Legislature(2023 - 2024)BARNES 124
05/06/2024 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| SB89 | |
| SB115 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 182 | TELECONFERENCED | |
| + | SB 234 | TELECONFERENCED | |
| + | SB 115 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | HJR 27 | TELECONFERENCED | |
| += | SB 89 | TELECONFERENCED | |
SB 115-PHYSICIAN ASSISTANT SCOPE OF PRACTICE
7:44:48 PM
CHAIR SUMNER announced that the final order of business would be
CS FOR SENATE BILL NO. 115(HSS), "An Act relating to physician
assistants; relating to physicians; and relating to health care
insurance policies."
7:44:57 PM
SENATOR L?KI TOBIN, Alaska State Legislature, as prime sponsor,
presented CSSB 115(HSS) and paraphrased the sponsor statement
[included in the committee packet], which read as follows
[original punctuation provided]:
We have all heard about long wait times and difficulty
accessing care across Alaska which frustrates patients
and creates impediments to quick diagnosis and
treatment. Senate Bill 115 would allow experienced
physician assistants to practice medical care
independently to the fullest extent of their
licensing, thus increasing the capacity of our medical
system and reducing unnecessarily strict regulations
on physician assistants.
Senate Bill 115 grants experienced physician
assistants the flexibility to increase their ability
to see and treat patients, which will benefit the
capacity of Alaska's medical system. This also
maintains the collaborative agreement structure
currently in place for less experienced physician
assistants.
Alaska has a demonstrated need for increasing
accessible medical care, reducing high medical costs,
and decreasing barriers to experienced medical
practitioners across Alaska. Over 90% of the physician
assistants in Alaska practice in rural areas.
Increasing the medical care available locally in rural
Alaska produces better outcomes and less expensive
care. This also allows patients to stay in their home
communities, thereby reducing strain on hub
communities. Additionally, Alaskans will be able to
receive care in their place of home, maintaining their
support networks and reducing the need for costly
inpatient services.
Senate Bill 115 does not sacrifice medical rigor or
oversight, but simply allows experienced and licensed
physician assistants to continue to offer high quality
medical care within their scope of practice. Thank you
for considering this prudent legislation.
7:52:24 PM
CHAIR SUMNER noted that there would not be a reading of the
sectional analysis for CSSB 115(HSS) and the committee would
hear invited testimony.
7:52:37 PM
HAROLD JOHNSTON, MD, Chair, Policy & Advocacy Committee, Alaska
Primary Care Association (PCA), gave invited testimony in
support of CSSB 115(HSS). He provided a background and related
the number of physician assistants (PAs) there are in the state.
He stressed strong support for CSSB 115(HSS) on behalf of
himself and PCA. He said the system is outdated and created an
unnecessary expense for community health centers thereby
becoming a barrier to recruitment. He opined that the bill
would not decrease the quality of care and collaborative
agreements would continue. He said it was time to recognize the
value that physician assistants provide and their unique role in
Alaska's health care system.
7:56:06 PM
REPRESENTATIVE FIELDS asked whether PCA collaborated remotely or
only at specific clinic sites.
DR. JOHNSTON responded that it depended on the number of staff
available.
REPRESENTATIVE FIELDS asked whether the medical doctors (MDs)
the PAs are collaborating with are not part of the federally
qualified health center (FQHC).
DR. JOHNSTON answered that if FQHC does not have any physicians
on staff then [the MDs] are not part of the FQHC.
REPRESENTATIVE FIELDS questioned whether there was anything that
prohibited PCA from collaborating with multiple rural sites that
may not have MDs on site at the time.
DR. JOHNSTON replied that PCA does not do direct patient care,
and for them to have a physician employed by PCA would be a very
challenging situation.
REPRESENTATIVE FIELDS noted that some HQFCs are part of tribal
health systems. He asked who the collaborative MDs were working
for.
DR. JOHNSTON replied that he had not worked for the health
tribal systems but offered his understanding that the tribal
partners collaborate with MDs employed by the tribal health
system.
7:59:38 PM
REPRESENTATIVE FIELDS asked whether it was PCA's goal to have
PAs run the clinics.
