San Francisco Medical Society Blog

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.

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.

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.

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)

AMA Update on Medicare Payment Rates

Thu, 03 Jan 2013 11:45:04 GMT

The American Taxpayer Relief Act of 2012 was signed into law January 2, 2013. The new law averts the 26.5% SGR cut for all of 2013 and the 2% sequester for the next two months. It also extends the work GPCI floor for a year. Today CMS released the attached announcement regarding updated 2013 Medicare payment amounts, claims processing, and reopening of the participation enrollment period.

Carriers are not expected to post the new rates on their web sites until at least next week and possibly later.

In the meantime, some practices are asking what they should charge. By law, Medicare is required to pay physicians the lesser of the submitted charge or the Medicare approved amount. For this reason, the SFMS is advising against submitting claims with the reduced 2013 amounts. Instead, we recommend physicians either defer submission of claims for 2013 dates of service until the new 2013 rates are published, or continue charging the 2012 rates.

In addition, due to relative value changes that will affect some 2013 payment amounts and limiting charges, for unassigned claims practices should probably wait to bill patients directly for cost-sharing amounts until the new 2013 rates are published.

Source: American Medical Association

Congress Stops Medicare Cuts for One Year as Part of Fiscal Cliff Legislation

Thu, 03 Jan 2013 09:49:59 GMT

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. The 2 percent sequestration cuts have also been deferred for two months.

The one-year fix comes with a $25 billion price tag. The cost of physician payment reform has been growing over the years as Congress continues to enact frequent short-terms fixes. As recently as 2005 the cost of permanent reform would have been $48 billion, but today it is estimated to be nearly $300 billion over the next 10 years. If action is not taken soon, the cost will continue to escalate to $500 billion in only a few short years.

The one-year freeze will be paid for with cuts to the Affordable Care Act's (ACA) new CO-OP program and other health care programs ($15 billion of the cuts impacting hospitals). At SFMS/CMA's urging, the ACA's Medicaid increase for primary care physicians was not used to pay for this temporary fix, despite earlier attempts to do so.

The Medicare fix is being paid for by:

Cuts to the ACA's CO-OP program (unobligated funds)
Extending the statute of limitations for recouping overpayments.
Adjusting the equipment utilization rate for Advanced imaging services.
Rebasing end stage renal disease payments based on utilization of drugs.
Equalizing stereotactic radiology hospital outpatient services with physician services.
Rebasing of Disproportionate Share Hospital payments.
Reducing multiple procedure payments when more than one therapy procedure is provided on the same day.
Eliminating funding for the Medicare improvement fund.
Eliminating the ACA long term care (LTC) CLASS act. (But establishes a LTC commission.)
Adjusting Medicare Advantage payments to account for differences in coding practices between fee-for-service and managed care risk adjustment formulas.

Importantly, the bill also lays the groundwork for an alternative Medicare payment system by establishing data systems and a registry for reporting on quality that will help physicians.

What does this mean for physician claims?

Because federal law requires Medicare contractors to hold claims for 14 days before releasing payment, there should be little if any impact on physicians' cash flow. Although there has been no official word from the Centers for Medicare and Medicaid Services, claims for services provided in the early days of 2013 will likely be processed under the new 2013 fee schedule. Palmetto, California's Medicare contractor, should have the new fee schedule posted on its website in about 10 days.

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 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.

Additional details will be provided as they become available.

Obama’s New Fiscal Cliff Offer Proposes Repeal of SGR

Tue, 18 Dec 2012 15:34:31 GMT

In the White House’s latest “fiscal cliff” offer to House Speaker John Boehner, President Obama proposed a permanent repeal of Medicare’s sustainable growth rate (SGR) alongside $400 billion health care savings, according to a source familiar with the talks.

A permanent fix would come with a $245 billion price tag and it’s still unclear how—or if—Congress would pay for a policy meant to stabilize doctor salaries.

