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History of MAPA

1970    The first formally trained PA begins practice in Minnesota.  He stayed only a short time; the second was Bob Freeman who came in 1971 and practiced with the same group from 1975 to 2005, when he retired.

 

1973    St. Cloud PA Program began.  Two classes graduated (1975 & 1976) but the program did not receive accreditation.

 

1976    The first organizational meeting of the Minnesota Society of Primary Care Physician Assistants is attended by 24 PAs.

 

1977    The second annual meeting was held with a formal change of name to the Minnesota Academy of Physician Assistants; 35 members attended. MAPA was incorporated.  The “incorporators” were Don Reed, June Randall, and Tom Phannenstein.  Don has moved to another state, Tom practiced in Mountain Lake until his untimely death in 2004 and June is now Dr. June LaValleur.

 

1978    MAPA approached the Legislature to seek recognition and regulation.  The Legislature decided that they would not “create any new professions” and “gave” the PA profession to the Commissioner of Health to regulate.

 

1978 thru 1984   A voluminous “Statement of Need and Reasonableness” was created along with innumerable versions of the eventual Rules.

 

1980    The Minnesota Insurance Commissioner disallowed MN Blue Cross/Blue Shield’s refusal to reimburse for services provided by a PA.

 

1984    In the Fall of 1984 the long awaited hearing on the proposed Rules took place and the Administrative Law Judge decided that the Rules, 5600.2600 – 5600.2665, were appropriate.  MAPA membership reached 73.

 

1985 thru 1987   The first members of the PA Advisory Council were appointed (they included Steve Scott and Steve Wandersee).  The Council and the Board of Medical Practice staff worked to prepare the many forms that the Rules required for implementation. 

 

1987    Registration applications were first mailed in April and in July the first PAs were registered with the Board of Medical Practice.  October 6, 1987, the 20th anniversary of the graduation of the first PA class from Duke University, is chosen as “PA Day”.  Medicare decided to cover physician services provided by PAs; in a nursing home at 85%, in a hospital at 75%, for assisting at surgery at 65%

 

1988    MAPA began formulating a five-year plan to acquire delegated prescriptive privileges

 

1989    Work continued on the five-year plan; surveying pharmacists and supervising physicians.  Also that year the Department of Health initiated changes to the original Rules to allow PAs to “order therapeutic procedures” and changed the on-site supervision requirement to 20% (as opposed to the eight hours per week that it had been).

 

1990    We accomplished the “five year plan” in record time!  On 4-26-90 the legislation was signed to allow delegated prescriptive privileges.  On the federal level - -  HCFA decided that PAs (and NPs) could perform some of the mandatory visits in skilled nursing facilities.  MAPA allocates funds to support efforts to establish a PA program in MN.

 

1991    MAPA observed legislation moving thru the Legislature that would provide loan forgiveness for certain health professions.  PAs were not initially included . . . . but MAPA was successful at getting us added.

 

1992    Even though the legislation passed in 1990, it took until 1992 for the “Rules” to be adopted that finally allowed us to actually “have” delegated prescriptive privileges.  Augsburg College develops a proposal for a PA program.

 

1993    MAPA continued to work with Dr. Mary Chelberg and others to develop the PA Program at Augsburg.

 

1994    MAPA, together with the MNA, introduced legislation to clarify questions surrounding dispensing.  The Health Professional Services Program (HPSP) was created by the Legislature; MAPA has a statutorily guaranteed seat on the advisory council for HPSP.

 

1995    This was truly a Banner Year.  Since the inception of the original Rules (1984) the profession had been under the jurisdiction of the Department of Health with the regulation done by the Board of Medical Practice.  It was in 1995 that the Department of Health decided to “give” the profession to the Board of Medical Practice.  So . . . .the BMP introduced legislation to move the Rules to Statute.  In the process we gained the delegated ability to prescribe controlled substances and eliminated the requirement for on site supervision. 

 

There was a down side. . . . . the Nurse Anesthetists were successful at attaching language to the legislation that prohibits us from prescribing, administering or dispensing  “anesthetics, other than local anesthetics, injected in connection with an operating room procedure, inhaled, and spinal anesthesia.” 

