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WAPA Pulse | 12/16/2019                                                                                                View this email in your browser
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Clinical Pearls: Reminding patients to shovel safely this season
While most people won't have a problem, shoveling snow can be dangerous for those who have risks of heart attacks. Sudden exertion, like moving hundreds of pounds of snow after being sedentary for several months, can put a big strain on the heart. Pushing a heavy snow blower also can cause injury.

Cold weather can also increase heart rate and blood pressure. It can make blood clot more easily and constrict arteries, which decreases blood supply. This is true even in healthy people. Individuals over the age of 40 or who are relatively inactive should be particularly careful.

Make sure your patients know the warning signs of a heart attack and share the following tips for shoveling snow:

  • Give yourself a break. Take frequent rest breaks during shoveling so you don’t over stress your heart. Pay attention to how your body feels during those breaks.
  • Don’t eat a heavy meal prior or soon after shoveling. Eating a large meal can put an extra load on your heart.   
  • Use a small shovel or consider a snow thrower. The act of lifting heavy snow can raise blood pressure acutely during the lift. It is safer to lift smaller amounts more times, than to lug a few huge shovelfuls of snow. When possible, simply push the snow.
  • Learn the heart attack warning signs and listen to your body, but remember this: Even if you’re not sure it’s a heart attack, have it checked out (tell a doctor about your symptoms). Minutes matter! Fast action can save lives — maybe your own. Don’t wait more than five minutes to call 9-1-1.
  • Don’t drink alcoholic beverages before or immediately after shoveling. Alcohol may increase a person’s sensation of warmth and may cause them to underestimate the extra strain their body is under in the cold.
  • Consult a doctor. If you have a medical condition, don’t exercise on a regular basis or are middle aged or older, meet with your doctor prior to the first anticipated snowfall.
  • Be aware of the dangers of hypothermia. Heart failure causes most deaths in hypothermia. To prevent hypothermia, dress in layers of warm clothing, which traps air between layers forming a protective insulation.
  • Wear a hat because much of your body’s heat can be lost through your head.

Advocacy Central
CARES Act Updates & How You Can Help Pass This Historic Bill
WAPA continues to work closely with bipartisan sponsors in the Senate and Assembly to advance the Collaboration and Rural Expansion of Services (CARES) Act (SB 515 and AB 575) for consideration by the 2019-2020 Wisconsin Legislature.

The CARES Act has been referred to the State Senate Committee on Elections, Ethics and Rural Issues
where it been co-sponsored by Senators Bernier, Kooyenga, Hansen, Tiffany, Schachtner and Bewley. Its companion bill has been referred to the State Assembly Committee on Regulatory Licensing Reform
where it has been co-sponsored by Representatives VanderMeer, Edming, Considine, Quinn, Felzkowski, Rohrkaste, Mursau, Sortwell, James, Summerfield, Tittl, Krug, Vruwink, Spiros, Dittrich, Anderson, Doyle, Kulp, Oldenburg, Ramthun, Tauchen, and Wichger.

You can help. Please visit to send a message to your representatives and encourage everyone you know to do so as well.

Here are more tools you may find helpful as you advocate for us:

All eyes are on Wisconsin and we need every PA to join the movement. Please visit and petition your representative to support us TODAY.

Wisconsin Legislative Updates
Harm to Health Care Professionals – Passed Assembly & Senate Committees
Under currently law, it is generally a Class A misdemeanor to cause bodily harm to another. For certain victims, such as emergency department health care providers, it is a Class H felony. SB 163/AB 175, authored by Sen. Kooyenga (R-Brookfield) and Rep. Magnafici (R-Dresser), would make it a Class H felony to cause bodily harm to a nurse or to an individual acting under the supervision of nurse.

Originally, the bill only applied to nurses, but WAPA worked with the Wisconsin Hospital Association on an amendment to expand the bill to include PAs and other health care professionals.

The Senate Committee on Judiciary & Public Safety voted on Sept. 25 to recommend passage of SB 163, with the amendment. The Assembly Committee on Criminal Justice & Public Safety voted on Oct. 17 to recommend passage of AB 175, with the amendment.