SGR is the formula that determines how much Medicare providers get paid, by tethering their salaries to overall growth in the economy. This formula has, for a decade now, always fallen short of keeping doctor salaries stable. This year, if we stuck to what the sustainable growth rate says doctors should be paid, physicians would end up taking a 26.5% pay cut.

That has meant that, year after year, Congress has had to pass a “doc-fix:” A short term funding patch to make up the difference between what the formula says doctors should get paid, and what it would take to keep their salaries stable. It’s become somewhat of a tradition, where Congress scrapes together small cuts from other programs to pay for the fix.

If the White House does indeed succeed in eliminating the sustainable growth rate, it would presumably need to find $245 billion to pay for the provision. It would also need to settle on a new formula to calculate what Medicare ought to pay doctors for each surgery they perform and medication they prescribe.

MedPac, a non-partisan body that advises Congress on Medicare policy, has its own preferred option. It has recommended that if Congress repeals the sustainable growth rate, it should continue to hold primary care doctor payments steady. At the same time, specialty doctors would see a haircut in their services for three years, and then see their rates freeze as well.

Source: Washington Post, Wonkblog, December 18, 2012

Obamacare—Past, Present, and Future, Part 1

Mon, 19 Nov 2012 16:34:20 GMT

By Andy Calman, MD, PhD

Note: This article was originally published in the October 2012 issue of San Francisco Medicine. Due to members' request for more information on health care reform and its impact on medicine, SFMS will be publishing a four-part series in the SFMS blog section.

Obamacare/PPACA—Beyond the Politics

Few people think it’s perfect, or anywhere near perfect. Many Americans believe Obamacare went too far. Others wish it had gone farther and had offered Medicare for all. But love it or hate it, the Patient Protection and Affordable Care Act of 2010—now referred to by both parties as Obamacare—is no longer a bill. It’s the law, and it's already being implemented. It’s time to get past the politics and familiarize ourselves with the many changes that have already taken place, the flood of newly insured patients arriving in little more than a year, and the long-term changes that will alter—for better or worse—nearly every aspect of how we practice our profession. Only a handful of Capitol Hill staffers and CMS bureaucrats know everything packed into the 907 pages of the PPACA, and the thousands of pages of its enabling regulations. But because every doctor needs to be aware of the key provisions, it is worthwhile to review a succinct implementation timeline.

What Has Already Changed

A number of the provisions of Obamacare have already taken effect.

Small businesses employing fewer than twenty-five employees—whose average wages are less than $50,000 per year—can currently receive subsidies of up to 35% for insuring their employees during tax years 2010 through 2013. The Medicare doughnut hole has been reduced by 50% and will be eliminated in 2020, with phased-in discounts for drugs in the doughnut hole. Insurers can no longer discriminate against children with preexisting conditions.
For adults with preexisting conditions, temporary high-risk pools (Pre-Existing Condition Insurance Plans, www.pcip.gov) have been created to bridge the gap until the state insurance exchanges begin enrollment in 2014. These plans are priced at the same community rates as those for healthy patients, with a maximum annual out-of-pocket of $5,950 and guaranteed issue—an excellent value for cancer patients and others who cannot otherwise obtain insurance.
There is a ban on lifetime coverage caps, and on rescission of coverage for Americans who get sick. All new individual plans must offer preventive care including mammograms and colonoscopies, as well as contraception (with exemptions for certain religious organizations), with no co-pays or deductibles.
Young adults can now stay on their parents’ policies until age 26, even if they reside elsewhere. States who provide Medicaid up to 133% of FPL (federal poverty level) receive federal matching funds. And last month, thousands of astonished Americans received rebate checks from their health insurance companies due to a provision requiring that 80% of premium revenue (85% for large groups) be spent on actual health care.

2014: Individual Mandate, Medicaid Expansion, and Health Insurance Exchanges

Although many of the provisions implemented so far are popular, some of the provisions that will transform health care beginning in 2014—just over a year away—are more controversial. Americans who are not already covered by public or private health insurance will be required to purchase an individual plan or pay a penalty. CBO estimates that about 1.2% of the population will pay the penalty in 2016.

