BILL ANALYSIS Ó
SB 337
Page 1
SENATE THIRD READING
SB
337 (Pavley)
As Amended September 1, 2015
Majority vote
SENATE VOTE: 38-0
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+-----------------------+---------------------|
|Business & |14-0 |Bonilla, Jones, Baker, | |
|Professions | |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 | |
| | | | |
| | | | |
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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
must be jointly signed and dated by the supervising
physician and the PA.
b) Use a combination of the two other mechanisms - the
existing 5% countersignature mechanism and the new medical
SB 337
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records review mechanism. During each month for which a
sample is reviewed, the physician must:
i) Review at least one of the medical records in the
sample using the existing five percent countersignature
mechanism; and,
ii)Review at least one of the medical records in the sample
using the new medical records review method.
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
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described BPC Section 3502.1(c)(2); and,
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."
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Background. Existing law requires a PA's supervising physician
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:
0001907
SB 337
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