BILL ANALYSIS Ó
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|Hearing Date:June 23, 2014 |Bill No:AB |
| |2102 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Ted W. Lieu, Chair
Bill No: AB 2102Author:Ting
As Amended:June 2, 2014 Fiscal: Yes
SUBJECT: Licensees: data collection.
SUMMARY: Requires the Board of Registered Nursing (BRN), The
Physician Assistant Board (PAB), the Respiratory Care Board (RCB) and
the Board of Vocational Nursing and Psychiatric Technicians (BVNPT) to
collect and report specific demographic data relating to its
licensees, subject to a licensee's discretion to report his or her
race or ethnicity, to the Office of Statewide Health Planning and
Development (OSHPD). Requires the boards to collect this data at
least biennially at the time of issuing an initial license or renewal
license.
Existing law:
1)Establishes the BRN which licenses and regulates the practices of
registered nurses. (Business and Professions Code (BPC) § 2700 et
seq.)
2)Establishes the PAB to license and regulate the practice of
physician assistants. (BPC § 3500 et seq.)
3)Establishes the RCB to license and regulate the practice of
respiratory care therapists. (BPC § 3700 et seq.)
4)Establishes the BVNPT to license and regulate the practice of
vocational nurses and psychiatric technicians. (BPC § 2840, 4800 et
seq.)
5)Requires BRN to collect and analyze workforce data from its
licensees for future workforce planning and produce reports at least
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biennially. (BPC) § 2717)
6)Requires OSHPD to prepare an annual report to the Legislature that
does all of the following: (Health and Safety Code § 128052)
a) Identify education and employment trends in the healthcare
profession;
b) Report on the current supply and demand for health care
workers in California and gaps in the educational pipeline
producing workers in specific occupations and geographic areas;
and,
c) Recommend state policy needed to address issues of workforce
shortage and distribution.
This bill:
1) Requires the BRN, PAB, RCB and BVNPT to collect at least biennially
at the time of issuing an initial and a renewal license, the
following data:
a) Location of practice, including city, county and ZIP
code
b) Race or ethnicity
c) Gender
d) Languages spoken
e) Educational background
2) Specifies that a licensee may, but is not required to, report his
or her race or ethnicity to the board.
3) Authorizes the BRN to expend $145,000 from the BRN Fund within the
Professions and Vocations Fund in order to implement the data
collection.
FISCAL EFFECT: This measure is keyed "fiscal" by Legislative Counsel.
According to an Assembly Appropriations Committee analysis dated
April 30, 2014, potential one-time costs of up to $90,000 (various
fee-supported special funds) if programming changes are necessary to
the information technology system supporting licensure functions.
COMMENTS:
1. Purpose. This bill is sponsored by the California Pan-Ethnic
Health Network and the Latino Coalition for a Healthy California .
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According to the Author, "With the implementation of the federal
Affordable Care Act, the majority of those newly eligible for
health care coverage will be from communities of color.
Additionally, 35 percent of the newly eligible will be Limited
English Proficient. Currently, the Medical and Dental Boards
collect demographic data on their workforce. AB 2102 expands that
charge to other health care professionals to ensure our newly
insured communities have access to culturally and linguistically
appropriate services?The experience of stark racial and ethnic
health disparities among communities of color necessitates a
diverse and culturally appropriate workforce?According to the
National Institutes of Health, when health care is respectful and
responsive to diverse patients, disparities decrease and access to
quality care increases. Other benefits of culturally appropriate
care include improved patient data collection, increased
preventative care, increased cost savings and reduced number of
missed medical visits."
2. Background.
a) Culturally and Linguistically Appropriate Care. For millions
of Californians, comprehensive access to healthcare depends on
professionals who can provide culturally and linguistically
appropriate medical services. California collects data on
healthcare occupations, but current data is insufficient for
determining the state's capacity to address the needs of our
diverse population, in particular language access.
Research indicates that a failure to provide adequate language
access can result in dire consequences. Language barriers can
contribute to inadequate patient evaluation and diagnosis, lack
of appropriate and/or timely treatment and other medical errors
that can jeopardize patient safety and lead to unnecessary
procedures and costs. Although the state is acutely aware of its
diverse needs, the limited English-proficient enrollees of the
state's seven largest health plans still report more problems
understanding their physician than their English proficient
counterparts (11.2% vs. 2.6%). They are also more likely to
believe they would have received better care if they were of a
different race/ethnicity (14% vs. 3.2%).
b) OSHPD and The Healthcare Workforce Clearinghouse (HWC). The
HWC, housed within OSHPD, is tasked with collecting and analyzing
data on health care occupations. However, race, language capacity
and gender demographic information for many important allied
health professions is incomplete or uncollected. OSHPD does not
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receive key data from licensees of the California Respiratory
Care Board, Physician Assistant Committee, and the California
Board of Vocational Nurses and Psychiatric Technicians. Health
professionals governed by these boards are responsible for
critical patient needs, such as measurement of vital signs and
basic client assessments. They interact with nearly all patients
visiting a physician and often provide care to the most sensitive
patients in our population.
For 2014, the Healthcare Workforce Clearinghouse will produce an
in-depth report on physician assistants based on 2013 survey data
collected by the California Academy of Physician Assistants
(CAPA). This report will be an expansion of the current Survey
Snapshot: Physician Assistants. It is unclear if this will be a
continuing partnership that will be able to provide annual data.
