San Francisco Medical Society Blog

Your Help Needed to Oppose SB 62 (Bill Requiring Medical Board Investigations for Prescription Drug Deaths)

Tue, 21 May 2013 16:43:41 GMT

On Thursday, May 23, the Senate Appropriations Committee will be considering a bill that would require a coroner to file a report with the medical board when a controlled substance is found to be a contributing factor in a death. While well-intentioned, SB 62 simplifies a very complicated issue to the potential detriment of patients.

SFMS/CMA is urging physicians to contact their senators today and ask them to oppose this flawed bill.

SB 62 (Price) would expand provisions to require a coroner to file a report with the Medical Board of California when he or she determines that a Schedule II, III, or IV drug was a contributing factor in a death.

Senator Price's stated assumption that a coroner’s report connects the dots between overdose deaths and so-called physician overprescribing is fundamentally flawed. This bill is a response to growing concern about prescription drug abuse, an issue that is of great concern to SFMS/CMA and physicians across the state. However, the statistics show that the vast majority of people who abuse prescription drugs acquire them from friends and family (often without their knowledge) or from sources other than the prescriber. There are also many circumstances in which individuals with legitimate prescriptions for controlled substances might die, including non-compliance with prescriber's orders or mixing the drugs with other substances like illicit drugs or alcohol.

If this bill is allowed to become law, it will become increasingly more difficult for patients being treated for pain to get appropriate treatment, as physicians will become less likely to prescribe controlled substances for fear of a medical board investigation.

We ask that you and your colleagues call, fax, or email your legislators TODAY.

Call (877) 362-8455 to be connected with your legislator or click here to send an email (sample email via link).

Talking Points

As a physician, I am very concerned about the growth in prescription drug abuse and want to be a partner in addressing it, but SB 62 is an approach that will have significant unintended consequences.
The reports being required under SB 62 will make physicians less likely to prescribe drugs on Schedule II, III, and IV for fear of investigation even in instances when the care is appropriate. Doing so will impact patient’s ability to get appropriate pain management.
There are many circumstances in which a person with a legitimate prescription for a controlled substance may die, including the patient being non-compliant with the prescriber’s orders or mixing the drugs with other substances like illicit drugs or alcohol.
Patients being treated for pain may also have comorbities that could result in death. None of these instances reflect inappropriate practice by a physician and yet all of them could be reported to the medical board for investigation under SB 62.
Further, the vast majority of people (70%) who use drugs for non-medical purposes did not get it from a prescriber, but from other sources.
The risk of negatively impacting patient care must be balanced with the potential benefit. Given all the extenuating factors that exist in assessing overdoses related to controlled substances, SB 62 is not balanced.

10,000 Health Care Providers to Rally to Stop Medi-Cal Cuts at State Capitol

Mon, 13 May 2013 16:21:30 GMT

SFMS and CMA have joined an unprecedented coalition of physicians, dentists, health care workers and hospitals working to stop the 10% Medi-Cal reimbursement rate cut.

The We Care for California coalition was borne of an effort to build a strong coalition of diverse organizations fighting to ensure that California’s health care system doesn’t continue to get short changed. So often in the past, health care advocates have become divided in their efforts, so focused on individual organizational interests, that the collective strength is weakened. We Care for California intends to stand undivided in using the coalition’s collective influence in defense of health care.

The coalition’s first major effort is to ensure that two CMA-sponsored bills—SB 640 (Lara) and AB 900 (Alejo)—are passed by the Legislature and signed by Governor Brown. Both bills, sponsored by CMA, would stop the 10 percent Medi-Cal rate cut.

Join “We Care for California” in Sacramento on Tuesday, June 4 from 11 am to 4 pm

to call on State Legislators and the Governor to stop the $1 billion reduction in provider rates in the Medi-Cal program. SFMS/CMA physicians will stand with nurses, dentists, and other health care providers as well as patient and consumer groups to advocate for the support of SB 640 and AB 900.

This will be the largest health care gathering ever at the state Capitol, and will send a powerful message that we expect our elected leaders to stand up for quality care in California.

The goal is to bring 10,000 health care providers together from across the state participate.

Buses will be available to transport anyone who wants to participate from hospitals around the state to the Capitol building in Sacramento at no charge to the participant. If you are interested in attending the event, please register at www.wecareforca.org to reserve a seat on the bus nearest you.

Click here for detailed event and RSVP information.

SFMS/CMA asks California Supreme Court to Depublish Case that Ignores MICRA's Definition of Professional Negligence

Fri, 10 May 2013 10:04:16 GMT

The California Medical Association (CMA), together with other amici, has asked the California Supreme Court to depublish an appellate court opinion that thwarts the long-standing definition of "professional negligence" in California's Medical Injury Compensation Reform Act (MICRA). The ruling, if allowed to stand as precedent for future cases, could be misused to undermine the goals of MICRA and adversely affect the entirety of the health care system and safety net in California.

In Flores vs. Presbyterian Intercommunity Hospital, a hospital inpatient sued for injuries she allegedly sustained from a fall when her hospital bed rail collapsed. The appeals court ruled that the negligence did not occur in the rendering of professional services and as such was subject to the two-year statute of limitations for ordinary negligence rather than the one-year statute of limitations for professional negligence.

