California ACEP opposed SB 697

[PACali]

Just got this email from one of the physicians I work with. She actually supports SB 697. California Academy of Emergency Physician (ACEP) members are getting an email to oppose  SB 697, which I am not surprised. We are doing something progressive, there will be resistance for sure. I am doing my part to educate my physician colleagues that we want to eliminate the requirement of Delegation of Service Agreement (DSA) and the scope of practice for a PA will determine at the practice level instead of at the state level.  Calfornia NPs do not need a DSA to practice.  but I still think we need an official response from California Academy of PA (CAPA) or PA for Tomorrow.

 

Edited March 31, 2019 by PACali

[LT_Oneal_PAC]

Is anyone surprised by this? Individual physicians in the trenches are our friends, never organizations.

[PACali]

Not surprised, that just how politic is. But I do think we need to educate our "actual" physician colleagues who valued us that passing SB 697 will not make them get fired and be replaced by PAs. We are simply trying to eliminate the administrative burden here in California. The NPs here in California does not require a Delegated Service Agreement (DSA) to practice. 

[LT_Oneal_PAC]

54 minutes ago, PACali said:

Not surprised, that just how politic is. But I do think we need to educate our "actual" physician colleagues who valued us that passing SB 697 will not make them get fired and be replaced by PAs. We are simply trying to eliminate the administrative burden here in California. The NPs here in California does not require a Delegated Service Agreement (DSA) to practice. 

A worthy effort. I don’t think it will work though. They haven’t listened yet and don’t think they will.

 

Edit to add: I see you were speaking about those who previously supported us. I think that is very worthy and would do some good.

[lemurcatta]

Did you send this on to CAPA?

 

[spflynn4]

Would it help to send ACEP a link to both bills being considered? It seems as though everybody would prefer OTP over a full push for independence, but I wonder if it might be a moot point to convince an organization that sounds like they've made up their mind. 

[PACali]

On 3/30/2019 at 10:40 PM, lemurcatta said:

Did you send this on to CAPA?

 

Already sent it to CAPA and PAFT. 

I agree with LT_Oneal_PAC. Some people are just going to oppose anything we do to advance the profession and I am not surprised at all. But for those who are supporting us or at least willing to listen, we need to try very hard to educate and reinforce the value of OTP.  

[sas5814]

PAFT is discussing the issue as we speak.

CAEM is on a national march to impede OTP because they don't understand it. More education and communication is needed.

 

Edited April 4, 2019 by sas5814
Duh...

[Guest Paula]

4 hours ago, sas5814 said:

PAFT is discussing the issue as we speak.

CAPA is on a national march to impede OTP because they don't understand it. More education and communication is needed.

 

What?  CAPA is opposing OTP?  Are you kidding?  When you say CAPA are you referring to the California PA Association?  

[sas5814]

Sorry...mixed my acronyms. The ER physicians groups nationally and by default the states

Their national group has already published a statement opposing OTP and now one by one the state orgs are following.

[Guest Paula]

thanks for clearing that up, Scott.  That means the WI ACEP chapter will likely oppose our bill.  The discussion has been had with them by our President and they seemed supportive.  We are getting prepared for the groups that will oppose us too.

 

I sure hope CAPA prevails.  

[sas5814]

Let me add their opposition is not specifically about OTP but more a statement that ER teams should be led by ER physicians. I believe that with some soothing talk and explanation about what OTP is and isn't they might soften their stance.

[MediMike]

I hope so! I wandered into a discussion on SDN and man. oh. man.

I've always heard about how toxic it is but I was blown away by the ED MDs perspectives (or at least this small sample)

Best of luck to you all!!!

[KpsPac]

13 hours ago, Paula said:

 That means the WI ACEP chapter will likely oppose our bill.  

13 hours ago, Paula said:

 

I think we should assume all states’ ACEP will oppose what they consider an expansion of scope. 

Education is needed within our own ranks, so it would stand to reason that those who are worried about their turf would need extra schooling. 

[PACali]

5 hours ago, KpsPac said:

I think we should assume all states’ ACEP will oppose what they consider an expansion of scope. 

Education is needed within our own ranks, so it would stand to reason that those who are worried about their turf would need extra schooling. 

Agree. 

Just to put it into perspective the NP passed Full Practice Authority last year in Illinois. Illinois is the home of AMA. 

https://www.americanmedspa.org/blogpost/1633466/306570/Med-Spa-Law-Update-Illinois-Nurse-Practitioners-and-Full-Practice-Authority

 

[PACali]

 

Just got an email from CAPA, they are aware of the recent opposition from some physician organizations and they are working on meeting with the stakeholders to make sure they understand the intention of SB 697. SB 697  is scheduled to be heard on April 22, 2019 in the Senate Business and Profession Committee. It looks like the senators from this committee will ultimately decide the outcome of the bill. Please spend one minute to email and asking them to vote yes on SB 697. Here is the link of those senators  https://sbp.senate.ca.gov/

I also there started a FB page about OTP in California just to spread the news. fb.me/OTPCAPAS 

There are still many PAs don't know what is going on. We need all hands on deck. 