Direct Primary Care – Passed Senate Committee

The Assembly Committee on Small Business Development voted to recommend passage of the direct primary care bill on Oct. 2. The Senate Committee on Health & Human Services voted to recommend passage of the bill on Oct. 23.

Recall, Sen. Chris Kapenga (R-Delafield) and Rep. Joe Sanfelippo (R-New Berlin) have reintroduced a bill (SB 28/AB 26) establishing parameters for the practice of direct primary care in Wisconsin. The bill is largely the same as the version that passed the Assembly last session.

The direct primary care bills:

  • Do not include a Medical Assistance (MA) pilot program or work group (last session’s bills included such provisions).
  • Include a list of providers, such as physicians, physician assistants, nurses, and chiropractors, who may enter into such agreements but specifies they must provide primary care under their own scope of practice.
  • Require such agreements to state they are not health insurance and may not satisfy coverage requirements under federal law.
  • Require such agreements to state that services under the agreement may already be covered by the patient’s health insurance and that agreement fees may not be credited towards deductibles or out-of-pocket maximum amounts under the patient’s health insurance, if any.
  • Prohibit the provider or patient from billing an insurer for the services provided under the agreement.
  • Prohibit a provider, when selecting patients with whom to enter an agreement, from discriminating on the basis of age, disability, genetic information, health status, or pre-existing conditions, among other factors.
  • Expressly preserve the authority of the Department of Safety & Professional Services and the Department of Trade, Agriculture & Consumer Protection to regulate agreements.

In addition, an OCI-requested amendment, agreed to by the authors, would expressly preserve the ability of OCI to regulate agreements that do not meet the definition of direct primary care agreements under the bill and that meet the definition of insurance under state law.

Similar legislation failed to pass last legislative session.

WAPA is registered in support of this legislation and we will share updates as this bill progresses.

We are WAPA
Message from the President
In my last several messages, I have spent time outlining what WAPA has done for PAs in the state legislatively. This month, I want to expand upon the ways that PAs have given back to WAPA and to the profession. During the past year and a half as a WAPA Board member, I have been heartened to see PAs become increasingly involved in their professional organization. More and more PAs are realizing that we are stronger together!

One of WAPA’s most active groups is the CME committee and their hard work has definitely paid off. The WAPA Great Midwestern Medical Conference just concluded and it was a tremendous success! The American Club in Kohler was an outstanding venue. Topics were relevant and speakers were top notch. There were opportunities for networking and socializing. I want to applaud this dedicated group of volunteers who strive to provide quality CME for our members. And if you missed the conference, don’t worry. Spring conference promises to be just as amazing!

The Foundation just completed their primary fundraiser, the Foundation Dinner, which took place during the conference. Scholarships for deserving students were awarded and PA of the Year and PA Leader of the Year were honored. The winners, as well as all the nominees, were impressive, all shining stars of our profession! The event was a satisfying conclusion to the work of the Foundation in 2019.

WAPA’s newest endeavor is the APP Leadership Coalition which just held its second meeting. The group enjoyed an inspirational talk by Dr. Jeremy Welsh of the University of Lynchburg. The purpose of this coalition is to connect PAs and NPs in leadership positions. The group will work together to improve APP practice in the state.

It has been an honor to be part of the WAPA Board and to be in the presence of these dedicated volunteers. I have grown personally and professionally as a result. In other words, I have received as much as I have given. I am so glad that I have become involved with WAPA and I encourage you to do the same. Next month, we will be seeking nominations for Regional Representatives, President-elect, and AAPA House of Delegates. All are opportunities to learn and grow. If you feel you need expand beyond clinical practice but aren’t sure how, consider becoming involved in WAPA. You won’t regret it!

Respectfully submitted,

Julie Doyle, PA-C
WAPA President

PAs Who Hustle Hard: WAPA Foundation Awards
Meet WAPA Foundation's PA Leader of the Year and three PAs of the Year
In conjunction with the Great Midwestern Medical Conference, WAPA is proud to have recognized four total PAs at the WAPA Foundation Dinner and Award evening. Special thanks to volunteers Kim Shefchik, PA-C, and Jean Fischer, PA-C, for organizing a very special evening.

