The pace of legislation has slowed with the Legislature's preoccupation with the pursuit of a budget fix for the estimated $24 billion deficit for the budget year beginning July 1, 2009. Many bills were held in the Senate or Assembly Appropriations Committee due to any element of increased costs to the state. The budget fix proposed by the Governor would enact major cuts to state programs and costs with a pledge of no new taxes. On the health care side of the state budget the Governor has proposed the following;
- Elimination of Healthy Families Program
- Elimination of some Medi-Cal eligibility categories
- No physician provider rate cuts due to lawsuits that have stopped the previous rate cut attempts. However, the Administration does propose a broadly defined expansion of their Medicaid waiver plan to allow them to make changes more expeditiously to the Medi-Cal program. Many believe that is a veiled attempt to be able to enact mid-year provider rate cuts and not be subject to legal challenge.
- Reductions in funding to the Breast and Cervical Cancer Early Detection Program.
The stated goal of the Legislature and the Governor is to craft a budget agreement by the end of June. The State Controller has warned that the state will have a cash flow problem in later July if spending reductions are not enacted prior to that date. Many Democrats have raised serious concerns of an "all cuts approach" to balancing the budget and have suggested revenue enhancements. Only time will tell how this deficit will be solved but the days of gimmicks and unfounded optimism in revenue and expense estimates seem to have ended.
P.A. use of Fluoroscopy
We have written previously regarding AB 356 (Fletcher) that was sponsored by the Physician Assistants to allow them to sit for exams to utilize ionizing radiation. The bill as introduced was very broad and would have allowed them to utilize a wide variety of modalities. The CRS opposed early versions and met several times with the P.A. representatives.
AB 356 has now been amended to allow a Physician Assistant to sit for the exam as an Operator/Supervisor and allow them to use fluoroscopy within their scope of practice and under the supervision of a physician who also possesses a Fluoroscopy permit. A P.A. would also have to document 40 hours of training/education and subsequently obtain 10 hours of CME every 2 years. The supervising physician would determine what procedures could be performed by the PA since they remain responsible for supervision and verification of competency. AB 356 has passed the Assembly and is awaiting hearing in the Senate.
Bills to Allow District Hospitals to Employ Physicians
California law prohibits hospitals from employing physicians with exceptions for some county hospitals and purely charitable institutions. This is the bar on the corporate practice of medicine intended to allow physicians to practice without interference from business interests though an employment situation. It allows the medical staff to function independently in the best interests of the patient.
Several years ago legislation was adopted to create a program for about to 20 physicians to be employed by district hospitals that met certain criteria, i.e. rural, financial operating losses, and have at least 50% Medi-Cal patient base. That pilot program also required the Medical Board of Ca. to issue a report on the pilot, which they did this last October. That report was inconclusive since the number of actual physicians employed by district hospitals under the pilot was only five.
This year there are three new bills, AB 646 (Swanson), AB 648 (Chesbro) and SB 726 (Ashburn), introduced to either allow district hospitals to employ a limited number or any number of physicians or to allow any acute care hospital to employ physicians. District hospitals cite the difficulty in recruiting physicians to rural and poor performing hospitals and that being able to employ physicians will make that easier. We have opposed any broad change to the current prohibition except one that focuses on certain types of troubled hospitals and with only modest expansion of the number of physician who can be employed.
SB 726 has been amended to revise the current pilot project to allow the following;
- Apply to a district hospital that either a small or rural hospital in a medically underserved area.
- Allow the employment of a physician in the following specialties, family practice, internal medicine, general surgery ,and OB GYNs., but only after proof that the hospital has attempted to recruit such a physician for one year and been unsuccessful. The type of specialty could be expanded but only after additional documentation of attempts and concurrence of the medical staff.
- Any individual district hospital could only employ two physicians.
The CRS is supportive of SB 726 as an alternative to the other bills that would generally remove the prohibition on district hospital employment of physician. Both AB 646 and 648 have passed the Assembly and will be heard in the Senate Health Committee that passed the amended version of SB 726. SB 726 will now also be heard in the Assembly.
