ARIZONA REGULATORY BOARD OF PHYSICIAN ASSISTANTS Annual Report FY 2009—2010 Arizona Regulatory Board of Physician Assistants FY 2009‐2010 Annual Report Letter to the Governor Dear Governor Brewer: It is my pleasure to present to you the Arizona Regulatory Board of Physician Assistants’ Fiscal Year 2009—2010 Annual Report. This year was important to physician assistant regulation. As the number of physician assistants (PAs) licensed in Arizona rose by 6.7 percent in the last year, and by almost 14% over the last two years, it is clear that the role of PAs in healthcare delivery has and will continue to become integral to Arizona’s citizens. The Board spent much of this year refining its processes to ensure seamless licensing and enforcement procedures. As a result, the average number of days to process a PA license has decreased by 16 days and the average number of days to investigate a PA complaint was just 106 days. This year also saw the advent of legislation that has significantly altered the landscape of PA practice in Arizona. The legislation, as introduced in House Bill 2021, makes changes to the original laws governing the PA profession. The Board will actively address the new legislation next year as it updates its Administrative Rules. Finally, the Board proudly launched its redesigned website this year. The new site, which meets the Arizona Government Information Technology Agency requirements for look and feel, also hosts on-line PA license renewals and physician assistant search services. The Board relies on its website to disseminate information to the public and licensees quickly and the website redesign helps categorize this information in an easy-to-read and accessible format. Very Truly Yours, Lisa S. Wynn, Executive Director Arizona Regulatory ArizonaBoard Medical of Physician Board Assistants FY 2009‐2010 Annual Report Board Membership Joan Reynolds, M.M.S., PA-C, Chair—Ms. Reynolds is a practicing Physician Assistant. She has been employed by Mayo Clinic Scottsdale since 1993. She has been employed as a Physician Assistant since 1986, serving in primary care settings. Ms. Reynolds earned her Physician Assistant degree at Hahnemann University in Philadelphia, Pennsylvania. Ms. Reynolds received her Masters degree in Medical Science through Nova Southeastern University. She is past-president of the Arizona State Association of Physician Assistants, has served as an elected delegate to the American Academy of Physician Assistants in the House of Delegates for the past 10 years. She has received the recognition of “Arizona PA of the Year in 2004,” serves as a preceptor for PA students in Internal Medicine at Mayo Clinic Scottsdale, and is an Adjunct Faculty member for Midwestern University in Glendale, Arizona and for Arizona School of Health Sciences, a school of A.T. Still University in Mesa. Michael E. Goodwin, P.A., Vice-Chair—Mr. Goodwin is the founder and owner of Occupational Assessments & Services, an occupational medicine provider in and outside the State of Arizona . He received his physician assistant training at the United States Medical Center in Springfield , Missouri . He also attended the University of Cincinnati residency in occupational medicine. Mr. Goodwin is currently a member of the Executive Board, Section on Medical Center Occupational Health, for the American College of Occupational and Environmental Medicine. He is also a member of the adjunct faculty at Arizona School of Health Sciences and is a member of the Advisory Board for the Arizona Valle del Sol Association of Occupation Health Services. He is a founding member of the Arizona State Association of Physician Assistants. Other organizations in which he holds membership include the American Academy of Physician Assistants in Occupational and Environmental Medicine, the American Academy of Physician Assistants, and the American Medical Association. Carole A. Crevier, Public Member—Ms. Crevier is a retired business executive. From 1995 to 1998, she was a member of the Arizona Medical Board. She was elected Board Secretary and chaired the Medical Board’s Process Review Committee. Before retiring, Ms. Crevier was involved in a number of management organizations. She is a past member of the American College of Emergency Physicians Practice Management Committee, a Fellow and Past President of the American College of Cardiovascular Administrators, and previous Regional Director and Chairperson, Program Planning Committee, and Fellow for the American Academy of Medical Administrators. Ms. Crevier has a Bachelor of Arts in Management and a Master of Arts in Organizational Management from the University of Phoenix. Page 2 Arizona Regulatory ArizonaBoard Medical of Physician Board Assistants FY 2009‐2010 Annual Report Board Membership Jay M. Crutchfield, M.D., F.A.C.S.—Dr. Crutchfield is a Board-certified general surgeon who practices in Prescott. A native Arizonan, Dr. Crutchfield obtained his undergraduate degree from the University of Arizona and received his medical degree from the Mount Sinai School of Medicine of City University of New York. Dr. Crutchfield has previously served as a member of the Arizona Medical Board. Geoffrey W. Hoffa, M.S., P.A.