry Service has 559 FTEE positions
Both have full time Consultants, even though field based, they are full time, and Optometry Chief spends at least two days a week inside VHA..

Point: Nursing Service total 60,828
RN's 37,727 FTEE LVN's or Nursing Assistants total 23,101
NP's total 3,037 total including APN's in this FTEE..
Administrative Nursing Positions inside of VHA: Total 39 RN FTEE !
Total RN's Administrative in Medical Centers: 1,017 RN's
RN's in Research Positions, including of course one in VHA 114 FTEE.
VHA Field Based RN's in Administrative Positions at VISN Level or other Special Administrative sites, 635 RN FTEE's in administrative support!
Well, that leaves 32,130 RN's at the bedside "floor RN's" taking care of patients...
So, RN's obviously have a lot of representation and sit on many VHA committee's, advisory councils, Task Force's, etc. etc. health care planning boards...

Point: Psychology Service, 1,640 FTEE and they have full time FTEE in VHA.
Dental Service FTEE 870 FTEE, and of course they have one FTEE inside VHA

Point : PA's number of FTEE is now 1,568 FTEE.
The PA Representative is Part time, field based, and has a very limited travel budget...

NOW OUR POINT: the President Bud Shelton and Vice President of VAPAA John Fields along with the Executive Director of VAPAA are going to Washington DC to complain to Congress about these long delays in making the PA Advisor a full time position inside VHA in Washington DC.
They will be meeting with veteran service organizations, over 18 members of Congress on Monday, Tuesday, and Wednesday next week January 24-26th
Also they will bring attention to the fact that new Title 38 Employment Standards which are long over due for change, need to be completed by this March as promised, with the PA Advisor being able to travel into VHA to complete these and meet with all the necessary staff to get their approval.
That is about it, you know the drill for sure, but we need to raise the alarm, and stop waiting for someone to do the right thing.

Your help is URGENTLY needed! Write to Congressman Buyers, the Chairman of the House VA Committee. If you don't get out there and send a letter to Congressman Buyers or you will NOT have a prayer at advancement or even at job security!
Read and copy this letter and use it for yours to the Congressman!

-TZ, your Legislative Chair