IT IS IMPORTANT TO NOTE:

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1 News Official Publication of the California Academy of PAs surgeon and physician assistant shall conduct a medical records review meeting at least once a month during at least 10 months of the year. During any month in which a medical records review meeting occurs, the supervising physician and surgeon and physician assistant shall review an aggregate of at least 10 medical records of patients treated by the physician assistant functioning under protocols. Documentation of medical records reviewed during the month shall be jointly signed and dated by the supervising physician and surgeon and the physician assistant. \ November/December 2015 The Magazine CAPA Successfully Fights for California PAs: The New Year Brings New Ways to Document PA Supervision in California by Teresa Anderson, MPH; Public Policy Director The 2015 legislative year ended with a HUGE victory for PAs across California. SB 337 Physician Assistants (Pavley) was signed by Governor Jerry Brown on October 6, 2015, appropriately so, as it was PA Day! The last couple of articles I have written have been about the importance and the process of this bill and the incredible teamwork it takes to get through the legislative process, especially with a sponsored bill. Now, what does the bill actually do? What does it mean for you and your team? Why is it important for advancing the PA profession in California? with existing law, nothing needs to change your team can still choose supervising physician co-signature as the method for documenting required supervision. Specific to Schedule II medications, existing law MANDATES 100% of the medical records of patients provided care by a PA, when a Schedule II medication has been ordered, shall be reviewed, countersigned and dated by the supervising physician within 7 DAYS. SB 337 introduces, into law, the following option: Section (3)(e)(2) On January 1, 2016, physician/ (iii) The supervising physician If the physician assistant has PA teams will have additional and surgeon shall review a sample documentation evidencing the options for documenting required of at least 10 medical records per successful completion of an supervision when PAs are functioning month, at least 10 months during education course that covers under protocols. There are specific the year, using a combination of controlled substances, and that requirements related to documenting the countersignature mechanism controlled substance education supervision and review when described in clause (i) and the course (A) meets the standards, care is provided by a PA. One medical records review meeting including pharmacological requirement applies for all medical mechanism described in clause content, established in Sections records, and another requirement (ii). During each month for and of is specific for those medical records which a sample is reviewed, at Title 16 of the California when prescriptions for Schedule II least one of the medical records Code of Regulations, and (B) is medications are written by a PA. in the sample shall be reviewed provided either by an accredited using the mechanism described in continuing education provider or The two NEW METHODS of clause (i) and at least one of the by an approved physician assistant documentation specific to patient medical records in the sample shall training program, the supervising care include: be reviewed using the mechanism physician and surgeon shall review, described in clause (ii). countersign, and date, within seven Section 3502 (2)(A) Business and days, a sample consisting of the Profession Code IT IS IMPORTANT TO NOTE: (ii) The supervising physician and for those teams who are satisfied Continued on page 5

2 News At the Table Editor Gaye Breyman, CAE Managing Editor Denise Werner Proofreaders Coryn Henderson Jonathan Kulesza Editorial Board Jeremy A. Adler, MS, PA-C Roy Guizado, MS, PA-C, DFAAPA Ana Maldonado, MPH, DHSc, PA-C Bob Miller, PA CAPA Board of Directors President Roy Guizado, MS, PA-C, DFAAPA Jeremy Adler, MS, PA-C, CAPA Immediate Past President; Kathryn Scott, CAPA Lobbyist; Robert Sachs, PA-C, PAB President; Teresa Anderson, MPH, CAPA Public Policy Director and Christine J. Lally, Board and Bureau Relations Deputy Director Department of Consumer Affairs at the Physician Assistant Board meeting on August 3, Immediate Past President Jeremy A. Adler, MS, PA-C Vice President Ana Maldonado, MPH, DHSc, PA-C Secretary Christy Eskes, DHSc, MPA, PA-C Treasurer Bob Miller, PA Directors-At-Large Sue Gilroy, PA-C Cherri L. Penne-Myers, PA-C Tim Madden of Randlett, Nelson and Madden Government Relations Firm; Assembly Member Sebastian Ridley-Thomas and Teresa Anderson, MPH at the reception honoring Assembly Member Ridley- Thomas on September 3, Assembly Member Freddie Rodriguez and CAPA President, Roy Guizado, MS, PA-C, DFAAPA at the reception honoring Assembly Member Rodriguez on November 4, Kevin Robertson, MHS, PA-C Saloni Swarup, PA-C Student Representative Emily McCoy, PA-S The CAPA News is the official publication of the California Academy of PAs. This publication is devoted to informing PAs to enable them to better serve the public health and welfare. The publisher assumes no responsibility for unsolicited material. Letters to the editor are encouraged; the publisher reserves the right to publish, in whole or in part, all letters received. Byline articles express the opinion of the author and do not necessarily reflect the views or policies of the California Academy of PAs. The CAPA office is located at: 2318 S. Fairview St. Santa Ana, CA Office: (714) Fax: (714) Internet: California Academy of PAs California PAs Who Have Been Continuously Certified for 40 Years NCCPA celebrates 40 years of serving the public through PA certification and recognizes those PAs who have been continuously certified for 40 years. CAPA is proud to recognize these California PAs who are pioneers of the profession. We thank them for their commitment to the PA profession and to the patients they serve. Marshall Blesofsky, PA-C George Bliss, PA-C Larry Bos, PA-C Kenneth Chastek, PA-C Carmen Marmo, PA-C Don Massie, PA-C Thomas Miller, PA-C Gary Nelson, PA-C Michael Davis, PA-C Alan Fribourg, PA-C Michael Gonzalez, PA-C John Olson, PA-C Gerald Polk, PA-C Thomas Robinson, PA-C Larry Rosebraugh, PA-C Thomas Robinson, PA-C John Howard, PA-C James Knight, PA-C Elizabeth Sivesind, PA-C C. Stewart, PA-C Robert Witcosky, PA-C David Young, PA-C 2 CAPA NEWS

3 ICD 10 Questions? Try Out This Website Recommended by Bob Miller, PA; Professional Practice Committee Chair With ICD 10 launched on October 1, providers are still looking for answers to questions about coding and the best ways to be successful and appropriate in their billing. If you are looking for help with the current huge conversion to ICD 10, here is a home page with reference links to contact lists, information, FAQs and videos on the subject. This CMS website may be a great place to find answers to your questions by accessing their various guides using the link below. This link can also be found on the CAPA website at Inside This Issue At the Table... 2 California PAs Who Have Been Continuously Certified for 40 Years... 2 ICD 10 Questions? Try Out This Website... 3 SB 337 Highlights - Section 3502 of the Business and Professions Code... 4 SB 337 Highlights - Section 3501 of the Business and Professions Code... 5 Are We Merely Assistants? Legislation SB 337 Ignites Discussion... 6 New CAPA CME Opportunities Coming in Nominating Committee... 8 CAPA Leadership Opportunities... 8 The Relationship Between the Increasing Scope of PA Practice and the Business of Medicine... 9 Coordinating Health Care in Primary Care Settings It s a Wonderful Job CAPA Conference 2015 Inspiring PAs! CAPA Conference Highlights Annual Conference Recap Inspired by You! Thoughts on Palm Springs Medical Malpractice Claims and Physician Assistants Update on the New Vaccination Legislation The PA Profession: A Worldwide View CME: Mental Health in Primary Care CAPA at Napa Laughing Away Your Stress Sharpen the Saw Thank You 2015 Student Ambassadors CAPA Connections CAPA Student Scholarships Deadline December 31, Notice to CAPA members Welcome New Members Local Groups NOVEMBER/DECEMBER

4 SB 337 HIGHLIGHTS Section 3502 of the Business and Professions Code is amended (excerpted in part from the SB 337) The supervising physician and surgeon (SP) shall use one or more of the following mechanisms to ensure adequate supervision of the physician assistant (PA) functioning under the protocols: (i) (i) The SP shall review, countersign, and date a sample consisting of, at a minimum, 5 percent of the medical records of patients treated by the PA functioning under the protocols within 30 days of the date of treatment by the PA. This is existing law and has been since the passage of AB 3 in If you and your SP find this way of documenting supervision best for your practice, there is no need to change ANYTHING with SB 337. Just keep doing what you are doing. (ii) and/or (ii) The SP and PA shall conduct a medical records review meeting at least once a month during at least 10 months of the year. During any month in which a medical records review meeting occurs, the SP and PA shall review an aggregate of at least 10 medical records of patients treated by the PA functioning under protocols. Documentation of medical records reviewed during the month shall be jointly signed and dated by the SP and PA. This option is a new one for California PAs and their SPs. Your EHR system may not allow for co-signature of the SP or you may find that you and your SP prefer to review cases in person or electronically, such as over the phone, instead of co-signing charts. You may choose this option instead of the way you are currently documenting supervision. A medical records review meeting is defined as a meeting between the supervising physician and surgeon and the physician assistant during which medical records are reviewed to ensure adequate supervision of the PA functioning under protocols. Medical records review meetings may occur in person or by electronic communication. (iii) A combination of both (i) and (ii) above (iii) The SP shall review a sample of at least 10 medical records per month, at least 10 months during the year, using a combination of the countersignature mechanism described in clause (i) and the medical records review meeting mechanism described in clause (ii). During each month for which a sample is reviewed, at least one of the medical records in the sample shall be reviewed using the mechanism described in clause (i) and at least one of the medical records in the sample shall be reviewed using the mechanism described in clause (ii). 4 CAPA NEWS This clause (iii) ensures if you use both mechanisms (offering greater flexibility for some practices), there is a minimum of 10 medical records per month for 10 months of year using both mechanisms. It is simply options (i) and (ii) above, ensuring a minimum number of medical cases are reviewed.