CMA, California Dental Association, and California Hospital Association filed a joint amicus letter urging the Supreme Court to depublish the Court of Appeal’s opinion on the grounds that the opinion was wrongly decided, having been based on a poor factual record and consideration of less than all the pertinent authority.

CMA’s letter points out that under the long-standing definitions in MICRA, professional negligence includes any act or omission by a health care provider in the rendering of professional services for which the provider is licensed. Despite this clear definition and the fact that the provision and maintenance of safe hospital beds is a service for which hospitals are licensed, the Court of Appeal’s opinion failed to even address the pertinent licensing laws and regulations.

CMA and the other amici urged depublication because this wrongly decided opinion will not provide meaningful guidance in future cases and obscures the definition of what constitutes professional negligence under MICRA.

MICRA, California’s landmark professional liability reforms, have for nearly 40 years fairly compensated injured parties while protecting access to care for Californians.

Click here for more information on MICRA.

Update on Scope of Practice Legislation

Tue, 30 Apr 2013 13:09:57 GMT

A package of bills aiming to expand or alter the scope of practice for a collection of allied health professionals successfully cleared the Senate Committee on Business, Profession and Economic Development yesterday.

The scope bills—SB 491, 492 and 493—are being authored by Sen. Ed Hernandez (D-West Covina) and deal with the respective scopes of practice for nurse practitioners, optometrists and pharmacists in California.

While all three bills are now heading to the Senate Committee on Appropriations, SFMS/CMA made important headway on these proposals, garnering some significant concessions that we hope to build upon as the legislation moves forward.

This is the first step in a long journey for these bills, and CMA staff will continue to work diligently to ensure that our concerns are addressed. We also expect the proposals to face an enhanced level of scrutiny should they be approved on the Senate floor and enter the Assembly.

Below is an update on where the bills now stand, including highlights of some of the many amendments and revisions that took place in the past few weeks.

SB 491 - Nurse Practioners

This bill would expand the scope of practice for California’s Nurse Practitioners, allowing them to establish independent practices without the supervision of a partner physician. SFMS and CMA have consistently “opposed” this bill.

Our primary concern with this bill continues to center on the issue of patient safety, but also touches upon the increased costs that may come with under qualified health care professionals ordering unnecessary tests or making superfluous recommendations to specialists. In addition, we called attention to the fact that nurse practitioners did not move to medically underserved areas in Arizona, a stat that granted them independent practice in 1985.

SB 492 - Optometric Corporations

SB 492 initially sought to dramatically expand the scope of practice for California’s optometrists, originally asking that they be allowed to diagnose and treat a host of ailments that manifest in the eye, including diabetes and high blood pressure. In its original form, the bill also allowed optometrists to administer surgical procedures current outside their legal scope of practice.

While SFMS/CMA continues to take an opposed position on this bill, significant amendments have taken place in the past few days. As it stands now, all of the surgical procedures and most of the treatments generally reserved for ophthalmologists have been removed from the bill. This represents significant progress and will provide us a place to build from as the bill moves forward.

SFMS/CMA still has considerable concerns regarding primary care responsibilities that would be extended to optometrists if the bill is allowed to move forward, specifically regarding the ability to diagnose, rather than simply screen for, ailments that may manifest in the eye. It should be noted, however, that optometrists have agreed to not include treatment for primary care in the most recent version of their proposal. We remain committed to working with the author to address these concerns.

SB 493 - Pharmacy Practice

SB 493 seeks to expand the existing scope of practice for pharmacists in California, and is perhaps the bill where SFMS/CMA made its greatest progress leading up to Monday’s hearing. As a result, SFMS/CMA originally took an opposed position to the bill, but has since moved to “oppose unless amended” in advance of Monday’s hearing.

Initially, this bill would have expanded pharmacists’ scope in a way that allowed them to prescribe a wide variety of drugs without physician supervision. Following a round of amendments, much of the prescribing authority has been removed from the bill, but there continue to be some major areas of concern for SFMS/CMA.

The major concern deals with the author’s desire to allow pharmacists to prescribe smoking cessation drugs that both the Medical Board of California and SFMS/CMA consider to be psychotropic in nature. We believe this to present a major risk to patient safety and will continue to oppose the bill until these issues are resolved. Several members of the committee also raised this concern, and as a result, the sponsors acknowledged the issue and committed to working with CMA to resolve it.

As mentioned before, all of these bills still face some considerable hurdles before they can become law and we believe the level of scrutiny will increase as they move forward.

Physicians and Lawmakers Promote Workforce Legislation

Thu, 18 Apr 2013 15:50:56 GMT

A coalition of physicians, legislators, medical students, and residents gathered on the steps of the Capitol to support several key pieces of legislation that will address California's mounting issues regarding its physician workforce during CMA Lobby Day.

California’s health care industry is expected to see an enormous surge in demand beginning in 2014, when the implementation of the Patient Protection and Affordable Care Act (ACA) begins the process of extending coverage to what many analysts are projecting could be more than 5 million currently uninsured residents. To compound this problem, a large number of these currently uninsured residents live in areas of the state already grappling with long-standing physician shortages.

