Legislature(2023 - 2024)BELTZ 105 (TSBldg)
02/28/2024 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| SB121 | |
| SB115 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 121 | TELECONFERENCED | |
| + | SB 115 | TELECONFERENCED | |
SB 115-PHYSICIAN ASSISTANT SCOPE OF PRACTICE
[CSSB 115(EDC) was before the committee.]
3:26:43 PM
CHAIR BJORKMAN reconvened the meeting and announced the
consideration of SENATE BILL NO. 115 "An Act relating to
physician assistants; relating to physicians; and relating to
health care insurance policies."
3:27:06 PM
SENATOR LÖKI TOBIN, District I, Alaska State Legislature,
Juneau, Alaska, sponsor of SB 115 by request. She gave a brief
overview of SB 115. She explained that SB 115 would allow
physician assistants to provide care to patients without the
direct oversight of a physician. She emphasized that SB 115 has
clear stipulations about education requirements and time in
active practice in collaboration with a physician. She commented
that healthcare practitioners do not operate independently and
often call upon one another with questions when dealing with
complex issues. She said that currently, there is a limited
number of physicians available to meet the demand of care in the
state. She stated that 69 percent of primary care providers are
located in urban areas, while more than 90 percent of Alaska's
physician assistants (PA) operate in rural areas, where they
provide basic, quality medical care. For these PAs, their
collaborating physicians may be far away - which does not allow
for direct oversight. She explained that SB 115 was amended by
the Senate Health, Education and Social Services Standing
Committee so that PAs with more than 4,000 hours would be able
to operate independently. She noted that PAs have a great deal
of professional and lived experience and added that, on average,
PAs have over 3,000 hours of direct patient care prior to
entering into an accredited PA program.
3:29:35 PM
SENATOR TOBIN said that accepted into a PA program, students
learn via classroom and in a clinical setting often alongside
other students for 27 months. She said that graduates must
complete 100 continuing education hours every two years - and
take a comprehensive exam every ten years. This is in addition
to the required national certifying exam and licensing in SB.
She clarified that, in spite of this education, PAs are not
medical doctors. She pointed out that Alaskans face high needs
and high costs for medical services - and the laws governing PAs
are some of the most limiting in the country. She went on to
explain that PAs are subject to the prescription drug monitoring
program and must comply with the SB Drug Enforcement Agency. She
noted that national laws grant PAs prescriptive privileges in
states where pharmaceutical training standards are met. She
reiterated that PAs play an important role in medical care and
their work is broad in scope. She said that SB 115 would allow
them to do so - as long as they receive adequate training and
education.
3:32:17 PM
MACKENZIE POPE, Staff, Senator Löki Tobin, SB State Legislature,
Juneau, SB, provided the sectional analysis for SB 115:
[Original punctuation provided.]
Senate Bill 115: Sectional Analysis
Section 1. Amends AS 08.64.107 by changing the term
"regulation" to "licensure and scope of practice."
Section 2. Amends AS 08.64.107 by adding four new
subsections:
Subsection (b) describes the procedures and
evaluations physician assistants can perform,
including their ability to: perform comprehensive
health histories and physical examinations of
patients; treat disease and injury; and
prescribe, dispense, order, and administer
schedule II, III, IV, or V controlled substance
under federal law if the physician assistant has
a valid federal Drug Enforcement Administration
registration number.
3:33:16 PM
MS POPE continued the sectional analysis for SB 115:
[Original punctuation provided.]
Subsection (c) establishes that a physician
assistant with less than 2,000 hours of practice
may practice only under collaborative agreement
with one (or more) physician to provide care in a
hospital, clinic, or other clinical setting.
These collaborative agreements must be in writing
and describe how the collaboration will be
executed between the physician and physician
assistant.
Subsection (d) requires that a physician
assistant in a collaborative agreement or the
collaborating physician shall provide a copy of
their collaborative agreement and relevant
documentation to the State Medical Board upon
request.
Subsection (e) defines collaborative agreement.
Section 3. Amends 08.64.170 to authorize a physician
assistant to practice medicine independently, with
those practicing with less than 2000 hours required to
operate under a collaborative agreement as authorized
in the previous section.
Section 4. Amends AS 11.71.900 to include physician
assistants under the definition of "practitioner."
Section 5. Amends AS 21.07.010 to disallow a contract
between a participating health care provider and
health care insurer from including a provision that
imposes a practice, education, or collaboration
requirement on physician assistants which is
inconsistent with or more restrictive than the
requirements stipulated under AS 08.64.107.
