Week 1 (History)

Question 1

What is the last US territory to authorize PA practice?

Answer 1

Puerto Rico (2019)

Question 2

In __________, ____________ University’s first PA class matriculates with four students

Answer 2

1965; Duke

Question 3

The first PA Graduating Class graduated when?

(Know this)

Answer 3

Oct 6, 1967 (National PA day)

Question 4

What report recommends that State Medical Practice Acts be amended to permit PA practice under physician supervision?

Answer 4

NIH

Question 5

The AMA endorses the ___________________ concept in 1970

Answer 5

Physician Associate

Question 6

___________ Governor Ronald Reagan signs Assembly Bill 2109 into law making his state the first to enact enabling legislation for PAs

Answer 6

California

Question 7

Mississippi becomes the last state to enact PA legislation in what year?

Answer 7

1999

Question 8

What does TAPA do for us?

Answer 8

Advocacy, legal advice, state laws, networking, discounts
(part time attorney + 2 lobbyists)

Question 9

1) What is our state professional organization?
2) What is its mission?

Answer 9

1) TAPA
2) Promote quality, cost-effective and accessible healthcare, and to promote the professional and personal development of physician assistants.

Question 10

Who can answer your practice questions and give you professional guidance?

Answer 10

TAPA

Question 11

What do the 2 lobbyists employed by TAPA do?

Answer 11

1) Both lobbyists (John Williams and Katherine Moffat) attend legislative hearings throughout the session to monitor activity and advocate for PAs.
2) Each January, 1,500-2,000 bills are filed in the General Assembly; John Williams reviews each of these bills to determine if they affect PA practice

Question 12

What does TAPA monitor and push for?

Answer 12

1) Monitors legislative and regulatory developments that could affect the PA scope of practice in Tennessee.
2) Pushes for passage of legislation that allows PAs to practice at the highest level of their training.

Question 13

1) TAPA has a Student Affairs Committee made up of representatives from each PA Program. This committee elects what?
2) TAPA is divided into six ______________ regions. Each region has a director who serves on the Board of Directors.

Answer 13

1) the Student Representative to TAPA’s Board of Directors.
2) geographical

Question 14

What is optimal team practice (OTP) (2017)?

Answer 14

PAs working together with physicians and others healthcare professionals w/o administrative constraints

Question 15

What are the 3 goals of OTP 2017?

Answer 15

1) Elimination of legal requirement for a specific relationship bet PA and MD (SP) for PA to practice
to full extent of their education, training and experience
2) Create a majority-PA board to regulate PAs or add PAs/MDs who work with PAs
3) Authorize PAs to be eligible for direct payment by all public and private insurers

Question 16

Describe the goals of optimal team practice (2017; don’t need to know all details)

Answer 16

1) Elimination of legal requirement for a specific relationship bet PA and MD (SP) for PA to practice
to full extent of their education, training and experience
-need collaboration tho
2) Create a majority-PA board to regulate PAs or add PAs/MDs who work with PAs
3) Authorize PAs to be eligible for direct payment by all public and private insurers

Question 17

What are 2 other bills recently passed/proposed? (in TN)

Answer 17

1) Telemedicine
2) PA compact licensure

Question 18

What do the following do?
Telemedicine-HB 0498 (B.Martin)/SB 0721 (Massey)
PA Compact-HB 1862 (Faison)/SB 1727 (Jackson)

Answer 18

1) Allowing collaborating physicians in practices which provide services solely through telemedicine to conduct all 12 of the required monthly visits per year remotely. (Telemedicine)
2) Proving for an exemption to the 16-month-in-person encounter and relationship requirement when a pt is receiving an initial encounter/evaluation for behavioral health treatment. (Telemedicine; don’t really need to know)
3) Ease application for multiple state license for PA telemedicine providers (PA Compact)

Question 19

PA Practice Act-HB 1272(Cochran)/SB 1171 (Swann): What did it do?

Answer 19

Modernized the oversight and regulation of PAs which has not been updated in TN since 1999.

Question 20

PA Practice Act-HB 1272(Cochran)/SB 1171 (Swann)

Answer 20

1) New grads- 3 years or 6,000 hrs post-graduate clinical practice
2) <6,000 change to new specialty: 6 months supervision practices to determine oversight, (including chart review: blocked), visits to remote locations, training, assessment
3) limits on surgical procedures
4) limits on use of medical specialty titles
5) no changes to prescribing, including opioids

Question 21

What parts of PA Practice Act-HB 1272(Cochran)/SB 1171 (Swann) was blocked?