 

Augsburg PA Program accepted their first class of PA students in May; as did Mayo-Gundersen-University of Wisconsin-LaCrosse in September.  MAPA membership stood at 226.  MAPA created a scholarship committee.  The first MAPA website was created.

 

1996    MAPA celebrated our 20th anniversary!  The scholarship committee gave away $2500 to deserving students.

 

1997    We introduced legislation that included the “disaster bill” and removal of the sunset on the PA Advisory Council.  On a Federal level - - the Balanced Budget Act raised the reimbursement level for ALL physician services provided by PAs to 85% of the physician rate.  In May the AAPA meeting was held in Minneapolis.

 

1998    MAPA observed that there was legislation introduced to revise who could be included in professional corporations.  We used grass roots “lobbying” and were successful at getting included.  The MMA House of Delegates was discussing narrowing the definition of who can provide sports exams . . . MAPA was invited to present testimony.  The Minnesota Department of Transportation determined that PAs do not have the statutory ability to perform DOT exams.

 

1999    We introduced the “Disaster Bill” (it had failed to progress in 1997).  The MN DOT decided that if our supervising physician(s) were to provide a letter to accompany each DOT certificate stating that the supervisor had delegated the ability to perform the DOT exam to the PA then we could sign the form(s).

 

MAPA received the AAPA Chapter Excellence Award for medium size chapters.  MAPA created the intranet site for sharing of information among members.

 

2000    MAPA contracts with OJ Doyle for lobbying services.  Because of OJ’s daily presence at the Capitol we have increased exposure and recognition.  A group seeking to expand the definition of who can perform school bus driver physicals approached him and voila . . . we were added!  We are included in the list of providers who can staff a specialized ground transport service.

 

MAPA successfully introduced legislation .to create term limits for members of the PA Advisory Council and to include PAs as named / covered providers for Medicaid.  The Minnesota DOT finally agreed that listing “performing DOT exams and signing appropriate forms” on our supervisory agreement is adequate for documentation of such delegation.  (Thus eliminating the need for the aforementioned letter.)

 

2001    MAPA introduced legislation to eliminate the statutory requirement for infection control CME.  We also introduced legislation to revise the prescriptive review requirement.  This eliminated the “daily retrospective review” and made it “at least weekly”.  It eliminated the statutory requirement for “signature and date” of the review and stating that the “process and schedule for the review must be outlined in the delegation agreement.”

 

2002    After years of lobbying Medica decided to credential PAs . . . . they had previously declined to credential anyone other than “independent licensed practitioners”.  Legislation was introduced to provide malpractice coverage for those providing voluntary health care services and PAs were included in the list.  We received assurance from Blue Cross-Blue Shield that they will cover “medication management” services provided by PAs.  MAPA contracted with The Harrington Company for administrative services.  MAPA begins a relationship with The Prouty Project for semi-annual Strategic Planning meetings.  MAPA membership is 464 (337 fellow, 109 student, 2 associate, 6 affiliate, 10 sustaining).

 

2003    MAPA introduced legislation to allow supervising physicians to delegate the ability to sign disability parking permits to the PAs they work with.  This legislation also allows psychiatrists to delegate the signing of 72-hour hold documents to the PAs who work with them in psychiatric facilities.  In addition there was a proposal to allow PAs to sign death certificates which was opposed by MMA and was withdrawn.  MAPA membership is at 476 (363 fellow, 87 student, 11 sustaining, 2 associate, 5 affiliate).

 

MAPA receives the AAPA Chapter Excellence Award for large chapters.

 

2004    MAPA introduced legislation with three objectives: 1) separate the fact of having a job from the process of receiving permanent registration; 2) allow supervising physicians to delegate the performance of radiographic procedures; and 3) clearly state that certain forms of anesthesia are allowed to be administered by PAs for the purpose of airway management and to facilitate emergency diagnostic or therapeutic procedures.  Number 1 & 2 passed.  Number 3 was stymied by the MNA / CRNAs and, quite interestingly, a handful of emergency physicians also had some concerns.  MAPA membership stands at 543 (396 fellow, 142 student, 2 associate, 3 affiliate, 9 other).