Section 6. Removes the direct supervision requirement
for physician assistants under the definition of
"attending physician" as stated in AS 23.30.395, which
allows employees to designate physician assistants as
responsible for their care under the Alaska Workers
Compensation Act.
3:35:09 PM
MS. POPE continued the sectional analysis for SB 115:
[Original punctuation provided.]
Section 7. Removes the direct supervision requirement
for physician assistants under the definition of
"health care provider" as stated in AS 33.30.901,
which allows physician assistants to provide medical
services as a health care provider within the
Department of Corrections statute definition.
3:35:31 PM
SENATOR TOBIN stated she has many invited testifiers who can
speak to the rigor of their academic performance, expertise, and
answer questions.
3:35:57 PM
SENATOR BJORKMAN announced invited testimony.
3:36:19 PM
SENATOR BJORKMAN turned the gavel over to Senator Gray-Jackson.
3:36:25 PM
JENNIFER FAYETTE, Co-Chair, Legislative Committee, Alaska
Academy of Physician Assistants, Anchorage, Alaska, testified by
invitation on SB 115. She said she is a lifelong Alaskan and
practicing PA in Anchorage. She stated that PAs provide
essential, high-quality medical patient-centered care throughout
the state. She surmised that all those present have a family
member who has received treatment from a PA. She explained that
PAs diagnose illnesses, develop and manage treatment plans,
manage their own patient panels, and often serve as the
patient's principal healthcare provider. The latter is
particularly true in rural areas. She said that PAs hold a state
medical license, medical liability insurance, and Drug
Enforcement Administration (DEA) license. She stated that PAs
are responsible for the care that they provide. She asserted
that PAs are crucial to Alaska's healthcare system. She pointed
out that healthcare worker shortages have long been an issue in
the state and demand is increasing. She noted that Alaska is
faced with unique challenges for access to - and delivery of -
medical care. She said that these challenges occur in rural
areas as well as urban specialty care clinics. She added that
some patients will wait over nine months to see a medical
specialist - this is a worsening problem. She said that state
projections indicate that Alaska is expected to have the most
significant shortages of any state moving forward. She stated
that, since its creation in the 1960s, the primary goal of the
PA program has been to increase access to care. She opined that
Alaska would benefit from updating PA practice laws. She
suggested that this would make Alaska more appealing to local PA
program graduates and providers from other states.
3:38:29 PM
[SENATOR GRAY-JACKSON returned the gavel to Chair Bjorkman.]
MS. FAYETTE stated that PAs are highly trained healthcare
professionals whose broad generalist medical education allows
them to adapt to the evolving needs of the healthcare system.
She noted that there are 306 accredited PA programs in US, with
only one independent accrediting body. The Accreditation Review
Commission on Education for the Physician Assistant (ARC-PA)
includes representatives from a variety of medical organizations
and ensures that these programs adhere to a high accreditation
standard. She explained that PA curriculum is modeled after
medical school curriculum and includes clinical rotations
alongside other medical students. She noted that the average PA
program applicant has over 3,000 hours of direct patient contact
prior to applying. PAs must also complete specific prerequisites
during their undergraduate education.
MS. FAYETTE detailed how students progress through the program.
Graduates must complete a comprehensive national exam. The exam
must be taken every ten years and PAs must complete 100 hours of
continuing education each year, in addition to state
requirements. She briefly shared her own education experience.
She stated that PAs are not doctors and their education is not
equivalent. However, they are well-trained medical providers who
are capable of providing medical care to Alaskans. She said that
PAs want to fill this role for Alaskans. She stated that as
president of AK APA, she was contacted by clinics and asked to
explain current state regulations and how to comply with them.
She said she was often asked why anyone would hire a PA when it
also involves securing an MD to supervise them. She explained
that restrictive regulations impact patients and PAs. She said
that research has shown that the most successful teams fully
utilize the skills of each member and support efficient,
patient-centered healthcare and added that collaborative care
models have been modified in many states. These modifications
allow PAs to fully utilize their education, training, and
experience, and range from no requirement for post-graduate
hours to 10,000 hours.
3:42:08 PM
MS. FAYETTE noted that the several branches of federal
government, including military and native agencies, have removed
or modernized the supervisory/collaboration requirements,
recognizing that PAs are capable of practicing autonomously. She
referred to a recently published ten-year study that found that
removing these restrictive requirements does not increase the
risk to patients or rates of malpractice. She stated that many
similar reports show the positive potential of PAs. She said
that SB 115 would define the PA scope of practice, ensuring that
Alaskans' access to care is not restricted. It would also remove
the oversight requirements after a set amount of post-graduate
clinical hours. Additionally, PAs would be recognized as
practitioners alongside medical doctors. She opined that PAs are
an essential part of the healthcare system and asserted that
barriers to PA practice must be removed in order to meet the
needs of the healthcare system in Alaska.
