San Francisco Medical Society Blog

CMS Announces $1 Billion Initiative to Provide Better, Lower-Cost Health Care

Tue, 21 May 2013 12:43:24 GMT

U.S. Health and Human Services Secretary Kathleen Sebelius announced second round of Health Care Innovation Awards, a nearly $1 billion initiative that will fund projects to transform the health care system by delivering better care and lowering costs.

“These awards will continue our work to drive down health care costs while providing high quality care to all Americans, and I’m excited to see the innovative ideas these applicants will bring to the table,” Sebelius said.

Last year, the Centers for Medicare & Medicaid Services (CMS) awarded 107 round one Health Care Innovation Awards (out of nearly 3,000 applications) to organizations that are currently testing innovative solutions to improve outcomes and reduce costs.

This second round of Health Care Innovation Awards differs from the first round in that CMS is specifically seeking innovations in four areas: rapidly reducing costs for patients with Medicare and Medicaid in outpatient hospital and other settings; improving care for populations with specialized needs; testing improved financial and clinical models for specific types of providers, including specialists; and linking clinical care delivery to preventive and population health.Like the first round, these awards will emphasize results and ensure program integrity.

More than 15 innovation awards were given to groups in California in 2012, including:

$4.7 million to the Family Service Agency of San Francisco to expand and test its model for Prevention and Recovery in Early Psychosis (PREP) for low-income, largely Latino counties in the San Francisco area.
$6.9 million to the San Francisco Community College District (City College of San Francisco), in partnership with the University of California San Francisco and Yale University, to address the health care needs of high-risk/high-cost Medicaid and Medicaid-eligible patients released from prison, targeting eleven community health centers in six states.
$13 million to Sutter Health is receiving an award to expand their Advanced Illness Management program (AIM) across the entire Sutter Health system in Northern California, serving patients who have severe chronic illness but are not ready for hospice care, are in clinical, functional, or nutritional decline, and are high-level consumers of health care.

Click here to view the full list of California award recipients.

MICRA Under Attack; Changing/Overturning MICRA Impedes Access to Health Care for Californians

Fri, 10 May 2013 10:51:22 GMT

California’s trial attorneys launched an all-out assault on California's historic tort reform law, which since 1975 has helped keep malpractice premiums in-check and ensured that California’s patients have access to affordable health care.

On May 2, 2013, a coalition—including the Consumer Attorneys of California and the trial lawyer-funded Consumer Watchdog group—announced intentions to seek to overturn California's landmark Medical Injury Compensation Reform Act (MICRA) through a ballot initiative. The group has until September to submit a proposed initiative to qualify for the November 2014 general election ballot.

If successful, the trial attorney’s efforts will cause malpractice rates to skyrocket, and recreate the same conditions that threatened to throw California’s health care system into crisis during the early 1970s. Prior to MICRA, out-of-control medical liability costs were forcing community clinics, health centers, physicians and other health care providers out of practice.

California’s MICRA has been a national success story with broad public support and has safeguarded both patients and our health care delivery system for decades. Risky reforms like the ones being threatened by the trial lawyers would severely impede our state’s ability to provide health care to the poorest and most vulnerable patients. At a time when we are trying to implement federal health care reform and provide access to health care to all Californians, this is the worst possible overreach at the worst possible time.

"The threat of a ballot measure is nothing more than a money grab by trial lawyers," says CMA President Paul R. Phinney, MD. "And one that that will come at the expense of higher health costs for all patients and decreased access for patients and clinics already struggling to keep their doors open. We cannot and will not let that happen."

Click here for more information on MICRA, and what you can do to help in the fight.

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.

Medicare MAC Contract Protest Update

Mon, 29 Apr 2013 10:23:10 GMT

The U.S. Court of Federal Claims has denied two protests that were filed challenging a decision by the Centers for Medicare and Medicaid Services (CMS) to award the Medicare Administrative Contractor (MAC) contract for Medicare Parts A and B in Jurisdiction E to Noridian Administrative Services.

CMS and Noridian will now move forward to implement the new contract and expects this process to complete by mid-September 2013. SFMS/CMA has and will continue to work closely with CMS and the new contractor to ensure a smooth transition.

