BILL ANALYSIS Ó
-----------------------------------------------------------------
|SENATE RULES COMMITTEE | SB 337|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
-----------------------------------------------------------------
UNFINISHED BUSINESS
Bill No: SB 337
Author: Pavley (D)
Amended: 9/1/15
Vote: 21
SENATE BUS, PROF. & ECON. DEV. COMMITTEE: 9-0, 4/20/15
AYES: Hill, Bates, Berryhill, Block, Galgiani, Hernandez,
Jackson, Mendoza, Wieckowski
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SENATE FLOOR: 38-0, 5/26/15
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Fuller, Gaines, Galgiani, Hancock,
Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno,
Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Moorlach,
Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Runner, Stone,
Vidak, Wieckowski, Wolk
NO VOTE RECORDED: Hall
ASSEMBLY FLOOR: 80-0, 9/3/15 - See last page for vote
SUBJECT: Physician assistants
SOURCE: California Academy of Physician Assistants
DIGEST: This bill provides two additional mechanisms for a
supervising physician and surgeon to ensure adequate supervision
of a physician assistant (PA) functioning under the protocols.
Assembly Amendments clarify that medical review meetings may
occur in person or by electronic communication and specify how
often a medical records review meeting must occur and in what
manner.
SB 337
Page 2
ANALYSIS:
Existing law:
1)Establishes the Physician Assistant Board within the
jurisdiction of the Medical Board of California (MBC) to
administer and enforce the Medical Practice Act. (Business
and Professions Code (BPC) § 3504)
2)Requires a PA and his or her supervising physician to
establish written guidelines for the adequate supervision of
the PA, and the requirement may be satisfied by the
supervising physician adopting protocols for some or all of
the tasks performed by the PA. (BPC § 3502 (c)(1))
3)Requires a supervising physician to review, countersign, and
date a sample consisting of, at a minimum, five percent of the
medical records of patients treated by the PA within 30 days
of the date of treatment. Requires the supervising physician
to select for review those cases that by diagnosis, problem,
treatment, or procedure represent the most significant risk to
the patient. (BPC § 3502 (c)(2))
4)Requires a supervising physician who delegates the authority
to issue a drug order to a PA to prepare and adopt a formulary
and protocols that specify all criteria for the use of a
particular drug of device, and any contraindications for the
selection. Protocols for Schedule II controlled substances
shall address the diagnosis of illness, injury, or condition
for which the Schedule II controlled substance is being
administered, provided, or issued. (BPC § 3502.1(a)(2))
5)Requires a supervising physician to review and countersign
within seven days the record of any patient cared for by a PA
for whom the PA's Schedule II drug order has been issued or
carried out. (BPC § 3502.1 (e))
This bill:
1)Defines "medical records review meeting" as a meeting between
the supervising physician and surgeon and the PA during which
SB 337
Page 3
medical records are reviewed to ensure adequate supervision of
the PA functioning under protocols. Medical records review
meetings may occur in person or by electronic communication.
2)Requires that the medical record identify the physician and
surgeon who is responsible for the supervision of the PA for
each episode of patient care.
3)Authorizes a supervising physician and surgeon to conduct a
medical records review meeting at least once a month during at
least 10 months of the year. During any month in which a
medical records review meeting occurs, the supervising
physician and surgeon and PA shall review an aggregate of at
least 10 medical records of patients treated by the PA
functioning under protocols. Documentation of medical records
reviewed during the month shall be jointly signed and dated by
the supervising physician and surgeon and the PA.
4)Authorizes a supervising physician and surgeon to conduct a
medical records review by reviewing a sample of at least 10
medical records per month, at least 10 months during the year,
using a combination of the countersignature mechanism and the
medical records review meeting mechanism, as specified.
5)Authorizes a supervising physician and surgeon to review,
countersign, and date, within seven days, a sample consisting
of the medical records of at least 20 percent of the patients
cared for by the PA for whom the PA's Schedule II drug order
has been issued or carried out, if the PA has documentation
evidencing the successful completion of an education course
that covers controlled substances, and that controlled
substance education course meets specified standards.
6)Makes technical changes.
Background
SB 337
Page 4
According to the author, "This bill is also needed to address an
issue related to co-signatures on Schedule II medications. In
August of 2014 the DEA published a final rule, effective October
6, 2014, following recommendations from the U.S. Food and Drug
Administration (FDA) to up-schedule or reclassify hydrocodone
combination products (HCP) from a Schedule III controlled
substance to a Schedule II. The rescheduling of HCPs has had a
significant impact, and unintended consequence, on some
practices throughout California as existing law requires a 100%
physician co-signature requirement on these medications within
7 days. This can be particularly challenging for practices that
employ PAs to practice medicine in areas such as pain
management, orthopedics, general surgery and several other
practice types. The new ruling restricts the ability of a
practice to fully utilize the PAs they employ as there is no
other profession with prescribing privileges that has that level
of mandate for documentation. Further, a co-signature mandate
of 100% is overly burdensome for physicians in various practice
types.