Answer 21

1) Including chart review
2) Scope of PA practice may differ from physician

Question 22

1) The National Professional Society of PAs is what?
2) Where was it established/ when?
3) Who were the first members?

Answer 22

1) AAPA
2) North Carolina in 1968
3) Military corpsmen from Duke University, the first graduating class

Question 23

NCCPA Code of Conduct (National level): list the first 11 points

Answer 23

1) shall not engage in cheating or other dishonest behavior that violates exam security
2) shall not engage in irregular behavior
3) shall not employ deceptive means, in obtaining or maintaining an NCCPA credential.
4) shall not manufacture, modify, reproduce, distribute or use a fraudulent or otherwise unauthorized NCCPA certificate.
5) shall not falsely represent themselves in any way to be a Physician Assistant-Certified (PA-C) designee, aCertificate of Added Qualification (CAQ) recipient, or a PA-C Emeritus
6) shall promptly inform NCCPA when possessing knowledge or evidence cheating on or misuse of questions from an NCCPA examination
7) fraudulent use/ misrepresentation of NCCPA certification status by a physician assistant or any other individual
8) professional boundaries in their interactions with patients and others.
9) shall avoid behavior that would pose a threat patient’s interest during the delivery of health care.
10) shall not disclose patient confidential information
11) shall recognize and understand their professional and personal limitations.

Question 24

NCCPA Code of Conduct (National level): list the rest of it

Answer 24

12) shall practice without impairment from substance abuse/cognitive deficiency or mental illness
13) demonstrate the ability to engage in the practice of medicine within their chosen areas of practice safely and competently.
14) shall behave in a manner that is lawful and ethical, during and outside the practice of medicine, that upholds accepted standards of professional practice and conduct.
must report to the NCCPA any adverse regulatory or credentialing action within 30 days of issuance
15) must report to NCCPA within 30 days of convictions, guilty pleas or no contest pleas to felonies and certain misdemeanors, as described more fully in thePolicies and Procedures forPA Disciplinary Matters.
16) must cooperate with and respond to inquiries from NCCPA certification-related matters or disciplinary proceedings.
17) must comply with conditions set forth by NCCPA, unless due to circumstances beyond the PA’s control.

Question 25

PA Practice Act is at what level?

Answer 25

State

Question 26

Describe the PA practice act

Answer 26

The protocol must be reviewed and updated biennially – signed and dated by both the PA and the physician The protocol must be maintained at the PA’s practice site and made immediately available upon request to inspectors from the Tennessee Department of Health (written or digital) TAPA has a template for purchase on the TAPA website

Question 27

Describe the current scope of practice

Answer 27

The physician must have experience or expertise in the same area of medicine as the PA working with them. The PA may only perform those tasks which are within the PA’s range of skills and competence, and which are within the usual scope of practice of the collaborating physician. The range of services which may be provided by the PA must be set forth in a written protocol, jointly developed by the PA and physician. Make sure you know how to perform skills. (exceptions)

Question 28

1&2

Answer 28

1. Licensure-state the term (dates, etc) 2. Full prescriptive authority (DEA license Controlled Substances II-V)* II. Methamphetamines, Adderall, Vicodin/Norco III. Tylenol with codeine, Testosterone IV. Xanax, Ambien,Valium V. Robitussin AC, Lomotil (contain opioid/codeine) *state specific

Question 29

Scope 1) The PA profession is moving away from what? 2) A collaborating physician must possess what? 3) What physician may not perform this function?

Answer 29

1) The PA profession is moving away from using the term “supervision” and using “collaboration” 2) A current, unencumbered license to practice medicine in Tennessee (or state of practice) 3) A physician who does not normally provide patient care -In Tennessee, a collaborating physician must be an MD, DO; Podiatrist under certain conditions

Question 30

4.& 5. Describe how co-signing is determined at practice level

Answer 30

1) Generally, a collaborating physician must review at least 20% of charts monitored or written by a PA/APRN And 2) make at least one visit to every remote site at least every 30 days

Question 31

What are some newly approved things within our scope of practice in TN as of 2025 (Don't memorize this)

Answer 31

a. order Durable medical equipment (DME) b. nutrition c. blood and blood products d. diagnostic support services: Home health, hospice, PT, OT e. sign death certificates

Question 32

Upon graduation from PA school, you will be faced with what steps?

