Oregon House Health Committee hears testimony on bill that removes supervision requirements for Physician Assistants

The Oregon House Committee on Health Care heard public testimony on a bill that would remove the requirement for physician assistants to practice under physicians.

Currently, a supervising physician may use the services of a Physician Assistant (PA) in accordance with a practice agreement, which is a written agreement between a PA and a supervising physician or supervising physician organization (SPO) that describes what and how the PA will practice. The supervising physician or SPO is responsible for the direction and review of medical services provided by a PA.

 

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House Bill 3036 is a bill that would remove the requirement that PAs practice under a supervising physician. Instead PAs would enter into “collaborative agreements” with physicians, podiatric physicians or clinically experienced physician assistants. 

These collaborative agreements would specify how PAs would collaborate with the care team. They would also remove the supervisory role and legal responsibility from the physician or SPO.   

This bill was requested by the Oregon Society of Physician Assistants (OSPA). 

The majority of the testimony was in favor of the bill. Organizations that testified in favor included Zoom+Care, OSPA and the Oregon Association of Hospitals and Health Systems (OAHHS). Dave Hunt, on behalf of OSPA, said that the bill will help lower administrative costs for practices. 

“Current statutory requirements and restrictions on Physician Assistants have resulted in unnecessary administrative burdens on employers who want to employ a PA to provide high quality health care to patients across Oregon.”

Andi Easton, the vice president of government affairs for OAHHS, said in written testimony that the bill will allow rural communities to receive quality care.

“The Oregon Association of Hospitals and Health Systems supports HB 3036 as we believe it will increase access to health care for rural and other underserved patients and communities in Oregon by removing unnecessary barriers to Physician Assistants (PAs) practicing to the full scope of their license and allow for innovative care delivery models. The “Health Care Workforce Needs Assessment” released by the OHA this month stated that “Oregon’s goals for health system transformation include achieving health equity, expanding access to care, ensuring financial sustainability and improving population health outcomes. In order to achieve these goals, Oregon must have a health care workforce that can effectively deliver high value care across the state.” We believe that PAs can be integral to achieving these goals.”

Although Easton is in favor of the bill, she did say she had concerns over the collaboration agreement structure, which she said may lead to disparities with how different health care entities structure their use of PAs.

Sam Barber, on behalf of the Oregon Academy of Family Physicians (OAFP), also had concerns over the collaboration agreement, and said there is more detail needed in the bill to ensure supervision for PAs with no clinical experience and PAs who have switched professions.

“As written, there is little in the bill to ensure that the supervision of PAs with little or no clinical experience is commensurate with their level of education, competencies and experience as a physician assistant. Similarly, for PAs who choose to switch specialties (e.g. from pediatrics to cardiology), there is nothing in the bill to ensure that the level of supervision is consistent with their competencies and experience.”

Barber also had concerns with the bill allowing for two PAs to enter into an agreement to practice independently. 

“The bill would allow two PAs to enter into a collaboration agreement with each other and practice independently. The OAFP is not opposed to independent practice for PAs in concept, but do wish to point out that more conversation is likely justified to ensure that independent PAs would be adequately trained and in turn that patients are served well. Ten thousand hours is a very reasonable starting point, but the bill is completely silent, for example, on who must track those hours.”

The OAFP pledged conditional support of the bill as long as these two items were addressed.

Arthur Towers, the political director of the Oregon Trial Lawyers Association (OTLA), testified against the bill because of OTLA’s concerns with the possibility of the change from “supervisory” to “collaborative” creating a situation where the responsibility of the outcome for the patient is removed from the physician or their organization to the PA.

“This is problematic since the physician assistant autonomy and standard of care would be based on the physician assistant’s location of practice and the physician assistant’s education, training and experience. This has the potential to be quite nebulous. As a patient, would my provider’s level of accountability be based on where she got her medical degree, and whether she is five years or 25 years into her career?”

Towers also agreed with the concerns raised by the OAFP. He said that although they oppose this bill as written, they look forward to working with policymakers and stakeholders to improve the bill.