February 2014

ARAPA Arkansas Academy of Physician Assistants

Meet Your Board Members! President: Kendall Key, PA-C graduated from Harding University PA program and is working with board certified dermatologist Dr Cheryl Hull at Hull Dermatology and Aesthetics in Rogers, AR. kendallkeypac@hullderm.com

President Elect: Chris Davis, PA-C graduated from Harding University PA program and is currently working in orthopaedics with Dr. Ken Martin at Martin Knee and Sports Medicine. He is married with four kids and served in pastoral ministry prior to his present career. pa.cdavis@gmail.com Past President: Tara Bruner, PA-C was involved in ARAPA as treasurer 2009-10, president elect 2011, president 2012-13. She graduated from University of Oklahoma Health Sciences Center PA school in 2005. She has worked in Bariatric/General Surgery in Oklahoma, Urgent Care, and currently Harding University PA program adjunct professor and PrimeCare Urgent Care. She is a member of the American Academy of Physician Assistants (AAPA) and Conference Education Program Committee (CEPC) for AAPA. Currently she lives in Searcy, AR with husband and 2 children. Being involved in ARAPA I see the need to further the PA profession and strengthen PAs in the state of Arkansas. I feel our biggest strength is the involvement of the PAs of the state, along with their physicians. I urge you to become an active member of ARAPA and AAPA as healthcare changes and our roles and rights become more pressing and valued. tbruner1@harding.edu Vice President: Amanda Diles, PA-C graduated from Harding University in 2005 with a BA and then from the PA program in 2007. She has worked in family practice and urgent care for the last 6 years. She is currently pursuing a MBA in Healthcare Management. She is married with 3 kids and lives in Searcy, AR. amandacdiles@gmail.com Treasurer: Mary Madill, PA-C graduated from Harding University PA program in 2007. She worked in rural family practice until moving back to Searcy in 2012 to join the faculty at Harding University where she is currently Assistant Professor and Academic Director of the PA program as of Nov 2013 and works part time at Duke Medical Clinic. mmadill@harding.edu   Secretary: Nicole Mount, PA-C graduated from the Harding University PA Program in 2007. She worked near Cincinnati, OH in a Rheumatology practice before returning to Searcy in 2013 to join the faculty at Harding University. She is currently an Assistant Professor and works part time in Family Practice at the Duke Clinic. lmount@harding.edu  

2014 ARAPA Board Members President Kendall Key Past President Tara Bruner President Elect Chris Davis Vice President Amanda Diles Treasurer Mary Madill Secretary Nicole Mount Director at large: Northwest Abby Cain Northeast Lindsey Wilson Central Janet Reed Southeast Gary Hill Southwest Johnathan Steele

Directors at Large: NW ARK: Abby Cain, PA-C graduated from University of Arkansas in 2008 with a BS in nutrition. She then went on to become a Registered Dietitian before going to Harding University PA program. She was the Student Representative in 2011-12. She now works in Fayetteville in Bariatric and General Surgery. abby.rice@live.unthsc.edu  

NE ARK: Lindsey Wilson, PA-C graduated from Harding University PA program in 2011 and works in Jonesboro, AR in Family Practice at Jonesboro HealthCare Clinic. lindseywilsonar@aol.com

Central ARK-Janet Reed, PA-C graduated from Harding PA program in 2009. She works in Conway in family practice with Dr. Brooks Lawrence. She and her husband Steve have one daughter who lives in Tennessee. kjsreed2@aol.com

SE ARK: Gary Hill, PA-C graduated from US Army PA Program in 1986 and served Active Duty with Arkansas Army National Guard until 2005 when he became the Clinical Director of the Harding University PA Program. He works one day a week at the Duke Medical Clinic in Searcy and serves on the Advisory Committee for the Arkansas Department of Health Drug Monitoring Program. Gary lives in Searcy with his wife and they have two grown children. ghill2@harding.edu  

SW ARK: Johnathan Steele, PA-C, MS, MMS, Added Qualification in Psychiatry, worked at Southwest Arkansas Counseling and Mental Health Center and in Psychiatry for over 7 years currently. He also currently works in Neurology part time at Christus St. Michael’s Hospital in Texarkana. Has worked in Urgent Care, Emergency Medicine in the past. His education includes BA in Psychology from Harding University, Masters in Clinical Psychology from Abilene Christian University, Master of Medical Science and Bachelor of Science from Nova Southeastern University, Ft. Lauderdale, FL. He is currently Southwest Arkansas Rotation Site Coordinator for UAMS PA program and has lectured at both Harding and UAMS PA programs. jsteele@swacmhc.com Governmental Affairs Chair: Tim Irizarry, PA-C, MS, NREMT-P, worked several years as a Paramedic and Deputy Coroner until starting PA school. Graduated July 2009 from Harding PA program. Has worked for Arkansas Urology until December 2013 when he became the provider at Epoch Men's Health in North Little Rock (a division of Arkansas Urology) specializing in men's health and testosterone issues. He is currently president of the Urological Association of Physician Assistants. timizzypac@yahoo.com   CME Chair: Mario Hofheinz, PA-C is an assistant professor at Harding University PA Program. mhofhein@harding.edu