 

 

[KpsPac]

https://pasfortomorrow.org/membership/

 

PAFT sent an open letter to the Exec Dir of CA ACEP at the request of members.

Want to make a change? We do!

Join us.

 

 

Dr. Frank Crosby, DHSc, PA-C, President       

 

Katie Dore, MHS, PAC-Vice President	Todd Kielman, MPAS, PA-C President Elect
Dr. Eric Holden, DHSc, PA-C, Past President	Kris Pyles-Sweet, MS, PA-C, Treasurer
Nichole Bateman, MPAS, PA-C, Secretary	Dr. Scott Stegall, PhD, PA-C, Director
Tessa Roulston, MS, MPAM, PA-C, Director	Nina Ong, PA-S, Student Director
Sara Young, PA-S, Student Director

 

April 9, 2019

Elena Lopez-Guzman, Executive Director California ACEP

Subject:  An open letter to California ACEP

                PAs for Tomorrow (PAFT) believes in action, terminology, and legislation removing barriers to efficient PA practice, allowing us to work closely with medical teams more effectively.  We support California SB 697 and believe that California ACEP would support it if you had a full understanding of what Optimal TEAM practice truly is.  On behalf of PAFT’s California-based members, we take umbrage at California ACEP providing misinformation to emergency physicians across the state.  We respectfully request that California ACEP support this bill as written, and provide accurate OTP information to the emergency physicians of your state, not simply scare tactics without evidence-based information.  There is a significant difference between legislatively-mandated supervision and collaboration requirements set at the medical organization level.  In fact, legislatively-mandated supervision takes away from medical director’s and department head’s ability to manage an emergency department, clinic, private practice, urgent care center, or hospital in the manner the medical staff deems best for that practice.

                It is clear that California ACEP leadership does not understand that removal of legislatively mandated supervision is NOT a call for PA independence.  Consider it to be a call for team-based patient care with the degree of medical team member oversight determined at the practice level.  Should the State of California tell emergency medicine physicians just how many PAs they are allowed to supervise, or should that determination be made by the physicians at the practice level?  Should the State of California tell medical directors how to manage and supervise any member of the health care team, or should medical directors determine that?  Removing legislatively-mandatedsupervisory requirements does not change the CLINICAL WORKING-RELATIONSHIP in any clinic setting.  PAs still practice as they do now, they still collaborate with other members of the medical team, and they make medical decisions and dispositions in accordance with clinic/hospital policy and accepted standard of care.  The difference is that there is less liability directed toward the “supervising” physician.  

                Did you know that there are 32 military bases in the State of California?  Did you know that military PAs do not have regulations (legislative requirements) for mandated supervision?  They may collaborate on an as needed basis with physicians (including specialists) and other team members. They, just as with civilian PAs, are required to meet the same standard of care as physicians.  Should a PA’s failure to meet that standard of care be held against a legislatively mandated supervisor, who may never have seen the patient or the chart?

                Your letter to physicians across the state indirectly implies that physicians do not require supervision.  Does that hold true for interns as well?  Residents?  The reality is that interns and residents are part of the medical care team.  They require supervision, but not legislatively-mandated supervision.  

PAs for Tomorrow (PAFT) is a professional group of PAs committed to the idea that the PA profession must present itself accurately, as autonomous professionals, to survive and prosper in the future medical care marketplace.  

 

Respectfully,

 

Dr Frank Crosby, DrHSc, PA-C

President, PAs for Tomorrow
pasfortomorrow.org
fcpresident@pasfortomorrow.org
 

 

 

 

Edited April 10, 2019 by KpsPac

[PACali]

On 4/9/2019 at 9:39 PM, KpsPac said:

https://pasfortomorrow.org/membership/

 

PAFT sent an open letter to the Exec Dir of CA ACEP at the request of members.

Want to make a change? We do!

Join us.