3:43:55 PM
CHRISTI FROILAND, representing self, Anchorage, Alaska,
testified by invitation on SB 115. She said she is a PA with 16
years of experience in the area of medical dermatology. She said
that medicine should be a collaborative practice. She shared a
story about her experience as a PA working closely with doctors
both as mentors and team members. She explained how her skills
work alongside - and independently of - the doctors on her team.
She explained how her broad skillset benefits doctors who
specialize in a particular field of study. She shared her
experience working as a PA in the dermatology field. She said
that in addition to teaching at Providence Medical Center, she
is a faculty member at the University of Washington, where she
teaches dermatology to medical residents; however, to practice,
she has to have a signed collaborative agreement. She said that
when discussing collaborative agreements, she is often asked
about her liability. She added that this seems to be doctors'
main concern, in spite of her high level of experience.
3:45:58 PM
MS. FROILAND expressed frustration that she likely has more
specialized experience doing in-office procedures than many
practicing doctors - yet is continually asked this question. She
asserted that her skills and education complement general
medicine quite well. She shared a recent experience in which the
liability of PAs was a concern - despite their having anywhere
from 5 to 15 years of experience. She said that PAs have the
education and training needed to do the jobs they are asked to
do and are liable for the care that they provide.
3:46:50 PM
She stated that SB 115 defines the PA scope of practice and
would recognize PAs alongside other medical practitioners. She
expressed concern about the fees charged in collaborative
agreements and explained the various collaborative agreement
scenarios and fees that impact PAs. In some cases, a doctor may
take as much as 50 percent of collections, which she asserted is
extortion. These high fees are prohibitive. She explained that a
PA can hire a new doctor, mentor and train them, and the doctor
can simultaneously supervise the PA. She asserted that this
needs to change to reflect how PAs practice and serve Alaskans.
She stated that SB 115 is about recognizing PAs as medical
providers and recognizing their scope of practice at the statute
level. She said that Alaska is one of the most difficult states
for PA licensing, which decreases access to care.
3:49:12 PM
CHAIR BJORKMAN opened public testimony on SB 115.
3:49:30 PM
WENDY SMITH, representing self, Juneau, Alaska, testified in
support of SB 115. She said she is a PA with over 20 years of
experience and is currently working at Juneau Urgent and Family
Care. She opined that one profession relying on another in order
to do its job is ridiculous. She said that for over 60 years,
PAs have been proving the safety and efficacy of their work and
it is time to modernize, which is what SB 115 would do. She
opined that being tied to one physician is archaic and there is
no longer a financial benefit to making collaborative
agreements. PAs are considered a liability as they do not bring
financial benefit to physicians working as part of a system. She
stated that access to care is important. She explained that when
working for a small practice that is directed by one physician,
the second collaborating physician must be outsourced. If this
relationship dissolves, the PA is not able to continue working.
She reiterated that the current statutory regulations limit her
ability to provide excellent care.
3:51:57 PM
MEGHAN HALL, representing self, Anchorage, Alaska, testified in
support of SB 115. She said she is a PA working in Anchorage and
SB 115 would keep Alaska relevant in the increasingly
competitive healthcare market for providers. She pointed out
that the healthcare industry has evolved over the past 50 years.
While PAs were initially intended to extend the reach of
physicians in a primary care setting, they now work in every
area of medicine. She said that this increases patients' access
to vital care. She acknowledged that PA is a relatively new
profession and is continually evolving and adapting to patient
needs and the changing healthcare system. PAs are committed to
patient safety and collaborative medicine. She said that SB 115
allows the profession to continue to grow and adapt. PAs have
moved into specialty and subspecialty care in response to the
demands for highly educated providers and treatment options that
require expertise. She asserted that letters from specialists
who oppose SB 115 is indicative of a move toward even greater
specialization; however, a medical system cannot function with
only specialist providers. She stated that PAs are trained as
medical generalists and are thus able to efficiently fill gaps
in care. She said that Alaska is struggling to recruit and
retain healthcare providers and SB 115 would advance PA practice
- and the healthcare system.
3:54:01 PM
CHAIR BJORKMAN held public testimony open.
[CHAIR BJORKMAN held SB 115 in committee.]