DR. JOHNSTON answered that it varies and further noted that PCA
does not run anything itself.
8:01:24 PM
JENNIFER FAYETTE, PA, gave invited testimony in support of CSSB
115(HSS). She said that in current times, PAs are involved in
almost every specialty and, in addition, their scope of practice
includes examining, diagnosing and treating their own patients.
She said CSSB 115(HSS) does not increase the scope of practice
but puts responsibility on it. She stressed that PAs help
Alaska as well as other states navigate provider shortages. She
opined that current statute is not supportive to the profession
and must be modernized. Passage of CSSB 115(HSS) is about
recognizing PAs full authority to fill the gaps in healthcare.
8:04:07 PM
REPRESENTATIVE FIELDS asked whether there are smaller community
clinics that are not served by a tribal health provider.
MS. FAYETTE offered her belief that there was another testifier
who could best speak to the question.
REPRESENTATIVE FIELDS asked whether the goal of the legislation
was for PAs to provide primary care.
MS. FAYETTE answered that the bill is about access to care and
stressed that people are waiting for care, especially in rural
communities.
REPRESENTATIVE FIELDS indicated that he struggled with the idea
of doctors who have received training versus a PA with much less
training.
MS. FAYETTE said it became harder to find collaborators in
Anchorage.
[The committee heard public testimony beginning here:}
8:08:41 PM
KRISTIN M. MITCHELL, MD, FACP, President, Alaska State Medical
Association, said she was opposed to CSSB 115(HSS), as written.
She listed medical entities that agree that medical teams should
be led by physicians, as they are uniquely qualified and have
extensive training. She noted prior testimony surrounding PAs
and close collaboration, and she stated that even PAs with many
years of clinical experience do not have the same training and
are not interchangeable with physicians. She clarified that the
Alaska State Medical Board is distinct from the State Medical
Board, which has undergone leadership changes recently. She
gave examples of other states' procedures regarding PAs. She
mentioned nationwide experiments in primary care utilizing PAs
to ease the burden of access, and the results lead to higher
costs for patients and health systems. She said wait lists for
specialists can grow from weeks to months. She stressed that
the current systems needed improvement and that the Alaska State
Medical Association would like to streamline licensing and
administration to focus on providing the best possible patient
care. Eliminating collaborative agreements could lead to
unintended consequences, she said, and without a physician to
give ultimate responsibility for a patient's care, she foresaw a
rise in malpractice insurance. She said CSSB 115(HSS) would
redefine the term "attending physician," which she opined was a
mistake. She reiterated that the Alaska State Medical
Association was in opposition to the bill as written but would
be willing to work with PA colleagues to craft better
regulations and submit improved legislation to the committee.
8:16:34 PM
REPRESENTATIVE FIELDS referenced Title 8 and the scope of
practice for MDs in statute versus regulation.
DR. MITCHELL replied that she was not an expert on the scope of
practice for MDs and would defer the inquiry to someone who had
access to statute.
REPRESENTATIVE FIELDS asked whether there was anything in the
legislation that would list PAs performing anything different
from MDs.
DR. MITCHELL questioned the language, "provide consultation upon
request", noting that typically it is a request by someone with
a higher level of specialty training. She speculated on further
verbiage that she found might be problematic.
REPRESENTATIVE FIELDS noted his discomfort in supporting the
bill in reference to whether what MDs do should be
differentiated. He sought guidance on how the scope of practice
for PAs could be narrowed to provide primary care, as he was not
persuaded of that yet.
DR. MITCHELL responded that she had asked for numbers about how
the PA workforce is distributed in Alaska but could not speak
knowledgably since she had not seen the numbers yet. She spoke
to other health systems being led by higher-level trained
physicians.
8:23:20 PM
The committee took an at-ease from 8:23 p.m. to 8:26 p.m.
8:26:06 PM
ROXANNE JONES, MD, Secretary of the Board, Alaska Academy of
Family Physicians, testified in opposition to CSSB 115(HSS).
She provided her professional background, including her
experience serving as a collaborating physician to PAs in many
states, and shared her first-hand experience around PAs. She
urged members to take more time on the bill and opined that PA
collaborative agreements need to be fixed, as it should be used
as a tool for PA practices. She added that the curricula in the
PA programs do not prepare PAs to practice without a supervisor
or collaborator. She noted that liability speaks loudly. She
urged the committee to not pass CSSB 115(HSS).