Several members of the state Legislature have introduced bills dealing to the various stages of physician training and development in California.

The first step, lawmakers agreed, was to ensure that California was taking the necessary measures to educate its future physicians, a goal which Senator Richard Roth (D – Riverside) and Assembly member Jose Medina (D – Riverside) believe would be furthered by funding the University of California, Riverside School of Medicine.

The pair, which has each authored a bill to allocate $15 million annually in state funds to the operation and expansion of the UC Riverside School of Medicine, agreed that the expansion of coverage called for under the ACA was a tremendous first step toward health care reform in California, but that more needed to be done, especially in regions struggling with existing physician shortages.

Other members of the Legislature have directed their attention toward California’s lack of residency slots, a problem which they claims sends California-educated physicians off to neighboring states, while the problem of access to care at home grows worse.

To remedy this issue, Assembly members Raul Bocanegra (D – Pacoima) and Rob Bonta (D – Alameda) have authored AB 1176, which would help fund and expand residency programs in California by placing a small fee on the state’s health plans.

Both Bocanegra and Bonta noted that an overwhelming majority of residents ultimately lay down roots in the state where they complete their residency training, and that California is doing itself a disservice by forcing California-educated physicians to seek programs in other states.

The financial burdens of a medical education also pose an enormous challenge to California’s students, speakers said, adding that the average medical student in California graduates with roughly $150,000-$160,000 in debt.

To relieve some of this burden, Assembly member Rudy Salas (D-Bakersfield) has authored AB 565, which would expand and strengthen the Steve Thompson Loan Repayment Program, which offers repayment assistance to physicians practicing in medically underserved areas of the state.

Together these bills will ensure that California’s physicians can continue to lead a health care model that will fully and adequately serve the state’s population.

AB 1176 passed with a 10-5 vote and AB 565 passed with unanimous support in Assembly Health Committee on Tuesday afternoon.

TRICARE Transition Survey

Wed, 10 Apr 2013 16:09:18 GMT

On April 1, 2013, UnitedHealth Military & Veterans Services (UMVS) began providing managed care services to 2.9 million TRICARE beneficiaries in the 21 western states, including California. On that date, UVMS took over the contract previously held by TriWest. Since then, the California Medical Association (CMA) has received reports from physician practices that have experienced various problems during the transition.

Your feedback is very important! The results of this survey will help CMA identify areas of concern, escalate those issues to UMVS and ensure the problems are addressed and resolved quickly.

Please share your experience! Click here to respond to our brief survey or visit http://www.surveymonkey.com/s/TRICAREtransitionsurvey.

Health Policy Report: Medical Policy-Making 2012

Mon, 08 Apr 2013 15:32:41 GMT

The 2012 SFMS delegation to the California Medical Association’s (CMA) annual House of Delegates meeting took a wide range of proposed resolutions for consideration by the statewide gathering. Each resolution, some with modification, moved important health care issues forward in the areas of health care delivery, health care mandates, and pharmaceutical industry issues, including medication disposal and insurance coverage.

Our roster of policy proposals this year, with outcomes, included:

Tracking Prescriptions to Curtail Medication Abuse (Rokeach, Loring, Turner): CMA supports the development of a fully functional, Web-based prescription drug monitoring program (PDMP), whether it be an improved CURES (Controlled Substances Review and Evaluation System) program or a new one that should be fully funded, including through a fee-per-prescription paid by manufacturers and suppliers of drugs monitored.

Reducing Overutilization: Physician Leadership (Denys, Fung, Eng): CMA supports physician-led, evidence-based efforts to improve appropriate use of medical services and will educate physicians, hospitals, health care leaders, and patients about the need for physician-led, evidence-based efforts to improve appropriate use of medical services. This resolution originally referred to the “Choosing Wisely” effort that will be the topic of the January/February 2013 edition of San Francisco Medicine.

"Pay for Delay" Practices on Generic Medications (Susens): CMA will ask AMA to support federal legislation that makes tactics delaying conversion of medications to generic status, also known as “pay for delay,” illegal in the United States. As noted in a recent NEJM piece, that might already be the case!

Increasing Utilization of POLST Orders (Newman, Schickedanz, Lopato): CMA encourages physicians to become educated about all aspects of the POLST form and to integrate discussions about, and use, POLST in all appropriate instances where medical services are provided to patients at the end of life. Surprisingly to many, this was perhaps the most hotly debated resolution of the year, as our original allowed for nurse practitioners to fill out POLST forms for physician confirmation, as is done in some other states.

Medical Mandates for Insurance Coverage and Medi-Cal (Chan): CMA supports the principle that mandated coverage for private insurers should also apply to publicly financed entities, when appropriate; and will advocate that the state legislature must budget for the increased cost to Medi-Cal and enrollees of the California Health Benefit Exchange when passing mandated coverage.

Promoting Quality and Transparency in Graduate Medical Education (Schickedanz): CMA supports efforts to urgently address the anticipated imbalance between the number of medical school graduates and available residency training positions; and greater transparency at all levels in the calculation, distribution, and tracking of graduate medical education (GME) funding; and will petition the Centers for Medicare and Medicaid Services to address perceived disparities in the distribution of GME funding.