-C—Mr. Hoffa is an NCCPA-certified physician assistant and has practiced in the Phoenix metropolitan area since 2001. He moved to Arizona in 1997 after receiving his Bachelor of Science Degree in Zoology from Michigan State University. He then earned a Master of Science in Physician Assistant Studies from the Arizona School of Health Sciences, A.T. Still University, in Mesa. Mr. Hoffa has practiced Gastroenterology and Hepatology, and in 2002 transitioned into Transplant Surgery at Mayo Clinic Hospital. While serving over five years in the multi-disciplinary service which included Transplant Hepatology, Transplant Nephrology, Hepatobiliary and Pancreatic surgery, as well as abdominal Transplant Surgery, he earned the academic title of Instructor of Medicine. He was the first physician assistant to be allowed associate membership into the American Society of Transplant Surgeons, where he has served as a P.A. liaison for the Legislative Committee. Active both in the clinical and policy aspects of the profession, he formed Hoffa Health Care (Geoffrey W. Hoffa, PLLC), which offers independent contracting clinical services and has enabled continued leadership for the profession. Mr. Hoffa Is a Fellow of the Arizona State Association of Physician Assistants, and the American Academy of Physician Assistants, and has served ASAPA as Chairman of the Public Relations Committee and as an elected Delegate to AAPA House of Delegates. Kristin A. Neal, MPH, P.A.-C—Ms. Neal is a practicing Physician Assistant with CIGNA Medical Group in the Urgent Care and Care Today clinics. She has been employed as a physician assistant since 1999, serving in primary care settings. Mrs. Neal earned her Physician Assistant degree at Midwestern University in Glendale, Arizona and her Masters of Public from the University of Utah. She served as the chair of the Legal and Legislative Committee for the Arizona Association of PAs, has served as an elected delegate to the American Academy of Physician Assistants in the House of Delegates for 6 years. She has received the recognition of “Arizona PA of the Year in 2004.” She served for 7 years as PA in the Arizona Army National Guard and completed the Army Flight Surgeon Course in 2003. She is an Adjunct Faculty member for Midwestern University in Glendale, Arizona. Page 3 Arizona Regulatory ArizonaBoard Medical of Physician Board Assistants FY 2009‐2010 Annual Report Board Membership Anna Marie Prassa, Public Member—Ms. Prassa founded Executive Stress Busters, Inc., and pioneered the 15-minute in-office massage concept to combat computer and work-related injuries. She also opened Natural Day Spa and is a highly trained motivational speaker. Ms. Prassa has a Bachelor of Science Degree. She has completed workshops and medical programs at the Touch Research Institute at the University of Miami School of Medicine and has attended an internship program at the University of Arizona in Tucson. In the past, Ms. Prassa has served as a member of the Arizona Homeopathic Board of Medical Examiners and the Arizona Acupuncture Board of Examiners. In April 2001, Ms. Prassa sold her businesses for a less stressful life and to pursue her speaking career. Gary Smith, M.D., F.A.A.F.P.—Dr. Smith is the owner of Family Doctors of Arizona, L.L.C., in Mesa which employs three physician assistants. He is the administrative medical director for the fire departments in Apache Junction, Gilbert, Mesa and Queen Creek and oversees their paramedic education. Dr. Smith is an Associate Professor of Medicine at the Arizona School of Health Sciences (ASHS), a School of A.T. Still University in Mesa. He serves on the Board of Directors for the Banner Physician Health Organization. He is a member of the Superstition District Committee of the Boy Scouts of America and is the recipient of the Silver Beaver Award. A graduate of Mesa High School, Dr. Smith received his medical degree from Ross University School of Medicine in Roseau, Dominica. He completed a three-year residency in Family Practice at the University of Nebraska Medical Center in Omaha, where he served as Chief Resident and was elected House Officer of the Year. Dr. Smith is Board-certified in Family Practice. Peter C. Wagner, D.O.—Dr. Wagner is the medical director of the Gila Crossing Clinic on the Pima Indian Reservation south of Phoenix. Prior to this position, he was in private practice for 15 years in Chandler. Dr. Wagner is a member of the clinical faculty at the Arizona College of Osteopathic Medicine in Glendale, Arizona. He is also a Commander in the U.S. Navy Reserve, and was called to active duty in 2003 under Operation Noble Eagle/ Enduring Freedom. He was assigned to Camp Pendleton Marine Corp Base for his tour of duty. Formerly, Dr. Wagner was the acting clinical director at Sells Indian Hospital in Sells, Arizona, a clinical lecturer at the University of Arizona Medical School, and the vice-chairman and chairman of the Family Medical Department at Mesa General Hospital. Dr. Wagner has served on the Arizona Osteopathic Association Committee on Comprehensive Planning. Page 4 Arizona Regulatory ArizonaBoard Medical of Physician Board Assistants FY 2009‐2010 Annual Report Board Membership Kelli M. Ward, D.O., M.P.H., FACOFP—Dr. Ward has had a medical practice in Lake Havasu City since 1999. She is Board-certified in Family Practice and has a Masters Degree in Public Health. Dr. Ward received her osteopathic medical degree from the West Virginia School of Osteopathic Medicine and continued her education with a family practice residency, a faculty development fellowship and clinician educator fellowship in Michigan. Additionally, Dr. Ward completed the Osteopathic Heritage Health Policy Fellowship in 2003. Dr. Ward is the president of the Arizona Society of the American College of Osteopathic Family Physicians, the president-elect of the Arizona Osteopathic Medical Association, and a member of the American Osteopathic Association. The Arizona Osteopathic Medical Association honored her with its “Physician of the Year” award for 2007. The American College of Osteopathic Family Physicians has named her the “Young Physician of the Year” for 2008. This year, the Board thanked former members Randy Danielsen, Ph.D., P.A.