Should Mandatory Peer Review Reporting Apply to Physician Assistants?

Recently, three U.S. Senators have asked federal health officials to review the way state medical boards regulate our nation’s physicians. This request was prompted by recent reports from a citizen’s watchdog group and three newspapers, including the Star Tribune, that “highlighted disturbing failures of state medical boards to discipline physicians,” the senators said. The letter was signed by Sens. Charles Grassley, R-Iowa, Orrin Hatch, R-Utah, and Max Baucus, D-Montana. The Medical Board of California has its own Enforcement Program. The responsibilities of the Enforcement Program include:

    • Receive, review, and evaluate complaints and other information relating to the practice of licensees.
    • Investigate the circumstances relating to complaints to determine whether the laws relating to physician practice have been violated.
    • Review proposed stipulated decisions and decisions following administrative hearings, and other disciplinary matters.
    • Carry out disciplinary action pursuant to final decisions.
    • Administer a program to oversee physicians on probation.

For disciplinary matters, the Board has the authority to make final decisions on cases. (Business and Professions Code § 2227).

Mandatory 805 Reporting

Section 805 report is the mechanism in which peer review bodies, most commonly found in hospitals, are required to report specific information regarding physicians to the Medical Board. The purpose of the peer review reporting requirement is intended to facilitate information sharing among health facilities regarding the qualifications and performance of health professionals. The goal is to enhance the quality of health care by assisting facilities in making informed decisions about providers of care. Any peer review body must file, which includes:

    • A health care facility or clinic licensed under Division 2 of the Health and Safety Code or a facility certified to participate in the federal Medicare Program as an ambulatory surgical center.
    • A health care service plan licensed under Chapter 2.2 of Division 2 of the Health and Safety Code or a disability insurer that contracts with licentiates.
    • A medical
      or podiatric professional society having as members at least 25% of the eligible licentiates in the area in which it functions, which is not organized for profit and which has been determined to be exempt from taxes.
    • A committee organized by any entity consisting of or employing more than 25 licentiates of the same class that functions for the purpose of reviewing the quality of care provided by members or employees.

(Business and Professions Code § 805(a)(1)(B)(i)-(iv)). “Peer review” is the process in which a peer review body reviews the basic qualifications, staff privileges, employment, medical outcomes, or professional conduct of licentiates to make recommendations for quality improvement and education… (Business and Professions Code § 805(a)(1)(A)(i)). “Licentiate” is currently defined as a physician and surgeon, doctor of podiatric medicine, clinical psychologist, marriage and family therapist, clinical social worker, professional clinical counselor, or dentist. “Licentiate” also includes a person authorized to practice medicine pursuant to Section 2113 or 2168. (Business and Professions Code § 805(a)(2)).

Section 805 as it Applies to Physician Assistants

Interestingly missing from the definition of “licentiate” is Physician Assistants. As the Business and Professional Code is written at this time, Physician Assistants are not subject to mandatory 805 reporting. This raises an interesting issue: should they be? A Physician Assistant is one who conducts physical exams, diagnoses and treats illnesses, writes prescriptions, administers tests, and assists in surgery. They work in hospitals, clinics, and other types of health facilities. They are a healthcare professional who is licensed to practice medicine under the supervision of a physician. California has a special committee of the Medical Board called the Physician’s Assistant Committee. The Physician’s Assistant Committee’s mission is to protect and serve consumers through licensing, education, and objective enforcement of the Physician Assistant laws and regulations. Currently they are working with the Legislature to include Physician Assistants within the definition of “licentiate,” but until that day comes, a Physician Assistant does not have to be eported, as a licentiate would be required, under Section 805.