Newsletter Chair: Kimberly Carlon, PA-C graduated from Harding University in 2009 with a BS in Biology and then in 2012 from the PA program. She currently works in urgent care for PrimeCare in Conway, AR. kcarlonpa@gmail.com Reimbursement Chair: Carol Michael Trana, PA-C is a 2013 graduate of Harding University PA Program. She has served as the student representative for the ARAPA Government Affairs Committee and is looking forward to working on the ARAPA Board as Reimbursement Chair. She is anticipating working in the Central Arkansas region. ctrana@harding.edu  

Membership Chairs: Julie Slavik graduated from University of Nebraska Medical Center and worked in pain management, and general orthopedics and orthopedic spine before moving to AR. Currently is working with Dr Gannon Randolph, Orthopedic Spine Surgeon with Ozark Orthopedics in Rogers, AR. Julie and her husband, Chris, enjoy kayaking and hiking in the beautiful Ozarks of Arkansas. slavik2pawol@gmail.com

Josh Matthews graduated from the University of Oklahoma in 2000. He spent five years working for the Kickapoo tribe of Oklahoma. He then worked for the Stillwater skin and cancer medical clinic for five years after that. He is currently working at Ozark dermatology clinic in Fayetteville, Arkansas. He enjoys spending time with his family on the lake, hiking, biking, and coaching little League football and basketball. joshframem@aol.com

Student Representatives: Katie Schaiff, UAMS PA Class of 2015, KSCHAIFF@uams.edu & Marshall Sexson, HU PA Class of 2015, jsexson@harding.edu

Meet Your Board Members!

Chris  Davis,  PA-­‐C,  President  Elect    October 1, 2014 is quickly approaching and will ultimately change each of our daily functions as we continue to provide healthcare. This is the date for compliance with the new ICD-10 codes to classify diseases and health problems. It was already pushed back one year from the proposed October 2013 start date, but it appears to be no longer avoidable. Officials from the CMS claim that the old ICD-9 coding system is outdated and inconsistent at this time. The new coding system will use alphanumeric coding and contain 3 to 7 characters versus a predominately numeric system of 3 to 5 digits. The transition is due to the lack of necessary detail and limited data concerning a patient’s medical condition and hospital inpatient procedures. An example of this change can be seen in the following orthopaedic setting.

Previous ICD-9 diagnosis code: 813.15, open fracture of head of radius

New ICD-10 diagnosis code: S52123C, displaced fracture of head of unspecified radius, initial encounter for open fracture type IIIA, IIIB, or IIIC.

So what does this mean for physician assistants? One, the new coding system will slow down patient encounters early on as we begin to learn the ICD-10 coding system and become familiar with the alphanumeric coding. In addition, it will likely be an additional cost placed on to the overhead of each practice as more personnel will be needed for coding, documentation, and reimbursement. Not only will documentation and coding be slowed down from each practice but it is also estimated that this will impede the already slow approval process of health insurance companies as well as reimbursement. Though this was believed by Health and Human Services to save up to $6 billion over 10 years, it is likely to cost each practice thousands in personnel, slowed patient visits, and untimely reimbursements. In preparation for this adjustment, it is important that we begin the process now in each of our clinics and hospital settings. Our clinical notes must become more detailed and specific to acquire the new coding system, our computer systems must be ready to make the transition, and our billing paperwork needs to begin to reflect the new ICD-10 setting. Additional information concerning the ICD-10 system can be found at http://www.cms.gov/Medicare/Coding/ICD10/Index.html    

Decoding the Healthcare System

Arkansas Academy of Physician Assistants

PO BOX 25842 Little Rock, AR 72221-5842

PHONE: 501-224-4840

FAX:

501-224-0988

E-MAIL: admin@arkansaspa.org

We’re on the Web!

See us at: www.arkansaspa.org

Hello, my name is Kendall Key, and I am the current ARAPA president for 2014. I am currently a physician assistant practicing at Hull Dermatology in Rogers, AR. I have been in practice for 2 years and can truly say how fortunate I am to be a part of ARAPA and have the support of its members. I am excited about the opportunities ahead of us for the upcoming year and looking forward to the new members who may be joining us in our efforts to improve the overall profession of Physician Assistant. One event that not only allows us to earn CME hours but also allows us to network with our fellow PAs is our annual CME conference that will be held in April of this upcoming year. It is a great opportunity to meet PAs from across the state and learn how ARAPA is striving to improve our profession both on a local and a legislative level. If at anytime you may have questions regarding ARAPA, our CME conference, or overall PA issues, please feel free to email either myself or Tara Bruner (past president) with your concerns. Thanks and here's to a great year!

