JAAPA | Journal of the American Academy of PAs

Osteoporosis commonly affects postmenopausal women and accounts for 300,000 hip fractures in the United States each year. More women are deferring or discontinuing pharmacologic treatment because of intolerable adverse reactions or fear of long-term safety. Supplementing dietary intake of certain vitamins and minerals can have positive effects on bone parameters. Calcium is frequently recommended for osteoporotic patients but many not confer much benefit toward bone density. Certain forms of vitamins A and K have been shown to increase bone density. Isoflavones and phytates are phytochemicals found in soy foods that are comparable to bisphosphonates when consumed at certain levels. Lastly, increasing certain daily fruit and vegetable servings can improve bone health. Nutritional interventions are typically safe alternatives that should be considered for postmenopausal women who are seeking nonpharmacologic treatment options for osteoporosis.

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AAPA is offering all PAs 3 months free* of AAPA fellow membership, no strings attached. Offer expires June 19!

Start using your free AAPA membership today!  Just sign into or create your AAPA account by June 19 and select the 3-month free fellow membership at checkout.

As a member, you’ll be part of the movement to advance PAs. Turn to Huddle, AAPA’s online community, for valuable PA discussions. Plus, stay up to date with free and discounted CME, including free post-tests in JAAPA. Discover exclusive PA career resources, from job search tools to leadership training.

See how an AAPA membership can support you during this difficult time and beyond.

*Free three-month trial fellow membership offer: Must sign up by June 19, 2020. Offer is available to non-members only. Trial membership does not include access to the 2020 Salary Report; we invite you to renew your trial membership to obtain access or you may access the 2019 Salary Report. Members on the trial fellow membership will also not be eligible to vote in AAPA elections (eligible voters must be current fellow or student members by May 18, 2020 to participate in AAPA 2020 elections). No credit card required.

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Free Online Courses for Early Onset Breast Cancer

One in 10 new breast cancer diagnoses is a woman under the age of 45. With our input, ACOG and the CDC have developed a free, CME-accredited course series called “Understanding Early Onset Breast Cancer” (EOBC). The courses will help clinicians identify and manage the unique risks faced by young women.

As routine preventive health care services are starting to resume through telehealth and in-person appointments, the new online courses will help clinicians:

• Identify various risk factors for EOBC and how strong of a predictor each risk factor is
• Identify current guidelines and recommendations for EOBC and distinguish points of differentiation
• Identify existing data, including gaps, about breast density and EOBC risk
• Acquire effective risk assessment tools, communication tools and techniques to employ in patient interactions
• Interpret trends in data and identify ways to mitigate the impact of health disparities in EOBC

As a Physician Assistant, we encourage you to take these courses. You can register here: acog.org/eobc.

Continuing Medical Education credit is provided through joint providership with The American College of Obstetricians and Gynecologists.

ACCME Accreditation

The American College of Obstetricians and Gynecologists is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA PRA Category 1 Credit(s)^TM 

The American College of Obstetricians and Gynecologists designates this enduring activity for a maximum of 7 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

College Cognate Credit(s)

The American College of Obstetricians and Gynecologists designates this enduring activity for a maximum of 7 Category 1 College Cognate Credit. The College has a reciprocity agreement with the AMA that allows AMA PRA Category 1 Credits^TM to be equivalent to College Cognate Credits. 

ANCCCA Accreditation
This nursing continuing professional development activity was approved by the Maryland Nurses Association, which is an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation (ANCCCA).

Continuing Nursing Education Activity Contact Hours
The Maryland Nurses Association designates this enduring material for 7 Contact Hour Credits. Nurses should claim only the credit commensurate with the extent of their participation in the activity.

Course Link: https://www.acog.org/education-and-events/emodules/emod024

ACOG has updated their COVID-19 FAQs for Obstetrician–Gynecologists, Gynecology

"These FAQs are based on expert opinion and intended to supplement guidance from the Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) Practice Advisory with information on how to optimize patient care in the context of COVID-19. The COVID-19 pandemic is a rapidly evolving situation and ACOG encourages local facilities and systems, with input from their obstetrics and gynecology care professionals, to develop innovative protocols that meet the care needs of their patients while considering CDC guidance, guidance from local and state health departments, local prevalence, community spread, health care personnel availability, access to readily available local resources, geography, and coordination with other centers.

As ACOG members continue providing patient care during this time, we understand that both they and their patients have questions about women's health during the pandemic. These FAQs are developed by several Task Forces, assembled of practicing obstetrician-gynecologists and ACOG members with expertise in obstetrics, maternal-fetal medicine, gynecology, gynecologic subspecialties, pediatric and adolescent gynecology, infectious disease, hospital systems, telehealth, and ethics, who are on the frontline caring for patients during this pandemic.

This is a rapidly changing landscape, and FAQs will be added or modified on a regular basis as the pandemic evolves and additional information becomes available." 

Visit the website here.

