David E. Mittman, PA, DFAAPA, president and chair of the American Academy of Physician Assistants (AAPA) Board of Directors, spoke with Clinical Advisor about the association’s legislative wins and advocacy work during the novel coronavirus (COVID-19) pandemic in the United States.

Q. Congratulations on a very successful legislative year in 2019. What are the AAPA’s goals for this year?

A: Right now, our top priority is empowering the PA workforce in their response to COVID-19. That objective is driving all our efforts to remove barriers to patient care on both the state and federal levels through modernizing PA laws and regulations; also, in supporting PAs in providing care to their patients. Whatever it takes, we will do. We will stand behind our members and all PAs in this time of crisis. They need to be able to provide care to all who need their care.

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Going into 2020, before COVID-19, our goals at the federal level were to continue pushing for important legislation to improve PA practice, including: 

  • Legislation to authorize PAs to receive direct payment from Medicare
  • Legislation to authorize PAs to order home health (which is now law and which we have been working on for years)
  • Legislation to authorize PAs to order diabetic shoes

These have all been introduced in both the US House and Senate, and we are actively working toward the passage of each of these critical pieces of legislation

On March 28, the president signed the Coronavirus Aid, Relief, and Economic Security Act or the CARES Act (H.R. 748) into law. AAPA was successful in securing the Home Health Care Planning Improvement Act (S. 296/H.R. 2150) as an inclusion in this emergency legislation. Including the Home Health Care Planning Improvement Act in the CARES Act permanently authorizes PAs and NPs to order home healthcare services for Medicare patients (in a manner consistent with state law). As healthcare facilities gird for an influx of patients with COVID-19, capacity will become a critical issue, and this authorization will ease some of that burden.

Outside of our legislative goals, we’re also continuing to advance the Title Change Investigation, and we’ve started our next Strategic Planning process to set AAPA’s priorities for the next 5 years.

Q. What have been the biggest barriers to states adopting new legislation regarding PAs?

A: I’d say understanding of what PAs do and who we are is a big challenge. That’s something we hear from PAs at the state level. Unfortunately, we continue to deal with the misperception that PAs are literally “assistants” to physicians. Fifty years ago, we were more of an experiment, but were never an assistant, even in those years. Today, our title confuses legislators, patients, and all others. It is just not an accurate way to describe our profession.

PAs practice medicine in all specialties with great autonomy, and often serve as a patient’s principal healthcare provider. Many PAs manage their own panels of patients. Physician organizations have also put up barriers to impede PAs being able to decrease barriers. I fear they also misunderstand our title, education, and clinical training.

Q: What about the name change?

A: We are still in the midst of the Title Change Investigation, which was initiated by a resolution in 2018 by AAPA’s House of Delegates. This is an extremely important issue for our members, so we need to be sure to cover all the bases. It’s an extremely thorough process, one that takes time.

AAPA is working with WPP/Landor, a world-renowned research, branding, and communications company. They have been leading extensive qualitative and quantitative research into the PA title, branding, and positioning. What we know is that 90% of PAs cite a disconnect between their official title — physician assistant — and their role in healthcare.

AAPA is working on a report regarding the state/federal, financial, political, branding aspects, and alternatives to the creation of a new professional title for physician assistants that accurately reflects AAPA professional practice policies.

Q: Many health care providers are concerned about the spread of infectious diseases. How has AAPA prepared its members for the outbreak of COVID-19?

A: To help PAs through the COVID-19 pandemic, we’ve created a resources center that we’re updating daily to ensure that PAs have access to all of the latest information. We also created a special page in AAPA’s Members Community: Huddle, an online discussion forum just for AAPA members. Our advocacy team is also hard at work to ensure that both state and federal emergency provisions and declarations remove barriers to help PAs contribute as much as they can to this response.

AAPA stays engaged with our members by sharing this current and important information on social media from reliable sources, such as the Centers for Disease Control and Prevention and the National Institutes of Health, and through our daily clinical e-newsletter. AAPA’s social media channels also provide a platform for PAs to communicate with each other and exchange information.