Answer 32

1) Passing the PANCE/NCCPA certification 2) Obtaining licensure 3) Defining your role in your new practice with your collaborating physician 4) Gaining insurance and/or hospital credentials 5) Practicing medicine as a PA-C 6) Life-long learning/continuing medical education (CME)

Question 33

Describe passing the PANCE

Answer 33

1) A PA graduate must pass the Physician Assistant National Certifying Exam (PANCE) to be eligible for licensure. (can take 7d after graduation; if fail, wait 90d to retest) 2) max 3x/yr; max 6x in 6 years (or lifetime); $500

Question 34

Describe what happens after passing the PANCE

Answer 34

-After passing the PANCE, a PA receives NCCPA certification and can add the “-C” behind “PA”. -In Tennessee, maintenance of NCCPA certification is not required in order to renew a license.*; However, NCCPA certification may be required by hospital and insurance credentialing boards, as well as by employers.

Question 35

Differentiate between a regular license and a temporary license

Answer 35

1) A graduate who has passed the PANCE can apply for full licensure. 2) Graduates waiting to take or pass the PANCE exam can apply for temporary licensure in Tennessee.

Question 36

In Tennessee, an individual must meet what qualifications for licensure?

Answer 36

1) Graduate from a PA program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) 2) Successfully complete the examination of the National Commission on the Certification of Physician Assistants (NCCPA) = PANCE 3) 3 letters of recommendation

Question 37

Describe state licensure renewal

Answer 37

1) In Tennessee, the renewal due date is the last day of your birth month (Q 2yrs) 2) DO NOT LET YOUR LICENSE LAPSE! This could result in fines and other disciplinary procedures. 3) It is the PA’s responsibility to renew his or her license – not the practice manager; not your collaborating physician.

Question 38

What are the limitations of a temporary license?

Answer 38

1) The physician must be on site at all times 2) The physician must co-sign 100% of patient charts

Question 39

1) Can a PA can apply for a DEA license with a temporary license? 2) How long can temporary licenses be held?

Answer 39

1) Yes; $888-valid 3 years -[your practice should pay for that] 2) Fifteen (15) months; can be renewed for an additional year.

Question 40

1) PAs are professionally and legally obligated to keep abreast of changes in medicine. This is primarily done through what? 2) Give examples of this

Answer 40

1) continuing medical education (CME). 2) CME can take various forms – medical journals, live instruction and online learning.

Question 41

1) What is CME required for? When must it be completed?? 2) What CME does the NCCPA require?

Answer 41

1) CME is also required for licensure renewal. 2) According to the Board on PAs, required CME must be completed during the 24 months preceding the submission of an application for renewal. 3) The NCCPA requires 100 hours of CME every two (2) years. Tennessee state laws mirrors this requirement. 50 must be from Category 1. 4) A PA’s license renewal cycle and NCCPA certification cycle may differ greatly. -Pay attention to deadlines for both.

Question 42

1) PANCE/PANRE LA is taken when? 2) When is CME done? 3) What is the difference between CAT 1 and 2?

Answer 42

1) Every 10 years 2) Q 2 years-100hrs 5 cycles every 10 years 3) CAT 1: 50hrs (always need at least 50) -PI-CME; Self-assessment -CAT 2 (teaching medicine, reading journal, etc) TOTAL=100

Question 43

Give examples of CAQ-Certificate of Added Qualifications (12)

Answer 43

Cardiovascular & Thoracic surgery (CVTS) Orthopedic surgery Emergency Medicine Hospital Medicine Nephrology Pediatrics Psychiatry Dermatology OBGYN Palliative/Hospice Occupational Medicine

Question 44

What is a PA-C Emeritus?

Answer 44

1) PA-C retired from clinical practice 2) Certified by NCCPA a minimum of 20 cumulative years or disabled 3) No reportable actions in their NCCPA disciplinary history/no disciplinary actions 4) One time fee 5) Maintain designation Q two years 6) NOT considered certified

Question 45

Once you begin practicing, you will go through two types of credentialing, which are what?

Answer 45

1) Hospital credentialing (if you work in a hospital setting or a surgical practice) 2) Insurance credentialing [Typically, the practice’s office manager or administrator will assist PAs and other clinicians with the credentialing process.]

Question 46

Differentiate between credentialing and privileging

Answer 46

1) Credentialing is the verification of a healthcare practitioner’s education, training, work experience, licensure, etc. 2) Privileging is granting approval for an individual to perform a specific procedure or specific set of privileges based on documented competence in the specialty in which privileges are requested.

Question 47

True or false: Providers cannot work in the hospital setting until they are credentialed and granted privileges.

Answer 47

True

Question 48

1) What is insurance credentialing? 2) What does it vary by? 3) What cannot happen until you're credentialed?

Answer 48

1) As with hospital credentialing, insurance credentialing is a process for verifying the provider’s education, training, experience, licensure and competency. 2) Insurance credentialing varies from carrier to carrier – some will credential a PA independently; others will credential under the collaborating physician or practice. 3) Providers are not eligible for reimbursement until they are credentialed.

