ABX1 1 (Nunez) is a long and complicated bill, with long and confusing passages meant to increase coverage of patients with publicly supported plans, hoping to increase federal contributions. It is worth reading the entire accompanying summary, which I believe to be substantially correct. Certain areas are of particular importance.
Requirements for of supervision of medical assistants, physician assistants, and nurse practitioners will be cut substantially. Nurse practitioner scope of practice will likely greatly increase, and historically, physician assistant scope of practice increases thereafter. The cost of scope of practice changes for nurse practitioners will be borne by doctors' and nurses' license fees.
This is a controversial area with physicians for and against increases of scope of practice. My own view is that there are very competent nurse practitioners and physician assistants, but their scope of practice needs to be limited to areas where they have been well trained; they must not practice unsupervised (as often happens in practice), and must not assume the role of a physician when they are outside their area of expertise. "If you want to be a doctor, you should go to medical school." There will be endless turf battles fought. I think that as a minimum, provision should be made to allow the patient to know if they are being seen by a physician and surgeon, nurse practitioner, physician assistant, medical assistant, midwife, podiatrist, chiropracter, physical therapist, respiratory therapist, or acupuncturist at every encounter with a medical professional. This will help empower the patient.
Elimination of assets as a test for Medi-Cal eligibility is an inappropriate gift of free healthcare to many people who will be able to contribute to the cost of their own care, paid for by the tax payers of California. Funds are stretched too thin to pay fairly for deserving patients; they should not be spent on people who can pay for their own care.
The California Health Care Cost and Quality Transparency Commission will require data submission from providers without reimbursement for the cost of compiling and forwarding the data. In fact, they will charge providers of the data to submit the data, with penalties of $100 to $1000 per day for reporting violations. Will medical services be reimbursed at a higher level to pay for this additional work associated with caring for patients?
There is an administrative patchwork to cover those under 3x the poverty level that may be needed due to federal law, but it should be simplified and include clear cut contributions/share of cost payments by the patients.
Pre-designation of regulations adapted from 1/1/08 to 12/31/11 as "emergency" is a dangerous precident, and no doubt will interfere with proper scrutiny of the regulations, or safeguards for those affected by the regulations.
-Len Doberne, MD