BILL ANALYSIS Ó
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Date of Hearing: May 6, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
ACR 107 (Bloom) - As Introduced: February 21, 2014
SUBJECT : Year of the Family Physician.
SUMMARY : Designates 2014 as the Year of the Family Physician.
Specifically, this resolution :
1)Declares, among other things, all of the following:
a) Family physicians are trusted members of their
communities; are dedicated to keeping patients as healthy
as possible throughout their lives; advocate for the
patient in an increasingly complex health care system;
provide care that covers all ages, sexes, each organ
system, and every disease; and, their practices are a place
for patients and families to turn to for care and needed
advice;
b) Family physicians can provide patients with a
patient-centered medical home (PCMH), through which they
receive a full range of services and individuals who
regularly visit a family physician in a PCMH are more
likely to receive preventive services, better management of
chronic illnesses, and have a decreased chance of premature
death, thereby improving health outcomes and lowering
costs;
c) Adults in the United States who have a family physician
or another type of primary care physician (PCP) have 33%
lower health care costs and 19% lower odds of dying than
those who see only a specialist; and, as a nation, we would
save $67 billion each year if everyone saw a family
physician or another type of primary care provider as their
usual source of care; and,
d) There is tremendous value to ensuring that all patients
have access to health insurance coverage and care,
especially as our communities face a dire shortage of PCPs,
including family physicians, a problem that will be
exacerbated by the entrance of millions of newly insured
into the health care market; and, the implementation of the
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Patient Protection and Affordable Care Act (ACA) will lead
to a significant demand for experienced and well-trained
health care professionals who can treat a wide variety of
health conditions.
2)Asserts that meeting the "Triple Aim" of better health, better
care, and lower costs in our health care system means placing
a new emphasis on primary care as provided by family
physicians and every patient and every family deserves a
family physician.
3)Resolves that the Legislature declares 2014 as the "Year of
the Family Physician" in recognition of the critically
important role family physicians will play for patients during
the implementation of the ACA and beyond; and, further
resolves that the Chief Clerk of the Assembly transmit copies
of this resolution to the author for appropriate distribution.
EXISTING STATE LAW :
1)Defines "PCP" as a physician who has the responsibility for
providing initial and primary care to patients, for
maintaining the continuity of patient care, and for initiating
referral for specialist care. Requires a PCP to be either a
physician who has limited his or her practice of medicine to
general practice or who is a board-certified or board-eligible
internist, pediatrician, obstetrician-gynecologist, or family
practitioner.
2)Establishes the Medical Board of California which licenses and
regulates physician and surgeons.
EXISTING FEDERAL LAW :
1)Defines "primary care provider," pursuant to the ACA Primary
Care Extension Program, as a clinician who provides
integrated, accessible health care services and who is
accountable for addressing a large majority of personal health
care needs, including providing preventive and health
promotion services for men, women, and children of all ages,
developing a sustained partnership with patients and
practicing in the context of family and community, as
recognized by a state licensing or regulatory authority,
unless otherwise specified.
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2)Defines, under the ACA, a PCMH as a mode of care that includes
personal physicians; whole person orientation; coordinated and
integrated care; safe and high-quality care through
evidence-informed medicine, appropriate use of health
information technology, and continuous quality improvements;
expanded access to care; and, payment that recognizes added
value from additional components of patient-centered care.
FISCAL EFFECT : None
COMMENTS :
1)PURPOSE OF THIS RESOLUTION . According to the author, this
resolution would recognize family physicians for the work they
do in providing preventative and restorative care to patients
with emotional and physical conditions, especially as their
role increases as the result of implementation of the ACA.
The author asserts that family physicians provide a very
important role in providing comprehensive care to their
patients on a wide range of ailments and disorders; and, they
are often the first to screen and diagnose their patients.
Family physicians are able to cultivate long-term
relationships with their patients and develop an understanding
of their individual medical, physical, and psychological
needs. Their dedication to their patients, practice, and
community is a testament to their skills as medical
professionals.
2)BACKGROUND . According to the U.S. Department of Health and
Human Services' Agency for Health care Research and Quality,
primary care is the cornerstone of health care. PCPs are a
foundational element of the U.S. health care system and are
required to meet our nation's triple aims of improving
quality, containing costs, and improving patient and family
experience. Primary care is also critical to ensuring access
to health care for all Americans and reducing disparities.
Whether the focus is on the individual, a population, or the
health care system, good access to primary care is associated
with more timely care, better preventive care, avoiding
unnecessary care, improved costs, and lower mortality.
Primary care by some measures is the largest aspect of our
health care system. In 2008, 490 million visits were made to
PCPs-a bit more than half of all visits to physicians'
offices.
