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Joelseff

Who's Down Wid OTP in Cali?

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From CAPA:

 

CAPA’s OTP Legislation Introduced in California Legislature

 

CAPA’s sponsored legislation to reform PA practice and improve healthcare access via the principles of Optimal Team Practice (OTP) has been introduced in the California Legislature. SB 697 (Caballero), seeks to amend the PA Practice Act in the Business and Professions Code to:

Allow PAs to work collaboratively within the healthcare team under practice agreements with the medical groups, clinics, or other employers.

Eliminate disincentives to employ PAs by ending archaic physician supervision requirements, such as delegation of services agreements (DSAs) and physician-to-PA ratios.

Demonstrate the value PAs provide by requiring transparent billing for PA services.

Promote the professional standing of PAs by establishing an independent licensing board.

 

CAPA will be advocating for SB 697 on all fronts: in the Capitol and in legislative districts, many of which have inadequate access to care and numbers of healthcare professionals – two problems that can be addressed by building a stronger PA profession. CAPA, will also advocate for the bill with a press campaign aimed at building awareness among legislators, other stakeholders and the general public. We’ll need CAPA members to help – by contacting their local representatives, alerting their PA colleagues and educating the physicians and other healthcare professionals with whom they work about the merits of OTP.

 

SB 697 will likely get its first hearing in the Senate Business and Professions Committee at the end of March or early April. CAPA members should stay tuned. We’ll let you know soon how you can help!

 

 

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I'm eagerly following along! Just sent emails to my local reps and I've got the petition printed out for my SP to sign ASAP. We're a PA-heavy practice in the LA area, so I know that we're all big supporters here

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SO it looks like it passed with *some* revisions.. a lot actually. I haven't read through all of it yet but seems like they kept "supervision" and all that that implies and only really removed the DSA in favor of a "practice agreement" which at least is defined by the practice vs the state...I think that's what happened...anyhoo here is the comparison between the original bill vs the amended bill:

http://leginfo.legislature.ca.gov/faces/billVersionsCompareClient.xhtml?bill_id=201920200SB697&cversion=20190SB69799INT

 

This kind of takes the wind out of my sails a little:

The PA renders the services under the supervision of a licensed physician and surgeon who is not subject to a disciplinary condition imposed by the Medical Board of California or by the Osteopathic Medical Board prohibiting that supervision or prohibiting the employment of a physician assistant. 

Looks like nothing really changed as far as autonomy...

 

Also they took this whole section out which included direct billing and reimbursement etc: 

 

(M) Prescribe, dispense, order, administer, and procure drugs and medical devices pursuant to Section 3502.1.
(N) Plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, nutrition, blood and blood products, and diagnostic support services, which include, but are not limited to, nursing, home health care, hospice, and physical and occupational therapy.
(b) A PA is authorized to bill for and receive direct payment for the medical services the PA provides.
(1) Payment for services within a PA’s scope of practice shall be made when ordered or performed by a PA, if the same service would have been covered if ordered or performed by a physician and surgeon.
(2) To ensure accountability and transparency for patients, payers, and the health care system, a PA shall be identified as the rendering professional in the billing and claims process when a PA delivers medical or surgical services to a patient.
(3) An insurance company, state governmental payer, or third-party payer shall not impose a practice, education, payment, or supervision requirement that is inconsistent with, or more restrictive than, this chapter or regulations issued pursuant to this chapter or that discriminates against legally qualified PAs based solely on their license.
(4) To facilitate more flexible employment arrangements, including, but not limited to, when a PA works with a staffing company or in a medical group structure, the PA may reassign the PA’s direct payment to the PA’s employer.
(c) A PA shall practice and collaborate in accordance with the practice agreement or an organized health care practice setting’s established internal processes, by consulting with or referring to, or both, the appropriate member or members of a health care team as indicated by the patient’s condition. This shall be done in a manner consistent with the education, training, experience, and competencies of the PA and the standard of care. A PA shall refer a patient to a physician and surgeon or other licensed health care provider if a situation or condition of the patient is beyond the scope of the education and training of the PA.
(d) (1) The degree of collaboration shall be outlined in the practice agreement, which shall be signed by both the PA and one or more physicians and surgeons and kept on file at the practice location. The practice agreement shall contain all of the following:
(A) The agreed upon process to ensure adequate communication, availability, and consultation between the physician and surgeon and PA in the provision of medical services to patients. This process should be customized based on the knowledge and skills of the PA and physician and surgeon consistent with their education, training, and experience.
(B) Patient referral and consultation.
(C) Emergency coverage for absences of a PA, including another PA or physician and surgeon.
(D) Methods for the continuing evaluation of the competency and qualifications of the PA.
(E) Guidelines for prescriptions.
(F) Any additional provisions, as agreed to by the PA and physician and surgeon.
(2) Any reference to “protocols” or “delegation of services agreement” in any law or regulation that references this chapter shall have the same meaning as “practice agreement,” as defined in Section 3501, or the established internal process for collaboration in any of the organized healthcare practice settings described in subdivision (e).
(e) (1) Notwithstanding subdivision (d), a PA providing medical services in one of the organized health care practice settings in paragraph (2) is exempt from the requirement to execute a practice agreement under subdivision (d) and instead shall collaborate utilizing the practice setting’s established internal process for determining the role and responsibilities for the PA based on the PA’s training, experience, qualifications, and competency.
 
That's a lot of Red!
 
But this seems like one of the few positives:
 
Nothing in statute or regulations shall require that a physician and surgeon review or countersign a medical record of a patient treated by a physician assistant, unless required by the practice agreement. The board may, as a condition of probation of a licensee, require the review or countersignature of records of patients treated by a physician assistant for a specified duration. 
 
So don't know what to make of it...What do you guys think? 
Edited by Joelseff

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better luck next year? 
 

Hope so but I will ask CAPA at this year's conference. I plan on going in August

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There is a post on the Huddle about this and there are only 3 posts on that thread... Its been a week since this development and I haven't even received a CAPA propaganda email about the development... On the huddle no posts from CAPA reps... Is the silence deafening?

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Update from CAPA:

 

https://capanet.org/2019/08/sb-697-update/

 

First off, We did not and will not get OTP in California this year.... There are definitely changes to SB697 which I was told was necessary because the legislature was going to kill it outright. They presented it at the CAPA conference in San Diego 2 weeks ago as "parity with NPs but not OTP." I assume because NPs don't have independence yet in California. I spoke with a few of the officials at CAPA who were tight lipped but I got the impression that if NPs gain independence here, they will push for that for us as well and this current bill will get our foot in the door.

 

I do think it's still better than nothing (which we have now) and would relieve restrictions at the practice level though I see most corporate health systems and larger physician group practices not changing much. Currently I work for a 10 provider practice (7 docs, 1 NP and 2 PAs) and the NPs and PAs have the same restrictions for cosignature etc. We have the same scope as well. Last place I worked (corporate 2 hospital system) had hundreds of providers and again, NPs and PAs had the same restrictions in outpatient while we PAs enjoyed the ability to work in ED and OR and FNPs were not allowed to round on inpatients but PAs were (this was defined by the practice/system). What I see this modified OTP as is just making this the law in California in all settings (make the practice define the role) so this part of OTP is preserved. I would have liked the direct billing part etc but I think we have to take one bite at a time. NPs have yet to win independence despite a yearly attempt for the past decade. Don't get me wrong, I'm all for it if they do so we can follow suit and use them as precedence).

 

Still a step forward is a step forward...

 

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