Accomplishments
Restoration of Medi-Cal 10% Provider Rate Cut for TDG Strategies Clients
TDG Strategies clients the California Ambulatory Surgery Association, California Orthotics & Prosthetics Association, and Hearing Healthcare Providers of California were three of only 31 provider types receiving a Medi-Cal 10% rate increase in the 2022-2023 State Budget. Bryce Docherty negotiated restoration of the Medi-Cal 10% provider rate cut with the Office of Governor Gavin Newsom and State Legislature.
This is a restoration of the 10% Medi-Cal provider rate cut implemented by then Governor Brown in 2011 by way of AB 97 (Chapter 3, Statutes of 2011), required the California Department of Health Care Services (DHCS) to reduce most Medi-Cal provider payments by 10%, with limited exceptions. Governor Newsom’s initial 2022-2023 State Budget proposal only restored the Medi-Cal 10% provider rate reductions for eight provider types based on COVID-19 pandemic impacts and the DHCS quality and equity goals. Albeit not a significant Medi-Cal rate increase, it does send a symbolic message that the Newsom Administration values the role TDG Strategies clients play in the larger healthcare delivery system in California, and the State Medi-Cal Program in particular.
$15 Million Appropriation to Fund Health Information Technology Workforce
In conjunction with RGS Consulting and Advocacy, Bryce Docherty was able to obtain $15 million in the 2022-2023 State Budget to fund Health IT Workforce Recruitment and Training for Clinics in Underserved Communities. TDG Strategies client OCHIN and their subsidiary the California Telehealth Network OCHIN are nonprofit health information technology and research networks of community providers that include over 47 California members serving over 1.5 million network patients, one third of whom are covered under Medi-Cal. OCHIN was exclusively awarded the $15 million by the California Department of Health Care Access and Information (HCAI).
This $15 million State Budget appropriation is transformational and will establish a modernized, technology-forward training and workforce development program that brings workforce development to individuals in underserved and rural communities to fill shortages at their neighborhood health center or local public health agency. Increasing the workforce by strengthening the health IT skills of operational and support staff will ensure the accuracy and integrity of digital claims and clinical data while relieving the burden on clinicians who are experiencing a high level of burn-out.
AB 2157 (Wood) – Chapter 278 of 2020
This legislation – sponsored by the California Society of Anesthesiologists (CSA) – codified sub-regulatory guidance issued by the California Department of Managed Health Care (DMHC) and provided further balance between physicians and health plans and/or insurers over billing and payment disputes for out-of-network healthcare services provided in an in-network facility. Guidance issued by the DMHC is a direct result of Bryce Docherty’s and CSA’s persistent efforts of petitioning the DMHC to provide more clarity on what information needs to be considered in these types of payment disputes.
AB 2157 has created a more equitable independent dispute resolution process (IDRP), which has benefited physicians, by ensuring that information submitted through the IDRP is kept confidential from opposing parties; that the independent arbiter conducts a “de novo” review of the claim dispute based solely on the information and documents timely submitted into evidence by the parties; and that the independent arbiter assigns reviewers to each case based on their relevant education, background, and medical claims payment and clinical experience.
In 2016 California passed AB 72 (Bonta) – Chapter 492, which rightfully removed patients from the middle of these contact and billing disputes between physicians and health plans and/or insurers and physicians if they receive services from an out-of-network provider in an in-network facility.
Bryce Docherty and CSA overcame initial concerns of Health Access California and AB 2157 passed with bipartisan and unanimous support.
Physician Anesthesiologist Week – 2015 through Present
These bipartisan measures – sponsored by the California Society of Anesthesiologists (CSA) since 2015 – annually recognize “Physician Anesthesiologist Week” and further memorializes the critical role physician anesthesiologists play in patient care throughout California.