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According to the 2010 American Medical Association (AMA)
Physician Masterfile, there are slightly more than 246,000
PCPs in the U.S. This number, however, overestimates how many
are currently practicing physicians and needs to be adjusted
because the AMA Physician Masterfile includes some retired
physicians and others who have left the workforce and a
substantial number of primary care trained physicians now
practice in non-primary care settings, including as
hospitalists and in emergency departments. After adjusting
for these factors, the number of practicing PCPs in the U.S.
is estimated to be approximately 209,000. Among physicians in
the U.S. who spend the majority of their time in direct
patient care, slightly less than one-third are specialists in
primary care.
3)TRIPLE AIM . Originally developed by the Institute for Health
care Improvement (IHI), the "Triple Aim" is an approach to
optimizing health system performance. Adopted by the Centers
for Medicare and Medicaid Services (CMS), the goals of the
Triple Aim are defined as: a) improving the patient
experience of care (including quality and satisfaction); b)
improving the health of populations; and, c) reducing the per
capita cost of health care. According to CMS, Office of the
Actuary, the U.S. health care system is the most costly in the
world, accounting for 17% of the gross domestic product with
estimates that percentage will grow to nearly 20% by 2020.
Aging populations and increased longevity, coupled with
chronic health problems, have become a challenge, putting new
demands on medical and social services.
In most health care settings today, no one is accountable for
all three dimensions of the IHI Triple Aim, although access to
primary care is essential. The role and impact of primary
care services must be substantially broadened and new models
of primary care, such as the PCMH must be utilized.
Organizations and communities that attain the Triple Aim will
have healthier populations. Patients with better access to
and utilization of primary care can expect less complex and
much more coordinated care and the burden of illnesses will
decrease. Importantly, stabilizing or reducing the per capita
cost of care for populations will give businesses the
opportunity to be more competitive, lessen the pressure on
publicly funded health care budgets, and provide communities
with more flexibility to invest in activities, such as schools
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and the lived environment, that increase the vitality and
economic wellbeing of their inhabitants.
4)PCP SHORTAGE . According to a study by the Robert Graham
Center there is a shortage of PCPs in the U.S., and the study
points out that California, compared to all other states,
could be facing the most severe shortage in the next 17 years.
The study suggests the state might need 8,243 more PCPs by
2030-that's 32% of its current workforce. The study finds
that the aging population, population growth, and more
patients due to the ACA are driving the increased need for
PCPs. As of 2010, California has more than 25,000 PCPs. The
state's current population to PCP ratio of 1483:1 is greater
than the national average of 1463:1.
5)SUPPORT . The California Academy of Family Physicians (CAFP)
is the sponsor of this resolution. CAFP writes that the
purpose of this resolution is to recognize the cost-reducing,
health-improving, and lifesaving work that California's family
physicians are doing every day, especially during this year of
health reform. There is tremendous value to ensuring that all
Californians have health insurance coverage, but Californians
also need access to care. CAFP states that there is an
extensive evidence base demonstrating that when patients have
access to good primary care, good things happen. Health care
quality and health outcomes improve, problems are diagnosed
earlier, self-reported health and mental health improve,
disparities are reduced, hospital admission rates and
emergency department utilization are reduced, and costs go
down. In short, the entire health care system becomes more
efficient and effective.
6)RELATED LEGISLATION .
a) AB 2458 (Bonilla) establishes the Graduate Medical
Education (GME) Fund to administer and fund grants to
graduate medical education residency programs. The
author's stated intention of this bill is to increase the
number of primary care residency slots in California. AB
2458 is currently on the Assembly Appropriations Suspense
File.
b) AB 1176 (Bocanegra and Bonta) would have established the
Medical Residency Training Program to fund GME residency
programs in California and would have required every health
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insurer or health plan that provides health care coverage
in this state to pay an annual GME assessment of $5.00 for
each covered life. AB 1176 was held under submission in
the Assembly Appropriations Committee.
c) AB 565 (Salas), Chapter 378, Statutes of 2013, revises
the Steven M. Thompson Physician Corps Loan Repayment
Program to include certain practice settings providing
primary care in underserved areas, that an applicant have
three years providing care to underserved populations or in
an underserved area, and gives preference to applicants who
agree to practice in a federally designated health
professional shortage area or provide care in underserved
areas to underserved populations.
d) ACR 84 (Rodriguez) proclaims May 18, 2014, though May
24, 2014, as Emergency Medical Services Week. ACR 84 is
pending on Assembly Third Reading.
REGISTERED SUPPORT / OPPOSITION :
Support
California Academy of Family Physicians
Opposition
None on file.
Analysis Prepared by : Patty Rodgers / HEALTH / (916) 319-2097