Legislature(2009 - 2010)BELTZ 105 (TSBldg)
03/10/2010 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearings | |
| SB46 | |
| SB172 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 46 | TELECONFERENCED | |
| += | SB 172 | TELECONFERENCED | |
SB 172-ALASKA HEALTH CARE COMMISSION
2:26:28 PM
CHAIR DAVIS announced consideration of SB 172. It was heard
previously.
SENATOR DONALD OLSON, sponsor of SB 172 said the bill relates to
the authorization of the Alaska Health Care Commission. This
will be a permanent commission to address health care issues and
rising health care costs. He noted that a proposed committee
substitute (CS) was distributed to members.
CHAIR DAVIS asked Mr. Obermeyer to review the changes
represented in the proposed CS.
2:28:17 PM
TOM OBERMEYER, staff to Senator Davis, said the only substantive
difference between the proposed CS and the original bill is on
page 3, line 6, relating to the composition and membership of
the commission under Sec. 18.09.020. Version S designates that
there will be 12 commission members; nine voting members will be
appointed by the governor, including the state medical director
as chair, and three nonvoting members will be ex officio members
from the House, the Senate, and Office of the Governor. The
original bill designated a 10 member commission.
2:30:51 PM
SENATOR PASKVAN moved to adopt the work draft CS for SB 172,
labeled 26-LS0790\S, as the working document. There being no
objection, version S was before the committee.
CHAIR DAVIS pointed out that the CS designates the medical
examiner as chair but it doesn't identify who will fill the
other seats. A separate handout proposes the organizations or
groups they might represent, but the designations will be made
following committee discussion and public testimony. She noted
that the commissioner of the Department of Health and Social
Services (DHSS) wrote to ask that the commission remain small
and to suggest that if the membership is increased that the new
members should represent [primary care physicians and the
behavioral health provider community.] It was the sponsor who
recommended adding two members for a total of 12, she said.
SENATOR DYSON observed that this seems to be a good way to
handle it.
2:34:28 PM
JAMES J. JORDAN, Executive Director, Alaska State Medical
Association, said ASMA represents physicians statewide and they
support creating the Alaska Health Care Commission in statute.
However, they would like the committee to consider physician
representation on this commission, both general practitioners
and general surgeons. He opined that physicians need to be at
the table helping develop Alaska's comprehensive statewide
health care policy and helping the commission fulfill its duties
in developing the strategies necessary to improve the health of
all Alaskans.
SENATOR DYSON asked if one of the voting members should have
significant experience in rural Alaska or does he believe that
the physician representation he suggested would adequately
represent the medical delivery teams in rural Alaska.
MR. JORDAN said he believes that the general practitioner could
represent the health care professionals that are part of the
healthcare delivery team, particularly with telemedicine.
2:38:02 PM
SENATOR PASKVAN observed that the proposed position number 8
designates a primary care physician who is licensed to practice
in the state and is board certified. He asked if board
certification is a meaningful requirement and if ASMA has a
position on that.
MR. JORDAN replied it's becoming uncommon to find primary care
physicians who are not board certified in Alaska. He described
the requirement as forward looking in light of the movement to
require board certification and continuing renewals in
licensures and certifications of competence.
CHAIR DAVIS said she'd like the administration to speak to that
because it was their recommendation.
2:40:10 PM
DEBORAH ERICKSON, Executive Director, Alaska Health Care
Commission (AHCC), said she works within the Department of
Health and Social Services (DHSS) and she is speaking today on
behalf of both DHSS and AHCC. She confirmed that DHSS suggested
the language related to the additional seat for a primary care
physician who practices family medicine, primary care internal
medicine, or pediatric medicine in the state. Because it's very
rare now for somebody to be practicing and licensed without
having board certification in any of these fields, DHSS would
have no objection to adding clarifying language that the
individual practicing would also be required to have board
certification in that particular field.
2:42:02 PM
SENATOR PASKVAN asked if she said the department wouldn't mind
if the board certification requirement were removed.
MS. ERICKSON replied DHSS doesn't have a concern with either
adding or leaving out the provision requiring board
certification.
CHAIR DAVIS said the committee needs to discuss and make a
decision on that matter. She asked if she's seen the list the
committee is considering.
MS. ERICKSON answered no.
CHAIR DAVIS said it was her intention to take testimony on the
proposed list of commission members before making a decision
about what to put in the final CS.
MS. ERICKSON said she'd like to first speak to the AHCC
recommendation about the size of the commission. The AHCC
January report included a recommendation for a permanent
commission established in statute and responsible for
comprehensive, sustained, accountable, and transparent health
system improvement planning for the state. They specifically
recommended that the commission remain the same size as the
existing commission, which is seven voting and three ex officio
members. AHCC made that recommendation with the specific
understanding that there was some support for a larger body. The
concern is that a larger commission would not facilitate
communication and decision making and that it might in fact
function more as an advocacy body. Thus, for reasons of
efficiency and the function of the group, AHCC wanted to state
on the record that the existing body worked well.