5 SB 337 HIGHLIGHTS Section 3501 of the Business and Professions Code is amended (excerpted in part from the SB 337) The supervising physician (SP) shall use either of the following mechanisms to ensure adequate supervision of the administration, provision, or issuance by a PA of a drug order to a patient for Schedule II controlled substances: (1) All medical records (100%) for patients who have been issued a Schedule II controlled substance shall be reviewed, countersigned, and dated by a supervising physician and surgeon within seven days. Current law. If you and your supervising physician and/or medical facility wish to continue to have 100% of the medical records reviewed and countersigned, there is no need to change anything. (2) or If the PA has completed an education course meeting the standards and content established in Sections and of Title 16 of the California Code of Regulations, the SP shall review, countersign and date, within 7 days, a sample consisting of at least 20% of the patients who have been issued a Schedule II controlled substance. New option beginning January 1, Note: If you have already completed CAPA s Controlled Substances Education Course, congratulations, you do not need to retake the course to meet the standards and content referenced above. CAPA Successfully Fights for California PAs... Continued from page 1 medical records of at least 20 percent of the patients cared for by the physician assistant for whom the physician assistant s Schedule II drug order has been issued or carried out. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established in Section of Title 16 of the California Code of Regulations. Physician assistants who have a certificate of completion of the course described in paragraph (2) of subdivision (c) shall be deemed to have met the education course requirement of this subdivision. IT IS IMPORTANT TO NOTE: if you have already taken a qualifying controlled substances education course (CSEC), your team is eligible for the new option beginning January 1, If you have not taken a CSEC, you are NOT eligible for this option, even after January 1, The bottom line is you MUST take a qualifying CSEC in order for your team to be eligible for this option, otherwise the 100% mandate applies. Now that we have discussed what SB 337 does and what it means for teams in California, it is essential that we examine why it is such an important step to advancing the PA profession in California. First, it is simply just good health care policy! Second, as licensed health care professionals practicing medicine in virtually every health care setting across the state, treating hundreds of thousands of patients every year, PAs are a critically important part of the health care system similar to a leg on a three-legged stool, it just doesn t work without one of the legs! Yet, the PA profession still struggles with reaching professional parity among parallel professions in large part due to administrative burdens like the 100% mandate for co-signatures related to C II orders making it sometimes less attractive to hire PAs. For example, many PAs work side-by-side with their NP colleagues everyday, seeing Continued on page 9 NOVEMBER/DECEMBER

6 Are We Merely Assistants? Legislation SB 337 Ignites Discussion by Jeremy A. Adler, MS, PA-C; Immediate Past President To achieve success with legislation that advances the PA profession in California as significantly as SB 337, CAPA must work with many stakeholders throughout the state to educate and compromise. Countless hours were devoted by CAPA staff, leaders and members during informal discussions, formal board meetings as well as legislative hearings within the Capitol. All this investment was to ensure CAPA s priorities were heard, understood and ultimately enacted for the benefit of California PAs, health care teams and patients. Throughout the legislative process, a fundamental concept arose surrounding the PA and physician relationship that can be summed into two different viewpoints: Are PAs professionals or technicians? If PAs are truly professional, they contain the capacity to work with other professionals to best determine how care is provided. If PAs are instead technicians, they need to be told exactly what they can do, when they can do it, how they can do it, where they can do it, etc. At CAPA s 39th Annual Conference in October 2015 the notion of PAs as professionals versus technicians was presented with questions and live audience polling answers on this topic. The lecture was recorded, placed online, and an online survey captured a larger response to these questions as well. It might not be of surprise, but over 96% of respondents indicated that PAs do not only see simple medical cases. When asked if the PA profession was chosen because they believed they lacked the capacity to be physicians, 91% disagreed, 6% were undecided and only 3% agreed. So why did PAs choose their profession? Watch Jeremy s lecture, recorded live at the CAPA Conference at: Approximately 89% of PAs surveyed indicated they chose PA because of the benefits of time in education, cost of education, employment availability and career flexibility. Of the many active debates amongst PAs, a common one over the years involves whether or not the profession s name Physician Assistant should be changed to Physician Associate? When surveyed, the results were somewhat mixed with 51% disagreeing, 21% undecided and 28% agreeing with changing the name. A question was presented which asked if the health care system in California would collapse if PAs decided for 1 week they would not work. The respondents indicated that 46% agreed the system would collapse and 32% disagreed, the rest were undecided. The relationship between PAs and physicians is critically important, and although advancement in the professionalism of PAs moves toward solidifying PA as an independent health profession, it does not direct PAs toward independent medical practice. The foundation and purpose of the PA profession rests on team practice with physicians. The education and licensure of PAs allow them to fill a need in health care that no other health profession can. PAs are both complementary and necessary in California s health care. The educational curriculum for PAs is based in general medicine and national certification requires a general medicine examination. PAs are readily deployable to meet the health needs of any community, in any area of medicine, all without additional education or certification. The flexibility of PAs in the health care workforce has proven that patients can obtain improved access to care, and the data supports that the care delivered by PAs is of high quality. The only way this works though is through team practice. For example, when a community requires health care providers in cardiology, and a PA moves from years of work in another area of medicine to address this need, it is imperative that the physician cardiologist work closely with the PA to determine how to best utilize their resources. In summary, it is the professional physician and professional PA who, in their individual practice, should determine the services provided. The focus should move from the physician and PA relationship toward the level of care the team provides to patients. With the chaptering of CAPA s sponsored bill, SB 337 (Pavley), a tremendous shift occurs for the PA profession in California. The longstanding singular way physicians have been documenting their supervisory responsibilities, through chart cosignature, has been diversified to offer a menu of additional mechanisms. In California, the existing concept in medical records documentation has always been that when a PA provides service to patients, they do so as an extension of their supervising physician. The PA has been coined, by some, as a mid- 6 CAPA NEWS

7 level or physician extender. The PA signature must then be co-signed by the physician in the patient s medical record, endorsing the care the PA provided. Although much progress was accomplished by CAPA over the years to reduce this administrative process from 100% of charts, down to the current 5% minimum (2008), the relationship concept has dictated that chart co-signature would need to be continued. So what is this shift? A new mechanism has been developed that reflects the interaction between physicians and PAs and ultimately represents two health professions collaborating in the care of patients. Physicians and PAs may conduct medical records review meetings, and with certain minimums, enable these meetings to ensure compliance with supervisory responsibilities. Essentially, these meetings represent two health professions working together, not independently, to improve the health of patients. Although documentation of this interaction is required, both Continued on page 22 New CAPA CME Opportunities Coming in 2016 PANRE 3-Day Review Course Friday, Saturday and Sunday, March 4-6, 2016* UC Davis, Betty Irene Moore School of Nursing 24 Hours of Cat. I CME Education Building, Room 1222 CAPA Member Price: $ X Street Non-Member Price: $570 Sacramento, CA Joe Gilboy, PA-C is the course instructor. For over a decade, Joe has taught scores of PANRE review courses from his home base in Orange County and serves as an educational consultant for several PA programs, including Stanford University, University of California Davis, Loma Linda University, San Joaquin Valley College, Marshall B. Ketchum University, A.T. Still University, and Touro University Nevada. This 3-day course will cover all the major systems including cardiology, pulmonology, GI, GU, OB-GYN, musculoskeletal, ENT, neurology, hematology, and endocrinology. Joe makes the class interactive and fun as you review various disease processes so that the concepts make sense not just memorized. There will be several quizzes and tests taken and reviewed over the 3 days. Bottom line, you will leave this course more enlightened and better prepared to take the PANRE. Cutting Into Orthopedics: An Orthopedic Review April 16, 2016* Marshall B. Ketchum University 2 Hours of Cat. I CME & 4 Hours of SA-CME Classroom A103 CAPA Member Price: $ Yorba Linda Blvd Non-Member Price: $310 Fullerton, CA Student Price: $90 Are you in primary care, emergency medicine and/or looking to improve your orthopedic knowledge base? Do you work in an orthopedic practice and are looking for a refresher course? Cutting Into Orthopedics is for you! This 1-day course offers a comprehensive review of common knee, hip, shoulder, elbow and spine pathology along with hands-on examination techniques. Attendees will also learn more about injection therapy, common pediatric disorders and common medical orthopedic problems. This course will offer 2 hours of Category I CME and 4 hours of Self-Assessment CME. Complete program information will be available soon. *If the minimum number of registrants is not met, the course may be cancelled. Visit capanet.org for more information and updates! NOVEMBER/DECEMBER

8 Nominating Committee by Eric Glassman, MHS, PA-C; Public Education Committee Chair and Nominating Committee Chair It is a pleasure and honor to serve as the Nominating Committee Chair. Some of you may not be aware but the CAPA Board of Directors is made up of elected PAs who run for a specific position within the Board. Every year dedicated individuals who want to volunteer for the benefit of CAPA, as well as its entire membership, run for office to help make critical decisions and do the work of CAPA. The Board of Directors, along with CAPA s amazing staff, strives to fulfill CAPA s mission statement which is,...to represent and serve PAs statewide. As an advocate of its members for the provision of quality health care, in collaboration with all health care professionals, CAPA will enhance, educate and empower PAs for the ultimate benefit of their patients. This year, the Board of Directors asked me to chair the Nominating Committee. The role of the Nominating Committee is to: 1. Actively solicit and encourage qualified candidates to seek elected Academy office CAPA Leadership Opportunities 2. Work to ensure that candidates represent the diversity of the Academy 3. Oversee all elections 4. Oversee the balloting of members 5. Ensure the election process is of the highest integrity CAPA has a long history of amazing leaders and this year is no different. I have two PAs on my Committee that exemplify both strong leadership skills, as well as high ethical and moral standards. It is a pleasure to serve on a committee with Jennifer Faggionato, PA-C and Vickie Cranford-Lonquich, PA-C. Both of these PAs are Past CAPA Presidents and longtime CAPA leaders. Vickie and Jennifer were asked to serve on the Committee to help ensure CAPA continues to be the model for PA state organizations across the country. They have always held CAPA in the highest regard and serve for the ultimate benefit of our membership. Elections for the CAPA Board of Directors and for Delegates to the AAPA House of Delegates in Las Vegas, Nevada in 2017 will be held in the Spring. If you are interested in running for office, please contact the Nominating Committee Chair, Eric Glassman, MHS, PA-C at ncc@capanet.org to learn more about CAPA leadership and where your experience and skills are most needed. Important Deadlines: Deadline for the CAPA office to receive Candidate Data Form for those who wish to be reviewed/endorsed by the Nominating Committee: March 7, Deadline for the CAPA office to receive Candidate Data Form for those who do not wish to go through the Nominating Committee: February 22, Jennifer Faggionato, PA-C has worked the last 10 years in plastic surgery full time and part time in dermatology. When I asked Jennifer why she is happy to volunteer for CAPA, Jennifer told me I respect and appreciate all the work that CAPA does to keep our profession thriving in California and I want to give back again. I enjoyed the years I was on the board with CAPA and now I am excited to serve in this capacity to help select and endorse those most qualified as CAPA leaders. Vickie Cranford-Lonquich, PA-C has worked in family practice/urgent care for the past 15 years. I asked Vickie what it means to her to be on the Nominating Committee Being on CAPA s Nominating Committee allows me to give back to the organization that has allowed PAs to practice at the highest level possible. Helping to ensure that quality candidates are available to lead us into the future is imperative. CAPA is always looking for strong leaders to enhance the organization and PA practice in California. If you think you may be interested in joining the CAPA leadership team or in learning more about running for the Board of Directors, please consider ing me at ncc@capanet.org. I d love to talk with you, so please don t hesitate to reach out to me. Application and interest materials can also be found online at CAPA elections are held every year in the spring. If being a leader is not your cup of tea, remember your vote still counts in helping shape the leadership that will represent you. When I say every vote counts, I mean it. Several years ago a Board of Director position was won by only one vote, and that vote could be yours! 8 CAPA NEWS