The new report for 2014 will include race/ethnicity and languages
spoken.
c) Department of Consumer Affairs Health Boards. Several boards
under the DCA collect information which is utilized by OSHPD.
For example, the Medical Board and Dental Board already report
languages spoken, race and gender information. However, other
boards collect and report different types of data. Below is a
list of the entities that would be impacted by this bill. The
data that each entity collects is outlined.
Board of Vocational Nurses and Psychiatric Technicians
Collects:
Current supply of providers by County
Age
Educational Programs Available in the State - public
and private
Partially Collects:
Gender. (Licensed Vocational Nurses (LVNs) and
psychiatric technicians are not required to report gender.
Less than 1% of LVNs report their gender and 77% of
psychiatric technicians did not report their gender.)
Does Not Collect:
Race/ethnicity
Languages Spoken
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California Respiratory Care Board
Collects:
Current supply of providers by County
Age
Educational Programs Available in the State
Number of RCP degrees awarded
Partially Collects:
Gender. (39% of Respiratory Care Practitioners do
not report their gender.)
Does Not Collect:
Race/ethnicity
Languages Spoken
Physician Assistant Committee
Collects:
Current supply of providers by County
Age
Educational Programs Available in the State
Number of graduates annually
Partially Collects:
Gender. (64% of Physician Assistant's gender is not
publicly reported.)
Does Not Collect:
Race/ethnicity
Languages Spoken
California Board of Registered Nursing
Collects:
Current supply of providers by County
Educational Programs Available in the State
Work setting
5 year employment goals
Gender. (This information is being collected as a
partnership with UCSF Center for Health Professions. The
survey is not mandatory.)
Unclear if collected:
Race/ethnicity
Languages Spoken
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Age
1. Arguments in Support. The California Pan-Ethnic Health Network
(Sponsor), and a host of other supporters of the bill including:
Having Our Say , Asian Law Alliance , Health House Within a MATCH
Coalition , Street Level Health Project, California Mental Health
Connection, Families in Good Health , Asian Pacific Policy &
Planning Council , Asian & Pacific Islander American Health Forum ,
The Greenlining Institute , Borrego Community Health Foundation, St.
John's Well Child & Family Center , Southeast Asia Resource Action
Center , Korean Resource Center and the Asian American Advancing
Justice- Los Angeles . These organizations similarly write in their
letters, "AB 2102 builds upon previous legislation that established
policies for the collection of demographic data on physician and
dentists. This bill requires boards under the Department of
Consumer Affairs to collect demographic data on registered nurses,
nurse practitioners, vocational nurses, physician assistants,
respiratory care providers and psychiatric technicians. AB 2102
will give California a more accurate picture of the geographic,
cultural and linguistic gaps in the health care workforce. The
data will also inform a more targeted approach to strengthen the
workforce."
The UDW/AFSCME Local 3930 also supports the bill and writes, "AB
2102 seeks to provide important demographic information to ensure
that our workforce effectively meets the growing needs of our
racially and ethnically diverse patient population."
The ACLU of California writes, "Health care access should be
guaranteed- and accessible- to all residents. The failure to meet
people's linguistic and cultural needs creates barriers to services
that can negatively affect health outcomes of already marginalized
groups. Racial disparities in health care access and outcomes are
inconsistent with American principles of fairness and equality."
The Latino Coalition for a Healthy California also writes, "AB 2102
aligns with our mission and builds off an existing practice to
assure we collect demographic data from fee-supported boards on
allied health professions in order to provide culturally and
linguistically appropriate quality care to all Californians. We
are committed to address workforce deficiencies for cultural
linguistically specific subpopulations that have traditionally
faced barriers to quality care, including Spanish speaking, Latino
communities."
The California Academy of Physician Assistants supports the bill
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and writes in their letter, "Consistent, reliable health workforce
data is critical to planning and allocating resources dedicated to
building a strong primary and specialty care health workforce in
the state."
The Disability Rights Education & Defense Fund also supports the
bill. In their letter they write, "The expansion of Medicaid for
low-income individuals and the development of federal and state
marketplaces under the Affordable Care Act (ACA) are bringing
healthcare coverage to millions of previously uninsured
individuals. This single fact means that, even as the state faces
projected shortages in its healthcare workforce, there will be an
increase in the demand for healthcare from people who cannot get
their routine preventive services and ongoing serious and/or
chronic concerns addressed. Moreover, there are additional factors
that illustrate how California's healthcare workforce not only
needs to grow merely to keep up with demand, but must grow in
specific ways to serve its diverse population."
SUPPORT AND OPPOSITION:
Support:
American Civil Liberties Union of California
Asian & Pacific Islander American Health Forum
Asian Americans Advancing Justice- Los Angeles
Asian Law Alliance
Asian Pacific Policy & Planning Council
Borrego Community Health Foundation
California Mental Health Connection
California Pan-Ethnic Health Network (Sponsor)
Disability Rights Education & Defense Fund
Families in Good Health
Having Our Say
Health House Within a MATCH Coalition
Korean Resource Center
Latino Coalition for a Healthy California (Sponsor)
Southeast Asia Resource Action Center
St John's Well Child & Family Center
Street Level Health Project
The Greenlining Institute
United Domestic Workers of America
WellSpace Health
51 individuals
Opposition:
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None received as of June 18, 2014
Consultant:Le Ondra Clark, Ph.D.