"Existing law requires a supervising physician to be available
in-person or through electronic communication at all times when
a PA is providing care for a patient. Given the many models of
team-based care supervising physicians and PA often practice at
different locations and lead PA run clinics as well as assume
significant administrative responsibilities. In this context, a
100% mandate on co-signatures creates a barrier to efficient
team-based care and stands to jeopardize access to appropriate
treatment of pain for those patients with legitimate need."
A PA performs many of the same diagnostic, preventative and
health maintenance services as a physician, but PAs are limited
in practice to those duties delegated by a supervising
physician. These services may include, but are not limited to,
the following:
Taking health histories.
Performing physical examinations.
Ordering X-rays and laboratory tests.
Ordering respiratory, occupational, or physical therapy
treatments.
SB 337
Page 5
Performing routine diagnostic tests.
Establishing diagnoses.
Treating and managing patient health problems.
Administering immunizations and injections.
Instructing and counseling patients.
Providing continuing care to patients in the home, hospital,
or extended care facility.
Providing referrals within the health care system.
Performing minor surgery.
Providing preventative health care services.
Acting as first or second assistants during surgery.
Responding to life-threatening emergencies.
A PA must attend a specialized medical training program
associated with a medical school that includes classroom studies
and clinical experience. An academic degree and/or certificate
is awarded upon graduation. Many PAs already have two- or
four-year academic degrees before entering a PA training
program. Most PA training programs require prior health care
experience. As of June 2013, there were 9,101 active California
PA licensees.
Supervision. Existing law has very specific requirements for a
supervising physician to delegate practice authority to a PA,
and the supervising physician must be physically or
electronically available to his or her PA at the time of
treatment. In addition to this, a supervising physician must
review, countersign, and date a sample of at least five percent
of a PA's cases within 30 days of treatment.
The author argues that the five percent review requirement is
outdated and unnecessary, given the close working relationship
between PAs and physicians and existing delegation of service
agreements and protocols. This bill provides two additional
mechanisms for a supervising physician to ensure adequate PA
supervision, and establishes an additional method to supervise a
PA's furnishing of Schedule II drugs.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
SB 337
Page 6
According to the Assembly Appropriations Committee, this bill
will have minor and absorbable costs to the Physician Assistant
Board within the MBC to conform to the new supervision options
(Physician Assistant Fund).
SUPPORT: (Verified9/3/15)
California Academy of Physician Assistants (source)
California Academy of Family Physicians
CAPG
Medical Board of California
Pacific Pain Medicine Consultants
Pacific Southwest Pain Center
Physician Assistant Board
Planned Parenthood Affiliates of California
OPPOSITION: (Verified9/3/15)
None received
ARGUMENTS IN SUPPORT: The source of this bill, the California
Academy of Physician Assistants, write, "With the implementation
of the Patient Protection and Affordable Care Act, Covered
California reported enrolling 3.4 million (1.4 through Covered
CA plans and 1.9 in Medi-Cal) previously uninsured people in the
first open enrollment year (2014). This bill recognizes the
need to increase access to high quality, cost-effective and
efficient team-based practice across all medical settings in
order to meet the rising demand for health care services
throughout the state.
"The physician/PA team is unique as PAs are licensed health
professionals who practice medicine as members of a
physician-led team, delivering a broad range of medical and
surgical services at the direction of and under the supervision
of his or her supervising physician. The supervising physician
delegates to a PA specified medical tasks and procedures,
consistent with his or her scope of practice, based on
SB 337
Page 7
education, training and experience.
"Established over 30 years ago, existing law stipulates
supervision criteria between a supervising physician and surgeon
and the Physician Assistant (PA). It narrowly defines
documentation of this required supervision in the form of the
supervising physician co-signature on the medical record. SB
377 increases the options for documenting supervision between a
supervising physician and PA would allow for flexibility at the
practice level to reflect current models of team-based care."
ASSEMBLY FLOOR: 80-0, 9/3/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,
Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,
Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder,
Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina,
Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen,
Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins
Prepared by:Sarah Huchel / B., P. & E.D. / (916) 651-4104
9/3/15 18:47:36
**** END ****