9 The Relationship Between the Increasing Scope of PA Practice and the Business of Medicine by Roy Guizado, MS, PA-C, DFAAPA; President I recently read an article entitled, EKGs, X-rays and Heart Procedures - the Role of Non- Physicians Grows, by Laura Ungar and Meghan Hover in the July 27, 2015 edition of USA TODAY regarding the roles of PAs and NPs. There are some interesting highlights I would like to share with the CAPA membership. PAs and NPs are performing more procedures that were once designated to physicians. PAs and NPs are being reimbursed for procedures such as EKG interpretation, GU exams and being surgical first assist. In 2013, there was an 11% increase in Medicare reimbursement for PAs compared to It is interesting to note that during that same timeframe, physician insurance reimbursement for the elderly and disabled decreased by approximately 5%. Medicare records in 2013 also document that NPs were provided payments that totaled $1.5 billion, while PAs received $1 billion. PA payments were up nearly 12% from the previous year, Family physicians, however, realized a 7.6% decrease in reimbursements. The procedures performed by PAs are also becoming more advanced and sophisticated. In 2013, about 900 PAs were reimbursed for heart bypass and 950 for spinal fusions as first assist in surgery. Medicare billing also indicates reimbursements for tissue biopsies, x-ray interpretation and other surgical procedures. There are a few factors for the increased number of reimbursements. One obvious factor is the growing number of advanced practice providers (PAs and NPs) in combination with an increasing physician shortage. The number of NPs in the United States in 2013 was 171,000, while the number of PAs was 102,000. The physician shortage is predicted to be between 46,000 to 90,000 by Another factor driving reimbursements is an increased number of patients seeking health care, either from the babyboomer generation or those enrolling in Obamacare, or both. Regardless of the reason, it is apparent that PAs and other advanced practice providers are making a significant impact to health care. PAs and NPs need to be cautious as they continue to bill Medicare. The U.S. government has been investigating all health care providers for incorrect, careless or fraudulent Medicare billing. Under current laws there are three ways for a PA to bill a Medicare patient encounter. Billing can be made under the PA provider number, or as a co-managed visit if both the PA and supervising physician see the patient, or if the PA CAPA Successfully Fights for California PAs... Continued from page 5 is carrying out a prescribed treatment plan established by the physician. Most PAs usually bill by using their own provider number and as a consequence are reimbursed at 85% of what a physician would be able to bill. While this discrepancy in billing between a PA and a physician causes decreased practice revenue, it can be argued that taxpayers are saving money when a PA provides health care to a Medicare patient. It is apparent that PAs are making an impact in health care, particularly Medicare. PAs are becoming more widely known to patients and their the role of PAs is shifting into a more prominent and public position. PAs are no longer viewed as an advanced medical assistant. We, as PAs, must continue to nurture and expand our image to patients and providers alike. As providers discover the vast scope of practice for PAs, the PA profession will continue to flourish. the same number of patients, treating similar conditions, performing the exact same procedures, ordering the same tests, ordering the same medications, etc. yet at the end of the day, week or month, the co-signature requirement only applies to PAs as NPs don t have any co-signature requirements. In fact, there is not one other licensed health care professional that has the type of cosignature mandates that PAs do. From a policy perspective, a 100% mandate, on anything, is overly burdensome and doesn t reflect or respect the value of team-based care. So, while at first glance SB 337 may seem like a simple bill that increases options for documenting required supervision, keep in mind it is also ushers in significant policy advancements and professional practices for PAs in California. Continued on page 22 NOVEMBER/DECEMBER

10 Coordinating Health Care in Primary Care Settings by Ana Maldonado, MPH, DHSc, PA-C; Vice President The concept of coordinated care is based on the premise that a 15-minute visit does not allow a clinician sufficient time to provide the variety of services expected in primary care. 10 CAPA NEWS Over the past years, I have been employed in community health centers providing primary care. This environment, the federally-qualified community health care centers, is where I have worked clinically for most of my 32-year career. Granted, I am in PA education now and only participate in clinical work one day a week, yet my professional history and experience has informed me of the multiple ways that primary care can be delivered both functionally and dysfunctionally. Most recently, I have been working in collaboration with Thomas Bodenheimer s team from the UCSF Center for Excellence in Primary Care implementing The Teamlet Model of Primary Care. Dr. Bodenhiemer framed this method of coordinated care in his article, Coordinating Care A Perilous Journey through the Health Care System, published March 6, 2008 in the New England Journal of Medicine as a Health Policy Report. In this article, Dr. Bodenheimer provides the reader with a succinct overview of the U.S. medical system s failures in providing care coordination (p 1065) and proceeds to outline models for improved care coordination. The concept of coordinated care is based on the premise that a 15-minute visit does not allow a clinician sufficient time to provide the variety of services expected in primary care. I think most of us will concur with this assessment. Many of us have explored multiple methods to fulfill some of the patient care expectations by working through lunches, earlier in the mornings or late into the evenings and, in some cases, by utilizing remote electronic medical record systems to compensate for the limited time allotted to the patient/provider encounter. What some clinical practices have embarked on to change and enhance this situation are: Electronic referrals and consultations with specialty care providers The development of Referral Agreements Plans and systems for care after hospital discharge Care transition programs Practice implementation of the Teamlet Model I would like to present my recent experience with the Teamlet Model and the advantages I have experienced with its implementation at my clinical site. The model is designed with very specific goals. These include: 1. To improve the patient experience and enhance patients self-management skills by expanding the clinical encounter to include one-on-one time with a trained health coach 2. To improve process and outcome measures for preventive and chronic care by delegating routine processes (e.g. ordering periodic cholesterol measurements or mammograms based on standing orders) to health coaches and by working more intensively with patients on their chronic disease selfmanagement skills 3. To enhance the work life of primary care clinicians by offloading tasks that can be completed by non-clinician staff 4. To ensure that all medical practice personnel are working to their fullest potential by providing additional training, cross-training and mentoring so that they are able to function as health coaches 5. To cut health care costs by reducing unnecessary hospitalizations and emergency department visits through intensive management of high-risk and high-utilizing patients by using health coaches to provide frequent personal contact with these patients. (Bodenheimer & Laing, 2007) In the teamlet model, there is generally one clinician and one or two health coaches. A coach can be a trained medical assistant, community health worker, licensed practical or vocational nurse, registered nurse or health educator. In my clinical setting, the health coach has been a UCSF nursing student that was matched with me by the faculty. The health coach and I have worked together for a year using the following methodology. The Previsit This visit is generally conducted by my health coach. After our first few sessions together, we were able to Huddle to identify chronically ill patients on my appointment panels that historically had problems with continuity of care, health literacy

11 and/or self-care management. Following the identification of these patients, the health coach would contact the patient prior to their visit to negotiate an agenda for the up-coming visit. The agenda setting would include my proposed agenda for the visit, as well as the elicited patient agenda items. During this previsit, the health coach would elicit the basic history from the patient, check on medication use, encourage the patient to present for the visit with their medications, follow-up on indicated tests or specialty encounters and retrieve information from both, prior to the scheduled visit. Important components of the previsit are the medication reconciliation and follow-up on the status of routine chronic disease and preventive services obtained by standing orders or protocols. The health coach has also taken the time to explain the recommended screening and health care maintenance tests and results when available. The Visit Following obtaining the consent from the patient, my health coach often enters the exam room with me after we have reviewed the chart and the expectations of the visit. The coach observes the interaction with the patient and documents components of the history and physical examination very much like a scribe. In addition, the coach, at times, will fill out forms, order laboratory tests, order x-ray studies and referrals and will send electronic prescriptions as authorized by me. At times, she assists in the room with some of the procedures. All of these activities provide me with the time to focus on cognitive work as I work on the diagnosis and management of the patient s care. The Post Visit The purpose of the post visit is to ensure that the patient understands what has occurred during the visit and to engage the patient in self-management skill building. It is also to enhance the patient s experience with the clinical encounter. I have found this component of the visit to be the most helpful to me as a clinician and many of the patients have expressed satisfaction with the post visit health coach involvement. During this time, the health coach has been able to solicit the patient s concerns, answer any questions and summarize the visit and, using the teachback method, assist in clarifying patient understanding of the clinical advice and treatment plan. The health coach reviews behavioral goal setting with the patient in order to improve on health-related behaviors, e.g. dietary changes, exercise, smoking cessation, medication adherence. The health coach has also been instrumental with warm hand-offs to social workers, health educators, psychologists and other important ancillary services within the clinic setting. Between Visits The effort the health coach has offered through the between visit patient contact and follow-up has proven to be an essential component of this model. The follow-up phone contact with the patient to assess how they are doing, reinforcing some of the items discussed in the visit, disseminating information from labs, imaging and/or specialist consultations adds a level of continuity of care that is often missed by me until the next follow-up visit with the patient. In conclusion, this model of course is not perfect and, at times due to educational costs in preparing staff and making the health coaches available, may seem prohibitive. However, from my personal experience, these barriers can be overcome and result in an enhanced, patientcentered approach to care, satisfying the expectations of the patient, the provider, the health coach and the primary care medical service delivering care. References Bodenheimer, T. Coordinating care A perilous journey through the health care system. New England Journal of Medicine 2008;358: Bodenheimer, T. & Laing, B.Y. The Teamlet model of primary care, Annals of Family Medicine 2007;5: NOVEMBER/DECEMBER

12 It s a Wonderful Job by Kevin Robertson, MHS, PA-C; Director-At-Large A team is in place to ensure that our mission is defended and supported in Sacramento. We ve heard so much recently in national articles and reports, particularly after National PA Day/Week, about how much we PAs love our job. In California, through CAPA, we have had the added benefit of having an incredible legal and legislative team who have fought consistently and hard to develop how we practice medicine in this state. I was talking with a PA friend recently about the success of the CAPA Annual Conference in Palm Springs. The attendance this year was huge but I wondered why even more of my peers and colleagues don t attend the Conference, aside from scheduling and other professional or family obligations and why every PA in this state isn t a CAPA member? It made me think. Don t we all realize we have the best job as a result of the hard work done by PAs and others that came before us? My mind drifted and I thought about it another way: What would my job look like WITHOUT the work and support of CAPA? It s easy to imagine what our job would be like without that support if we re aware of some of the CAPAinitiated/sponsored legislation created and passed over the last couple of decades. Decades! One cannot deny the impact on our daily routine these state Capitol victories have had on our profession. This is a large reason why PAs in this state have the best jobs! Earlier this year, I was privileged to join PAs from around the state to participate in PA Lobby Day, a successful CAPA effort to support SB 337. The Sacramento lobby effort, on behalf of my peers in the state, showed me how much time and effort goes into developing who we are as a profession while protecting what we do from those with other interests. One full day of visiting legislators can wipe you out, but I was gratified by the work we accomplished that day. Just ONE day. I realized there is a movement that goes on continuously, yearround, which affords each of us the benefits of the profession we love so much. Someone is fighting for that. A team is in place to ensure that our mission is defended and supported in Sacramento. Every CAPA member in this state is on that team. Some of my peers might ask about CAPA membership this way: What s in it for me? Ok, here s a short list As a PA, are you able to become a shareholder in a medical corporation? Has Blue Cross of California improved its policy regarding payment of services by PAs? As a PA, are you an agent of your supervising physician, and able issue medical orders to nurses? As a PA, are you able to write prescription drug orders? Does the California Pharmacy Board acknowledge that we as PAs can write for Schedule II-V medications? Are you able to sign for pharmaceutical samples? Are you able to perform particular DMV physicals and sign certain DMV forms? Are you allowed to administer methadone? If you perform surgery, are you able to perform part of the surgery without your SP directly involved, scrubbed in or physically in the room? Can part of your student loan, up to $20K be assumed if you agree to work in a medically underserved area? Do you work in the ED and are able to provide evaluation and treatment as well as specialty consulting in that setting? Are you able to supervise medical assistants across all medical office settings? As a PA, are you able to be defined as a primary care provider? Is your practice allowed to determine the method of documenting supervision? What will I get out of being a CAPA member? One might argue, you have to just go to work every day to see. You may not realize there is work done behind the scenes contributing to our ranking as one of the professions with the highest job satisfaction. Are the benefits you enjoy as part of your job created in a vacuum? Nope. It s hard to imagine that donating the equivalent of just one hour of your salary to the CAPA Political Action Committee and maybe a few hours pay for CAPA membership to support what CAPA does in Sacramento couldn t be seen as a worthy contribution. It is a contribution to your future and a tip-of-the-hat to our peers before us who have helped shape and define the very practice we are privileged to be in right now. What would your practice look like WITHOUT the contribution of PAs across the state? I challenge each person reading this article to invite a PA counterpart or peer to join in helping us do this work together. We strive for teamwork as the core of our PAphysician relationship; how about teamwork as it relates to our own PA counterparts? Yes, we love what we do, but we can t do it without each other s support we just aren t built that way. That s in part why our career, particularly in California, is the best and among the most envied professions across the country! It s a wonderful job! 12 CAPA NEWS