Jurisdiction E (previously called Jurisdiction 1) covers California, Nevada and Hawaii, as well as the U.S. territories of American Samoa, Guam and the Northern Mariana Islands. Jurisdiction E includes over 3.5 million Medicare fee-for-service beneficiaries, 500 Medicare hospitals and 86,500 physicians. MACs process Part A and Part B claims and perform other critical Medicare operational functions, including enrolling, educating and auditing Medicare providers.

SB 304 Would Strip Medical Board of Power To Investigate Physicians

Fri, 26 Apr 2013 11:24:19 GMT

Lawmakers are considering SB 304, a bill that would eliminate the Medical Board of California's authority to investigate physician misconduct.

The board has been criticized for failing to discipline physicians accused of harming patients, particularly doctors suspected of overprescribing addictive pain medications.

According to a December 2012 Los Angeles Times investigation, at least 30 patients in Southern California died of prescription drug overdoses or related causes while their physicians were being investigated by the medical board.

Physicians were reprimanded or placed on probation in 80% of the 190 cases of overprescribing filed by the board since 2005. However, physicians in most of those cases were permitted to continue writing prescriptions with few or no restrictions.

According to the bill authors—Sen. Curren Price (D-Los Angeles) and Assembly member Richard Gordon (D-Menlo Park)—the California attorney general would handle investigations of physician misconduct.

The change would leave the medical board to deal mostly with licensing doctors.

Source: California Healthline, April 26, 2013.

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.

End-to-end Testing Will Ensure Streamlined Transitions to Updated HIPAA Transactions and Operating Rules

Fri, 22 Mar 2013 13:05:43 GMT

To ensure streamlined transitions to operating rule and standard transaction updates, unlike the previous move from the 4010 to 5010 version of HIPAA transactions, AMA has long advocated for pre-pilot testing of the future versions of the Health Insurance Portability and Accountability Act (HIPAA) standard transactions and operating rules prior to adoption. Such testing is crucial to ensure minimal physician practice disruption. As a result of AMA’s effective advocacy, the Centers for Medicare and Medicaid Services (CMS) awarded a grant to the National Government Services to develop and pilot an end-to-end testing process through the End-to-End Testing Industry Collaborative Partner (ICP) work group, in which AMA participates. This process is intended to be used for all future operating rule and standard system updates, as well as the pending ICD-10-CM update.

The ICP over the past four months has reviewed end-to-end testing documents for use by payers, vendors and providers. Physician feedback is requested on these documents. Click here to access the CMS End-to-End Testing web page to provide feedback or obtain more information.

In addition, CMS has awarded a contract to Emdeon to perform pilot testing on the 6020 version of the Accredited Standards Committee X12 (ASC X12) standard transactions to determine the impact to the healthcare industry of moving to new standards. During this pilot testing, deficiencies or areas for potential transmission disruption will be identified and fixed, prior to adoption of the next version of standard transactions.

Sequestration FAQ for California Physicians

Mon, 11 Mar 2013 12:33:22 GMT

The $85.4 billion 2013 sequester includes a 2% cut (or $10 billion) in Medicare provider payments. Below are answers to frequently asked questions about the sequestration cuts.

When do the cuts take effect?

All cuts were triggered on March 1, but most cuts will not happen until April 1. Physicians who see Medicare patients will see a 2% reduction in their payments beginning April 1.

What Medicare cuts can physicians expect?

Per CMS, the Medicare fee-for-service program (Part A and Part B) claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will be reduced by 2%.

Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will also be reduced by 2% for claims with dates-of-service on or after April 1, 2013.

The claims payment adjustment will be applied to all claims after determining coinsurance, any applicable deductible and any applicable Medicare secondary payment adjustments.

Though beneficiary payments for deductibles and coinsurance are not subject to the 2% payment reduction, Medicare’s payment to beneficiaries for unassigned claims is subject to the 2% reduction. CMS encourages Medicare physicians who bill claims on an unassigned basis to discuss with beneficiaries the impact of sequestration on Medicare’s reimbursement.

The sequestration cuts are 2% across the board for all Medicare fee-for-service claims. It also affects physicians contracting with Medicare Advantage plans. Medicare Advantage plan payments will also be cut by 2%.