After consideration of a number of factors surrounding plans for in-person meetings in the coming months, ACOG has made the necessary and difficult decision to cancel all in-person meetings for the remainder of 2020. This includes scientific and clinical meetings, professional conferences, committee meetings, and executive board meetings. Protecting the health, safety, and well-being of our staff, our members, their families, our communities, and ultimately the patients we serve is paramount. We have heard from many of you that institutional travel bans, state and local regulations, financial concerns, as well as safety consideration would limit your ability to attend.

As an organization of physicians who provide essential care, we know the importance of ensuring that our members are able to be in their communities—where you continue to help patients during this challenging time. We also acknowledge our responsibility to model social distancing and not contribute to the spread of the virus.

While you continue to care for patients during the pandemic, ACOG will continue to support you and your practice through providing evidence-based clinical guidance and patient information. We also will continue our steadfast advocacy for you, your practices, and your patients at the local, state, and national level.

We know that ACOG meetings are a time to acquire new information, share ideas and practices, as well as connect with colleagues from across the country. We are working to transition our in-person meetings to robust virtual experiences that provide the education, connections, and community we all value deeply.

If you were registered for an upcoming meeting, your registration will be automatically cancelled, and a full refund provided. Please allow us time to process those refunds. More information about virtual offerings will be posted on ACOG.org and social media in the days and weeks ahead.

Thank you for your unwavering commitment to excellence in women’s health care.

We look forward to continuing to support you and for better days where we will be able to gather in person again.

With sincere appreciation and gratitude,

Eva Chalas, MD, FACOG, FACS
President

Maureen Phipps, MD, MPH, FACOG
Chief Executive Officer

Full article here.

Law, Policy and Breastfeeding Goals - Healthy People 2020 Report

Find attached a summary of the report, The Role of Law and Policy in Assisting Families to Reach Healthy People’s Maternal, Infant, and Child Health Breastfeeding Goals in the United States, which is the third in a series of reports that highlights the practical application of law and policy to improve health across the Nation. Each report also has success stories, or Bright Spots, that illustrate how communities have used law and policy to help meet their health goals and achieve Healthy People targets.

In order to read the executive summary and to access the full report or read the related Bright Spots, visit: https://healthypeople.gov/2020/law-and-health-policy/topic/maternal-infant-child-health. 

PAs for Global Health | Melanie Jacobs, MMS, PA-C

These are challenging times, but as healthcare workers we are powering through; working in increasingly stressful and unprecedented situations. I am a physician assistant practicing inpatient obstetrics and gynecology. I truly enjoy my job. It is challenging and stimulating, as well as rewarding and enjoyable. Yet, among my friends and family there is a common misconception that my line of work is “always happy.” Many think my daily tasks involve delivering newborns, which is true a majority of the time. But not always. Obstetric emergencies occur: fetal bradycardias, urgent cesarean deliveries, and maternal hemorrhages. And they happen relatively often considering I work in a large tertiary hospital in New York City. Managing the emergencies and high acuity situations is part of the day-to-day.

During the coronavirus pandemic, providers in Ob/Gyn are facing new challenges. Obstetrics is not a medical specialty which can dissolve and redeploy healthcare workers. Labor & Delivery still operates 24 hours a day, 7 days a week, as women need medical support and obstetricians to deliver. The inpatient floor is busy as ever, including triage (the curtained off area where providers assess patients and decide if they meet criteria for admission), or the “Ob ED” as some call it. With the added layer of numerous asymptomatic coronavirus patients and the support persons present, providers including myself are constantly exposed. Treating every patient as a PUI (Persons Under Investigation), we are required to wear PPE and don and doff in every room, until the nasopharyngeal swab results come in. As I end my shift, with cracked knuckles and dry hands, more and more patients’ tests results are positive. This is the new reality.

Read more.

Waiver Temporarily Eliminates Requirement for Medicare Patients in Hospital to be Under Care of Physician | By Michael Powe, Vice President of Reimbursement & Professional Advocacy

The Centers for Medicare and Medicaid Services (CMS) initiated another round of regulatory relief on March 30 aimed at increasing the ability of PAs, other health professionals and hospitals to deliver needed care to patients during the COVID-19 crisis. These temporary waivers are designed to remove unnecessary administrative and regulatory requirements and provide maximum flexibility to increase access to care for patients.

The regulations will immediately allow for:

• Waiving a long-standing provision which requires that Medicare patients in the hospital be under the care of a physician. This allows hospitals to use other practitioners, such as PAs, to the fullest extent possible.
• The use of telephonic (as opposed to the previous audio-visual requirement) evaluation of management codes;
• Waiving certain requirements to allow hospitals to hire PAs, physicians and other health professionals to increase workforce capacity and deal with potential patient surges;
• Health professionals to temporarily enroll in Medicare including those who previously officially opted out of Medicare for the required two-year period;
• Temporarily permit non-hospital buildings to be used for patient care and quarantine sites, if approved by the state.

CMS is authorized to waive regulatory requirements for federal programs including Medicare, and for Medicare beneficiaries. However, CMS can’t alter or override existing state laws, hospital policies, such as, bylaws or privileging requirements, or regulations in state Medicaid programs.