13 CAPA Conference 2015 Inspiring PAs! by Sue Gilroy, PA-C; Director-At-Large The theme of this year s CAPA Conference was Inspiration. On-site we had Inspiration Trees and what a great response! There were small tags with inspirational quotes on the front and PAs had the opportunity to write anything that moved them regarding inspiration a person, feelings, the PA profession whatever their muse was. Mostly, the trees gave the attendees a moment to stop and reflect, and this was evident by the very few blank tags left by Sunday. Here are some of the randomly chosen thoughts. Hope they inspire you as a CAPA member and a PA. To Mike Scarano, our legal counsel for over 25 years: You have inspired so many in your years of dedication to the PA profession in California. We truly would not be the same without you. Thank you! We need not think or believe alike to love alike. Jed sparkles! My mother always told me to never give up! Thank you Mom for being so supportive. Love you. Patients often don t care how much you know until they know how much you care. To Gaye Breyman: the PA dream maker of the world! To all my fellow PAs: You inspire me! To PA school: The most fun I would never want to have again. (a new graduate, perhaps?) Don t worry-the medical interns really DO know less than you do. Thank you to the patients who say: You have saved my life-thank you! I wouldn t have changed without you and I wouldn t be here! Excited to be here! Thank you to Julie and Lucy for guiding me and helping me become a PA. Kate M Inspired by my grandmother (LVN),, Jen Z Dr Ken Bernstein-Your wisdom and support has led me to where I am today. Take it from a Dino. Being a PA & being with those people that make it happen has been magnificent. Drive On!! Thank you to my patients at St. John s Clinic. You inspire me to continue to serve the community. I so appreciate your compliments that keep me going, especially on my most challenging days. B. Lindsey-A remarkable woman who I am just barely getting to know and in a short period of time though her grace has changed my life. Thanks. Vicki inspires my belief in higher guidance & reasons for survival. I will never forget Dr. Kenneth Chin for inspiring me to be all I can be. He believed in me and that means everything Thank you Dr. Chin! And finally: Thank you to all the speakers and volunteers who take time out of their busy schedules to dedicate their time to making PA a great and respectable field. Together we will flourish. Thanks. You have to love our PAs! THANK YOU For Your Generous Support of the Cyber Café and WiFi service in the CAPA Conference Lecture Halls NOVEMBER/DECEMBER

14 Fun California Academy of PAs Annual Conference Inspiring PAs CAPA Conference Highlights Cat. I CME Pride of the Profession Honorees CAPA Honors Senator Fran Pavley Bob Sachs, PA-C; Bob Miller, PA; Gaye Breyman, CAE and Mike Scarano. Not pictured: Congressperson Karen Bass (former PA from Los Angeles). CAPA s highest honor has been bestowed on only 5 people. Four of them gathered in Palm Springs as we honored the newest recipient, long-time legal counsel, Michael Scarano. CAPA Awarded Senator Fran Pavley District 27 CAPA s Legislator of the Decade In recognition of her dedication to the PA Profession and commitment to strengthening the PA Practice Act in California October CAPA NEWS

15 2015! SA-CME CAPA Honors Elise Thurau Legislative Director, Senator Pavley We know for sure that without Elise s expertise, dedication and commitment, SB 337 (with all its twists and turns) would not have made it to the Governor s desk. Senator Pavley and Elise are a shining example of an effective team! PArty in Palm Springs Always a CAPA Conference highlight the Friday night CAPA Dance. And, no CAPA Dance is complete until the Electric Slide is danced at least once. NOVEMBER/DECEMBER

16 Annual Conference Recap Inspired by You! by Christy Eskes, DHSc, MPA, PA-C; Secretary and CME Committee Chair What a conference we had in Palm Springs! This was our 39th Annual Conference, and the theme was Inspiring PAs. Each morning began with an inspirational talk to set the tone for the day. CAPA PAC Chair, Sonny Cline reminded PAs to be the miracle their patients may need. CAPA s longtime legal counsel, Mike Scarano, was honored with a tribute to his legacy detailing all he has done for California PAs. There was not a dry eye in the house as several past CAPA leaders and his daughter Amy, a current PA student, shared the impact he has had on them personally and professionally. Immediate Past President, Jeremy Adler, also provided a thought-provoking talk about re-positioning the PA profession that was recorded and is now available on YouTube. We have received incredible feedback on how excellent each of the speakers was this year. With diverse topics covering everything from women s health to psychiatry to orthopedics, there was truly something for every PA. We were pleased to offer 4 hours of Self-Assessment CME (SA-CME) for the first time and also had an opportunity for Performance- Improvement CME (PI-CME) through the American Academy of Nephrology PAs with a brand new interactive course on Chronic Kidney Disease that was truly phenomenal. Greg Thomas, MPH, Director of External Relations, NCCPA presented updates from the NCCPA focusing on the new CME requirements that helped attendees better understand what is needed in the new 10-year recertification cycle. With the governor signing SB 337 just 2 days before the conference began, we had much to celebrate. We were pleased to publicly honor the author of this and several other CAPA-sponsored bills, Senator Fran Pavley, and her incredible staff who make such legislative successes possible. The PArty continued at the CAPA Dance on Friday night. Then, the Student Medical Challenge Bowl on Saturday was held indoors out of the heat, creating a true PArty atmosphere led by PA Greg Mennie s incredible band. With multiple rounds of challenging questions, Western University of Health Sciences emerged as the winner of the coveted and hard-won trophy. Such a conference would not be possible without a solid, hardworking team. We heard multiple comments that everyone in their blue CAPA shirts was so cheerful and helpful. The Student Ambassadors selected represented their PA programs extremely well with their dedication, professionalism, hard work and enthusiasm. Special thanks to our On-site CME Committee members, Saloni Swarup, PA-C; Chelsea Hemming, PA-C; Jamie McCoy, PA-C and Travis Martois, PA-C for helping to make everything run smoothly. And of course, without the CAPA staff, this Conference could not happen. All of the behindthe-scenes details are taken care of with such aplomb. We are so fortunate to have such remarkable staff at CAPA. A huge THANK YOU to all those who made this a memorable and inspiring Conference! Join us for the 40th Annual Conference in Palm Springs, October 6-9, 2016, as we honor our past and imagine our future! CAPA Conference Highlights Rick Rifenbark CAPA Legal Counsel Foley & Lardner LLP Team CAPA -We Honor Kathryn Scott CAPA Lobbyist Capitol Partners We are fortunate to have a stellar team working for California PAs. Rick and Kathryn are key to CAPA s success each and every day. Their work on SB 337 was incredible and made a difference at every turn. CAPA Honors Teresa Anderson, MPH, CAPA Public Policy Director Teresa is in Sacramento working each day for California PAs. It is safe to say that without Teresa, SB 337 would never have made it past introduction. For the past year this bill was not time consuming, it was life consuming and then some. She worked hard for this bill and she works hard for us every day in Sacramento. There is simply no better advocate! 16 CAPA NEWS

17 Thoughts on Palm Springs by Sonny Cline, PA-C, MA, M.Div; Political Action Committee Chair I love the pool at the Renaissance Hotel in Palm Springs, but it seems I never make my way to that beautiful cement pond until the very last day. Most of my time at Palm Springs is spent encouraging all of you to give to the CAPA PAC or engaged in great conversations with so many. As a matter of fact, that is probably the aspect of the Conference I love the most the many conversations with great people. Some I just met, others I have known for years, but I m always surprised to learn something new about each of you and I m left feeling pride about being a PA. We have so many quality individuals involved in the PA profession in California, it stands to reason why so many others are drawn to join us. Why wouldn t you want to be part of a group of well-educated people, assured of what we have chosen as a career and excited about what we do every day? It is icing on the cake that we make a real difference in the lives of human beings every hour we work. What a great life, and it shows on the faces of those who attended the Palm Springs Conference this year. For those of you who did not attend, we missed you and honestly hope you will consider coming next year. There is something very satisfying about being around so many people who enjoy your same profession, but who also know the demands of what we all endure. The ability to chat with each other about the struggles in clinics, the crappy EMR system that keeps crashing, the one patient that keeps wearing us down for this reason or that and the never ending notes that must be done. These conversations help me realize that I m not alone and that everyone finds the profession difficult and challenging at times. I also enjoyed my conversations with the students. The ones I interacted with struck me as, well, quite young actually. Maybe it s just me getting older and feeling older. It seems the average age of PA students has dropped significantly, although I have no statistics for this notion. I will say this, however, I feel good about the students I spoke with at the Conference. They seemed determined, hardworking and personable and that gives me hope for the future of the profession. They do, however, have the burden on their shoulders of carrying on a great tradition and adding to the solid foundation put in place by those such as Rod Moser, Bob Miller and the many others who blazed the trail ahead of them and me for that matter. I just want to say thanks so much to so many Josh Hanson for letting me fly his drone (how cool was that!), the CAPA staff for making me look better than I really am, to Teresa Anderson for being the very best policy person at the Capitol, to Jed Grant for making me feel like I wasn t the only one at the craps table who didn t know what to do, to Saloni Swarup for the shared memory regarding our moms, to Jeremy Adler for his forward thinking about our profession and the discussions we had, to Cherri Penne-Myers for her continued commitment to the CAPA PAC, to Mike Scarano, not just for being a great lawyer, but for being a great dad which encourages me to do the same, to Gaye Breyman for her ongoing leadership, to those who attended my lectures and taught me more about my topic via your comments and questions and to the many others I do not have room in this article to mention. I came home refreshed and ready to go back to work, as I hope you did. Keep at it, and give it your best every day. I am already looking forward to next year and the possibility of hitting that pool maybe just a little earlier. Congratulations Western University In an exciting match, held indoors this year to provide more seating and comfort, Western University won the coveted CAPA Student Challenge Bowl Trophy to display at the program for a year. CAPA All-Star Band Our sincere thanks to Greg Mennie, PA-C (on drums) and his CAPA All-Star Band. Bringing the Student Challenge Bowl (and the band) indoors made for a wonderful PArty atmosphere. NOVEMBER/DECEMBER