Certain details of the Medicare sequester still have not been made public. For example, we do not yet know how the Medicare Advantage plans will pass down the payment cuts to contracting or employed physicians.

How do I bill Medicare after March 1, 2013?

Physicians should continue billing as usual until more guidance has been provided by the Centers for Medicare and Medicaid Services.

Will Medicare EHR incentive payments be cut?

While CMS has released no specific information on how it will handle the sequestration cuts, there is a possibility that providers may see a 2% cut to their EHR “meaningful use” incentive payments. This money had been set aside under the 2009 federal economic stimulus package for both Medicare and Medicaid, so it is unclear whether it will be impacted by the sequestration cuts. Medicaid is exempt from the sequester.

What programs are exempt from the sequestration?

Medicaid, Social Security and the Veteran’s Administration are exempt from the cuts.

How will the cuts impact health care in California?

The White House issued a report showing that California would be impacted by the following cuts: Medicare, public health, childhood vaccinations, mental health, AIDs and HIV treatment and prevention.

Vaccines for Children: Reduced funding for the federal Vaccines for Children program means that approximately 15,810 fewer children in California will qualify for free vaccines for diseases such as measles, mumps, rubella, tetanus, whooping cough, influenza and Hepatitis B.

Public Health: California will lose approximately $2.6 million in funds to respond to public health threats including infectious diseases, natural disasters and biological, chemical, nuclear, and radiological events. In addition, California will lose about $12.4 million in grants to help prevent and treat substance abuse, resulting in around 9,400 fewer admissions to substance abuse programs. California will also lose $2 million for AIDS treatment and HIV prevention.
Medicare: All Medicare physician services and Medicare Advantage plans will be cut by 2%. Graduate Medical Education and all other programs within Medicare will be negatively impacted as well.

Click here for the White House summary of the impact of the 2013 sequestration on California.

What can I do to help stop these cuts?

It is not too late for physicians to contact Congress to explain the impact that a 2% Medicare payment cut will have on physicians and their patients.

Given that most of the cuts won’t actually be implemented until April 1, it is possible that Congress will eventually come to an agreement and reverse some of the sequestration cuts.

Contact your U.S. representative and senators today; send them an email and call their offices through AMA’s grassroots hotline at (800) 833- 6354. Enter your zip code and you will be automatically connected to your representatives. Your patients can help, too, by contacting Congress through the AMA’s Patients’ Action Network hotline at (888) 434-6200.

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.

California Heavily Affected by Looming Sequester Cuts

Mon, 25 Feb 2013 11:07:30 GMT

The White House detailed how California and other states would be affected if a deal is not reached by Friday to avoid automatic cuts under sequestration.

The automatic cuts involve nearly $1 trillion in across-the-board reductions over a decade, including a 2% reduction to Medicare reimbursement rates.

If the sequester cuts go through as expected, Obama administration officials and experts estimate that California would lose about $670 million annually in federal grants, as well as $3.3 billion in military and defense revenue.

Health and human services-related cuts in California would involve the loss of:

$12.4 million in grants to prevent and treat substance use disorders;
$2.6 million in funds to help improve the state's response to public health threats;
$2 million in funds for the California Department of Public Health, resulting in 49,300 fewer HIV tests; and,
$1.1 million in funds for vaccines, resulting in 15,810 fewer children receiving immunizations.

Although it is unlikely that federal lawmakers will reach a deal by March 1, they are expected by Wednesday to hold votes on competing measures to avoid sequester.

A plan by Senate Majority Leader Harry Reid (D-Nev.) would delay the cuts until January 2014, replacing them with a mix of $110 billion in new tax revenue and more narrowly tailored spending cuts.

Meanwhile, a plan by Senate Minority Leader Mitch McConnell (R-Ky.) still is being developed. Officials say McConnell’s plan might leave the sequester in place but allow for more flexibility among agencies in implementing the cuts.

Source: California Healthline, February 25, 2013.

Physician Group Coalition Expands List of Overused Tests, Treatments in Choosing Wisely Campaign

Thu, 21 Feb 2013 14:13:55 GMT

17 medical specialty societies have added their names and recommendations to a list of overused tests and procedures that should be avoided.