Cell Phone Use in Cars (Udovic-Constant, Fouras): CMA will support public education efforts regarding the dangers of distracted driving, particularly activities that take drivers’ eyes off the road, and will ask the AMA to do likewise. Our original was more forceful, asking for more severe penalties and even bans.

There was much more, with something of interest to every specialty, practice setting, and personality.

Click here to view the full list of the new policies adopted at the 2012 CMA House of Delegates.

Interested in submitting a resolution or suggesting a resolution idea for 2013 HOD? Please contact SFMS at membership@sfms.org.

SFMS/CMA-Sponsored SB 640 Bill to Stop Implementation of Medi-Cal Cuts Introduced Today

Thu, 04 Apr 2013 15:13:07 GMT

Senator Ricardo Lara (D – Long Beach) introduced Senate Bill 640 today, which will stop the implementation of a 10% rate cut to Medi-Cal. The cut was part of the health services trailer bill (AB 97) to the 2011-12 state budget. SB 640 is co-sponsored by the SFMS and CMA.

“California has one of the lowest reimbursement rates for Medicaid in the nation,” said CMA President Paul Phinney, MD. “At a time when millions of new patients will be entering the program under health reform, the state should not be looking to rate cuts as a budget solution.”

SB 640 would block the 10% Medi-Cal provider rate cut and would stop the state from ‘clawing back’ rate cuts from providers dating back to 2011.

SFMS and CMA applaud Senator Lara for his commitment to ensure accessible health care for all. Cutting resources while adding patients to the Medi-Cal managed care system will make it hard for patients to find doctors and will delay much needed federal health reform in California. The cuts in trailer bill AB 97 were proposed when California was facing an enormous budget deficit. Those times have changed and there is no need to punish California’s poor and vulnerable patients any longer.

"This measure protects our most vulnerable communities from the devastating impacts of the cuts to Medi-Cal," stated Senator Lara. "I am proud to partner with CMA and the broad coalition of advocates to ensure that all of our communities have access to health care."

Following approval of the AB 97, CMA along with the California Dental Association, California Pharmacists Association, National Association of Chain Drug Stores, California Association of Medical Suppliers, Aids Healthcare Foundation and American Medical Response, filed suit against both the California Department of Health Care Services and the U.S. Department of Health and Human Services seeking to stop implementation of the cuts. That case is currently being considered by the 9^th Circuit Court of Appeals.

Click here for more information about the CMA lawsuit to stop the Medi-Cal cuts.

CMS Approves Medicare/Medi-Cal Duals Project

Thu, 28 Mar 2013 17:28:13 GMT

The Department of Health Care Services (DHCS) announced that the federal Centers for Medicare and Medicaid Services (CMS) has given approval to the project to require Medicare/Medi-Cal dual eligibles to enroll in a managed care plan. The project, which was previously known as the “Coordinated Care Initiative,” will now be called CalMediConnect.

Size and Scope of the Project

The project will begin no sooner than October 1, 2013 and will impact approximately 450,000 duals in eight counties—Alameda, Los Angeles, Orange, Riverside, San Diego, San Mateo, San Bernardino, and Santa Clara. As a result of intensive SFMS/CMA advocacy, enrollment in Los Angeles County will be capped at 200,000 people.

Duals should receive their first notices about the transition in July 2013, with enrollments set to begin in October. How quickly enrollment happens will vary by county, from three months in San Mateo to 15 months in Los Angeles. In all other counties, the time frame will be 12 months.

Although patients will be passively enrolled, they will be able to opt out for their Medicare benefits at any time. There will be no lock-in period.

Continuity of Care Provisions

Under the terms of the MOU, duals who do enroll in managed care for their Medi-Cal and Medicare benefits will be able to continue seeing an existing Medicare provider for up to six months, even if that physician is not contracted with the health plan. Payment for the services will be at Medicare rates.

Also, in urgent or emergent situations, plans will be required to pay out-of-network providers at Medicare rates. This is a provision that SFMS/CMA fought for in the bill to protect physicians, especially those in emergency rooms.

Network Adequacy

SFMS/CMA is pleased that the plan includes extensive network adequacy and financial solvency requirements for the participating plans. This, again, was something we have fought for in the legislative process.

Next Steps

Now that DHCS and CMS have finalized their MOU, they will be jointly negotiating with health plans on a three-way contract. As noted above, duals should be receiving notifications about the change in July.

Feds Allows States to Cut Medicaid Pay, Files Brief in CMA Court Battle

Fri, 08 Mar 2013 12:59:51 GMT

The U.S. Department of Justice filed a brief last Friday before the Ninth Circuit Court of Appeals arguing states can cut Medicaid (Medi-Cal in California) providers’ reimbursement as long as it does not harm access to care.

Earlier this year, SFMS/CMA have requested an en banc review from the Ninth Circuit as part of an effort to stop the State of California from implementing a 10% cut to Medi-Cal provider reimbursement rates.

In December 2012, a three judge panel of the Ninth Circuit ruled that the state could move forward with the rate cuts, passed by the Legislature in the spring of 2011, despite an earlier district court ruling that found that the cuts would irreparably harm the millions of patients who rely on Medi-Cal for health care. CMA and the other plaintiffs in the case are requesting a rehearing from the full Ninth Circuit Court of Appeals.