18 Medical Malpractice Claims and PAs Medical malpractice claims can be asserted against any healthcare provider, including physician assistants (PAs). As PAs are now found in many settings and as the demand for PAs grows, the reality is that physician assistants are more frequently finding themselves defending the care they provide to patients. This case involves a thirty-one year-old patient who presented to the ED with a history of fever, nausea, vomiting, and diarrhea. The patient claimed the PA did not diagnose a bacterial infection. The PA claimed the diagnosis was based on the decedent s symptoms at the time, multiple physical exams and tests, and the decedent s history. The patient/plaintiff s decedent, a thirty-one year old man, presented to the emergency room with a history of fever, nausea, vomiting, and diarrhea. Lab testing revealed an elevated white blood cell count. The defendant s physician assistant diagnosed an acute viral syndrome and discharged the patient. The defendant supervising physician reportedly agreed with the diagnosis and discharge. The decedent returned to the ED two days later and was diagnosed with pneumonia. He developed Adult Respiratory Distress Syndrome (ARDS) and died. An autopsy revealed he died of Legionella pneumonia. The plaintiff alleged that the defendant PA failed to diagnose and treat the bacterial infection. The defense contended that although the white blood cell count was elevated, there was no identifiable source of bacterial infection at the time of the ED visit. The PA alleged that her diagnosis was based on the decedent s symptoms at the time, multiple physical exams and tests, and the decedent s history. According to published reports, the jury returned a defense verdict. Risk Management is an integral part of a healthcare professional s standard business practice. Risk management activities include identifying and evaluating risks, followed by implementing the most advantageous methods of reducing or eliminating these risks. The following risk control recommendations can be used to enhance quality of care and reduce risk: Carefully document discussions with the patient and/or responsible party regarding diagnostic test results (both normal and abnormal), as well as recommendations for continued treatment and patient response to results Carefully document your clinical decision-making process leading to the diagnosis and treatment plan. Similarly, document your rationale for any deviation in practice from established clinical protocols, guidelines or standards Seek alternative physician assistance or consultation if the collaborating/supervising or employing physician is not providing adequate support. Diligently screen, test for, monitor and/or treat diseases known to have high morbidity and mortality, such as cancer, infection, heart disease, hypertension and diabetes. Utilize evidence-based clinical practice guidelines or protocols when establishing a diagnosis and providing treatment, and document the clinical justification for deviations from protocols. Obtain results from indicated diagnostic tests, procedures and consultations before documenting the diagnosis and implementing the treatment plan. Seek diagnostic procedure and test results proactively, and document all findings and subsequent treatment actions. Seek timely specialist consultations and advice regarding patients with recurring complaints and/or signs and symptoms that do not respond to the prescribed treatment. Notify patients of abnormal findings in a timely manner and schedule follow-up appointments without delay. Consult with the supervising physician at least as frequently as required and for all cases of difficult or delayed diagnosis. Request regular chart review and ongoing feedback regarding the appropriateness of treatment and care. Notify patients when indicated health screening activities are due and follow up if patients do not respond, documenting all communications. Record all patient noncompliance with ordered testing and treatment, as well as all counseling given and other efforts made to encourage compliance. It is the PA s duty to practice within the boundaries of a PA s scope of practice. These are determined by four parameters: education and experience; state law; facility policy; and the supervising physician s delegatory decisions. Complying with each boundary must be followed in order to promote effective patient-centered care and may protect you from being named in a lawsuit. By using this example, PAs have a better understanding of the risks they may encounter on a daily basis. With permission from Medical Malpractice Verdicts, Settlements & Experts; Lewis Laska, Editor, 901 Church St., Nashville, TN , This risk management information was provided by Healthcare Providers Service Organization (HPSO), the #1 provider of professional liability insurance for over 1 million healthcare professionals, and is now offering the same quality coverage, financial strength and level of service to Physician Assistants. The professional liability insurance policy is administered through HPSO and underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an to service@hpso.com or call CAPA 1115

19 Update on the New Vaccination Legislation by Cherri Penne-Myers, PA-C; Director-At-Large On June 30, 2015, Governor Brown signed SB 277, the most stringent vaccine mandate in the United States. This new law goes into effect on July 1, This legislation will require most all California school children who are enrolled in public or private schools or in day care facilities to be fully vaccinated against whooping cough, measles and other diseases regardless of their parents personal or religious beliefs. This legislation stems from the outbreak of measles that was traced to Disneyland in late December 2014 which spread to 130 individuals across the state of California. Only two other states, Mississippi and West Virginia permit only medical exemptions as legitimate reasons to avoid vaccinations. California will now join the ranks of these two other states that disallow exemptions based on religious or philosophical beliefs. Under the law, a physician has broad authority to grant a medical exemption, not only to children who have had severe reactions to vaccines in the past, but also if a family member had a bad reaction to a vaccine. Schools and day care centers are currently responsible for verifying the vaccinations of the student. Some parents may choose to avoid immunizations by doing home schooling or hiring a private nanny over day care. Which vaccinations are needed to start school you ask? For children ages 4 to 6 years old, the Hundreds of protesters gathered outside the Capitol on June 9, 2015, to rally against SB 277, which would mandate vaccines for schoolchildren. (Jessica Calefati, Bay Area News Group) recommendations is DTaP which includes diphtheria, tetanus and pertussis (whooping cough); chicken pox, MMR (measles, mumps and rubella), and polio. Older children need a booster shot for the DTaP. For teenagers, the CDC (Center for Disease Control and Prevention) recommends teens be vaccinated against human papilloma virus. There is also a recommendation by the CDC for college freshmen to be vaccinated against Meningococcal meningitis. Statistics show that freshmen in college are seven times more likely to contract Meningococcal meningitis than the general populations. On June 9th, many of us were in Sacramento for PA Lobby Day It also happened to be the day that the 18-member State Assembly Health Committee met to hear public testimony on SB 277. Over a thousand parents and children came out to speak against the legislation on mandating vaccinations. The halls and cafeterias on all levels of the state house were filled with parents and children standing or sitting on the floors watching the monitors of what was occurring in the chamber where the Health Committee was hearing public comment. I had on my I LOVE IMMUNITY sticker and was certainly stared at by many of the anti-vaccination parents while I waited in line to be able to announce my support to the State Assembly Health Committee. Fortunately for us, the supporters of SB 277 were the first to give our support. The hearing ended up lasting five hours. I still wonder if all the anti-vaccination parents were able to give their comment which consisted of giving your name, city and whether you supported the legislation or opposed it. No other comment was allowed. As I stood in line I wondered how many of these parents were vaccinated as a child/teen. In addition to visiting several lawmaker s offices on June 9th, being able to give comment of support to a legislative committee and seeing part of a legislation process in action was a highlight of the day in Sacramento. I want to mention, at the time we thought the measles outbreak that occurred at Disneyland was a major outbreak. However, there was another outbreak that occurred in an Ohio Amish community which affected 383 Amish individuals in June This is a religious community which is considered to be a contained community. The source was unvaccinated Amish missionaries who had traveled to the Philippines to build homes. The Amish are a group that usually do not vaccinate in their community. With the outbreak in their community, more than 8,ooo Amish were vaccinated against the measles. NOVEMBER/DECEMBER

20 The PA Profession: A Worldwide View by Saloni A. Swarup, PA-C; Director-At-Large and Committee on Diversity Chair Hello everyone! Welcome back to the CAPA News after our Palm Springs Conference this year. It was a fantastic celebration of our profession filled with inspiration. Next year, we celebrate CAPA s 40th birthday in Palm Springs!!! I hope you join us in this celebration! This article is an exploration of the PA profession outside the U.S. I was curious to see how many countries actually have a profession similar to ours? How is their education program? What is the scope of their practice? How are they working toward bettering their profession? Several countries around the world have PA education programs and practicing PAs within the medical communities: Australia, Canada, England, Germany, Ghana, India, Kenya, The Netherlands, Saudi Arabia, Scotland, South Africa and the U.S. Below is a brief synopsis of the PA education programs and professions around the world. In all of these countries, including the U.S., the PA profession emerged due to the shortage of health care professionals in the medical communities. These shortages are particularly evident in remote and rural areas. Most of these programs have been inspired by the American PA professional model. Many have adapted their professions after attending AAPA conferences. AUSTRALIA: In 2007, the Health Innovation Advisory Subcommittee representative attended AAPA s Annual Conference. As a result, Mt. Isa Center for Rural and Remote Health, located in northwestern Queensland, recognized the shortage in health care professionals and acted. In 2007, they hosted PA students from the U.S. during their clinical year of school. Our students worked with Australia s medical students in rural health rotations. This experience educated Australian physicians about the role a PA can play within patient care and led to working familiarity with PAs. The first Master s program in Australia began in 2009 at the University of Queensland. At the same time, a demonstration project with six PAs from the U.S. was launched by the state of Queensland Ministry of Health. Since that time other universities around Australia have begun PA programs. The Australian Society of Physician Assistants, a national organization, is instrumental in integrating PAs into the Australian Medical Community. Currently, James Cook University is the sole university in Australia that offers a PA training program. The University of Queensland does not currently have an active program. CANADA: Since the mid- 1980s, Canada s armed forces/military has trained PAs through the Canadian Forces Health Services training Center in Borden, Ontario. Canada s formal PA profession began in 2004 after the Canadian Medical Association accredited the program. Eventually, the military PAs were placed on rotation within the civilian health care system. This created an interest in the development of PA positions within the civilian sector. Manitoba and Ontario were the pioneering provinces that developed PA programs. In 2008, a 3-year demonstration project involving 30 American and Canadian PAs was launched in Ontario. Canadian schools include University of Manitoba, McMaster University, University of Toronto. Northern Ontario School of Medicine and Michener Institute for Applied Health Sciences. These schools apply a problem-based learning model within the PA programs. Students must pass a national PA certification examination to achieve the status of a certified PA. Representatives of these universities have attended AAPA conferences. Canadian Association of Physician Assistants ( CAPA ) helps Canada integrate PAs within the medical community and patient health care. THE NETHERLANDS: After noticing a severe shortage in health care professionals in 2001, the University Medical Center in Leiden launched a pilot program with four students. In a matter of two years, two universities, HAN University of Applied Sciences Arnhem/Nijmegan and University of Applied Sciences, Utrecht started PA programs. Other current universities include Rotterdam, Hanze University of Groingen and Inholland University graduate School. All of these programs are Masters of Physician Assistant programs and are 30-month programs. The teaching model in these schools is tied to a specialty, mainly surgical specialties. These programs are 20 CAPA NEWS