The penalty—1% of income, rising to 2.5% in 2016, with a minimum of $695 per year for individuals and $2,095 for families—is rather small compared to the cost of health insurance, and many Americans will elect to pay the penalty/tax instead of purchasing expensive coverage. Persons with religious exemptions, such as Christian Scientists, are exempt from the penalty. Additionally, there is an exemption if the least expensive available plan exceeds 8% of family income. These people, as well as individuals under 30, will have the option to purchase cheaper “catastrophic” high-deductible plans instead.

Beginning in 2014, the ban on discrimination against people with preexisting conditions will apply to adults as well as children. Annual spending caps will be banned. Consumers and small businesses will be able to shop for plans in “health insurance exchanges” set up by each state, comparing the cost and features of standardized Bronze, Silver, Gold, and Platinum benefits packages. These benefits packages must provide specified “minimum essential benefits” and will be actuarially standardized so that, for example, a Bronze Plan would cover 60% and a Platinum Plan 90% of services for an average population, with the remainder paid by co-payments and deductibles. However, the annual out-of-pocket maximum would be capped at $5,950 per individual ($11,900 per family) for individual plans and at $2,000 ($4,000 per family) for small group plans.

Policies offered by the exchanges must offer “guaranteed issue” and “community rating,” where premiums are adjusted only by geographic region, age, and tobacco use, without regard to gender or preexisting conditions.

Some states have declined to set up their own exchanges. The department of HHS is empowered to set up exchanges for these states, but funding for these federal exchanges is uncertain and depends on the will of the next Congress.

Dr. Andrew Calman practices ophthalmology at CPMC-St. Luke’s and teaches at CPMC and UCSF. He is past president of the California Academy of Eye Physicians and Surgeons, chair of the SFMS’s Political Action Committee, and served for many years on California’s Medicare Carrier Advisory Committee as well as the National Health Policy Committee of the American Academy of Ophthalmology.

Election 2012: Update of Candidates and Issues that SFMS Was Watching This Election Cycle.

Wed, 07 Nov 2012 12:03:39 GMT

National

President Obama won a second term, which will likely mean that health care reform as currently configured will continue. Get ready for a very busy few years of implementing additional reforms.
No surprises that Senator Feinstein and Congresswoman Pelosi won again. The Senate remains in the control of the Democrats and the House in control of the Republicans.
Long-time Congressman Pete Stark was defeated by Eric Swadwell, a fellow Democrat. Stark has worked closely with the CMA for many years and championed many CMA causes.
In Assembly District 19, Phil Ting beat Michael Breyer in a closer election than many thought it would be after Breyer raised a lot of money and contributed some of his own to defeat Ting. The SFMS PAC and CALPAC made contributions to Ting’s campaign and the CALPAC endorsed him.
Tom Ammiano again won his Assembly seat handily in District 17.
Mark Leno easily won his Senate seat, as well.

Local

Eric Mar was re-elected to the SF Board of Supervisors from District 1. The SFMS PAC contributed to his campaign.
David Chiu was re-elected in District 3 and had received SFMS PAC support.
In District 5 London Breed appears to be beating the incumbent Christina Olague. Olague was targeted by local groups because of her vote on the Mirkarimi issue.
Norman Yee is narrowly beating F.X. Crowley for the seat in District 7. Both received SFMS PAC support.
In District 9 and 11, David Campos and John Avalos ran unopposed.

Propositions

CMA supported Prop 30, the Governors’ proposal for tax increases and it was passed.
CMA opposed Prop 32, which would limit political contributions and it was defeated.
The repeal of the death penalty was defeated and this had been the subject of a SFMS resolution to the recent CMA House of Delegates. The SFMS resolution was also defeated at the HOD.