The justice department's brief urged the court to uphold the cuts and insisted that the Centers for Medicare and Medicaid Services (CMS) is not required to disapprove the plan amendments because they were motivated by “budgetary reasons.”

"It is entirely appropriate for a state to review its Medicaid plan to determine whether it can continue to satisfy its statutory obligations at lower payment rates," the justice department wrote in the brief.

CMA and the other plaintiffs in the case—California Dental Association, California Pharmacists Association , National Association of Chain Drug Stores, California Association of Medical Product Suppliers, AIDS Healthcare Foundation and American Medical Response—argue that reducing payments in the Medi-Cal system will force providers out of the program at a time when millions of new patients will be diverted into the Medi-Cal system.

If the state moves forward with these cuts, access to care will be devastated, not only for the existing Medi-Cal patients, but also the 900,000 kids moving from the Healthy Families program into Medi-Cal in 2013 and the millions of patients that will be newly eligible for Medi-Cal under the Affordable Care Act in 2014.

SFMS/CMA Joins Amicus Briefs Challenging Proposition 8 and the Defense of Marriage Act

Thu, 28 Feb 2013 13:08:47 GMT

Today, the SFMS and CMA joined the AMA and dozens of other health care organizations in filing an amicus brief with the US Supreme Court challenging California’s Proposition 8, which denies state recognition of same-sex marriages. Tomorrow, a similar brief will be submitted challenging the Defense of Marriage Act, which denies benefits to same-sex partners of federal employees.

“CMA strongly supports efforts to reduce health care disparities among members of same sex households, including measures to afford such households equal rights and privileges to health care, health insurance and survivor benefits,” said CMA President Paul Phinney, MD. “We also recognize that denying civil marriage contributes to worse health outcomes for gay and lesbian individuals, couples and their families.”

The brief states that the listed Amici—which includes leading associations of psychological, psychiatric, medical and social work professionals— have sought to present an accurate and responsible summary of the current scientific and professional knowledge concerning sexual orientation and families relevant to this case.

These briefs were filed based on policy passed at last year’s House of Delegates:

Date Adopted: 10/15/2012
Status: Adopted

Resolved #1 - That CMA support efforts to reduce health care disparities among members of same-sex households including minor children

Resolved #2 - That CMA support measures providing same-sex households with the same rights and privileges to health care, health insurance, and survivor benefits afforded to opposite-sex households

Resolved #3 - That CMA recognize that denying civil marriage contributes to poorer health outcomes for gay and lesbian individuals, couples and their families.

For a full copy of the Perry brief, please click here.

Most California Voters Support Soda Tax To Boost Students' Health According to Poll

Fri, 15 Feb 2013 11:20:16 GMT

68% of voters said they would support a tax on sugar-sweetened beverages if the revenue boosted school nutrition and physical activity programs, according to a new Field Poll.

The poll—conducted on behalf of the California Endowment—surveyed 1,184 registered California voters by telephone in October 2012.

According to the poll, 75% of respondents said that regularly drinking sugar-sweetened sodas increases the chance of individuals becoming overweight, while 42% said the same for sugar-sweetened energy drinks, and 26% said the same for sugar-sweetened sports drinks.

The SFMS and CMA have been strong advocates on combating child obesity. CMA took a policy position in support of the ban after its House of Delegates approved the resolution submitted by SFMS members Shannon Udovic-Constant, Arti Desai, and Adam Shickedanz introduced the resolution “Marketing of Unhealthy Food and Beverages to Children” at the 2011 HOD.

Additionally, CMA sponsored AB 1746, which would ban the sale of sugary sports drinks on middle and high school campuses throughout California. They are currently prohibited on elementary school campuses. Existing education code bans the sale of sodas in schools; this legislation would expand that to include sugary drinks.

Click here to read the original SFMS/CMA press release about AB 1746.

Source: California Healthline, February 15, 2013.

CMA Files Request for En Banc Review to Stop Medi-Cal Cuts

Mon, 28 Jan 2013 13:53:11 GMT

This morning, the California Medical Association (CMA) filed a request for an en banc review by the Ninth Circuit Court of Appeals to stop the State of California from implementing a 10% cut to Medi-Cal provider reimbursement rates. Last month , a three judge panel of the Ninth Circuit ruled that the state could move forward with the rate cuts, passed by the Legislature in the spring of 2011, despite an earlier district court ruling that found that the cuts would irreparably harm the millions of patients who rely on Medi-Cal for health care. CMA and the other plaintiffs in the case are now requesting a rehearing from the full Ninth Circuit Court of Appeals.

Following the reversal, Governor Jerry Brown issued his 2013-2014 budget proposal, which includes a 10% Medi-Cal reimbursement cut, retroactive to January 1, 2013.

CMA and the other plaintiffs in CMA et al. v. Douglas et al. – California Hospital Association, California Dental Association, California Pharmacists Association, National Association of Chain Drug Stores, California Association of Medical Product Suppliers, AIDS Healthcare Foundation and American Medical Response – argue that reducing payments in the Medi-Cal system will force providers out of the program at a time when millions of new patients will be diverted into the Medi-Cal system.