21 funded by the Ministry of Healthcare and the Ministry of Education. Every student in this program adapts a dual work-education model wherein they are employed within their area of specialty while they attend school. They also must complete a Master s thesis which employs practical research in order to graduate. Netherland s Association of Physician Assistants is working to develop the profession s legal status and representing the PA profession. ENGLAND/UNITED KINGDOM: The PA profession began here after 10 U.S. educated PAs were employed as part of a demonstration project in 2004 to work in primary care and emergency medicine in West Midlands, England. After realizing the impact this project had on the health care system, four PA programs were implemented. In 2004, a primary care PA program was launched at the University of Wolverhampton. In addition, the University of Birmingham, St. Georges; University of London and University of Hertfordshire began PA programs. All of these programs were established as postgraduate degrees. In 2006, the National Health Service, Department of Health released a report titled, The Competence and Curriculum Framework for the Physician Assistant. This report highlighted all adapted aspects of the medical curriculum for PAs. In 2009, a demonstration project in Scotland with U.S. PAs was instrumental in initiating the profession in Scotland. Ireland is also exploring developing the PA profession. GHANA: Ghana s PA profession development began with a process to upgrade the medical assistant into PAcapable roles. This was a result of representatives from Ghana visiting American PA programs. Medical Assistants in Ghana have been trained at the Kintampo Rural Training School in Sunyani, Ghana since INDIA: India s PA journey began with the recognition of a growing need by the medical community. In 1992, Madras Medical Mission began training PAs. After being well-received by both medical practitioners and patients, more PA programs were created at various universities. SAUDI ARABIA: In Fall 2010, Saudi Arabia began its first PA program at Prince Sultan Military College of Health Sciences in Dhahran. This program was designed as a Master s degree program that was a 28-month program. SOUTH AMERICA: PAs are referred to as Clinical Associates in South America. The Walter Sisulu University in the Eastern Cape province began a Bachelor of Clinical Medical Practice program to train the Clinical Associates. All the information in this article demonstrates how our profession has spread its wings across the globe and has addressed and resolved the scarcity of quality health care across the world. As the result of all of our fellow PA s hard work, we have been able to create a profession that aids our patients within a well-equipped health care system. It is imperative we continue to aid each other in the progression of our profession. We have strength in numbers, but networking with each other will only make us stronger. After all, One Team One Dream! References Australian Society of Physician Assistants org/about.html Physician Assistant Education: Five Countries. Roderick S. Hooker, PhD, PA, The Lewin Group, Falls Church, Virginia; Luppo Kuilman, MPA, Hanze University of Applied Sciences, Groningen, The Netherlands, and University of Kentucky, Lexington, Kentucky. org/index.php?ht=action/ GetDocumentAction/i/ International Academy go Physician Associate Educators programs Canadian Association of Physician Assistants Netherland s Association of Physician Assistants. NOVEMBER/DECEMBER

22 CAPA Successfully Fights for California PAs... Are We Merely Assistants? Legislation SB 337 Ignites Discussion Continued from page 9 A few other noteworthy bills that were Chaptered this year include: AB 637 (Campos) Physician Orders for Life Sustaining Treatment (POLST) Forms. This bill, beginning January 1, 2016 authorizes PAs to sign POLST forms. AB 679 (Allen) Controlled Substances extends the deadline for mandatory enrollment in the CURES system from Jan to July 1, SB 137 (Hernandez) Provider Directories requires, among other things, the Dept. of Managed Health Care and the Dept. of Insurance to develop uniform standards for provider directories, updated weekly on-line and quarterly in print and the directory must include PAs. The legislature reconvenes on January 4, 2016 for the second year of the legislative session and CAPA will continue to work hard for you to make sure health care policy and legislation reflect the importance of team-based care. Continued from page 7 the physician and PA jointly and equally provide their professional signatures to memorialize that the interaction occurred, but not with the PA having a subordinate signature and the physician an endorsing one. One of the most interesting discoveries that arose from SB 337 surrounds these issues of professionalism of PAs. There are many myths surrounding PA practice, such as PAs seeing only simple medical cases or that PAs chose their profession because they feel they lack the capacity to be physicians. As the bar is raised on the professionalism expected of PAs, I am certain that the close relationships PAs have with physicians, and all other health professions, will advance the practice of medicine in California for the ultimate benefit of our patients. See highlights of SB 337 on pages 4 and 5. Celebrate with us at CAPA s 40th Annual Conference Palm Springs, CA October 6-9, 2016 Make the most of your trip to Napa! RSVP NOW for a free, CMEgranting one-day mental health training, Mental Health in Primary Care. This will be held the day after CAPA at Napa, and at the same hotel. When: Sunday 2/28/16, all day Where: Napa Valley Marriott Hotel & Spa Cost: FREE; meals provided RSVP/Questions: Julie Charles, MBA , julie.charles@tu.edu 22 CAPA NEWS

23 One-Day Conference in Napa at the Napa Valley 6 Hours of Cat. I CME Controlled Substances Course on Sunday Registration Form Name PA-C PA PA-S NP MD/DO Other PA License # CAPA at Napa Address City State Zip Code Phone ( ) Fax ( ) Work Address Saturday, February 27, :45 a.m. - 4:45 p.m. Register online at Program 8:00 a.m. 8:45 a.m. Registration, Continental Breakfast and Exhibits 8:45 a.m. 8:50 a.m. CAPA President s Welcome Roy Guizado, MS, PA-C, DFAAPA 8:50 a.m. 9:45 a.m. No T for Old Men Jerome Minkoff, MD, FACP 9:45 a.m. 10:40 a.m. HIV Testing and Management: New Directions for Primary Care Sam Wijesinghe MS, MPAS, PA-C, AAHIVS 10:40 a.m. 11:25 a.m. Break and Exhibits 11:25 a.m. 11:35 a.m. Repositioning the PA Profession Jeremy Adler, MS, PA-C 11:35 a.m. 12:30 p.m. Venous Insufficiency Robert Coronado, MD 12:30 p.m. 12:45 p.m. Celebrating 20 Years of CAPA at Napa 12:45 p.m. 1:45 p.m. Lunch 1:45 p.m. 2:40 p.m. My Head Hurts! Greg Mennie, PA-C 2:40 p.m. 3:35 p.m. Finding the Sweet Spot Kim Zuber, PA-C 3:35 p.m. 3:45 p.m. Break 3:45 p.m. 4:40 p.m. Abdominal Pain in the ER Jed A. Grant, MPAS, PA-C 4:40 p.m. 4:45 p.m. Prize Drawing and Closing 6 Hours Category I - CME Credit Applied For Application has been made to the American Academy of Physician Assistants (AAPA) for 6 hours of Category I CME credit. Approval is pending. Courses will be canceled if minimum number of registrants is not met. The planners and sponsors of this function claim no liability for the safety of any attendee while in transit to or from this event. The planners and sponsors reserve the right to change speakers and/or cancel the event due to unforeseen circumstances without penalty. The total amount of any liability of the planners and sponsors will be limited to a refund of the registration fees. City State Zip Code Phone ( ) Fax ( ) CAPA Member - $150 Non-Member - $240 CAPA Member PA Student - $50 Non-Member PA Student - $70 Napa Conference and CAPA Membership through 4/30/17 - $275 Late Registration Fee after February 1, add $20 Vegetarian Meal Required or Gluten-Free Meal Required Total Amount $ Signature CVV# Exp. In accordance with the Americans with Disabilities Act, please check here if you have any special needs. You will be contacted by CAPA. Mail Registration Form and make checks payable to: CAPA California Academy of PAs 2318 S. Fairview St. Santa Ana, CA Phone: (714) Fax: (714) or Register online at: Celebrating 20 Years On Saturday, February 3, 1996, CAPA held our first CAPA at Napa Conference. This year we celebrate 20 years of what quickly became the favorite CAPA Conference for many. The one-day, CAPA at Napa Conference was the idea of then CAPA board member, Cyndy Flores, PA-C. Twenty years later we gather in the beautiful Napa Valley to celebrate this wonderful little conference and Cyndy Flores! We hope you will join us! CAPA at Napa February 27, 2016 at 12:30 p.m. NOVEMBER/DECEMBER

24 Students Students Students Students Students Students Laughing Away Your Stress by Emily McCoy, PA-S; Student Representative MBKU Class of 2016 Have you ever thought about the quote, Laughter is the best medicine, and asked yourself why it really is? According to the book, Humor as an Instructional Defibrillator, the author suggests that humor s primary psychological role is an emotional response or buffer to relieve physical stress. Laughter has been shown to spark a physiological effect that reduces stress hormones such as serum cortisol, epinephrine and dopac. (Beck, 2002). As stated by the Mayo Clinic, laughter can also enhance your intake of oxygenrich air, stimulate your heart, lungs, and muscles and increase the endorphins that are released by your brain. (Mayo Clinic, 2013) Laughter is critical for your health and well-being, especially during PA school when stress levels are at their peak and your health is commonly put on the back burner. Throughout my first year of PA school, I learned to cope with the many challenges and stressful days by trying to keep a positive attitude, smile as much as I can and allow myself to laugh as much as possible, while at the same time trying to act professional :). One way I incorporated laughter into my study routine was to make up funny mnemonics so that the information could stick better in my brain. I soon realized that if there was humor involved in what someone was teaching me or in a topic I was trying to learn then it made it that much easier to understand and retain. The book, Laughing and Learning: An Alternative to Shut Up and Listen, states that the use of humor relieves tension, enhances memory, increases class interest, masks embarrassment, heightens self-efficacy and fosters group cohesion. (Jonas, 2009) I believe that one of the main reasons why my MBKU PA class has formed such a strong bond over the last year is because we spent a lot of time laughing with each other and even at each other. We all had a mutual understanding that class can t always be serious and we made sure of it. Since laughter has been proven to be so valuable for our health, here are some funny things I have realized this past year in PA school: 1. I quickly learned that in PA school my Google searches would never be considered appropriate and I was always worried what someone outside my class might think if they happened to stumble across my browsing history. 2. Do not study for your genitourinary or gynecology module in public! I was recently studying some gynecology material at a coffee shop while on my lunch break and got some major glares from people around me. Oops! 3. Remember, not everyone likes to talk about medical topics at the dinner table. You become so immersed in what you are learning that it seems to be the only thing you want to talk about. 4. Someone in your class will fall asleep during a test before your first year is over and there is no correct way to wake them up without looking like you are attempting to cheat. 5. Your professors will be some of the smartest people you meet but very likely won t be able to figure out the projector, work the computer or get embedded videos in their PowerPoint to play. :) 6. No matter how hard you try not to, you will convince yourself you have multiple health problems before your first year is over and one of those problems will most likely be psych-related. All joking aside, you will miss PA school when it is over. Although I still have one year left, I am now in my clinical rotations and I don t get to see my classmates and professors every day like I used to. I miss the countless hours of laughing with them and I always look forward to the next time I get to see them. Enjoy the process while you can and make sure you laugh. References -Beck, R.A. (2002). Humor as an Instructional Defibrillator. Sterling, VA: Stylus Publishing -Stress Relief from Laughter? It s no joke. Mayo Clinic. (2013, July 23) -Jonas, P.M., (2009). An Alternative to Shut Up and Listen. Latham, MD: Rowman and Littlefield Education. 24 CAPA NEWS