Question 49

You will likely submit insurance credentialing through the Council for Affordable Quality Healthcare(CAQH). CAQH is a nonprofit alliance of America’s leading health plans. What does CAQH allow for?

Answer 49

Providers to submit one application to meet the needs of all the health plans and hospitals participating in the CAQH effort. -eliminates the need for providers to submit the same information to multiple organizations.

Question 50

What do you get after you're credentialed?

Answer 50

1) National Provider Identifier (NPI; Same number throughout career) 2) The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for healthcare providers and health plans

Question 51

What are 3 parts of the Hippocratic oath?

Answer 51

1) Medical confidentiality 2) Nonmaleficence 3) Beneficence

Question 52

What oath do PAs follow?

Answer 52

The Physician Assistant Professional Oath

Question 53

What are the 6 PA core competencies?

Answer 53

1) Medical Knowledge 2) Interpersonal & Communications Skills 3) Patient Care 4) Professionalism 5) Practice-based Learning & Improvement 6) Systems-based Practice

Question 54

Describe the medical knowledge core competency

Answer 54

-Evidence-based medicine -Scientific principles r/t pt care -Etiologies, risk factors, underlying pathologies, epidemiology for medical conditions -s/sx of medical and surgical conditions -Appropriate diagnostic studies -Mgmt of general medical and surgical conditions, including pharmacologic and other tx -Interventions for prevention of dz and health promotion/maintenance -Screening methods to detect conditions in an asymptomatic pt -Hx and PE findings and diagnostic studies to formulate ddx

Question 55

Describe the interpersonal and communication skills core competency

Answer 55

-create and sustain a therapeutic and ethically sound relationship with patients -use effective communication skills to elicit and provide information -adapt communication style and messages to the context of the interaction -work effectively with physicians and other health care professionals as a member or leader of a health care team or other professional group -demonstrate emotional resilience and stability, adaptability, flexibility, and tolerance of ambiguity and anxiety -accurately and adequately document information regarding care for medical, legal, quality, and financial purposes

Question 56

Describe the patient care core competency

Answer 56

-work effectively with physicians and other health care professionals to provide patient centered care -demonstrate compassionate and respectful behaviors when interacting with patients and their families -obtain essential and accurate information about their patients -make decisions about diagnostic and therapeutic interventions based on patient information and preferences, current scientific evidence, and informed clinical judgment -develop and implement patient management plans counsel and educate patients and their families -perform medical and surgical procedures essential to their area of practice -provide health care services and education aimed at disease prevention and health maintenance -use information technology to support patient care decisions and patient education

Question 57

Describe the Practice-based Learning & Improvement core competency

Answer 57

1) analyze practice experience and perform practice-based improvement activities using a systematic methodology in concert with other members of the health care delivery team 2) locate, appraise, and integrate evidence from scientific studies related to their patients’ health 3) apply knowledge of study designs and statistical methods to the appraisal of clinical literature and other information on diagnostic and therapeutic effectiveness 4) utilize information technology to manage information, access medical information, and support their own education 5) recognize and appropriately address personal biases, gaps in medical knowledge, and physical limitations in themselves and others

Question 58

Describe the professionalism core competency

Answer 58

1) understanding of legal and regulatory requirements, as well as the appropriate role of the physician assistant professional relationships with physician supervisors and other health care providers 2) respect, compassion, and integrity 3) accountability to patients, society, and the profession 4) commitment to excellence and on-going professional development 5) commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices sensitivity and responsiveness to patients’ culture, age, gender, and abilities 6) self-reflection, critical curiosity, and initiative 7) healthy behaviors and life balance 8) commitment to the education of students and other health care professionals

Question 59

Give the pt 1 of systems-based practice core competency

Answer 59

1) effectively interact with different types of medical practice and delivery systems 2) understand the funding sources and payment systems that provide coverage for patient care and use the systems effectively 3) practice cost-effective health care and resource allocation that does not compromise quality of care 4) advocate for quality patient care and assist patients in dealing with system complexities 5) partner with supervising physicians, health care managers, and other health care providers to assess, coordinate, and improve the delivery and effectiveness of health care and patient outcomes

Question 60

Give the pt 2 of systems-based practice core competency

Answer 60

6) accept responsibility for promoting a safe environment for patient care and recognizing and correcting systems-based factors that negatively impact patient care 7) apply medical information and clinical data systems to provide effective, efficient patient care 8) recognize and appropriately address system biases that contribute to health care disparities 9) apply the concepts of population health to patient care