The updated list—which includes 90 new items—was released today that includes tests and procedures that participating societies consider possibly unnecessary or harmful.

The project, known as “Choose Wisely,” is being spearheaded by the American Board of Internal Medicine (ABIM) with the hope that the list will encourage patients and physicians to follow evidence-based guidelines in managing health problems, while avoiding procedures that could cause more harm than good.

While the campaign itself won’t measure any cost reductions achieved, there are billions in savings to be had by eliminating waste. The U.S. spends an estimated $2.5 trillion a year on health care, or more than $8,000 per person—far more than in other developed countries. Much of that money is wasted. The U.S. health care system squandered about $750 billion a year as of 2009, or more than a third of total health care expenditures, according to a report released last year by the Institute of Medicine. That included some $210 billion in excess costs due to unnecessary services.

The new recommendations include:

Waiting 6 weeks to do imaging for low back pain, unless red flags are present.
Avoiding elective, non-medically indicated inductions of labor between 39 weeks and 41 weeks.
Not requiring annual pap tests in women ages 30 to 65.
Steering clear of ordering antibiotics for adenoviral conjunctivitis.
Not ordering continuous telemetry monitoring outside of the ICU without using a protocol that governs continuation.

The full list of questionable tests and procedures is available at ChoosingWisely.org.

ABIM hopes to release a third list later this year that will include 13 more societies, including the American Academy of Dermatology and the American Academy of Orthopaedic Surgeons.

Click here to download the full list of Five Things Physicians and Patients Should Question (for physicians).

Click here to read about how the Choosing Wisely Campaign was launched from ABIM Board Chair, Catherine Lucey, MD.

Bowles, Simpson Unveil Deficit-Reduction Plan Includes Hefty Cuts for Health Care

Wed, 20 Feb 2013 14:21:56 GMT

Erskine Bowles and former Sen. Alan Simpson (R-Wyo.)—former co-chairs of President Obama’s deficit-reduction commission—unveiled a $2.4 trillion deficit-reduction proposal, which includes $600 billion in federal entitlement savings over a decade, in hopes of staving off the automatic cuts under sequestration that take effect on March 1.

The automatic cuts involve nearly $1 trillion in across-the-board reductions, including a 2% reduction to Medicare reimbursement rates. The Simpson-Bowles proposal would replace and double the savings in the sequester, on top of the $2.7 trillion in deficit reduction enacted by the fiscal cliff legislation Obama signed in January.

The plan would achieve the $600 billion in Medicare and Medicaid savings by decreasing provider payments, raising premiums for higher-income beneficiaries, reducing prescription drug costs, and making “adjustments to account for an aging population.” The plan also includes $600 billion in savings from tax code reforms and eliminating tax breaks, with the remaining savings coming from a mix of mandatory spending cuts and stricter limits on discretionary spending.

Simpson and Bowles indicated they will unveil a more detailed plan in the coming weeks, after lawmakers have had a chance to review and comment on their proposal. The plan is more ambitious than the $1.5 trillion in savings Obama called for in last week’s State of the Union address but is significantly smaller than the estimated $4 trillion House Republicans are seeking to reduce the deficit over a decade.

Source: California Healthline, February 20, 2012.

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.

CMS Releases Long-Overdue 'Sunshine Act' Rule

Mon, 04 Feb 2013 17:18:04 GMT

CMS announced the long-awaited final rule on the Physician Payments Sunshine Act last Friday, which will raise public awareness of the financial relationships between medical device and pharmaceutical companies and doctors and teaching hospitals.

The Sunshine Act—established under the Affordable Care Act—requires medical industry companies to disclose all transfers of monetary value over $10 to physicians and teaching hospitals.

Under the final rule, manufacturers of pharmaceutical and biological drugs, medical devices and medical supplies—covered by Medicare, Medicaid and CHIP—starting August 1 will be expected to report all consulting fees, travel reimbursements, research grants and other gifts with values over $10 that they give to physicians and teaching hospitals. In addition, the manufacturers and group purchasing organizations will be responsible for reporting physician ownership and investment interests.