25 Students Students Students Students Students Students Sharpen the Saw by Sandra Fineman, PA-C; Student Affairs Committee Chair It is that time of year when didactic lectures are getting heavier, challenges in clinical rotations are increasing, and you may start to wonder why you chose to pursue the PA profession in the first place. But, as Habit #7 in Stephen Covey s, 7 Habits of Highly Effective People says, it may be time to sharpen the saw. Covey uses the analogy of a woodcutter who is sawing for several days straight and through this process; the blade on his saw is getting dull, causing the woodcutter to become less and less productive. Therefore, the solution is to periodically sharpen the saw. Most students find it counterproductive when someone advises them to take a moment from their studies to get renewed. But I think the reason students find this advice so difficult to accept is because they do not understand the true concept of what it takes to sharpen the saw. Many students believe spending the day laying in the sun trying to forget about their demanding PA school s schedule is the solution. I suggest you take a different approach to the analogy: Take a moment and find an activity outside of PA school that you are passionate about, something that motivates and inspires you to regain your focus. Find something that reminds you of why you chose to pursue this noble profession. So, whether it is attending a CAPA Conference, volunteering at a health fair, or simply having a genuine conversation with an inspirational friend, I challenge you to look deep within and find your passion, your motivation, your means of sharpening the saw. Thank You 2015 Student Ambassadors CAPA Connections Stay Connected With Your Program s CAPA Student Liaison Hannah Betke, PA-S Western University Jennifer DeMoss, PA-S* Marshall B. Ketchum University Dipali Desai, PA-S Touro University Jodee Krainik, PA-S Touro University Sammy Lei, PA-S* Western University Annie Lin, PA-S University of Southern California Kathryn Mayo, PA-S Marshall B. Ketchum University Johnny Morales, PA-S Riverside Community College Ryan Nguyen, PA-S Western University Beverly Ruppert, PA-S Loma Linda University Amy Scarano, PA-S* Western University Amanda Thometz, PA-S Western University Wilson Truong, PA-S University of Southern California Loren Vaughan, PA-S Loma Linda University *Lead Student Ambassadors Loma Linda University Aivi Phung, PA-S Marshall B. Ketchum University Sakshi Madan, PA-S Riverside Community College Johnny Morales, PA-S Stanford University Pricilla Inda, PA-S Touro University Alyssa Stephens, PA-S Universtiy of California - Davis Nicole Davis, PA-S University of Southern California Audrey Zanzucchi, PA-S Western University Madison Zagurski, PA-S NOVEMBER/DECEMBER

26 Students Students Students Students Students Students CAPA Student Scholarships Deadline December 31, 2015 The Ruth Webb Minority Scholarship $2000 Scholarship Ruth Webb served as program director for the Charles R. Drew University PA Program for several years, and was actively involved with numerous local, state, and national professional organizations. She was not one to sit back and let others do the work. She took a very active role doing committee work. She served as Vice Chair of the Board on Medical Quality Assurance, member of the Physician Assistant Examining Committee, member of the California Council of PA and NP programs, and founding member of the LA County Joint Practice Advisory Council on NPs and PAs. Known for keeping it real, she would do whatever it took to help students achieve the goal of becoming a PA-C. The Ray Dale Memorial Scholarship $2000 Scholarship Ray Dale served as Executive Officer of the Physician Assistant Committee from , and was instrumental in the development and growth of CAPA as an organization representing our profession. Working with the Department of Consumer Affairs, he would give CAPA good counsel and support regarding legislative issues, and would help by acting as our lobbyist and attorney when CAPA could not afford one. He contributed his time and his efforts to the growth of the PA profession and protection of its consumers. The Community Outreach Scholarship $2000 Scholarship This scholarship will be awarded to a student who is currently in good academic standing and has demonstrated community outreach and other philanthropic activities as a student. Student Members of CAPA currently enrolled in primary care PA Programs located in the state of California are eligible to apply for CAPA scholarships. The deadline to apply for the three $2,000 CAPA Scholarships is December 31, Please visit the CAPA website for an application and for eligibility requirements. CALIFORNIA ACADEMY OF PHYSICIAN ASSISTANTS California Physician Assistant s and Supervising Physician s Legal Handbook R. Michael Scarano, Jr. Foley & Lardner LLP CAPA General Counsel FOURTH EDITION Fourth Edition of the California Physician Assistant s and Supervising Physician s Legal Handbook * NEW 4th Edition Notice to CAPA members is hereby given pursuant to CA Corporation Code Section Members of CAPA have the right to request and receive CAPA s balance sheet, an income statement and a statement of cash flows for the most recent fiscal year. Please note that the names and addresses of current members are located at the CAPA office located at 2318 S. Fairview Street, Santa Ana, CA Requests for information should be in writing and delivered to the CAPA office. Michael Scarano, Jr., Esq. authored the California Physician Assistant s and Supervising Physician s Legal Handbook. Newly updated, it answers scores of questions in a concise, clear fashion, with citations and appendices that will permit practitioners to read the operative statutes and regulations for themselves. A must have for all California practices employing PAs. Visit the CAPA website at for more information or to order the book online. *CAPA Member Price - $34.95 Non Member Price - $54.95 CAPA Members can log-in and view Job Listings. Employers know that the CAPA website is the best place to advertise for PA positions in California. Check the listings 26 CAPA NEWS

