August Pulse: E-cigarettes, "incident to" billing, WAPA Strategic Planning

Clinical Pearls: E-cigarettes on the rise
According to Children’s Hospital of Wisconsin, eight teenagers were hospitalized during the month of July with serious lung damage after the use of e-cigarettes or vaping. Here is some basic information on e-cigarettes and how to counsel your patients on the dangers of vaping:

E-cigarettes include e-pens, e-pipes, e-hookahs, e-cigars, and allow inhalation of aerosol containing nicotine or other substances.
Nicotine is extracted from tobacco and mixed with a base such as propylene glycol with other flavorings and chemicals such as formaldehyde and acrolein which can cause irreversible lung damage.
E-cigarettes are NOT a safer alternative to traditional cigarettes. Many contain high doses of nicotine, cancer causing chemicals, metals, and can be just as addictive. Long term effects are still unknown.
Teens that use e-cigarettes are at a higher risk of using traditional cigarettes.
The Food and Drug Administration has found that e-cigarettes are ineffective in helping smokers quit their habit.
The Wisconsin Dept. of Health sent out an alert to providers to be aware of any cases that present with a cough, shortness of breath, fatigue, chest pain and fevers with a history of e-cigarettes use up to months before presentation. Alert can be found here.
The American Lung Association has downloadable resources for patients here.

Sources: Lung.org, Journal Sentinel, DHS Severe Pulmonary Disease Among Adolescents who Reported Vaping (Memo)

Here's how you can help gain traction for the CARES Act

If you can help WAPA build support for the Collaboration and Rural Expansion of Services (CARES) Act by meeting with your local representatives, please email Melissa Graham or Paige Scobee -- every single PA's voice matters!

We are particularly interested in connecting with Health Committee members for the 2019-20 legislative session. The following have not been reached: Rep. Tony Kurtz (R) in Womewoc, Rep. Jesse Rodriguez (R) in Oak Creek, Rep. Chuck Wichgers (R) in Muskego, Rep. Mary Felzkowksi (R) in Irma, Rep. Gae Magnifici (R) in Dreser, Sen. Tim Carpenter (D) in Milwaukee, Rep. Daniel Riemer (D) in Milwaukee, Rep. Jimmy Anderson (D) in Fitchburg, Sen. Andre Jacque (R) in DePere, Rep. Chris Taylor (D) in Madison, Rep. Nancy VanderMeer (R) in Tomah.

WAPA members recently met with the Brown County Medical Society to present and discuss our CARES legislation for next session. WAPA shared information about the bill and about PAs in general, including PA training and differences between nurse practitioners and PAs. The presentation was well received by Brown County, and Dr. John Hartman, treasurer of Brown County Medical Society and Vice-Chair of Wisconsin Medical Society, is encouraging other county medical societies to set up similar meetings with WAPA.

If you are aware of a county medical society willing to meet with WAPA, please coordinate with Paige Scobee to set up a meeting.

Volunteer Health Care Provider Program bill introduced
State legislators have introduced a bi-partisan legislation (SB 155/AB 162) that would allow volunteer health providers who serve the homeless in free and charitable clinics to participate in the Volunteer Health Care Program. Currently, the Volunteer Health Care Program provides liability insurance to volunteer providers who serve non-Medicaid patients. Under this bill, providers and clinics who serve homeless Medicaid patients could participate in the program. Public hearings have been held on May 22 and most recently on July 16. There are several WAPA members who volunteer in their community, so we'll keep an eye on this bill for you.

If "incident to" Medicare billing is removed, what happens to PAs?

The Medicare Payment Advisory Commission (MedPAC) released its June 2019 Report to the Congress: Medicare and the Health Care Delivery System on June 14. The report included a recommendation to eliminate "incident to" billing for PAs (physician assistants) and advanced practice registered nurses (APRNs) under the Medicare program. AAPA posted a statement responding to this recommendation. AAPA has prepared a Q&A to help AAPA members better understand "incident to" billing. Click here to read the full Q&A.

In essence, services attributed to physicians that are performed by PAs under Medicare’s "incident to" billing mechanism would begin to accurately identify the PA who rendered the care.

Some employers of PAs may be concerned that elimination of "incident to" billing will lead to a decrease in reimbursement. However, most practices will find that not having to meet the additional, burdensome "incident to" requirements will lead to increased practice efficiency and better utilization of PAs, which will more than make up for the 15% difference in reimbursement. In addition to increased efficiency, elimination of "incident to" billing will reduce fraud and abuse compliance risks.

WAPA Foundation: Call for nominations and scholarship applications
2019 PA and PA-Leader of the year nominations can be made on the WAPA website. We are accepting nominations from now until August 31, 2019.

Please also review the current scholarships available. Deadlines are quickly approaching!

Ben Lawton, MD Advancing Careers Award
A $1,000 scholarship is available each year for a PA who is a WAPA member and who has made demonstrated steps toward advancing his or her career as a physician assistant. Download application.

Paul S. Robinson Leadership Award
A $1,000 scholarship will be awarded to a PA student in his/her final year of school, who demonstrates outstanding leadership. Download application.

Norine Friell Service Award
A $1,000 scholarship will be awarded a PA student in his/her final year of school, who demonstrates exemplary service to the community. Download application .

Robert T. Cooney, MD Scholarship
The $1,000 scholarship will be awarded to a recent graduate of one of Wisconsin's PA Programs who is committed to practicing family medicine in a small town or rural setting. Download application.

How available should my supervising physician be? What if they are unavailable during surgery? Keep calling (414) 253-8188 or emailing WAPA with your practice questions!

Most surgeons are available for consult during surgery as they are often on call for their group, even while in the surgical suite. If another staffperson, like a circulating nurse, can answer the surgeon’s pager and messages can be conveyed between the PA and surgeon via the intermediary -- that should be sufficient. There is nothing in MED 8 that specifies that a supervising physicians needs to be available to come to the bedside.

WAPA's Great Midwestern Medical Conference
October 23-25, 2019
American Club in Kohler, WI

Only one month left until your early-bird rates expire! Sign up before September 1 to capture the best price for your registration.

Did you know that we have updated topics and speakers online? Want to learn more about our obesity care track? Maybe you'd like to learn more about addiction (see Substance Use –Samuel Spencer, MPAS, PA-C, Emergency Medicine or Interacting with a Drug-Seeking Patient – Michael McNett, MD, Advocate/Aurora Health)? Or perhaps vascular disease (with Stephen Robischon, MPAS, PAC, Medical College of Wisconsin) and pulmonary hypertension (with Farhan Raza, MD, UW-Madison) is closer to your expertise.

Explore the preliminary program online. We're sure you'll find continuing education that relates directly to you and your area of medicine.