On May 13, Indiana Gov. Mike Pence welcomed representatives from the Indiana Academy of Physician Assistants, all four PA programs in the state, physicians, and AAPA staff to his office for a ceremonial bill signing for House Bill 1099. Effective July 1, the bill will move Indiana from two to four key elements of a Modern PA Practice Act with the addition of Schedule II prescriptive authority and the elimination of the requirement that a supervising physician be located in a contiguous county from where the PA is practicing. The new law also makes improvements to chart review requirements and physician-PA ratios.
COOA Director Liz Roe recently sat down with IAPA president-elect and legislative chair Courtney Doran, PA-C, to discuss IAPA’s success at the statehouse in 2013.
Bianca Belcher: Hi, my name is Bianca Belcher, and although I am a new graduate of the Northeastern PA Program, I’m not new to the role of advocacy. I was heavily involved in PA advocacy as a student, and continue to do so. Which is why I’m happy and proud to introduce AAPA’s new advocacy podcast.
Liz Roe: Good morning. This is Liz Roe, from the American Academy of Physician Assistants’ Constituent Organization and Outreach Advocacy department. I’m here today with Courtney Doran. She’s the president-elect and legislative chair for the Indiana Academy of Physician Assistants.
Indiana had an excellent legislative session this year. It improved PA-physician team practice across the board. PAs were included in four different bills that were intended to improve patient access to care. One of these bills, House Bill 1099, was wildly successful in improving the state’s PA practice act. It took a lot of planning, though, so Courtney, why don’t you tell us a little bit about how you set about drafting and crafting this bill?
Courtney Doran: Indiana historically does not have a wonderful practice act. IAPA leadership knew that we wanted to do something to improve patient access and the care that PAs are able to provide. We started about 18 months prior to legislation. We decided to meet with the physicians, and we met with the Indiana State Medical Association (ISMA) and their lobbyist and discussed ways that we could work together to improve the PA practice act and patient care.
The first step was that ISMA passed a resolution that endorsed the AMA guidelines for the physician-PA practice act. They resolved that they would work with IAPA to enhance patient care through effective collaboration.
This resolution required several months itself, and several drafts. IAPA helped with ideas on how to word things and ultimately the physicians came up with language that they wanted, and IAPA was pleased with the result.
Once the resolution was passed in September, an eight-member panel that consisted of three PAs, three physicians, and the ISMA and IAPA lobbyists worked together to draft 1099. So the language in 1099 is the result of doctors and PAs working together.
Liz: And your bill sponsor—how did you go about selecting the right lawmaker?
Courtney: Our lobbyist, Bill Cowan, and the ISMA lobbyist both have very good relationships with the legislators. And Rep. Steve Davidson is actually a pharmacist. So he understands healthcare more than many legislators. He was very receptive to the changes that needed to occur in our state and was instrumental in helping us get this accomplished.
Liz: What exactly did House Bill 1099 do?
Courtney: 1099 had four components in it.
It improved our (PAs’) prescriptive authority to include Schedule II medications. It also removed contiguous county language. This is something unique that Indiana had where a physician had to be within the contiguous county of the PA in order for the PA to provide care. That language was removed, and now the legislation is written so that a physician must be within a reasonable distance to supervise.
We have a ratio limitation of 2:1 in Indiana. The ratio did remain; however, it was reworded so that a physician can hire as many PAs as they want as long as they’re not supervising more than two at a time. This is at least a step in the right direction, because it does open the job market for PAs and allow for all of the part-time and shift work that occurs in today’s world.
Finally, our chart review was improved. Indiana has a fairly strict chart review where 100 percent of the PA’s charts were required to be signed within seven days for three years, and then if the PA switches jobs or gets a new supervising physician, that time has to start over. 1099 was able to compromise on that. The new regulation is 100 percent for one year, 50 percent for the second year and 25 percent for years thereafter. If the PA switches jobs or supervising physicians, that time does not need to start over unless they switch specialties.
Liz: So in January 2013, the bill sponsor, Rep. Davidson, introduced the bill. And then some fun things happened for IAPA. Why don’t you tell us a little bit about what happened?
Courtney: For the first year, IAPA sponsored a Lobby Day. It was very successful. It was more successful than we thought it was going to be for a first-time effort.
We had 200 PAs come to the statehouse. All four of the PA programs in Indiana were present, and they all brought students. We had a good mix of faculty, PA students and practicing PAs. We went to the statehouse and helped legislators have a better understanding of our profession. Rep. Davidson spoke at Lobby Day. We set up appointments, and PAs met with their individual legislators. While legislators in Indiana have an idea of what we do, after we met with them they all said they felt much more comfortable and confident in the decisions they’re making regarding our profession. I think the PAs enjoyed it, and I think the legislators enjoyed it, and it was a successful day.
Liz: That’s great. So the keys to your success were outreach to the key organizations and building a relationship with the medical association—working with them in advance of this effort. It was also about finding the right bill sponsor and then bringing in the PAs and students to help explain the profession to lawmakers. So what ended up happening?
Courtney: The bill passed. But not only did the bill pass, it passed unanimously in the House of Representatives, it passed unanimously in the Senate, and Gov. Pence signed it into law.
In the past, Indiana has struggled to get things done. And this bill passed with the overwhelming support of our leaders in this state. It shows that our profession does have a future in Indiana.
Liz: What are some of the take-home points? Did you learn anything along the way?
Courtney: A lot of our success is due to the healthcare climate in the nation and the need within our state. We struck while the iron was hot and were aware of healthcare needs within our state. That was very important.
Another key factor was working with the physicians in the initial stages. In the past, PAs have drafted language and then later asked physicians for support. Instead of doing it that way, we brought our physician supervisors to the table from the beginning. I think that was a huge reason for our success.
Lastly, it was that the PAs in Indiana became engaged. They showed up for Lobby Day, and showed that they understand that policy does affect their patient care. It was great to see all the PAs show up and do that. And it was also fantastic that all of our programs did that as well. That the universities are aware and the PAs are aware that this is the next generation. Getting them involved early in their education will be a benefit for them and for us.
Liz: How many key elements of a Modern PA Practice Act did Indiana have before this bill passed?
Courtney: We only had two before 1099, and we have doubled to four.
Liz: Indiana is on the move, and we look forward to seeing more great things from you all in the future.
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