8:31:45 PM
MS. FAYETTE spoke to medicine definitions in statute. She noted
the importance of putting the PA profession in statute, as it is
currently only in regulation. Additionally, she said she has
been engaging in this process for PAs, and that she had given
multiple presentations to the State Medical Board on the topic.
8:34:36 PM
CHAIR SUMNER opened public testimony on SB 115.
8:35:21 PM
CANDACE HICKEL, Physician Assistant, shared her extensive
background in the PA profession and opined that PA regulation
laws are antiquated, and she provided a brief history. She
highlighted the importance of PAs in Alaska and related the
training requirements for PAs. She said that she continued
close collaboration with surgeons by the design of a PA's
practice and policies already in place at the hospital. She
said people are asking for quality care and opined that PAs are
the solution. She urged support for CSSB 115(HSS) from the
legislature.
8:39:03 PM
The committee took a brief at-ease at 8:39 p.m.
8:39:19 PM
KARI BERNARD, Physician Assistant, testified in support of SB
115 and provided a research report and summary to the committee
[included in the committee packet]. She related that she had
been a PA for 20 years and provided a brief educational
background. She listed studies regarding PA provided care,
which included costs. She said studies do not support that PAs
are driving up the cost of care. She further summarized studies
of PAs following the same guidelines as physicians. She offered
to be available to answer more specific questions.
8:42:42 PM
BETSY DOUDS-PACVAN, PA, President, Alaska Academy of Physician's
Assistants, as a PA, provided her background working in
outpatient addiction treatment and behavioral health. She noted
that Alaska is experiencing a shortage of healthcare providers
and CSSB 115(HSS) would allow PAs the ability to practice to the
full extent of their rigorous training and education. She
opined that CSSB 115(HSS) is a tool that would allow PAs to join
the workforce more easily while continuing to be regulated.
8:45:53 PM
KATHERINE VAN ATTA, PA, testified in support of CSSB 115(HSS)
and shared her educational and professional background. She
noted that collaborative plans are not required to perform
effective consulting. She said CSSB 115(HSS) would support
giving healthcare providers to the rural and underserved areas
of the state that really need PAs. She touched on proposed
regulations and offered her belief that a different approach is
needed and that SB 115 could alleviate many issues.
8:48:38 PM
DANIEL REYNOLDS, DO, shared his work and military experiences
and noted the extensive time he spent working with PAs. He
opined that CSSB 115(HSS) supported the change that is needed
because of the training and skill level PAs currently get. He
said if there was a problem with care that is delivered, PAs
would not be practicing. He stressed that the care PAs deliver
is excellent and at a high level and he reiterated his support
for the proposed legislation.
8:51:24 PM
CHRISTI FROILAND, PA, provided her background in dermatology and
highlighted that she is a specialist to whom other offices
refer. She spoke to collaboration and that it is "built into
the DNA" of a PA. She further noted her teaching experiences.
She opined that CSSB 115(HSS) is not about independent practice;
it is about giving a PA the ability to practice to the full
extent of their training and to not be tied to one physician.
8:53:48 PM
ETHAN MCWILLIAMS, CEO, Wilderness Medical Staffing, testified in
support of CSSB 115(HSS). He provided his professional and
personal background. He said it is hard to find collaborating
physicians with the time needed for paperwork. He touched on
liability and insurance, and noted other states in which he had
worked. He added that his broker or carrier had never expressed
any concern about the insurability of PAs in those states;
therefore, he did not understand why Alaska would be different.
8:56:57 PM
MOLLY SOUTHWORTH, MD, Internist and Endocrinologist, American
College of Physicians, Alaska Chapter, testified in opposition
to CSSB 115(HSS) because of patient safety concerns and the need
to build stronger teams. She stressed that PAs are a vital part
of the system but are not trained with independent practice in
mind. She opined that the bill is a threat to Alaskans. She
suggested that CSSB 115(HSS) not be passed in its current form
and that a stronger bill be crafted that focused on improving
team collaboration.