California Official: State Could Dump Health Plan For Kids And Maintain Quality Care

Wed, 17 Oct 2012 10:34:39 GMT

California's top health official said Tuesday that she thinks the state can end a health care program for low-income children without disrupting their care.

Health shift will affect 860,000 in California, The Associated Press reported as California's top health care official told lawmakers Tuesday. She is confident the state can eliminate a health insurance program serving more than 860,000 children from low-income families without disrupting the quality of their care. Lawmakers held a hearing in the state Senate wanting to know if the administration is prepared to make the transition without disrupting children's medical care. California is eliminating its Healthy Families program and moving those children into the state's Medicaid program in an effort to save a projected $73 million a year.

Source: Kaiser Health News

SFMS/CMA Prevents Last Minute Move To Scuttle MICRA; MICRA Is Preserved

Tue, 04 Sep 2012 11:56:18 GMT

In the last days of the 2012 legislative session, a shell bill (SB 1528) was gutted and amended in an attempt by trial lawyers to undermine California’s Medical Injury Compensation Reform Act (MICRA). SFMS/CMA rallied its grassroots advocacy network and was able to thwart this move and the bill is dead for this legislative season.

The bill would have artificially inflated the medical expense damages by valuing them on the basis of the retail price of medical services provided, not the actual expense to the injured party. Simply put, this would allow trial lawyers to value medical expenses based on usual and customary fees that physicians are rarely are paid, not the discounted contract rates they receive. The legislation would have scrapped longstanding principals of law that allows an injured person to recover as economic medical expense damages only amounts actually paid or incurred for medical care and services.

A similar assault was mounted last year in the form of a lawsuit (Howell v. Hamilton Meats) brought before the California Supreme Court. Fortunately, the court ruled that an injured person is not entitled to recover economic damages for past medical expenses based on a provider’s undiscounted bill if that sum that was never paid by or on behalf of the injured person.

SB 1528 would have artificially inflated economic medical expense damage awards and undermined MICRA's intent to prevent double recovery of these damages. This, in turn, would have increased medical malpractice premiums for physicians, many of whom would be forced to close shop thereby further limiting access to care for all Californians.

Had this bill passed, it would have undermined the state's landmark MICRA law, which was signed by Gov. Brown in 1975 (during his first term as governor) and limits pain and suffering damages in medical malpractice cases to $250,000.

Oppose SB 1528 -- Last Minute Legislation Threatening MICRA

Fri, 31 Aug 2012 10:46:08 GMT

Call Your Legislator to Oppose SB 1528

The trial attorneys are at it once again, trying to push through last minute legislation that would undermine the Medical Injury Compensation Reform Act of 1975 (MICRA) and increase medical malpractice insurance rates.

They have introduced SB 1528, a bill that would artificially inflating economic medical expense damage awards in managed care cases. This bill would change the way medical expense economic damages are measured, allowing damages to be awarded without regard to the amount actually paid.

This, in turn, would increase medical malpractice premiums for physicians, many of whom would be forced to close shop thereby further limiting access to care for all Californians.

SB 1528 is under consideration on the Assembly Floor on this last day of the legislative session.

CALL NOW to urge your legislators to VOTE NO on SB 1528.

Please call (877) 362-8455 to be connected to your legislator. You will be asked to enter your zip code and select your legislators. Give your name, specialty and let them know that you are their constituent.

Make this call today to help preserve MICRA and keep professional liability insurance costs affordable ensure health care access for all.

Talking Points

SB 1528 will:

Result in vastly inflated economic damage awards for expenses the plaintiff never ha
Erode the foundation of MICRA by artificially inflating medical expense damage awards
Line the pockets of trial attorneys at the expense of the medical community
Further harm California's already limited access to health care

Click here for a 1-page floor alert on SB 1528 produced by CMA's Government Relations.

SFMS/CMA is working to preserve MICRA. Click here for a copy of the letter CMA sent to the Chair of the Assembly Judiciary Committee Bob Wieckowski opposing SB 1528.

