Physician Assistant – Sterling Heights

The Physician Assistant is responsible for making sure that the medical needs for our participants are provided in a collaborative practice model, is meeting the quality goals and score card metrics on a consistent basis, is compliant with all regulatory requirements/standards and are operating in an efficient and productive manner overall. The Physician Assistant reports to the Physician-In-Charge at their typical work location. If no Physician-In-Charge has been assigned to the center, the Physician Assistant will report to the Medical Director. In order to meet all necessary goals, it is imperative that the Physician Assistant completes all of the tasks outlined below.

SPECIFIC DUTIES AND FUNCTIONS

Assessments

Annual/Semiannual/Initial

• Performs comprehensive medical history and physical exam in collaboration with Physician-In-Charge (PIC) for their assigned panel every six months based off of the enrollment date. The PA is able to perform the initial assessment if directed by the PIC to complete.
• PAs are expected to be available to perform all assessments that have been scheduled. If the PA is unable to perform the assessment as scheduled (ex., due to vacation, illness, professional development, required meeting…) the expectation is PA will inform PIC and confirm appointments have been rescheduled. If unable to reschedule appointment, PA will collaborate with PIC to determine appointment coverage. Current expectation is for two assessments to be scheduled per working day.
• Documentation of assessment is expected to be thorough and comprehensive satisfying regulatory requirements and having appropriate medical decision plans collaborating with PIC.
• These assessments are to be documented on the “SOAP form” in TruChart.
• Completion of the note including assessment and plan is expected to be signed and closed at a maximum of five business days. Within 24 hours is the preferred standard for assessments to be completed.
• It is expected PA will communicate to collaborating PIC assessments performed on a daily basis.
• PA will discuss with their Participant Care Team (PCT) relevant findings or concerns that need to be addressed at the end of day PCT meeting.
• PA is responsible to update appropriate caregiver of visit findings if participant requests or is unable to be a reliable source of communication.
• PA is responsible in collaboration with PIC and nursing staff to follow all labs and testing ordered for their panel with timely adjustments or follow up testing ordered as indicated.

Any authorizations resulting from the visit should be completed by PA with RNCM tagged for review though TruChart “Orders Management” form and discussed with RNCM at PCT meeting.

• Other Duties as assigned.

Intake Pre-enrollment Meeting

• May be performed by PA if directed by PIC
• Expectation of meeting is detailed clarification of medical history, medications, and explanation of PACE clinical services. Review of all available medical records (participant supplied, EPIC care everywhere…) should be performed and summarized in the HPI.
• Documentation is to be completed on “PCP Progress Note” with working diagnosis entered in “Lifeplan Management” section.
• Documentation must be completed same day for review by IDT at next morning IDT meeting.
• It is expected PA will communicate to collaborating PIC visits performed on a daily basis.

Acute Visit

• Performs scheduled acute visits for members of their panel in collaboration with PIC. Four acute visits are available per PA per day. Emergent visits are not included in the four scheduled daily acute visits.
• These visits include but not limited to: Post-Hospital/ED, Consultations, Fall Assessments, Out-of-Town Assessments, Pain Assessments.
• Documentation is to be completed on “PCP Progress Note” form in TruChart.
• Note is expected to be completed on same day of visit.
  • If visit results in a need for ED visit, PA will collaborate with PIC, update caregiver if applicable, call report to ED, and place note in EPIC if being sent to HFHS ED.

It is expected PA will communicate to collaborating PIC and PCT to update plan of care and sign out.

On-Call

• The PA will be expected to be in the on-call pool sharing in weekdays, weeknights, and holidays
• It is the responsibility of the provider to answer or return all calls within 15 minutes
• PAs have physician coverage on a nightly basis.
• Call swapping, covering is allowed. It is the responsibility of the originally scheduled provider to confirm change and notify the Medical Director to update call calendar and notify Medstar call service.

Time & Expense Reporting

• PA is expected to utilize Ultipro for time reporting and coding on a daily basis.
• PTO is to be entered in Ultipro for approval based on available banked time.
• Unscheduled PTO (Less than 24 hours notice) requires a phone call to the PIC to ensure adequate clinic coverage. PA is required to email the following giving notice of absence: Medical Director, PIC, PCT members.
• Mileage is to be submitted in Ultipro with detail excel worksheet completed and provided to authorizing leader for review and approval.
• Mileage when permitted is to be calculated based on mileage driven less base commute.
• Approved CME and Expenses need to have excel worksheet completed with supporting documentation submitted for reimbursement.

Participant Care Team (PCT)

• PA is expected to be a collaborative team member.
• Expectation is to be present on-time and in-person at morning PCT meeting.
• End of day PCT meeting is flexible with arranged time and location of the core members (PA, SW, RNCM). Telephone meeting is acceptable when face-to-face is not possible due to field requirements for end of day meeting only.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Registered Professional Nurse, with current Michigan license, and Masters of Science in Nursing with a clinical nursing focus and Physician Assistant license.
• Three (3) to five (5) years of progressively more responsible experience as an RN in a clinical setting with expertise substantiated in the area of geriatrics is preferred, through education, experience and credentials. Must have one (1) year of experience with a frail or elderly population.
• The ability to establish and maintain interpersonal and interdepartmental relationships.
• The ability to apply principles of teaching/learning theories in planning and implementing educational activities.
• The ability to apply principles of research in studying nursing issues.
• The Physician Assistant participates in or facilitates QA projects resulting from data collection results.
• The Physician Assistant participates in various committees within PACE SEMI including, but not limited to:
  • Utilization Review Committee
  • Clinic/Primary Care Committee
  • Morbidity and Mortality Committee
  • Advising and counseling the staff nurses regarding program management;
• Supervision of the Physician Assistant will be provided by several methods:
  • Immediate, on-site supervision by the PACE SEMI physician;
  • Telephone consultation with a PACE SEMI physician who is not on the premises;
  • Conferences between the Physician Assistant and the physician regarding medical management, review of charts or any other situation that may arise;
  • Chart audits.
• The scope of supervision will depend upon the specific functions the Physician Assistant performs
• The Physician Assistant conducts research projects in accordance with established institutional protocols and in collaboration with other experts in the research or clinical area; he/she integrates the research findings to improve the delivery of nursing care and propose a plan for facilitating a change.
• The Physician Assistant promotes a nursing philosophy that stresses the nursing process and encourages accountability and professional growth of staff nurses.
• Must meet a standardized set of competencies (approved by CMS) before working independently.
• Must be medically cleared for communicable diseases and have all immunizations up-to-date before engaging in direct participant contact.

WORKING CONDITIONS:

• Working conditions are variable with exposure to communicable diseases, due to patient environment.
• Driving is required within PACE SEMI catchment area, with possible exposure to extreme temperatures, including heat and cold.
• Frequent walking, bending, lifting of forty (40) pounds or more may be needed in the performance of duties.

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