-C and Sigmund G. Popko, J.D. for their years of service and dedication to the mission of the PA Board. Both Dr. Danielsen and Mr. Popko displayed outstanding leadership and they were instrumental in developing Board rules and policy. Page 5 Arizona Regulatory ArizonaBoard Medical of Physician Board Assistants FY 2009‐2010 Annual Report Licensing As the number of physician assistants licensed in Arizona continues to rise, the degree of autonomy sought by these licensees also continues to increase. This year marked significant new legislation affecting the relationship between PAs and their supervising physicians. House Bill 2021, which was introduced by the Arizona State Association of Physician Assistants, eliminated the Arizona Medical Board’s approval of the supervising physician. The terms of supervising physician’s relationship with the PA must now be developed between the two parties. The legislation also makes clear that legal responsibility for the PA’s actions falls to the supervising physician. In preparation for this legislative change and the resultant loss of revenue received from the more than 1,000 supervision notifications processed, the Board elected to not fill a vacant position in the licensing department this year. Additionally, licensing staff streamlined its process for approving PA licenses and decreased the total number of days to approve a PA license from 18 days in FY 2009 to 11 days in 2010. It is the Board’s expectation that as the growth of healthcare providers continues to rise, that appropriate procedures will be in place to meet the increasing demands on licensing staff. Licenses Issued FY 09 FY 10 1,823 1,945 Licenses Issued 190 217 Temporary Licenses Issued 14 10 1,606 1,181 18 11 Total Number of Physician Assistants Supervision Notifications Processed Average Number of Days to Approve a PA Licens‐ ing Application Page 6 Arizona Regulatory ArizonaBoard Medical of Physician Board Assistants FY 2009‐2010 Annual Report Regulation standing contractors. This new system limits the flow of confidential health information, such as evaluation and treatment records, to Board staff, increases the trust between the PAs in the Program and the contractors, and puts measures in place to ensure any violation of the Program’s provisions will be immediately reported to the Board. The Board issued 21 actions this year, including nine advisory letters, one advisory letter with continuing medical education, and one non-disciplinary practice limitation. The Board’s Executive Director issued another four interim practice restrictions during the course of the investigative process. Interim actions may be dismissed at the end of the investigation or converted to a final disciplinary action. There were 18 PAs enrolled in the Board’s Physician Health Program this year. In order to better serve the PAs in the Program, all aspects of the PA’s health are monitored by the Board’s long- PA Regulation FY 09 FY 10 Investigations Remaining Open at Fiscal Year End 16 23 Number of PAs monitored for substance abuse/ dependence 15 17 Number of PAs monitored for heath issues 7 1 Disciplinary Actions 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 4 3 3 3 1 Letters of Reprimand Practice Restrictions Probation Loss of License Interim Practice Restrictions Page 7 Arizona Regulatory ArizonaBoard Medical of Physician Board Assistants FY 2009‐2010 Annual Report Technology Technology in the workforce remains at the heart of the Board as it continues to spur innovation and redefine processes. The Information Technology Office is committed to serving the business operations of the Arizona Regulatory Board of Physician Assistants by providing enterprise-wide, integrated solutions with emphasis on delivering best practice business results faster and more efficiently with fewer resources. There were many technological advances made this past year, below are some highlights. The Board’s physician database is more than a compilation of information, it is the primary application from which the Agency operates and through which public information is distributed. There were many advancements made to this application over the course of the past year, and our Agency moved to a new maintenance plan which offered significant cost savings. Much time and effort was spent on improving the availability, confidentiality and integrity of our Agency’s information resources, and many network improvements were implemented, including a complete network refresh, upgrading to a new anti-virus solution, implementing new anti-spam, computer security, vulnerability management and web filtering solutions to help protect against future threats. information resources. There was also an IT policy created and approved that establishes the responsibilities and restrictions to be complied with by all users of the Agency’s information resources. The Board also joined other State Agencies by redesigning our primary website to conform to State -wide standards for look and feel guidelines, and significantly improve the security of the site itself. Staff also took this opportunity to update the content and to make the site more user-friendly. Information can be posted to the website in real-time– ensuring the most up-to-date information is provided to the public. Building on the external website, the Agency also implemented an internal intranet that houses its policies and procedures, links to automated performance reports, and posts notices to staff about upcoming events. The Agency intranet is an example of how technology can bring an organization with many important and diverse divisions together into a cohesive group. Overall, Board IT staff plans to continue developing technological methods to automate and streamline current processes and intends to find more ways to leverage the Web for additional online service delivery which will promote increased efficiency. Board IT staff implemented a security awareness program to give our employees the needed tools and information to protect our Agency’s vital Page 8