Monday Rx: Urgent Legislation and COVID-19 Updates #NoOnAB890 August 24, 2020 1289 Assembly Bill 890 (Wood) Home Stretch We sent out various communications in the past several weeks to provide members with information to reach key legislators to vote “no” on this bill. Now the California Senate is set to vote on AB 890 that would grant full practice authority to nurse practitioners (NP's). This bill would remove critical patient protections by allowing NP's to practice without physician supervision. Physicians are urged to contact their legislators now and ask them to protect patient safety and vote NO on AB 890. We provided talking points and key phone numbers of policy makers. Make those calls today! Talking Points: AB 890 is poorly written, which is why the Medical Board of California and the Board of Registered Nursing are opposed. This bill asks the nursing board to develop standards for the practice of medicine, which is beyond their expertise and represents a danger to patient safety. NP's do not have adequate training or years of education to be qualified to practice medicine without physician oversight. Allowing practitioners to practice without physician supervision threatens patient safety, while also increasing overall health care costs due to overutilization of diagnostic tests and improper specialty referrals by undertrained nurse practitioners. Background LACMA and CMA strongly believe that simply expanding the scope of practice of allied health practitioners to give them independent and/or expanded practice will do nothing to improve access to care or quality of care in our state. Allowing practitioners to perform procedures they simply are not trained to do can only lead to unpredictable outcomes, higher costs, and greater fragmentation of care. As health care delivery becomes more complex, expanding the team of health care professionals that serves patients makes sense. However, it is not in the best interest of patients to abandon the current physician-led team approach to health care. Integrated team-based care led by physicians streamlines care, maintains, and improves patient safety and decreases costs. While an important part of the health care delivery system, nurse practitioners simply do not have adequate training or years of education to be qualified to practice medicine without physician oversight. Physicians must prove their competency throughout their extensive residency training programs. In addition to their years of medical education and training, and ongoing requirements for continuing medical education, the California Legislature recently extended physician residency requirements to a minimum of three years before physicians are eligible for full licensure. If we are raising the bar for physicians, why would we let nurse practitioners practice unsupervised without holding them to the same standard as physicians? This bill would instead remove necessary physician supervision, ultimately harming patients and decreasing the quality of care. AB 890 attempts to provide a veneer of physician involvement by loosely identifying which circumstances could call for an NP to consult with or refer a patient to a physician or surgeon. However, NP's would not be required to proactively identify a physician or hospital for referral or transfer. Nor would they be required to disclose those details to patients. Without that information, patients will be unable to make informed decisions about their care and could be exposed to large surprise bills for out-of-network care. AB 890 is merely an outline of a major policy change, which lacks critical details related to nurse practitioner competency requirements, scope limitations, requirements to serve underserved populations or regions, and many other details. As it stands, it is a dangerous bill that will do nothing to improve access to health care in California. The Medical Board of California and the Board of Registered Nursing are also strongly opposed to this flawed policy. District SD 26 Senator Ben Allen 916-651-4026 District SD 32 Senator Bob Archuleta 916-651-4032 District SD 35 Senator Steven Bradford 916-651-4035 District SD 24 Senator Maria Elena Durazo 916-651-4024 District SD 29 Senator Ling Chang 916-651-4029 District SD 33 Senator Lena Gonzalez 916-651-4033 District SD 30 Senator Holly Mitchell 916-651-4030 District SD 25 Senator Anthony Portantino 916-651-4025 District SD 22 Senator Susan Rubio 916-651-4922 Senate Bill 977 (Monning) Another Bad Bill SB 977 Talking Points LACMA has joined a coalition comprised of CMA, from clinics to hospitals, health systems to oppose this bill. This legislation would strain access to the health care system by creating an extreme and burdensome process for arrangements between individual providers that are essential to the delivery of care. These arrangements have never been more important as hospitals and providers react to the enormous challenges created by the unprecedented COVID-19 pandemic. Nowhere in California has the pandemic hit harder than in Los Angeles, where 27% of the state’s COVID-19 - hospitalized patients are being treated and where there have been over 200,000 cases since March. For additional talking points see letter. Here are targeted policy makers: Cottie Petrie-Norris (D-74) Orange Robert Rivas (D-30) Monterey, Santa Clara, Santa Cruz Susan Talamantes Eggman (D-13) San Joaquin Jesse Gabriel (D-45) Los Angeles, Ventura Richard Bloom (D-50) Los Angeles: 310-450-0041 Footnote: SB 977 passed the Assembly Appropriations Committee and will now be heard on the floor as soon as Tuesday, August 25th (tomorrow). Support for Low NOx Omnibus Rule Last week LACMA joined a coalition of like-minded organizations to urge the California Air Resources Board (CARB) to support the adoption of a strong Low NOx standard. We encouraged the Board to consider opportunities to strengthen the proposal to further accelerate its clean air and health benefits. Given the extreme public health burdens posed by harmful emissions from the heavy-duty truck sector, especially in our most overburdened communities, this rule’s focus on delivering real-world emission benefits is essential. Regulating the Stress Response for Kids: Practical Tips for Primary Care Providers This webinar will offer practical tips and examples on how providers can incorporate stress regulation strategies into their treatment planning for pediatric patients. Share definitions, research, and the clinical response to address toxic stress through stress regulation strategies. Review the Six Stress-Busting Strategies and other ACEs Aware resources. Provide concrete examples and specific strategies on how to speak to patients and caregivers about mindfulness, supportive relationships, and mental health prior to the need for a referral. This webinar is hosted by the ACEs Aware initiative, which offers provider training and clinical protocols for screening children and adults for adverse childhood events. Presenters: Dayna Long, MD, FAAP, Medical Director, Center for Child and Community Health, UCSF Benioff Children's Hospital Oakland Hilary M. Bowers, MD, FAAP, Director of Behavioral and Mental Health Services, Children’s Primary Care Medical Group Pradeep Gidwani, MD, MPH, FAAP, Medical Director, Healthy Development Services and First 5 First Steps Home Visiting Services AUGUST 26, 2020 | 12:00 PM - 1:00 PM Register Today Telehealth Series for Small and Medium Sized Practices Pt. 2: Getting Started In this webinar, CMA will present an approach for implementing a telehealth solution that is tailored to small and medium sized practices. Participants will be provided with a telehealth self-assessment, a summary of available telehealth tools, things to consider when implementing telehealth technology, and plenty of telehealth phone and video best practices, tips, example workflows and telehealth policies. The presentation will also discuss how to prioritize in-person visits vs. telehealth phone or video visits. This webinar series is made possible through the support of the California Health Care Foundation and is open to all physician practices. Presenters: David Ford, CMA Vice President of Health Information Technology Natalie Martin, MBA, SHRM-SCP, TCI-CF, President and CEO, Elevation Health Partners Rachel Proud, MPH, Senior Managing Consultant, Elevation Health Partners AUGUST 27, 2020 | 12:15 PM - 1:15 PM Register Today COVID-19 Cases in Los Angeles County Below is a link to the latest reports on cases, deaths and testing provided by Los Angeles County Department of Public Health. If you need any assistance please email me or visit www.ladocs.org and www.cmadocs.org. View Here August 24, 2020 Morning Brew Education: Schools across the U.S. are struggling to secure laptops for students this fall, per an AP investigation. Read the Full Article Here #MondayMotivation "No matter how hard the past is, you can always begin again." Gustavo Friederichsen Chief Executive Officer Los Angeles County Medical Association “If it matters to our LACMA members, it matters to me.”