Medicare SGR Faces A Bitter End As Senate, House Remain At Odds Over 'Doc Fix' Dilemma

Tue, 20 Dec 2011 13:30:29 GMT

The 2011 Congressional legislative session comes to a bitter end today. Members of Congress will go home for the holidays in a rare standoff that will not result in a last-minute agreement to stop the Medicare SGR 27.4% fee-for-service program payment cut, or extend the payroll tax cut and unemployment benefits. SFMS/CMA is absolutely outraged that Congress will adjourn and let this devastating nearly 30% payment cut take effect. For a decade, CMA and organized medicine has been calling upon Congress to eliminate the Medicare SGR. All year, Members of Congress made commitments to CMA physicians and seniors that they would stop the cuts and adopt a long-term solution to the failed Medicare SGR physician payment formula. In the height of irresponsibility, Congress will go home for the holidays and deal a terrible blow to physician practices and their patients. Most physicians will not be able to sustain such a cut and remain in the Medicare program. Others could be forced to close their doors. Seniors in California are already experiencing difficulty finding physicians. This will have a devastating impact on access to physicians for California’s 5 million seniors and nearly 1 million military families. Late last week, when negotiations failed between the House and the Senate, a bipartisan group of Republican and Democratic Senators crafted a short term two-month extension on the Medicare SGR, payroll tax cut, and unemployment issues to avoid the devastating cuts that will occur next week. The Senate passed the measure with overwhelming support 89-11. However, under the direction of Speaker Boehner, the House leadership rejected the 2 month extension and are holding out for a longer term deal. The standoff will remain unresolved until Congress returns in January 2012. SFMS/CMA has been advocating for legislation that eliminates the SGR and adopts a longer-term path to an alternative payment system. Within the last few days, to avoid the inevitable, CMA supported the 2-month stop-gap on the Medicare SGR to avoid devastating cuts and a retroactive payment restoration. Unfortunately, the Medicare SGR was tied to much larger controversial issues in the year-end legislative package. While no formal statements have been made by either the Senate or House leadership about their intent to return in January to stop the cuts, we expect Congress to return on January 3 rather than January 17 to address these issues. The House has created a conference committee to bargain over the differing House and Senate bills. The Centers for Medicare and Medicaid Services (CMS) announced that they would hold claims starting January 1 through January 17 to avoid paying physicians at the lower rate and to avoid a retroactive reconciliation of claims in the event Congress acts in early January to stop the cut. CMS said they will be forced to process claims at the lower rate starting January 18 if Congress does not stop the cut. SFMS/CMA will keep you informed as the debate continues. We have expressed our anger to our Congressional delegation for failing to keep their obligation to appropriately finance the Medicare program and to protect access to care.

Medicare SGR Patch Tied to Controversial Social Security Payroll Tax Cut Bill

Mon, 12 Dec 2011 16:54:57 GMT

Congress continues to work to form an agreement on stopping the 27.4% Medicare sustainable growth rate (SGR) fee-for-service program cuts before they take effect on January 1, 2012. Both the Republican and Democratic leaders in the House and the Senate have publicly said they are dedicated to stopping the Medicare fee-for-service payment cuts before the end of session. It is one of their top priorities and will be included in a large legislative package to extend the Social Security payroll tax cut and unemployment insurance benefits.

House Legislation

[caption id="" align="alignright" width="279" caption="A blog post from Boehner's office says everything in the bill is paid for through spending cuts rather than tax increases. Photo credit: AP"][/caption] The House Republican leaders unveiled the House legislation on December 9. Among many other things, it would stop the Medicare SGR fee-for-service payment cuts for two years and provide a 1% update in both 2012 and 2013. It also requires the Medicare Payment Advisory Commission (MedPAC), Government Accountability Office, and U.S. Department of Health and Human Services to make recommendations to Congress on long-term alternatives to the Medicare SGR physician payment system. There is also a relaxation of the restrictions on existing physician-owned hospitals. The legislation will be voted on in the House tomorrow, December 13.

