Status Update - Hawaii PA practice laws 3/8/19
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Aloha Hawaii PAs and friends,
Update on the status of Hawaii PA practice laws:
House Bill 935 was deferred in the Consumer Protection and Commerce committee hearing. There was strong opposition testimony that impacted progress.
The Senate version, Senate Bill 1406, was heard by the Consumer Protection and Health committee and was passed with amendments. The amendments narrowed the bill down to updates to 1) medical chart review and 2) CME only required for re-licensure. While we truly want to see some type of improvement to PA practice, we have concerns with the proposed amendments of SB1406 SD1. (Senate Bill 1406 Senate Draft 1)
Currently Hawaii regulations (rules) section 16-85-49(a)(5) require the supervising physician to only review the records of the patients seen by the PA within 7 days. Although burdensome, no co-sign required. The proposed amendment adds a tiered system to chart review which can lessen the number of charts to be reviewed however it also add a new co-sign requirement.
Some physicians already sign when they review based on their EMR systems and these amendments could offer a substantial admin break for them. Other physicians and practices would have increased administrative burdens to achieve this requirement. Bottom line, it makes co-signing a law.
Where did this language come from?
From the information I have researched, this “tiered chart review” language came from several years ago when the Hawaii Medical Board was working on updating the Hawaii Administrative Rules. (Statutes > Rules) The Board was trying to improve the medical chart review by moving to a tiered system and our official PA Advisor to the Board tells me it was only chart review and not co-sign at that time. PAs do not have their own board or a seat within the Hawaii Medical Board.
Why put these rule changes into a bill?
Great question, glad you asked. Simply put, rule/regulatory changes take a very long time to come to fruition. Hence why the Board was trying to make these changes years ago…I heard this has been anywhere from 2 to 8 years into the making. Statutory (law) changes via introducing bills into legislation can offer changes much faster.
What is next?
The Senate has accepted the drafts and referred to the House of Rep. for further committee hearings now that this is a much different version of the bill.
What does that mean?
The new version of the bill will go through more committee hearings and will require more testimony.
Is this a step forwards or backwards for PA practice?
Depending on your individual practice, fewer chart reviews may be worth the additional co-sign. For others it may be creating a whole new set of administrative burdens to PA practice.
Also, you may have opinions about the amendment language defining PA categories or if this is in line the evolution and current trends in PA practice. Read SB1406_SD1
What can be done?
1) Testify so we can improve the language as it moves through the House committee hearing. The first hearing with the HEALTH COMMITTEE is this Tuesday, 8:30am. Click here https://www.capitol.hawaii.gov/measure_indiv.aspx?billtype=SB&billnumber=1406&year=2019 to submit your testimony by Monday, 8:30am.
3) Ask your supervising physician to submit comment testimony. This way lawmakers can at least hear from more physicians with PA experience in the community, but they do not necessarily have to support or oppose the bill.
I am working with the Hawaii Medical Board and nurturing that relationship – please feel free to contact me so I can be the voice of Hawaii PAs and continue to be in their good graces. The Board will discuss these concerns at their next meeting.
In your service,