SB 1326 (Roth) – Chapter 226 of 2014
This legislation – sponsored by the Hearing Healthcare Providers of California (HHP) – provided clarification for consumers in defining the warranty period for hearing aids. The specificity SB 1326 provided further protected the public by providing the California Speech-Language Pathology & Audiology & Hearing Aid Dispensers Board (the Board) with consistent enforcement criteria when examining hearing aid dispensing complaints.
Existing law, the Song-Beverly Consumer Warranty Act (Song-Beverly), defines the obligations of retail sellers of assisted devices, including hearing aids. Song-Beverly also provides warranty and right of return provisions for consumers of assisted devices but does not clearly define when certain warranty and right of return provisions apply to hearing aids specifically. The vagueness of these provisions led to confusion by hearing aid dispensers and consumers and made it very difficult for the Board to mediate consumer complaints when parties involved had different interpretations of their rights and responsibilities under Song-Beverly.
Bryce Docherty and HHP negotiated amendments to overcome initial opposition from the Consumer Attorneys of California and the Consumer Federation of California.
SB 1095 (Rubio) – Chapter 454 of 2012
This bipartisan legislation – sponsored by the California Ambulatory Surgery Association (CASA) – allowed an accredited outpatient setting or Medicare certified ambulatory surgical center to obtain a limited pharmacy license from the California Board of Pharmacy (the Board). The ability to obtain a limited pharmacy license from the Board was only authorized for surgical clinics licensed by the California Department of Public Health (CDPH). These limited pharmacy licenses allow facilities to purchase a limited supply of drugs at wholesale and require these drugs to be stored safely by that facility.
Existing law provides specific oversight for an ambulatory surgery center (ASC) utilizing certain levels of anesthesia. However, the Board would not issue a pharmacy permit (i.e. limited pharmacy license) to an ASC until it could document state licensure. A court ruling (Capen v. Shewry (2007) 155 Cal.App.4th 378) in September 2007 prohibited the CDPH from issuing state licenses to almost all ASCs. As a result, accreditation and Medicare certification are the only other regulatory options for most ASCs. Without adding an accredited outpatient setting and Medicare certified ambulatory surgical center to the list of facilities that can obtain a limited pharmacy license from the Board, individual staff physicians were required to acquire and maintain a myriad of medications on-hand to dispense at the point of care as opposed to those medications simply being readily centralized and available by the ASC.
Bryce Docherty and CASA overcame initial opposition from the Board and negotiated amendments to eventually earn the Board’s unconditional support. Bryce Docherty and CASA also maintained support from the Medical Board of California and over 50 ambulatory surgery centers, among others.
SB 233 (Pavley) – Chapter 333 of 2011
This bipartisan legislation – sponsored by the California Academy of Physician Assistants (CAPA) – clarified an inconsistency in existing law by allowing physician assistants and other appropriate personnel, under the supervision of a physician, to provide consultation and treatment services in hospital emergency rooms.
By authorizing physician assistants to perform consultative and treatment services in the emergency room, access to urgent medical care increased and patient overcrowding decreased. Furthermore, SB 233 comported state law with federal Emergency Medical Treatment and Active Labor Act (EMTALA) regulations that allow the use of licensed non-physician practitioners in the emergency room as long as this authorization is consistent with their state scope of practice.
Bryce Docherty and CAPA overcame the opposition of the California Nurses Association and California Chapter – American College of Emergency Physicians. Mr. Docherty and CAPA also maintained an impressive support coalition, which included the Medical Board of California and United Nurses Association of California/Union of Health Care Professionals, among others.
SB 1069 (Pavley) – Chapter 512 of 2010
This bipartisan legislation – sponsored by the California Academy of Physician Assistants (CAPA) – clarified various inconsistencies in existing law by allowing physician assistants to order durable medical equipment; approve, sign, modify, or add to a treatment plan for home health or personal care services; and conduct specified physical examinations and sign corresponding certificates or forms. Under SB 1069, all of these functions are performed under physician supervision and consistent with the existing physician assistant scope of practice.