2014 President’s Note

Prevention and the Affordable Care Act

Amanda Diles, PA-C, Vice President

In 2010 the Affordable Care Act created a Prevention and Public Health Fund in an effort to

promote wellness, prevent disease, and protect against public health emergencies. It is important as both primary care providers and as specialist to know what is covered under “wellness.” The inclusion of these services are based on the United States Preventive Services Task Force (USPSTF) grade A and B recommendations. For “wellness” or “physical” visits the following E&M codes can be billed and are broken down by age:

• New Patient: 99381-99387 • Established Patient: 99391-99397

Along with these codes the following 15 services are covered for adults:

1. Abdominal Aortic Aneurysm screening – one time for men over 65 who have ever smoked (smoking defined as ever having smoked 100 cigarettes)

2. Alcohol misuse screening and counseling for all adults 3. Aspirin use for men and women of specified ages

(men over 45 for heart attack prevention and women over 55 for stroke prevention) 4. Blood pressure screening for all adults 5. Cholesterol screening for adults of specified ages or who are at high risk

(men 35 and older and women 45 and older or anyone at risk) 6. Colorectal cancer screening for adults over 50

(by DRE with FOBT, sigmoidoscopy, and/or colonoscopy) 7. Depression screening and counseling for all adults 8. Type 2 Diabetes screening for adults with a sustained BP 135/80+ 9. Diet counseling for all adults 10. HIV screening for adults at risk 11. Immunizations 12. Obesity screening and counseling 13. Sexually Transmitted Infection screening and prevention counseling 14. Tobacco Use screening and cessation interventions 15. Syphilis screening for adults at risk

For women an additional 11 services are covered:

1. BRCA counseling for women at high risk 2. Mammography screenings every 1-2 years for women over 40 3. Breast Cancer Chemoprevention for women at high risk 4. Cervical Cancer screening for sexually active women 5. HPV testing every 3 years for women 30 and older with normal cytology results 6. Chlamydia Infection for women 25 and younger or older women at risk 7. Contraception 8. Domestic violence screening and counseling 9. Folic Acid supplements for women who may become pregnant 10. Gonorrhea screening for women at risk 11. Osteoporosis screening for women over 60

The USPSTF has just released a new recommendation regarding lung cancer screening. As of 2013, annual screening for lung cancer with low-dose CT in adults aged 55-80 who have a 30 pack year smoking history or greater and either currently smoke or quit less than 15 years ago is recommended. As of right now it is not included on the list of covered services so please check with the patient’s insurance plan for benefit information. For pregnant women and children please visit The Health and Human Services website at http://wwww.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html.

ARAPA Annual CME Conference April 25-26, 2014

UAMS Campus in Little Rock Friday April 25th: 12-5 pm

Saturday April 26th: 8 am - 4 pm Further details TBA

Update from Membership

The membership committee has been working hard to try to bridge the gap between current members and state licensed physician assistants. We do not have updated information on members of ARAPA. Our new website management should help out with this tremendously. The new website update will allow us to keep better track of current ARAPA members' information. The committee will then work to identify the state licensed PA’s and compare this with our current ARAPA members. We hope for no discrepancy between ARAPA members and state licensed PA's. Our goal is to have 100% ARAPA membership with all state licensed PA's. We feel this is essential in moving forward with our profession's presence in the state of Arkansas. If you are currently licensed in our great state and not a member of ARAPA, we would like to encourage you to join. We would welcome any input regarding membership in the ARAPA, especially if you are not a member. We would like to know how we can improve ARAPA for all of our members and improve our profession in Arkansas. Josh Matthews, PA-C Membership Committee joshframem@aol.com

Remembering Lauren Bump The Harding community was stunned by the tragic death of Lauren Michelle Bump, a 24-year-old graduate student in the Physician Assistant program. Her body was discovered December 31, 2013 along a park trail in San Antonio, TX, near her parents’ home. She suffered multiple sharp-force injuries, according to the Bexar County Medical Examiner's Office, and her death has been ruled a homicide. Lauren was one of 35 in her PA class with plans to graduate in December 2014. Lauren became friends with everyone in her class and was loved by all who knew her. Shortly after hearing the news, university president Dr. Bruce McLarty, a small gathering of classmates, PA administrators, professors and staff met for prayer and to remember Lauren. At that service held on January 3rd, PA program director Dr. Mike Murphy read some excerpts from her application: “I also believe that Harding will help me attain my long-lived dream of serving in the mission field as a PA…. My life goal is to serve and love the others as the Lord has loved me, using all the gifts, resources and abilities He has supplied me." On Sunday January 12th, a memorial service and a candlelight vigil were held in Searcy. Several of her close friends read Lauren's blog post called "Success" from November 16, 2013, to honor her life. Lauren's teachers spoke about her, and a slideshow of her time at Harding was played. To catch a glimpse of her sweet spirit, read her blog (http://labump.blogspot.com/) and watch Lauren's video (http://vimeo.com/84280809).