 

 

Dr. Frank Crosby, DHSc, PA-C, President       

 

Katie Dore, MHS, PAC-Vice President	Todd Kielman, MPAS, PA-C President Elect
Dr. Eric Holden, DHSc, PA-C, Past President	Kris Pyles-Sweet, MS, PA-C, Treasurer
Nichole Bateman, MPAS, PA-C, Secretary	Dr. Scott Stegall, PhD, PA-C, Director
Tessa Roulston, MS, MPAM, PA-C, Director	Nina Ong, PA-S, Student Director
Sara Young, PA-S, Student Director

 

April 9, 2019

Elena Lopez-Guzman, Executive Director California ACEP

Subject:  An open letter to California ACEP

                PAs for Tomorrow (PAFT) believes in action, terminology, and legislation removing barriers to efficient PA practice, allowing us to work closely with medical teams more effectively.  We support California SB 697 and believe that California ACEP would support it if you had a full understanding of what Optimal TEAM practice truly is.  On behalf of PAFT’s California-based members, we take umbrage at California ACEP providing misinformation to emergency physicians across the state.  We respectfully request that California ACEP support this bill as written, and provide accurate OTP information to the emergency physicians of your state, not simply scare tactics without evidence-based information.  There is a significant difference between legislatively-mandated supervision and collaboration requirements set at the medical organization level.  In fact, legislatively-mandated supervision takes away from medical director’s and department head’s ability to manage an emergency department, clinic, private practice, urgent care center, or hospital in the manner the medical staff deems best for that practice.

                It is clear that California ACEP leadership does not understand that removal of legislatively mandated supervision is NOT a call for PA independence.  Consider it to be a call for team-based patient care with the degree of medical team member oversight determined at the practice level.  Should the State of California tell emergency medicine physicians just how many PAs they are allowed to supervise, or should that determination be made by the physicians at the practice level?  Should the State of California tell medical directors how to manage and supervise any member of the health care team, or should medical directors determine that?  Removing legislatively-mandatedsupervisory requirements does not change the CLINICAL WORKING-RELATIONSHIP in any clinic setting.  PAs still practice as they do now, they still collaborate with other members of the medical team, and they make medical decisions and dispositions in accordance with clinic/hospital policy and accepted standard of care.  The difference is that there is less liability directed toward the “supervising” physician.  

                Did you know that there are 32 military bases in the State of California?  Did you know that military PAs do not have regulations (legislative requirements) for mandated supervision?  They may collaborate on an as needed basis with physicians (including specialists) and other team members. They, just as with civilian PAs, are required to meet the same standard of care as physicians.  Should a PA’s failure to meet that standard of care be held against a legislatively mandated supervisor, who may never have seen the patient or the chart?

                Your letter to physicians across the state indirectly implies that physicians do not require supervision.  Does that hold true for interns as well?  Residents?  The reality is that interns and residents are part of the medical care team.  They require supervision, but not legislatively-mandated supervision.  

PAs for Tomorrow (PAFT) is a professional group of PAs committed to the idea that the PA profession must present itself accurately, as autonomous professionals, to survive and prosper in the future medical care marketplace.  

 

Respectfully,

 

Dr Frank Crosby, DrHSc, PA-C

President, PAs for Tomorrow
pasfortomorrow.org
fcpresident@pasfortomorrow.org
 

 

 

 

I want to thank PAFT for writing this response to California ACEP. PAFT made a very quick response to California ACEP. AS of now, base on the email I got from CAPA, the SB 697 bill has been amended prior to its April 22 hearing. Here is the amended bill http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB697.  In my opinion,  the bill is getting weak but I am not a lawyer. Please take a look and let me know what you think. Below is the email I got from CAPA. 

Edited April 15, 2019 by PACali

[sas5814]

Quite an improvement!

[spflynn4]

Saw today that the bill passed through its first committee with an 8-0 vote (with 1 "no vote recorded", whatever that means).

 

http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB697

[Joelseff]

Posted this on my OTP thread in the California section of this forum:

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? 

 

 

(MODS, maybe we can merge the two threads?)

Edited April 25, 2019 by Joelseff

[sas5814]

If supervision is still mandated at the state level then PA jobs are still at risk.

[Joelseff]

21 minutes ago, sas5814 said:

If supervision is still mandated at the state level then PA jobs are still at risk.

I agree.  This version of "OTP" from what i have read only took out the DSA and replaced it with a less restrictive "Practice Agreement."  That I think is not a major victory for PAs in California.  Was it worth all the stumping I did to my Physician colleagues and getting petitions etc? I dunno... It was a lot of noise that kind of fizzled I think. 

Edited April 25, 2019 by Joelseff

[sas5814]

You always have to take the big swing. Sometimes it works and sometimes it doesn't. perhaps this will make bigger changes next year easier.

 

[PACali]

On 4/25/2019 at 1:42 PM, sas5814 said:

You always have to take the big swing. Sometimes it works and sometimes it doesn't. perhaps this will make bigger changes next year easier.

 

That is exactly what I was told by people inside of CAPA. They took a big swing this time and they knew we will not get everything we wanted, but we can make small incremental steps. The revision was needed to get the CMA onboard. I don't like the revision, but I understand. 

This is the email I got from CAPA