2017 Legislative Update

Hello Delaware PA’s!


 I wanted to take some time to inform our members of what is going on in the DAPA world. I apologize for the lack of communication over the past few months, but we wanted to gather some information on an extremely important issue before reaching out to our members. DAPA has been working with the AAPA, and attending the AAPA leadership conference and House of Delegates to gather current information. This is a lengthy email, but this is of utmost importance because this is about the immediate future of your profession here in Delaware.

As you may or may not know, the AAPA has introduced recommendations for modernization of PA laws, the 6 Key Elements of Modern PA practice, and a newer one entitled Optimal Team Practice. This was created to remove the barriers that PAs are continually, and increasingly facing, at a national level. Here in Delaware, we are a small state, with about 650 licensed PA’s (only about 100 active DAPA members). There are 4000 licensed NPs in DE but only about 600-700 are clinically practicing. It should be noted that the majority of NPs in DE do NOT practice independently; they follow a collaborative agreement. PA’s are experiencing barriers with billing and reimbursement. NPs are enrolled as providers with most insurers, while most do not enroll PAs. Delaware Medicaid will not enroll PA’s as providers to allow for direct billing because we are considered dependent providers, as written by the current law verbiage of “Supervision”. Some insurers do allow us to bill directly (and may or may not reimburse at a lower rate) and some just have us bill under the physician. When we are not able to bill or be enrolled as the rendering provider for the care we provide, our contribution to health care is difficult to account for. Employers and billing companies find this challenging, and may restrict PA hiring due to these issues.

Recently DAPA has gotten word that certain ambulatory urgent care centers in Delaware are restricting hiring of PA’s. The PA Council discussed our barriers to practice and submitted legislation changes to the Board of Medicine (BOM) earlier this year. Unfortunately the BOM rejected our changes, one of the responses being that PAs are not as well trained as NPs! Although you may personally not feel any issue in your employment, there are many PAs in Delaware that are, and in the near future, you may be affected as well. Delaware patients are best served when both PA’s and NP’s have the same opportunities to provide care to our community and for both professions to maximize our potential scope of practice.

At this point, the DAPA board feels compelled to protect the interests of our profession, as well as align our state laws to reflect current AAPA standards and recommendations. We will do this by employing a lobbyist, and introducing our own legislation to the state this fall. We would like adhere to the AAPA 6 Key Elements by recommending the following changes:

remove the ratio of PA’s to physicians, change the “supervisory” language to “collaboration” and define the collaboration at the practice level, as determined by the experience and training of the PA and comfort level of the physician. This brings the PA law more in line with the NP practice and simplifies the process for employers, patients and insurers and even PAs . We feel this language change will then allow us to become enrolled with insurers as providers. These changes will also enable PAs to volunteer for homeless shelters, and community services without having to worry about finding a “supervising” physician.

In conclusion, DAPA is YOUR constituent organization that works to promote and protect the PA profession in this state. This is going to be a HUGE year, and our board is small, comprised of 5 volunteers. We have an AAPA representative to assist us but our lobbyist is going to be very costly. We ask that you please update your membership, renew your annual dues, and encourage your colleagues to join/renew. There are group discounts available on our website. You can expect more meetings and events this coming year so that we have the opportunity to work and network together.

Now more than ever, we need your voice and some extra help in achieving our goals. We need your time, talents, thoughts, and energy to help us out. This can be as simple as attending a meeting, going to Dover for a board of medicine meeting, discussing our issues with our state government and your colleagues, and providing DAPA with your feedback. We also need help with planning a Spring CME conference, Fall PA week activities, a potential fundraiser, and community service projects like the ITS OBVIOUS Campaign where we have partnered with the Medical Society of Delaware. We need our members to help keep things going, and it’s also wonderful and rewarding to get to know other PAs in our state. Please forward this email to ALL your PA colleagues, and discuss these issues with them. Together, we can make a difference to help improve our profession that we have all worked so hard for.

We will be notifying you of a fall meeting schedule; look forward to seeing you! I know this email will bring lots of questions, thoughts and concerns, so please email me, or any other board member, at any time!