PAs will need to check their individual state laws and workplace policies to determine how they can best utilize the CMS flexibility. AAPA is encouraging Governors to provide maximum flexibility for PAs to practice to the full extent of their education and experience by waiving physician supervision requirements during this crisis.

We’re Aggressively Working to Update Laws, Inform the Public | By David E. Mittman, PA, DFAAPA

What is AAPA doing to respond to the COVID-19 crisis? It’s a question I’ve been asked by many of you in private conversations and emails, and that I have seen consistently on social media and on the Huddle. So, let me answer this question directly. AAPA is aggressively advocating on your behalf during this crisis.

Over the last couple weeks, in collaboration with state chapters, AAPA’s work to remove supervision requirement for PAs in laws and regulations has intensified considerably. As you know, removal of supervision requirements was a goal solidified by the House of Delegates three years ago when it passed Optimal Team Practice (OTP).

COVID-19 has underscored why PAs passed this policy. During this national health crisis, policymakers and the public are recognizing the arbitrary nature of laws that require PAs to have an agreement with a specific physician in order to practice, or that require ratio restrictions. In a state where a physician is limited to “supervising” four PAs—what happens when that physician falls ill themselves?  What happens when a PA who practices at a private primary care office wants to help at a hospital that is overwhelmed with COVID-19 patients, yet can’t because they don’t have a “supervising” physician credentialed at that hospital? Those policies don’t serve our patients well.

AAPA is working on both short-term and longer-range strategies to ensure PAs can fully contribute not only to COVID-19 patient needs, but to the broader healthcare system in general:

• In the short-term, AAPA is calling on governors to immediately remove supervision requirements by issuing executive orders as five states have done at this time. In fact, we issued this press release today. We continue to support our state chapters in making these requests and have prepared sample executive order language. I recently authored an op-ed that clearly presents both the urgency and argument for why this action is critical to the COVID-19 response: “More physician assistants are ready to help with COVID-19—now governors must empower them.”
• AAPA’s longer-range advocacy strategy requires permanent legislative change to the restrictive and archaic barriers that preclude PAs from delivering to patients the medical care they are trained to provide. These changes take time, and are often incremental in nature as we’ve seen in the last week with victories in Kentucky, Washington, Maine, and Iowa, to name a few.

As you know, while governors can temporarily suspend supervision requirements for PAs, only state legislatures have full control over these permanent decisions. And, while the White House and federal agencies have recommended supervision requirements be eased, they have no authority in these state decisions. Nurse practitioners have worked more than 30 years to make progress on this issue. We can build on what they have done.

Among AAPA’s immediate federal priorities are requesting that the White House remove supervision requirements for federally employed PAs, such as those who work for the U.S. Department of Veterans Affairs or the Bureau of Prisons; and, advocating for personal protection equipment for PAs, signing on to this letter to Vice President Pence along with Congressional leaders.

One of AAPA’s federal priorities became a reality on March 27 when the President signed emergency legislation, the Coronavirus Aid, Relief, and Economic Security Act or the “CARES Act” (H.R. 748) that included the Home Health Care Planning Improvement Act (S. 296/H.R. 2150). AAPA had to act swiftly to attach our legislation to this larger vehicle, which was no easy feat. AAPA worked on home healthcare for over a decade and now, PAs can finally order home healthcare services for Medicare patients, freeing up beds for potential COVID-19 patients and others, and preventing the further spread of the virus.

AAPA is also providing valuable resources to our members, whether you are on the front lines providing clinical care, an educator retooling your curriculum for e-learning, or a student adapting to online classes. You can find tools and information on AAPA’s COVID-19 Resource Page, including shareable graphics for PAs to show their professional pride and deliver an important public health message.

We are also aggressively reaching out to national, state, and local media, correcting misinformation, and raising awareness of the contributions of PAs during this national crisis. AAPA has engaged a global public relations agency to assist to specifically leverage their national media contacts.

Now, back to the crisis at hand.

Over the coming days, more and more states will likely issue executive orders removing physician supervision requirements temporarily. PAs will have the opportunity, free from burdensome administrative constraints, to prove ourselves, to fully contribute to the healthcare team and to practice according to our training, education, and experience.

This is an occasion we can all rise to—and one that will pave the way for permanent change in the very near future, once the nation experiences what PAs are truly capable of accomplishing: saving lives.

Finally,  I would ask that you take a moment to tell us your story and how you’re contributing to the COVID-19 response. The more PA stories we have, the stronger case AAPA can make in our advocacy and media relations strategies. Take some pictures also (not of patients) of what you do best: contributing to the health of our nation. We will need to document this.

Also, be sure to check out this list of Frequently Asked Questions regarding the COVID-19 response and how AAPA is helping our members navigate this strange new world.

Stay healthy and safe, my friends. AAPA is by your side, and we have your back.

David E. Mittman, PA, DFAAPA, is AAPA president and chair of the Board. Contact him at dmittman@aapa.org.