8:59:25 PM
JOHNNA KOHL, MD, testified against CSSB 115(HSS) in its current
form and explained that two years of clinical practice does not
constitute an experienced assistant. She gave examples of real-
life situations in family medicine that, for example, there is a
difference in training between a PA and nurse practitioner. She
urged members to continue to work on the bill and not pass CSSB
115(HSS), as written.
9:01:53 PM
MEGHAN HALL, PA, testified in support in CSSB 115(HSS) in its
current form because the amendments have been made and many of
the concerns have been voiced. She offered her belief that the
bill would keep PAs relevant, recognize them as full members of
the health care team, and protect patient safety.
9:03:15 PM
MURRAY BUTTNER, MD, testified in support of CSSB 115(HSS). He
spoke to his work and board experience, as well as working with
PAs. He added that he had been a collaborating physician for 10
to 15 PAs in his 27 years in the profession. He went over the
outdated regulatory framework for PAs but not for other areas
such as for nurse practitioners. He offered his belief that the
bill currently written seemed reasonable and he hoped the
committee would see a way to move it.
9:06:20 PM
MARGARET CARLSON, MD, Family Medicine Physician, testified in
opposition to CSSB 115(HSS) and gave her professional
background. She said that she has been a collaborative
physician for PAs her whole career and respects them; however,
there is a difference in training that comes down to experience
and leadership. She related examples of patients not being
satisfied with their care and the wait times. She asked whether
access to care is more important than the quality of care. She
encouraged the committee to reconsider the bill.
9:09:27 PM
CAMILLA SULAK, MD, Board Member, American College of Emergency
Physicians, Alaska Chapter, testified in opposition to CSSB
115(HSS). She said a concern is safety and opined that PAs are
more likely to over-prescribe opiates. She related that health
care costs are already high and must not be increased; neither
should the wait times for care. Access to care is an issue as
well, she said, and many other states have voted against this
type of legislation.
9:12:30 PM
KATHRYNE MITCHELL, representing self, testified against CSSB
115(HSS) and opposed the 4,000-hour requirement. She
highlighted the differences in the education of a PA and a
medical doctor. She asked why Alaskans would want to go to
medical school when they can go practice with fewer hours.
9:15:17 PM
DANA KERR, MD, testified against CSSB 115(HSS) and the 4,000-
hour requirement. She opined that there needed to be minimum
testing. She stressed that she valued PAs both professionally
and personally. She relayed a personal anecdote regarding PAs'
knowledge, and the lack thereof. She said there needed to be
better standards.
REPRESENTATIVE FIELDS asked whether, if the state were to create
standards and diversity of training, there be a model to look to
for PAs.
MS. KERR replied that she was not aware of current tests as PA
training has not been for independent practice. She agreed that
it should be explored.
9:19:00 PM
CHAIR SUMNER, after ascertaining no one else wished to testify,
closed public testimony.
9:19:12 PM
REPRESENTATIVE FIELDS asked about standards of apprenticeship
testing.
MS. HICKEL replied that there are post-graduate fellowship
trainings. She highlighted that the purpose of the bill was to
improve access to quality care in Alaska.
9:20:49 PM
REPRESENTATIVE RUFFRIDGE inquired about current PA licensing and
collaboration. He said he heard that there are 1,000 licensed
PAs in the state and asked whether there was a record of the
collaborative physicians that reside in the state.
9:21:47 PM
GLENN SAVIERS, Deputy Director, Division of Corporations,
Business, & Professional Licensing, Department of Commerce,
Community & Economic Development (DCCED), addressed
Representative Ruffridge and said it would not be an easily
pulled record; it would take some time.
REPRESENTATIVE RUFFRIDGE asked whether an MD outside the state
could sign a collaborative agreement.
MS. SAVIERS offered to follow up regarding out of state
collaborating physicians.
9:24:06 PM
REPRESENTATIVE FIELDS asked whether there was a way to regulate
collaborative fees or whether there were options other than
collaborative fees.
MS. HICKEL answered that that had been considered the past
several years but culminated in the bill in its present form,
which she supported.
9:25:30 PM
CHAIR SUMNER announced that CSSB 115(HSS) was held over.