Joshua Knox, PA-C, Marquette University PA Program Faculty (pictured above, first on the left)
PA of the Year
Josh is a Clinical Associate Professor who teaches emergency medicine, clinical medicine, procedures, clinical decision-making, community clinics, public health project development and public health. He has a PA fellowship in gastroenterology and hepatology and a MA in health education. He helped Marquette to start and expand it's programs working with local clinics for the homeless/underserved.

Amy Parins, PA-C, UW-Madison PA Program Faculty (pictured above, second)
PA of the Year

Amy serves as a clinical instructor in clinical medicine, diagnostic methods, population health, and clinical skills labs with the University of Wisconsin-Madison Physician Assistant Program. She's especially drawn to patients coping with mental illness, substance use disorders (SUDs) and chronic pain. The opioid crisis is deeply personal to Amy and she uses her experiences to teach her students. They say she’s, "
totally changed my perspective on drug addiction and its affects" and "reminded me of the importance in taking time to understand the patient and their difficulties, but also to meet the patient where they are at and tell them you are not there to judge them, rather you are there to help them in whatever way you can."

Margaret Straub, PA-C, UW-Health PA Program Faculty, Radiation Oncology (pictured third)
PA Leader of the Year

Margaret has educated the next generation of PAs by lecturing through UW-Madison PA Program for the past 14 years. She serves on the APP (Advance Practice Provider) credentialing committee, APP Council and as an APP representative to provide insight on the role of APP’s at a new hospital facility which will open in 2023. She's known for identifying patient needs in radiation and oncology service that lead to new patient education materials and tools as well as bi-monthly education series, focusing especially on women’s health and sexuality. Since 2016, Margaret has been the recipient of the "UW Health Patient Experience Award" every year, and, to put that into perspective, UW-Health has over 500 advanced practice providers Margaret was only one of 13 providers to receive this award back in in 2016.

C. Miranda Spindt, Carroll University PA Program Faculty, Director of Physician Assistant Studies at Carroll University (pictured fourth)
PA of the Year

After graduating, Miranda joined the US Air Force where she trained as a combat flight medic. She's precepted PA students for 17 years prior to joining Carroll, where her passion for teaching led her to obtain a Masters in Education from A.T. Still University. She has also giving back to the community, serving as a Board Member for La Casa de Esperanza in Waukesha and volunteering with St. Joseph's Free Clinic, the Hope Center and St. Paul's Catholic Church medical missions.
For the PA Today
Question: I’ve seen many positions that are hiring PAs for Locum Tenens work. It’s listed as 1099 work. Are PAs in WI are allowed to do this? What I’ve found online is that it’s a gray area and may be more related to the employer and not straight across the board, is that true?

Keep calling (414) 253-8188 or emailing WAPA with your practice questions!

Answer: Self-employment is prohibited by both statute and rule in Wisconsin. We suspect that if a PA was being investigated for some type of allegation and they were found to be practicing as an independent contractor 1099 employee, then presumably they could be charged with practicing outside of their license.

This is how WAPA replies to question at hand but if you have a specific case that needs to be discussed, we encourage you to contact an employment attorney.
Upcoming Events
WAPA's Great Midwestern Medical Conference
April 1-3, 2020
Concourse Hotel & Governor's Club, Madison, WI

Join us in Madison for the Spring CME Conference, April 1-3, at the Concourse Hotel & Governor’s Club. We are pleased to offer a newly expanded program, offering up to 22 CME credits.

Engage yourself with 2 hours of training on motivational interviewing for substance use disorders. Choose from a menu of hands-on workshops covering everything from dental care to women’s health topics.

Enrich your mind with exciting tracks, including a full-day behavioral health track on Wednesday and a women’s health track on Thursday. Select lectures covering a variety of primary care topics, including diabetes medication, smoking cessation, hyperlipidemia and obesity. Looking for education on acute care? Check out sessions on bedside echocardiogram, pancreatitis and emergency psychiatry.

Explore your networking opportunities and your state capital. The conference will feature expanded networking opportunities (more details to come!) to make connections and socialize with friends and colleagues.
Top Jobs from the WAPA Career Center
Looking for ways to get your job opening noticed? Head on over to the WAPA Career Center to advertise your positions with WAPA members. Members can search this job board for free.

Glenwood, Minnesota

Madison, Wisconsin

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