27 Welcome New Members July 22, 2015 through November 3, 2015 Local Groups Erin Abston, PA-C Kellie Acosta, PA-S Lauren Adams, PA-C Godwin Aduba, PA-C Jamie Ahner, PA-C A. Alabi Akinloye, PA-C Ron Alforja, PA-C David Allen, DC, ATC, PA-C Mykeisha Alzaatra, PA-C Erika Amthor, PA-C Matthew Anderson, PA-C Jocelyn Anderson, PA-S Telly Arispe, PA-S Sarah Armato, PA Derek Asimus, PA-S Diane Asmuth, PA-C Irina Bails, PA-C Stephanie Bareis, PA-C Henry Barraza, MSPAS, PA-C Emily Barrick, PA-C Bryan Batdorf, PA Meagan Bathurst, PA-C Tivona Batieste Hannah Baum, PA-S Steven Bayer, PA-S Justina Bell, PA-C Matthew Belmont, PA-C Jennifer Benson, MPAS, PA-C Deborah Bergman, PA-S Elisabeth Bertoline, PA-C Mark Beyer, PA-S Brooke Blomberg, PA-S Richard Bohnemann, PA-C Erin Borini, PA-C Larissa Botcharnikova, PA-C Ellen Boynton, PA Dorothy Bratton-Sandoval, PA-C Jafari Brown, PA-C Melinda Brown, PA-C Alicia Brown, PA-C Danielle Burgess, PA-C Cassandra Bush, PA-C Lisa Bush, PA-C, MPH Melissa Bustos, PA-C Karla Cabrera, PA-C Amber Calderaro, PA-C Mikel Calderon, PA Nicholas Campbell, PA-S Joanne Campbell, RPA-C Linda Candiotti, PA-C Kevin Canlas, PA-S Anthony Capati, PA-S Robert Cardenas, PA-C Megan Carter, PA-S Vincent Caserio, PA-S Patricia Casipe Grace Castanon, PA-S Sallie Cataldo, PA-S Kendra Cavazo, PA-C William Chamberlain, PA-C Wei Chan, PA-C Brian Chen, PA-C Curtis Ciesinski, PA-S Janelle Colangelo, PA-C John Coleman, PA-C Shelton Colinco, PA-C Benito Contreras, PA-C Joanna Corona, PA-S Nicolas Corvini, PA-S Breana Coville, PA-C Brittany Cox, PA-C Kelly Coyne, PA-C Joseph Crispin, PA Marlyn Cuenca, PA-C Lauren Cuevas, PA-C Francesca Cuttaia, PA-C Lyndsey Cwikla, PA-C Amy Dahlberg-Wisman, MS, PA-C Ebrahim Daneshvar, PA Parvaneh Darvish, PA-C Tracy Dau, MS, PA-C Jonathan Davies, PA-C Lisa Davis, PA-C Tiana Davison, PA-S Nelae DeChurch, PA-C Joyce Delgado, PA-C Vanessa Delgado, PA-C Robyn Dettmar, PA-C Michael Devereux, PA-C Ajitpal Dhillon, PA Brianna DiMasi, PA-S Hang Doan, PA-S Surime Dobrin, PA-C Rebecca Dodd, PA-C Emily Dowe, PA-C Zulma Duarte, PA-S Courtney Eastman, PA-C Charles Edward, PA-C Yarom Eloul, PA-C Edwin Enwia, CCT, PA-S Pedro Escobar, PA-C, MSPAS, MPH Mario Esquivel, PA-C Raul Estrada, PA-C Rachel Fairman, PA-S Mitchell Fallon, PA Aaron Farmer, PA-C Dina Farzan, PA-C Bambi Fass, PA-C Kristyl Felix Aleksandr Filen, PA-C Maureen Fleming-Mullins, PA-C Jessica Flores, PA-S Jeremy Fong, PA-C Rebecca Fort, PA-S Jeremy Frisby, PA-S Paul Fry, PA-C Jenny Fu, PA-C Jamie Fung, PA-S Teodora Gaidadjiev, PA-C Nicole Galle, PA-S Melissa Galvez, PA-C Jeff Garber, PA-C Genevieve Garcia Ruben Garcia De Alba, PA-C Jardena Garner, PA-C Kirsten George, PA-C Peta-Gay Gihbsson, PA-C Marina Gonzalez, PA-C Michael Gonzalez, PA-S Jeff Goodale, PA-C Lauren Gorence, PA-C Mike Gottus, PA-C Karen Goyal, PA-C Billy Graham, PA-C, MPAS Stephen Grant, PA-C Crystal Gray, PA-C Shirley Gray, PA Robert Grigg, PA-S Seth Grisham, PA-S Debra Gromacki-Blyth, PA-C Jonathan Guinto, PA-S Saige Gurtowski, PA-C Nayanna Hage, PA-C Anne Hall, PA-C Allison Hallinan, PA-C Marie Hamilton, PA-C, ATC Tommy Hammonds, PA-C Jarrod Harbour, PA-C Curtis Hazell Dem Hechanova, PA-C Heather Heck, PA-C Ryan Heitman, PA-C Laci Helmhout, PA-C Ann Marie Hembrough, PA-C Jennifer Herrera, PA-C James Hill, PA Donald Hills, PA-C Lynne Hinkle, PA-C Catherine Hoelzer, PA-C Tara Holguin, PA-S Jennifer Holman, PA Laura Houck, PA-C Angela Hsu, PA-S Robert Hsu, MPAS, PA-C Thuy Hua, PA-C Basharat Hussain, PA-S Michelle Huynh, PA-S Jenna Hynes, PA-S Bernadette Hystad, PA-C Pamela Ibanez, MHS, PA-C Robert Inzunza, PA La Shawnta Jackson, PA-C Ryan Jacobs, PA-C Brenda Jimenez, PA-C Kathryn Johnson, PA-C Jeremy Johnson, PA-S LaKesha Johnson, PA-C Helene Jolly, PA-C Katherine Jones, PA-C Adrienne Kane, PA-C Alexander Kaye, PA-S Gerald Kayingo, PA-C, PhD Debbie Keefe, PA-C Julie Kelly, PA-C Ryan Kennedy, PA-S Misbah Khan, PA-C Laura Kirk, PA-C Elaine Kletsman, PA Catherine Knight, PA-S Katie Knott, PA-C Tara Konat, PA-C Nicole Kramer, PA-S Keri Kres, PA-C Robert Krochalis Soliani, MPH/PA-C Joseph Krpalek, PA-S Lesley Laird, PA-C Vanessa Lazaro, PA-C Maricela Ledezma, PA-S Jason Lee Grace Lee, PA-C Alisia Lee, PA-C Mark Lee, PA-C Margaret Legan, PA-S Leigh-Anne Lehrman, PA-C Sammy Lei, PA-S Zenda Lewis, PA-C Carol Li Anthony Lim, PA-C Sarah Linder, PA-C Lara Lingwall, PA-C Christine Liu, PA-S Lily Liu, PA-S Erik Luansing, PA-C Ginger Lucero, PA-C Ian Mac Allister, PA-S Desirae Macias, PA Vinh Mai Penny Makabenta, PA-C Michela Maletis, PA-S Jeffrey Manese, PA-C Jeremiah Martinez, PA-C Kathleen Marty, PA-C Mimi Mathews, PA-C Caitlin Matsumoto, PA-C Heather May, PA-S Kathryn Mayo, PA-S Fabio Mazzarelli, PA-S Lindsey McAtee, PA-C Dana McCaulley Robert McDaniel, PA-C Scott McFarland, PA-S Jennifer McGovern, PA-S Joy McMasters, PA-C Sherry Mesman, CPA Stephen Metz II Mandy Metzger, PA-C Troy Metzger, PA-C Oscar Miles-Smith, Jr, PA-C Frankie Miller, PA Nathan Miller, PA-C Bernadette Miller, PA-S Sharolunda Mitchell Mai Moiseshyn, PA-C Ross Monroe, PA-C Brian Montgomery, PA-C Juanita Moore, PA-C Victor Moore, PA-C Yolanda Moore, PA-C Lindsey Morris, PA-C Jamie Morrison, PA-S Shannon Mullen, PA-C Sarah Munar, PA-S Lindsay Murphy, PA-C Adam Musgrave, PA-C Ryan Muth, PA Alexandra Mychaliska, PA-C Nicole Myers, PA-C Phillip Myers, PA-C Eliza Nader, PA-C Rebecca Naor, PA-C Hilary Nelson, PA-C Tracy Nguyen, PA-S Alice Nguyen, PA-C Heather Nguyen, PA-C Tammy Nguyen, PA-C Grace Nguyen, PA-S Catherine Nguyen, PA-S Abram Nunn, PA-C Jose Nuno, PA-C Jessika O Brien, PA-C Sabrina Oei, PA-S Michael Olds, PA-C Tamara O Nan, PA-C Kathryn O Neil, PA-S Jon Onosaki, PA-C Bryce Pace, PA-S Genevieve Painter, PA-S Amanda Paranda, PA-C Lucy Paredes, PA-C Sijin Park, PA-S Tatsiana Parker, PA-S Tariq Parwani, PA-C Erin Pascale, PA Kelly Pate, PA-C Chrysanta Patio, PA-C Amanda Pedota, PA-C Tiffany Penhallurick, PA-C Kipley Pereles, PA-S Rossy Perez, PA-C Sharon Perez, PA-C Sarah Pertschuk, PA-C Suzanne Petersen, PA-C Andrew Phan, PA-S Brandin Phillips, PA-C Michael Ryan Pingol, PA-S Hannah Prawat, PA-C Rudy Ramirez, PA-C Manuel Ramirez, PA-C Alain Raymond, PA-C Rachael Rebujio, PA-S Sadaf Regar, PA-C Sean Reilly, PA-C Jemmy Reuter, PA-C Alfred Reyno, PA-C Paul Rhee, PA-S Shannon Rice, PA-C Andrea Rich, PA-S Steven Rigor, PA-C Juan Riojas, PA-C Dale Risenhoover, PA-C Tammy Robison, PA-C Natalie Robles, PA-S Richard Rockstad, PA-C Lala Rodriguez, PA-C Jose T Rodriguez, PA-C Adrian Rojas, PA-C Sandro Romero, PA-C Cesar Romero, PA-S Denise Ros Amber Ross, PA-C Christine Roth, PA-S Nahal Sahelimoghavami, PA-S Udara Samarasinghe, PA-C Sara Sameshima, PA-S Gary Sanchez, PA-C Ivanely Sanchez, PA-S Jonathan Sanz, PA-C Jessica Sarder, PA-S, MA Sunny Sawyer, PA-C Donald Schiller, PA-S Ashley Schmidt, PA-S Mary Schneider, MAS, PA-C James Schroeder, PA-C, DFAAPA Teri Scott, NP-C Judith Seargeant, PA-C Kiran Semelsberger, PA-C Ji (Jenna) Seo, PA-C Monica Separzadeh, PA-C Brian Shaghafi, PA-C Ashley Shaw, PA-S Nancy Shaw, PA-C Kelly Sherwood, PA-C Saema Sial, PA-C Mandeep Sidhu, PA-C Jane Simard, PA-C Ivan Simunovic, PA-S Ashley Smaldone, PA-C Allison Smith, PA-S Brandon Smith, PA-C Mary Evelyn Smith, PA-C Vance Snyder, PA-C Bora Song, PA-C Kali Southworth, PA-C Lara St. John, PA-S Stanislav Stanislavov, PA-C Allison Stewart, PA-S Christine Stolsig, PA-C Michelle Stone, PA-C Jermaine Stubblefield, PA-C Melissa Stucky, PA-C Philip Suh, PA-S Jennifer Swisher, PA-C Heather Sykes, PA-C Krystian Szczesik, PA-S Mark Tabor, PA-C Lauren Takata, PA-C Craig Tambatamba, RRT, PA-S Matt Tan, PA-S Stephanie Tarlow, PA Alexandra Taylor, PA-S Brian Tesnar, PhD, PA-C April Theisen, PA-C Chinwe Thomas, PA-S Jeffrey Thompson, PA Kristen Thorensen, PA-C Cristina Tipei, PA-C Amanda Tipton, PA-C Wesley Tolles, PA-C Manuel Tovar, PA-C Lacey Townsend, PA-C Dan Tran, PA-C, EMT Doreena Tran, PA-S Stephanie Tran, PA-S Lien Tran, PA-S Miguel Trujillo, PA-C Lynn Uchizono, PA-C Susanne Valenti, PA-C Onil Vallecillo, PA-C Penny Van Patten, PA-C Steve Van Patten, PA-C Marilyn Varela Morales, PA-C Edgar Vargas, PA-C Stacey Vasquez, PA-S Diana Velazquez, PA-C Gustavo Victoria, PA-S Brandon Vlahos Trang Vo, PA-S Marianna Vosk, PA-C Donna Vuu, PA-S Ryan Wada, PA-C Naomi Wai, PA-C Ghazel Waiz Angela Wang, PA-S Shiloh Wecklich, PA-C Alyssa Weiner, PA-C Donna Wilcox, PA-C Clara Wilson, PA-C Nicole Wilson, PA-C Bradley Winkel, PA-C Susan Wrubel, PA-C, NP Aleah Wysozan, PA-S Casey Yin, PA-S Alice Yoon, PA-S Helen Zhu, PA-S Redding Area PA/NP Alliance P.O. Box , Redding, CA Summer Ross, PA-C; (530) summerlynn712@gmail.com Physician Assistant Society of Sacramento (PASS) Atul Sharma, PA-C, President; (916) pasocietyofsac@yahoo.com; pasocietyofsac@groups.facebook.com Contra Costa Clinicians Association Brian Costello, PA-C; (925) contracostapas.com San Francisco Bay Area Physician Assistants (SFBAPA) Martin Kramer, PA-C; (415) Lombard St., Apt. 118, San Francisco, CA mkramersf@hotmail.com Bay Area Mid-Level Practitioners Rose Abendroth, PA-C; (650) , Fax: (650) rosepard@aol.com Matt Dillon, PA-C; (650) , mattdillon42@hotmail.com Bay Area Non-Docs Linda O Keeffe, PA-C; (650) , lindapac@aol.com Northcoast Association of Advanced Practice Clinicians John Coleman, PA-C; (707) , streetdrag49@sbcglobal.net Stanislaus County NP/PA Network Brian Cormier, PA-C; (209) , briancor@verizon.net Stockton Midlevels Roy Blanco, PA-C; (209) stocktonmidlevels@gmail.com Journal Club for PAs and NPs (Fresno area) Cristina Lopez, PA-C; (559) ; Fax: (559) clopez875@aol.com; th St, Sanger, CA Central Coast Nurse Practitioners & Physician Assistants Kris Dillworth, NP; ccnppa@yahoo.com Sharon Girard, PA-C; (305) ; ccnppa@yahoo.com Orange County Hung Nguyen, PA-C; nhy52@yahoo.com So Cal PAs Linda Aghakhanian, PA-C; want2heal@hotmail.com San Gabriel Valley Local Group M. Rachel DuBria, PA-C; (818) , racheldca@aol.com San Fernando/Santa Clarita Valley Group Jonah Tan, MPT, PA-C; (818) , jotptpa@yahoo.com Coachella Valley Physician Assistant Group Matthew Keane, MS, PA-C; mkeanepas@gmail.com San Diego Area Bernard Casillan, PA-C; info@sdpasociety.com NOVEMBER/DECEMBER

28 Address Service Requested California Academy of PAs 2318 S. Fairview St. Santa Ana, CA PRSRT STD US POSTAGE PAID SANTA ANA, CA PERMIT NO 949 One-Day Conference in Napa at the Napa Valley 6 Hours of Cat. I CME CAPA at Napa Wishes you... Saturday, February 27, :45 a.m. - 4:45 p.m. Register online at Healthy Sponsored by the California Academy of PAs Holidays With CAPA s efforts resulting in the successful passage of SB 337, effective January 1, 2016, PAs holding a certificate of completion from CAPA s past or upcoming Controlled Substances Education Courses have mechanisms to reduce physician co-signatures from a mandatory 100% of Schedule II medical records down to 20%. 6 Hours Cat. I CME Controlled Substances Education Course for PAs Saturday, January 23, 2016 Scripps Green Hospital Timken Amphitheater N Torrey Pines Rd La Jolla, CA Sunday, February 28, 2016 Napa Valley Marriott (following CAPA at Napa) 3425 Solano Ave Napa, CA Wednesday, October 5, 2016 Renaissance Palm Springs (preceding CAPA Conference) 888 E Tahquitz Canyon Way Palm Springs, CA