“Cutting payment to Medi-Cal providers by 10 percent will have a huge impact on patient access to care,” said Paul R. Phinney, MD, CMA president. “The state is in much better fiscal shape now than when these cuts were initially proposed in 2011 and with millions of new Medi-Cal patients entering the program under the Affordable Care Act, we simply cannot continue to cut resources and expect successful implementation of health reform in California.”

The lawsuit to prevent the cuts was originally filed by CMA in November 2011.

New 2013 California Laws of Interest to Physicians

Mon, 14 Jan 2013 16:41:01 GMT

The California Legislature had an active year passing many new laws affecting health care. In particular, the Legislature passed bills pertaining to public health, health care coverage, workers' compensation and scope of practice.

Click here for an extensive list of the many significant new health laws of interest to physicians.

Some of the notable legislation include:

AB 589 (Perea) – Medical School Scholarships
SFMS/CMA Position: Sponsor
Establishes the Steven M. Thompson Medical School Scholarship Program within the Health Professions Education Foundation to promote the education of medical doctors and doctors of osteopathy. Provides up to a specified sum per recipient in scholarships to selected participants who agree in writing prior to completing an accredited medical or osteopathic school based in the United States to serve in an eligible setting. Establishes a related account within the Health Professions Education Fund. (Health & Safety Code add Article 6, commencing with §128560, to Chapter 5 of Part 3 of Division 107)

AB 137 (Portantino) – Health Care Coverage: Mammographies
SFMS/CMA Position: Support
Requires every individual or group health insurance policy to provide coverage for mammography, for screening or diagnostic purposes, upon referral by a participating nurse practitioner, participating certified nurse-midwife, participating physician assistant or participating physician, as specified, based on medical need regardless of age. Because this bill would specify additional requirements for health care service plans, the willful violation of which would be considered a crime. (Health & Safety Code §1367.65; Insurance Code §10123.81)

AB 1083 (Monning) – Health Care Coverage
SFMS/CMA Position: Support
Reforms California's small group health insurance laws to enact the federal Patient Protection and Affordable Care Act (ACA). Prohibits a health care service plan contract or health insurance policy from imposing any preexisting condition provisions upon any individual. Provides an exception. Revises and recasts those provisions consistent with the ACA. Requires a specified notice regarding grandfathering such plans to all subscribers and insureds. Relates to open enrollment periods and rates. Makes certain provisions inoperative if provisions of the act are repealed. Requires specified reports. (Health & Safety Code §§1385.01, 1393.6, 1348.95, 1357.19, and 1357.55, to add Article 3.16, commencing with §1357.500, and Article 3.17, commencing with §1357.600, to Chapter 2.2 of Division 2 of, and to repeal and add Article 3.15, commencing with §1357.50, of Chapter 2.2 of Division 2; Insurance Code §§10181, 10127.19, 10198.10, 10750, add Chapter 8.01, commencing with §10753, and Chapter 8.02, commencing with §10755, to Part 2 of Division 2 of, and to repeal and add Article 7, commencing with §10198.6, of Chapter 1 of Part 2 of Division 2)

AB 1301 (Hill) – Retail Tobacco Sales: Stake Act
SFMS/CMA Position: Support
Amends the Stop Tobacco Access to Kids Enforcement Act. Removes the schedule for State Board of Equalization action in response to the occurrence of a violation of the Act or the related misdemeanor provision. Requires the board to assess a civil penalty and suspend or revoke a retailer's license for subsequent violations. Requires the assessment of an additional civil penalty to be deposited in the existing Cigarette and Tobacco Products Compliance Fund to fund suspension and revocation activities. (Business & Professions Code §§22958 and 22974.8; Penal Code §308)

AB 2348 (Mitchell) – Nurses: Drug Dispensing
Allows registered nurses (RNs) to dispense and administer hormonal contraceptives under a standardized procedure, as specified, and allows RNs to dispense drugs and devices upon an order by a certified nurse-midwife (CNM), a nurse practitioner (NP) or a physician assistant (PA) issued pursuant to standardized procedures while functioning within specified clinic settings. Expands the types of clinics in which an RN may dispense drugs or devices upon an order by a physician and surgeon, a CNM, an NP, or a PA to include intermittent clinics and student health centers operated by public higher education institutions. (Business & Professions Code §§2725.1 and 2725.2)

Update: CMS Released Instructions to Contractors for Implementation of the Revised Fee Schedule

Thu, 03 Jan 2013 10:04:17 GMT

On January 3, the Centers for Medicare and Medicaid Services (CMS) released instructions to Medicare contractors for implementation of the revised fee schedule.

As we reported yesterday, Congress on January 1 passed HR 8, the American Taxpayer Relief Act, narrowly averting the so-called "fiscal cliff." The bill includes a one-year Medicare fee-for-service physician payment freeze, meaning the 26.5 percent sustainable growth rate (SGR) cut has been averted, for now.

In order to allow sufficient time to develop, test, and implement the revised 2013 Medicare physician fee schedule, Medicare contractors have been instructed that they can hold claims with January 2013 dates of service for up to 10 business days. CMS expects these claims to be released into processing no later than January 16, 2013.

The claim hold should have minimal impact on physician cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.