2:45:30 PM
MS. ERICKSON said the Department of Health and Social Services
also believes that the commission should maintain a relatively
small size, but the two additional seats would be acceptable. If
these are added, DHSS recommends that they be designated for a
primary care physician and a representative from the behavioral
health provider community. Although they're somewhat different
than DHSS suggested, she believes that the department would find
the descriptions for the primary care physician and the
behavioral health provider acceptable.
2:46:57 PM
JEFF JESSEE, CEO, Alaska Mental Health Trust Authority (AMHTA),
said AMHTA wants a seat at the table too. He is familiar with
the struggle to keep a group small enough to be functional and
still represent all of the necessary aspects adequately so
decisions are fully informed and representative of the issues
that need to be considered. While he's pleased that there is
interest in adding behavioral health representation to the
commission, he believes that it's critical to have someone who
has a system wide perspective. He confirmed this with
Commissioner Hogan and he expected the DHSS representative to
convey that the department would support the behavioral health
representative being a representative of AMHTA. That
representative might be a provider or an administrator of an
organization but they would be able to represent the interests
of the behavioral health system and have a systemic view of this
issue. This would bring the type of expertise and information
that would be most helpful to the commission, he concluded.
SENATOR DYSON asked if the mental health community would include
people who deal with substance abuse.
MR. JESSEE answered yes; the term behavioral health is
universally used to denote both mental health and substance
abuse.
2:51:01 PM
WAYNE STEVENS, President and CEO, Alaska State Chamber of
Commerce (ASCC), related that he has served as a member of the
Health Care Commission for the past year. This temporary
commission expires this year and while it began to address many
relevant issues, it doesn't have time to address them to the
degree required. Alaska's health care system needs adjustment in
order to provide cost effective, quality access to residents and
the best first step to address these issues is to establish in
statute the Alaska Health Care Commission. Experts and
representatives of key stakeholders appointed to this body will
form a plan to realign the system. The Alaska State Chamber of
Commerce supports a permanent commission that will provide
recommendations to the governor and Legislature that will result
in a health care system that provides quality and affordable
access to all Alaskans. The ASCC also supports including seats
on the commission for the state chamber and for primary care.
2:53:29 PM
SENATOR DYSON asked if he has a specific member to recommend.
MR. STEVENS replied he isn't seeking a seat for himself and he
doesn't have a specific recommendation, but he does believe that
the business community needs representation because it is a
significant contributor to the health care system. He added that
he has an interest in the health care community and served on
the Kodiak hospital board for about 14 years. And as a
representative of the business community he has an interest and
understanding of how to control and contain costs. According to
testimony the commission received, there are four basic parts to
the cost equation in the drivers of health care: 50 percent is
personal responsibility; 20 percent is the environment in which
you live; 20 percent is genetics; and 10 percent is the cost of
access to health care. When you're not addressing the largest
part of the problem it's not productive to argue about the
smallest part of the problem, he concluded.
2:56:51 PM
SHELLY HUGHES, Alaska Primary Care Association (APCA), thanked
the committee for adding a primary care position to the bill.
She echoed Mr. Jessee's statement that a representative with a
system perspective would benefit the commission more than say a
solo practice physician who is focused on patient care. APCA
could provide this perspective for medical, basic dental,
behavior health, and the many primary care provider type
positions. While the position could be filled by a physician,
administrators sometimes have a better overall sense of what
works in the overall system, she said. Because primary care is
so key to costs and prevention, it's important to have someone
with this system approach, she concluded.
CHAIR DAVIS said she would take direction from the members and
the sponsor with respect to the proposed list of representatives
before she had a new CS drafted.
2:59:05 PM
SENATOR OLSON said he agrees that a large commission could be
unwieldy, but busy schedules can make it difficult to get enough
people to a meeting to get a fair cross section, particularly
with health care providers. Referencing the earlier discussion
about board certification, he said he doesn't support that idea.
Another concern relates to the governor making the appointments
because it vests too much power in that office. He asked the
committee to consider the alternatives.
CHAIR DAVIS said she and the committee would take that into
consideration, but the governor wouldn't have full control
because people would submit their application and the governor
would have to select from the list.
3:03:12 PM
DENISE LICCIOLI, Staff to Senator Olson, referenced an earlier
statement that the sponsor asked for the commission
representatives listed on the handout and said that's correct
for the first seven positions but not eight and nine. The
sponsor clarified that he doesn't support the requirement for
board certification for position eight and for position nine the
sponsor requested a member from the Alaska Mental Health Trust
Authority.
CHAIR DAVIS held SB 172 in committee.
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