CMS set the August 1 start-date for data collection to give the affected entities time to prepare, officials said. All data collected from August through December must be reported to CMS by March 31, 2014, according to the rule. The agency will publish the data on a public website by September 30, 2014, one year later than the date originally set in the ACA.

Physicians will be given a 45-day "review and correction" period to ensure the accuracy of any disclosures to CMS, according to the final rule. The rule also notes that the Sunshine Act overrides similar state laws, creating the possibility of "cost-savings, since a single reporting system for reporting this information is less burdensome than multiple programs".

The final rule is scheduled for publication in the Federal Register at the end of this week.

Source: California Healthline, February 4, 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.

FDA Panel Votes for Tighter Controls on Vicodin

Fri, 25 Jan 2013 13:47:52 GMT

A U.S. Food and Drug Administration panel voted today to place stricter controls on popular narcotic painkillers.

The 19 to 10 vote, which is advisory, will help the FDA decide whether to recommend moving drugs such as Vicodin, which contain the opioid painkiller, hydrocodone, from Schedule III to Schedule II under the Controlled Substances Act.

Ever since coming on the market 40 years ago, hydrocodone drugs have had fewer restrictions on them than drugs such as morphine and OxyContin, which contains the opioid oxycodone.

However, as overdose deaths and addiction rates soared over the past decade or so, putting stricter controls on hydrocodone has been the focus of efforts to reform the use of opioids and deal with America's opioid epidemic.

Stricter Schedule II status means that fewer prescriptions can be written at one time. For each visit to the doctor, a patient can get up to six months of prescriptions of Schedule III opioids such as Vicodin, compared with up to three months for Schedule II drugs.

Schedule II drugs also have stricter handling and storage requirements.

It was not known when the FDA would make a final decision on the issue.

Source: Journal Sentinel, January 25, 2013.

Anthem Requires Contracted Providers to Notify Patients Before Making Out-of-Network Referrals

Fri, 25 Jan 2013 11:38:31 GMT

In late November, Anthem Blue Cross announced that it would soon begin requiring contracted physicians to notify patients in writing before making out of network referrals. Effective March 1, the payor’s new “Advance Notice for Use of a Non-Participating Provider Policy” (APN policy) requires this notice be given using the payor-provided APN form. The policy does not apply to emergencies.

While Blue Cross has included language in its contracts since 2008 requiring physicians to disclose to patients and document the same type of information included in the APN form, it was not often enforced.

According to Blue Cross, it frequently receives complaints from patients who were unaware that they were being referred to out-of-network providers. The payor says that its new policy is not intended to deter patients from using their out-of-network benefits. Rather, it is intended to help patients make informed decisions about their coverage and options.

Brown Highlights Budget, Health Care in State of the State Address

Fri, 25 Jan 2013 11:06:42 GMT

Governor Jerry Brown promoted his fiscal year 2013-2014 budget proposal and discussed several state health care initiatives in In his State of the State address yesterday.

Budget Comments

Earlier this month, Brown released his budget plan. He said that if implemented, the proposal would leave the state with a budget surplus of $851 million. The plan projects $98.5 billion in revenue and transfers, and it estimates $97.7 billion in spending.

Brown's plan includes an expansion of Medi-Cal to individuals with incomes up to 138% of the federal poverty level. The expansion—included in the Affordable Care Act—is expected to add up to 1.5 million newly eligible adults to the program.

The budget plan also includes a 4.9% funding increase for In-Home Supportive Services—with an assumption that the state will implement a 20% reduction in IHSS service hours in November—and a $142 million funding increase for Cal-WORKs, the state's welfare-to-work program

In addition, the budget proposal allocates $1.6 billion for a court-appointed federal overseer to manage continued improvements in the state's prison health care system.

Health Care Comments

Discussing the Medi-Cal expansion, Brown called the initiative "incredibly complex" and said it will "test our ingenuity" and "will not be achieved overnight." He said, "Given the costs involved, great prudence should guide every step of the way."

Brown also said that the state must develop "the right relationship with the counties" to successfully implement the expansion.

Brown also called for a special session of the Legislature beginning next week that will focus on implementing ACA provisions.

Source: California Healthline, January 25, 2013.