Proposed funding sources

The bill provides funding sources from the Patient Protection and Affordable Care Act (ACA) including cuts to government subsidies to buy health insurance for individuals whose income level increases during the same fiscal year, as well as cuts to the ACA public health and prevention fund, which SFMS/CMA are strenuously opposing. The proposal would also raise Medicare premiums on individuals making more than $1 million. It reduces Medicare payments for E&M services provided in hospital outpatient settings to the same level those services are reimbursed in physician offices. And, it reduces payments to Disproportionate Share Hospitals, which the hospitals strongly oppose.

Timing and process

At this point, the Medicare SGR is being solely negotiated out of House Speaker John Boehner’s office with the Senate leaders and President Obama, and is tied to the outcome of the Social Security payroll tax cut deal. Voting on this legislation could come as early as December 13. Most expect it to pass the House; however, the bill faces stiff opposition from both Republicans and Democrats in the Senate. The opposition to the proposal is related to some of the funding sources, the limited extension of unemployment benefits, the changes in funding for the Social Security Trust Fund, and the inclusion of the controversial Keystone XL oil/gas pipeline across the Midwest. Senators are not, however, opposed to the Medicare SGR provision.

Negotiations continue this week

The Senate is expected to vote down the House Republican plan on Thursday, which will spur another round of negotiations. Congress is set to adjourn on Friday, December 16, but the leadership has said they will hold session through the following week until they reach an agreement. SFMS/CMA are working to obtain assurances from the California House Republican leaders and Senate offices that if the payroll tax deal goes down, they will still address the SGR cuts in separate legislation before they go home for the holidays. If the negotiations totally blow up, the Senate may try to run a Continuing Resolution (CR), which will include a stop-gap on the Medicare SGR cut. However, as controversial funding sources are negotiated out of the bill, that could reduce the length of the SGR stop gap from two years to one year, or change the payment increase. Moreover, there is a chance the rancor could stall all legislation, which means physicians could be hit with a 27.4 percent cut until Congress returns in January. As the Congressional bargaining continues, California physicians should know that Congressional leaders are working as quickly as possible to stop the Medicare SGR fee-for-service payment cut. However, politics over the larger issues is hindering a resolution to the Medicare SGR cut. SFMS/CMA will remain vigilant in keeping the pressure on our Congressional delegation and leaders to ensure the Medicare SGR cut is stopped as soon as possible – and for as long as possible. We have told Congress that these cuts will have a drastically negative impact on physicians and their patients, and that they cannot go home without stopping them. We have also been clear that a retroactive stoppage in January would be disastrous. Physicians should not be forced to finance the Medicare program on their backs because of Congress’s irresponsibility.

Please help to keep the pressure on Congress to stop the Medicare fee-for-service SGR payment cut! Contact your legislator today!

Please use the AMA hotline at (800) 833-6354. Enter your ZIP code and it will automatically connect you to your Representative. Please call the hotline again to reach Senators Boxer and Feinstein. You can also send emails via https://writerep.house.gov, www.boxer.senate.gov and www.feinstein.senate.gov. The sheer volume of calls is important so Congress knows you are watching closely and they must act. Tell your Representatives and Senators Boxer and Feinstein that:

The Medicare SGR cut must be stopped before the end of the year.
The cuts will harm access to care for 5 million California seniors.
The cuts will wreak havoc on physician practices.
Congress should not go home and think it’s OK to stop the cut retroactively in January.
Physicians should not be forced to finance the Medicare program because of Congress’s irresponsibility.

Click here for more coverage on the SGR bandage.