Bryce Docherty and CAPA maintained an impressive support coalition, which included: American Congress of Obstetricians and Gynecologists; District American Federation of State, County and Municipal Employees, AFL-CIO; California Academy of Family Physicians; California Assisted Living Association; California Chapter – American College of Emergency Physicians; California Medical Association; California Psychiatric Association; California Radiological Society; Medical Board of California; Osteopathic Physicians and Surgeons of California; and United Nurses Association of California/Union of Health Care Professionals, among others.
Proposed Elimination of Orthotic and Prosthetic Benefits in the Medi-Cal Program
Governor Schwarzenegger proposed eliminating Orthotic and Prosthetic (O&P) benefits in order to bridge the $25 billion California budget deficit for the fiscal year 2010-2011. O&P services were one of several “Optional” benefits slated for elimination in the California Medi-Cal Program.
Bryce Docherty outlined and executed a strategic grassroots and lobbying effort deployed by the California Orthotic and Prosthetic Association (COPA). Part of the public affairs campaign to reject the proposed O&P elimination included evidence that these services actually saved the State money and how these patients needed O&P services in order to remain productive as active members of the California economic recovery.
As a result of the tenacious COPA campaign led by Bryce Docherty, the Senate and Assembly Budget Committees both rejected Governor Schwarzenegger’s proposed elimination of O&P services from the Medi-Cal Program. COPA was also able to keep the proposed cuts out of the “May Revise” and final budget deficit solution agreed upon by legislative leaders and Governor Schwarzenegger, which was eventually adopted by the full Senate and Assembly.
Bryce Docherty has also provided similar strategic counsel to O&P providers in other states, such as Arizona, who were fighting similar state budget battles to eliminate these services.
AB 356 (Fletcher) – Chapter 434 of 2009
This bipartisan legislation – sponsored by the California Academy of Physician Assistants (CAPA) – specifically authorized physician assistants to take the appropriate licensing exams for fluoroscopy licentiate permits issued by the Radiologic Health Branch of the California Department of Public Health.
Bryce Docherty and CAPA recognized that patient safety always comes first and sought a solution that simply allowed physician assistants to comply with requirements set forth for other health professionals who perform medical procedures utilizing fluoroscopy. Therefore, in addition to prerequisite coursework and training in fluoroscopy, AB 356 required that physician assistants who are eligible for fluoroscopy permits also need to meet the same continuing education requirements in radiation safety to maintain that permit as other licentiates of the healing arts.
SB 171 (Pavley) – Chapter 34 of 2009
This bipartisan legislation – sponsored by the California Academy of Physician Assistants (CAPA) – clarified an inconsistency in existing law by allowing physician assistants under the supervision of a physician, nurse practitioners, certified nurse-midwives, and other licensed advanced practice nurses under a physician standardized procedure and protocol (collectively hereafter, “Midlevel Practitioners”), to conduct medical examinations on school teachers and other school personnel applicants seeking employment by a school district or a county superintendent of schools.
This legislation further clarified existing law by also allowing these Mid-level Practitioners to submit the completed medical exam certificate to the relevant school district or county superintendent of schools. Prior to the enactment of this legislation, California law only allowed these medical examinations and subsequent certificates to be performed and submitted by physicians.
Bryce Docherty maintained an impressive support coalition, which included: American Federation of State, County and Municipal Employees, AFL-CIO; California Association for Nurse Practitioners; California Medical Association; California Nurse-Midwives Association; Los Angeles County of Education; and United Nurses Association of California/Union of Health Care Professionals, among others.
AB 3 (Bass) – Chapter 376 of 2007
This bipartisan legislation – sponsored by the California Academy of Physician Assistants (CAPA) – represents the largest overhaul of the Physician Assistant Practice Act since its inception over 30 years ago. Aptly coined the “California Physician Team Practice Improvement Act,” this bill reduced capricious barriers that hindered patient access to high-quality medical care provided by physician assistants. Specifically, the clinically sound and cost-effective approach of this bill did not eliminate physician supervision of physician assistants, but instead simply eliminated unnecessary restrictions at the discretion of physicians in determining how best to exercise that supervision.
