BILL ANALYSIS Ó SB 337 Page 1 SENATE THIRD READING SB 337 (Pavley) As Amended June 16, 2015 Majority vote SENATE VOTE: 38-0 ------------------------------------------------------------------ |Committee |Votes|Ayes |Noes | | | | | | | | | | | | | | | | |----------------+-----+----------------------+--------------------| |Business & |14-0 |Bonilla, Jones, | | |Professions | |Baker, Bloom, Campos, | | | | |Chang, Dodd, Eggman, | | | | |Gatto, Holden, | | | | |Mullin, Ting, Wilk, | | | | |Wood | | | | | | | |----------------+-----+----------------------+--------------------| |Appropriations |14-0 |Gomez, Bigelow, | | | | |Bloom, Bonta, | | | | |Calderon, Chang, | | | | |Eggman, Gallagher, | | | | | | | | | | | | | | |Eduardo Garcia, | | | | |Jones, Quirk, Rendon, | | | | |Weber, Wood | | SB 337 Page 2 | | | | | | | | | | ------------------------------------------------------------------ SUMMARY: Authorizes a physician supervising a physician assistant (PA) to use two additional mechanisms for the general supervision of a PA, authorizes a physician to use one additional mechanism for the supervision of a PA that administers a Schedule II controlled substance, and requires a PA's patient medical records to identify the PA's supervising physician. Specifically, this bill: 1)Revises the definition of "medical records review meeting" to mean a meeting between the supervising physician and the PA during which medical records are reviewed to ensure adequate supervision of the PA functioning under protocols. 2)Authorizes the supervising physician and PA to hold medical records review meetings in person or by electronic communication. 3)Requires the medical record, for each episode of care for a patient, to identify the physician who is responsible for the supervision of the PA. 4)Authorizes a physician to choose from two additional mechanisms to supervise a PA, making a total of three mechanisms: a) Conduct a medical records review meeting at least once a month during at least 10 months of the year-any month in which a medical records review meeting occurs, the supervising physician and PA must review an aggregate of at least 10 medical records of patients treated by the PA. Documentation of medical records reviewed during the month SB 337 Page 3 must be jointly signed and dated by the supervising physician and the PA. b) Develop review methods for the review of cases involving treatment by the PA. The review methods must be identified in the delegation of services agreement and include at least an aggregate of 10 cases per month for at least 10 months of the year. Documentation of the cases reviewed during the month must be jointly signed and dated by the physician and PA. 5)States that, in complying with the supervision requirements 4) above, the physician must select for review those cases that by diagnosis, problem treatment, or procedure represent, in the physician's judgment, the most significant risk to the patient. 6)States that compliance with Business and Professions Code (BPC) Section 3502 (numbers 3), 4), and 5) above) will be also considered compliance with section 1399.546 of Title 16 of the California Code of Regulations. 7)Authorizes a physician to use an additional mechanism for the supervision of a PA that prescribes a Schedule II controlled substance. The physician may review, countersign, and date, within seven days, a sample consisting of the medical records of at least 20% of the patients with the PA's Schedule II prescriptions if: a) The PA has: i) Completed a controlled substances education course that meets the standards established in the PAB's regulations and is provided either by an accredited continuing education provider or by an approved physician assistant training program; or, ii)The PA has a certificate of completion of the course described BPC Section 3502.1(c)(2); and, SB 337 Page 4 b) The supervision is verified and documented in the manner established by the PAB's regulations. 8)Makes other minor technical and clarifying changes. FISCAL EFFECT: According to the Assembly Appropriations Committee, this bill will result in minor and absorbable costs to the Physician Assistant Board (PAB) within the Medical Board of California to conform to the new supervision options. COMMENTS: Purpose. This bill is sponsored by the California Academy of Physician Assistants. According to the author, "[This bill] increases options for the physician/PA team to document supervision. The options included in the bill will strengthen the team-based approach by encouraging more active discussion during the records review. "The Patient Protection and Affordable Care Act has resulted in millions of additional people seeking health care services in California. This increase has created an even greater need for high quality, efficient team-based care across all medical settings. "This is especially true for the practice of physician assistants, who are authorized to provide physician exams, diagnose and treat illness, and prescribe medication, under the supervision of a physician. [This bill] recognizes the growing changes in medical practice settings and the use of electronic medical records to update methods for documentation of the supervision of PAs and encourages more interactive review of patient cases." Background. Existing law requires a PA's supervising physician SB 337 Page 5 to countersign a sample of at least five percent of the medical records of patients treated by the PA within 30 days of the date of treatment. According to the author, the requirement does not accommodate many care delivery models. Therefore, this bill seeks to add two additional mechanisms which provide a supervising physician more options to adequately supervise a PA depending on the care delivery model. Supervision of Controlled Substances. Under existing law, a physician must countersign the medical record of all the PA's patients within seven days of prescribing the drug for Schedule II controlled substances. Because existing law allows a physician to provide supervision electronically, the author states that PA-lead clinics may be unable to provide Schedule II drugs (such as hydrocodone combination product drugs like Vicodin) if the physician must be physically available to countersign the medical records within seven days for every prescription. Therefore, this bill seeks to provide an additional supervision mechanism for Schedule II drugs. For a full discussion of this bill, please see the policy committee analysis. Analysis Prepared by: Vincent Chee / B. & P. / (916) 319-3301 FN: 0001848 SB 337 Page 6