Based on prior history of similar fee schedule updates, SFMS/CMA believes that physicians may expect to see claims paid in approximately 21 days, rather than the usual 14 days.

According to CMS, Medicare contractors will be posting the new payment rates on their websites no later than January 23, 2013.

The 2013 fee schedule will not be exactly the same as the 2012 fee schedule. Although Congress stopped the 26.5 percent SGR cut, there were other components of the fee schedule formula that affect payment that may have changed, such as the relative value units (RVUs).

Physicians have the option of holding claims and submitting them after the new fee schedule is released. If you choose to submit claims in the interim, SFMS/CMA suggests that both participating and non-participating physicians bill their usual and customary fees-for-services to Medicare. Billing at your customary fee ensures that Medicare pays the highest amount possible when the claim is processed.

Source: California Medical Association, December 03, 2013.

CMS Forced To Implement 26.5% Medicare SGR Rate Cut

Fri, 21 Dec 2012 11:49:35 GMT

The Centers for Medicare & Medicaid (CMS) issued a statement on Wednesday morning that because of Congressional inaction the agency will be forced implement the Medicare sustainable growth rate (SGR) formula cut of 26.5 percent beginning January 1, 2013.

If Congress does adjourn without addressing the payment cut, CMS has said it will follow normal claims processing procedures. That is, claims will not be held and Medicare carriers will process payments for physician services provided after December 31 under the normal 14-day cycle required by law. Payment for these claims would be based on the new, lower fee schedule conversion factor of $25.0008, as opposed to the current rate of $34.0376.

The California Medical Association (CMA) has spoken with California leadership in Congress to confirm that the fiscal cliff negotiations have broken down. There is also no agreement within Congress to pass a stand-alone SGR bill.

Both Republican and Democratic leaders understand that physicians cannot sustain a 26.5 percent Medicare payment cut, but it is now caught up in the politics of the “fiscal cliff.” It is critical that physicians keep contacting their members of Congress to demand action.

In addition to the SGR cut, physicians are facing a potential two percent "sequestration" cut. The sequestration cuts are part of the $1.2 trillion in cuts required by the budget deal worked out to end last year's debt-ceiling crisis.

Ultimately, CMA does not think Congress will allow the cuts to go forward on any long-term basis. At this time, it is impossible to predict whether the 112th Congress will find a way to pass a stop-gap measure before adjourning, how long such a measure would last, or how long payment cuts will be in effect until legislation can be passed after the 113th Congress convenes in January.

It is inexcusable that Congress is once again putting Medicare patients and the practices of physicians who provide them needed health care at significant risk.

“The health care delivery system is going to see an influx of patients in the next 18 months,” said Dr. Phinney. “We simply cannot continue to cut resources while adding more patients. The result will be millions of patients with insurance coverage, unable to see a physician. This is especially true in California, where we are also battling cuts to the state’s Medicaid program at the same time.”

The financial disruption this situation will cause for physicians and their practices is unacceptable. CMA will continue to fervently convey this message in the strongest possible terms to Congress and the Administration. Our grassroots network has been activated, and we are seeking your voices to tell Congress just how deeply its inaction will affect you.

Despite these efforts, CMA feels compelled to advise physicians to start making plans to mitigate this disruption and meet their own financial obligations in January. Given the potential impact on practice revenue in early January, physicians should be certain that adequate arrangements are in place to sustain their practices. For those physicians who are forced into the untenable position of limiting their involvement with the Medicare program because it threatens the viability of their practices, we urge that patients be notified promptly so that they, too, can explore other options for obtaining needed medical care.

Physicians should also be aware that they have until Dec. 31, 2012, to make changes to their Medicare participation status for 2013.

CMA will remain engaged throughout the holidays and keep you informed of any new developments.

Call Now!

Contact your members of Congress and urge them to work together to stop the Medicare payment cuts before they take effect on January 1, 2013.

To contact your members of Congress, use AMA’s grassroots hotline,(800) 833-6354. You will be asked to enter your ZIP code and select your Representative. Please select your Representative first, then call back to connect with Senators Boxer and Feinstein.

Source: California Medical Association, December 20, 2012.

SFMS/CMA Responds to Ninth Circuit Ruling Vacating Preliminary Injunction for Reimbursement Rate Cuts

Fri, 14 Dec 2012 11:28:14 GMT

On Thursday, a three judge panel of the California Ninth Circuit Court of Appeals issued its opinion in CMA et al. v. Douglas et al. The Ninth Circuit panel reversed the district court’s decision and ruled that California can reduce Medi-Cal payments for health care providers by 10%.

As you will recall, the SFMS/CMA—along with the California Dental Association, California Pharmacists Association, National Association of Chain Drug Stores, California Association of Medical Product Suppliers, AIDS Healthcare Foundation, and American Medical Response—filed a lawsuit against the California Department of Health Care Services (DHCS) and the U.S. Department of Health and Human Services (HHS). The lawsuit was filed in response to HHS's approval of the state's 2011 10% reimbursement rate cut for Medi-Cal providers. On February 1, 2012, U.S. District Court Judge Christina Snyder granted our request for a preliminary injunction to invalidate and stop the implementation of the approved 10% Medi-Cal rate reduction. Today’s decision vacates the preliminary injunction.