The four main tenants of this legislation are the following:
- increased the physician assistant supervision ratio from 2:1 to 4: 1;
- eliminated the patient-specific approval for controlled substances based on education standards approved by the Physician Assistant Committee;
- reduced the chart countersignature requirement from 10 to 5 percent; and
- allowed physician assistants to bill for all Medi-Cal services within their scope of practice.
Bryce Docherty maintained an impressive support coalition, which included: American College of Emergency Physicians, California Chapter; California Academy of Family Physicians; California Medical Association; California Psychiatric Association; Kaiser Permanente; and the Medical Board of California, among others.
AB 139 (Bass) – Chapter 158 of 2007
This bipartisan legislation – sponsored by the California Academy of Physician Assistants (CAPA) – clarified an inconsistency in existing law by allowing physician assistants and advanced practice registered nurses (i.e. nurse practitioners, nurse midwives, and nurse anesthetists) to conduct medical examinations on applicants seeking a license to drive a school bus, youth activity bus, farm labor vehicle, and paratransit vehicles. California law did not otherwise restrict the ability of clinically appropriate physician assistants and advanced practice registered nurses to perform medical or physical examinations and other routine medical services except for this inconsistency in the California Vehicle Code.
Bryce Docherty maintained a strong support coalition, which included: California Association of Nurse Anesthetists; California Association for Nurse Practitioners; California Medical Association; California Nurses Association; California Nurse-Midwives Association; Kaiser Permanente; and United Transportation Union, among others.
Patient Medication Safety Regulations – C.C.R. Sections 1793.7 and 1793.8
These regulations – sponsored by the California Society of Health-System Pharmacists (CSHP) – were adopted on January 5, 2007, by the California Board of Pharmacy. These regulations allow pharmacy technicians to check the work of other pharmacy technicians in connection with filling floor and ward stock and unit dose distribution systems for acute care hospital patients whose orders have been previously reviewed and approved by a licensed pharmacist. These regulations were modeled after similar pilot projects at Long Beach Memorial Medical Center and Cedars-Sinai Medical Center.
AB 2012 (Emmerson) – Chapter 756 of 2006
This legislation – sponsored by the California Orthotics and Prosthetics Association (COPA) – clarified an existing requirement which mandates that health plans and insurers “offer” coverage for orthotic and prosthetic (O&P) devices and services consistent with the method and manner of other basic healthcare covered services. This bill represents the most successful accomplishment for amputee and congenital birth defect patients in over 30 years.
Correcting this coverage inequity garnered opposition from America’s Health Insurance Plans; Association of California Life and Health Insurance Companies; California Association of Health Plans; California Chamber of Commerce; Health Net; and Kaiser Permanente. Irrespective of this opposition, AB 2012 enjoyed bipartisan support throughout the legislative process thanks in no small measure to the angelic testimony of Camille Baker, a very brave 10-year-old fifth-grader from Galt, California.
Bryce Docherty also created an impressive and powerful support coalition, which included: Amputee Coalition of America; Amputee Connection of Redlands; Beverly Hills Prosthetics Orthotics, Inc.; California Catholic Conference; California Medical Association; California Physician Medicine and Rehabilitation Association; California Podiatric Medical Association; California Society of Industrial Medicine and Surgery; Nobbe Orthopedics, Inc.; Orthotic and Prosthetic Centers at the University of California San Francisco; R and J Prosthetic Appliances Co., Inc.; and VQ Orthocare, among others.
ACR 145 (Nakanishi) – Chapter 108 of 2006
This bipartisan measure – sponsored by the California Academy of Eye Physicians and Surgeons (CAEPS) – established a panel, comprised of specified healthcare and education members appointed by the Senate Rules Committee and Assembly Speaker, to study existing vision screening and appraisal requirements for children. This measure also required the panel to make recommendations and submit them to the Assembly and Senate Committees on Health regarding ways to improve those requirements.