 

2005    Due to health concerns OJ Doyle needed to resign as our Lobbyist.  MAPA contracts with Tom Lehman as our new Lobbyist.  MAPA introduces legislation to remove the “at least weekly” provision on review of prescriptive practice.  The new requirement is that “this review must take place as outlined in the internal protocol”.  In addition that legislation removed the requirement for phone numbers on prescriptions written by PAs (thus bringing the information required on prescriptions generated by PAs (thus bringing the information on prescriptions generated by PAs in line with those of physicians and nurse practitioners.)

 

2006    MAPA didn’t introduce any legislation this year.  However, Tom’s ever watchful eye caught sight of a bill that provides protection from civil liability for prescribers serving patients that have been civilly committed or incarcerated. The bill addressed the concern of health care providers being responsible for the actions of former patients who are no longer under their care.  He was successful at getting PAs added to the list of covered prescribers.

 

MAPA met with representatives from HealthPartners, Blue Cross/Blue Shield and Medica to discuss concerns about coverage for physician services provided by PAs. 

Augsburg PA Program holds its first annual High School Curriculum Project.

 

MAPA received the AAPA Chapter Excellence Award for large chapters.

 

2007    January - MAPA first annual wine tasting as a scholarship fundraiser is held at the home of Cal and Nancy Nelson on Lake Minnetonka. MAPA changes from Harrington to MAFP for administrative services effective June 1st.   The Freedom to Breath Act passes and is effective October 1st.  MAPA was a sponsoring organization in this effort.   MAPA joins the Minnesota Alliance for Patient Safety (MAPS) coalition.  MAPA Reimbursement Committee meets with PreferredOne to discuss concerns about coverage for physician services provided by PAs.  MAPA wins AAPA Award of Excellence for medium size chapters.   

 

2008    Health Care Reform legislation signed by Governor Pawlenty including:

  • The health care homes standards that will be developed must encourage the use of primary care, including the use of PAs, who are defined in the law as a “personal clinician” along with Physicians and Advanced Practice Nurses.
  • A study to be conducted by the Commissioner of Health on healthcare work force shortages must study the changes necessary in health care licensure and regulation to ensure the full utilization of PAs and other licensed health care professionals in the health care home and primary delivery system;  and
  • MAPA is authorized to appoint a member to the Health Care Reform Review Council, which is charged with reviewing the progress of implementing the healthcare reforms contained in the bill. 

 

Wanda Andrews represents MAPA on the Health Care Reform Review Council.  Dave Barlow was on the Healthcare

Workforce Shortage Study group.  Lisa Benish was a member of the Health Care Homes Criteria Work Group.  Brooke Hovick was on the Total Knee Replacement Basket of Care work group.   

 

AAPA Award of Achievement for medium size chapter  goes to MAPA.

 

2009    MAPA Technical Amendment Bill is introduced.  Sponsoring Legislators are:

 

House Authors:

Kim Norton, District 29B, Chief Author
Tom Emmer, District 19B
Erin Murphy,  District 64A
Linda Slocum, District 63B
Speaker Margaret Anderson Kelliher,, District 60A

 

Senate Authors:
Linda Higgins, District 58, Chief Author
John Marty, District 54
John Doll, District 40
Sharon Erickson Ropes, District 31
Paul Koering, District 12

 

The components of the Bill include:

  • PA “registration” is changed to “licensure”
  • The Practice Setting Description is changed to a Notice of Intent to Practice. Alternate supervising physicians are not included in the document.
  • The Supervisory Agreement is changed to a Delegation Agreement. Alternate supervising physicians may be included within the document, or in separate supporting documents
  • The phrase “internal protocol” is deleted. The Delegation Agreement specifies the characteristics of supervision.
  • The locum tenens provision is deleted.
  • The temporary registration provision is deleted.
  • The number of PAs to be supervised by an individual physician is increased to five, with exceptions to this limit at the Board’s discretion and under the disaster provision.
  • The optional delegation of authority to issue a 72 hr emergency admission is specified, and PAs are added as examiners for this purpose.
  • The disaster provision is modified in line with AAPA recommendations.
  • The duties of the Physician Assistant Advisory Council are expanded.

 

PA Day on the Hill was held January 27.  The personal visits of the 18 participants, combined with the many written communications from those unable to attend, helped the Legislators understand the importance of this Bill.

 

May 22, 2009 Governor Pawlenty signs the Bill (it had been combined into a larger omnibus bill and is found in 2009 Session Law Chapter 159)

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