The rate cuts will significantly impact access to care for Medi-Cal patients.

CMA President Paul Phinney, MD said, “Our hope is that state officials and Governor Brown can look at the situation and decide not to move forward with these cuts. It was a tough budget decision that was made when the state was in a much more dire fiscal situation than it is now. Moving forward with these cuts will impact the 900,000 kids moving from the successful Healthy Families Program into Medi-Cal, the millions of patients that will be newly eligible for Medi-Cal under federal health reform and the existing patient base as well. We need to ensure that health insurance isn’t just an empty promise for these patients.”

SFMS/CMA will be meeting with our partners and stakeholders to evaluate options moving forward, including requesting an En banc rehearing from the full Ninth Circuit Court of Appeals.

SFMS/CMA and DHCS to Present Complimentary December Webinar About "Coordinated Care" Initiative

Mon, 10 Dec 2012 12:49:57 GMT

The California Department of Health Services (DHCS) and the SFMS/CMA are sponsoring a free webinar on the state’s new Coordinated Care Initiative (CCI) for dual eligibles—Californians eligible for both Medi-Cal and Medicare. The webinar takes place on December 19, 2012, from 12:15pm to 1:15 pm and is free for all physicians.

The Coordinated Care Initiative (CCI) was authorized by the Assembly in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that would see more than 75% of California’s dual eligible beneficiaries transition to managed care plans.

Although the project is still pending federal approval, DHCS plans to begin passively enrolling dual eligible patients residing in eight of California's largest counties beginning in 2013. Under the pilot program, patients will be enrolled in a managed care plan unless they actively opt out.

SFMS/CMA remains concerned over the breadth of this so-called pilot project and has urged CMS to require the state to scale it back. Any transition that involves 75% of all dual eligibles cannot be considered a pilot. In October, the CMA’s annual House of Delegates authored a resolution that calls on CMA to collect data from its membership regarding difficulties with the duals transition and, if difficulties are found to be widespread, report them to DHCS, the California Department of Managed Health Care and CMS.

Click here to register for the December 19 free webinar.

Two CMA Members Headed to Congress

Mon, 19 Nov 2012 15:46:50 GMT

California voters are sending two physician to the U.S. House of Representatives after this month’s election.

In an upset, Raul Ruiz, MD, defeated incumbent Mary Bono Mack for the 36^th Congressional District seat in the Coachella Valley. Dr. Ruiz, an emergency room physician, handed Bono Mack the first defeat of her 14 years in office.

Farther north, Ami Bera, MD, won over Dan Lungren in the race for the 7^th Congressional District in suburban Sacramento.

“Over the next two years, we will see more rapid change in the health care delivery system than ever before,” said CMA President Paul R. Phinney MD. “With Drs. Ruiz and Bera headed to Washington, we can be assured that physicians and patients will be represented as we help to develop a system that is patient-centric rather than profit-centric, high quality, high-value, evidence-based and universally accessible."

Drs. Ruiz and Bera, both Democrats, are members of the CMA. A total of 28 physicians had their names on ballots across the country Tuesday, including 17 incumbents and 11 challengers. Of the 20 physician members of Congress, 17 are in the House and three in the Senate.

SFMS/CMA Urges Congress to Stop $11 billion in Medicare Sequestration Cuts

Mon, 17 Sep 2012 16:39:52 GMT

Hospitals and other providers will see Medicare payment reductions totaling $11.1 billion next year, due to the Budget Control Act of 2011, unless Congress passes new measures to prevent the cuts, according to a report from the White House’s Office of Management and Budget.

This comes just days after the SFMS/CMA, American Medical Association, and 99 other state and specialty societies submitted a letter to Congress urging the passage of legislation nullifying the 2 percent cut payments called for under the sequestration act.

The 2 percent Medicare “sequestration” cuts are part of the $1.2 trillion in cuts required by the Sequestration Transparency Act, part of a deal worked out to end last year’s debt-ceiling crisis. Under the act, across-the-board cuts will be triggered if Congress fails to come to an agreement on how to reduce the federal deficit.

These cuts would come on top of the 27 percent Medicare physician payment cuts triggered by the flawed sustainable growth rate (SGR) formula.

The letter to Congress argues that “the combination of a sequestration cut and looming Medicare sustainable growth rate payment cut would not only impede improvements to our health care system, it could lead to serious access to care issues for Medicare patients as well as employment reductions in medical practices, we strongly urge Congress to work diligently during the fall to reach a bipartisan agreement to pass legislation nullifying the Medicare physician payment cuts.”

SFMS/CMA and the other cosigners also expressed a commitment to work with Congress on the shared goal of delivery and payment reform in the Medicare program. “To reach this goal, adequate and stable investments are necessary so that physicians can modernize their practices to support the coordinated care that will improve health and prevent costly complications and enable the participation in new payment and delivery models,” the letter said.

The sequestration cuts will take effect on January 2, 2013, if Congress fails to either reach a deficit reduction agreement or takes additional legislative action to stop the cuts. Congressional Republicans remain deadlocked with the Obama Administration over sharp differences in their preferred approaches to reduce future deficits.