Victory For Seniors: Calif. Adult Day Health Care Center Lawsuit Resolved

Fri, 18 Nov 2011 11:39:01 GMT

Really, it's all about Esther Darling. The 74-year-old is the poster child for adult day health care services. She had a stroke, deals with diabetes and congestive heart failure, takes multiple medications and receives care and treatment at a day center in Yolo County. "If it wasn’t for the [Adult Day Health Care (ADHC)] therapy, I wouldn’t be able to walk today," Darling said. "They said I wouldn't walk anymore, but I was determined to prove them wrong." Darling is the named plaintiff in a lawsuit against the Department of Health Care Services settled yesterday, just prior to a scheduled federal court hearing. She stands to benefit from the new program in that settlement, Community-Based Adult Services (CBAS), which is designed to provide "ADHC-like services" to current ADHC beneficiaries who are at risk for being institutionalized, such as Darling. The settlement has three main components:

CBAS will provide services roughly equivalent to those currently offered at ADHC centers, and funded at the same rate, for patients who qualify. Eligibility is based on medical need, for those who are at risk for institutionalization. DHCS officials estimate about half of the current ADHC beneficiaries will be eligible, though that number could rise, based on assessments that still need to be conducted.
CBAS will provide enhanced case management in an integrated managed care setting for those who are not in imminent danger of institutionalization. All patients who want to receive these benefits—whether it's CBAS-eligible patients or the ones who receive more intensive case management service—will need to enroll in a managed care plan.
The settlement extends by three months the deadline for elimination of ADHC as a Medi-Cal benefit (also referred to as an optional Medicaid benefit), from December 1 to March 1.

The state Legislature, which voted to eliminate ADHC as a Medi-Cal benefit in March, allocated $85 million to a new program to be called Keeping Adults Free from Institutions. Gov. Jerry Brown (D) vetoed the ADHC replacement plan in July. The big difference between the Legislature-backed KAFI program and the current settlement CBAS program is that the new program is not capped. The benefit will be available for those who qualify for it, not restricted by a hard cap upper limit for the program cost.

Source: California Healthline, November 18, 2011.

TAKE ACTION NOW!! Urge Congress to Repeal the Medicare SGR and Prevent Further Cuts to Medi-Cal

Wed, 05 Oct 2011 13:31:54 GMT

Congress has appointed a Joint Select Committee on Deficit Reduction to develop $1.5 trillion in spending cuts/revenue increases by Thanksgiving. On January 1, 2012, physicians face a 30 percent Medicare sustainable growth rate (SGR) payment cut. The San Francisco Medical Society and California Medical Association (CMA) are joining the American Medical Association, state medical associations, and national medical specialty societies in a united campaign to get a permanent repeal of the flawed Medicare SGR formula included in the deficit reduction package that is currently being developed by Congress’ Joint Select Committee on Deficit Reduction. The deficit reduction committee is also considering proposals that would reduce federal matching funds for California’s Medi-Cal and Healthy Families programs. Decreases in federal expenditures would force California to further reduce physician payment rates and increase patient co-payments. SFMS, CMA, and the physicians of California are extremely concerned that additional cuts to already low payment rates will exacerbate the current access to care problems and cause irreparable harm to patients. There is unanimous agreement that cuts of this magnitude would result in serious disruptions in care for the nation’s elderly and disabled populations, and cannot be allowed to occur. We are asking Congress to repeal the SGR and work with us over the next few years to test and develop alternative payment models and health care delivery systems that ensure access to efficient, appropriate, high-quality, coordinated care. We believe that stable reimbursement in these programs not only protects access to care but also makes economic sense as physicians are important employers in their communities and repealing the SGR saves hundreds of billions of dollars. Physicians have been running a Medicare SGR marathon with Congress for the last decade. We are close to the finish line and need to make one last sprint! It’s NOW OR NEVER!

CONTACT CONGRESS TODAY!

EMAIL Senators Boxer and Feinstein through http://writerep.house.gov; www.boxer.senate.gov and www.feinstein.senate.gov. Also contact Congressman Becerra (D-LA), a member of the Deficit Committee at www.becerra.house.gov. Messages can also be sent to California Representatives who are in leadership positions: House Whip-Congressman Kevin McCarthy www.kevinmccarthy.house.gov; and House Minority Leader-Congresswoman Nancy Pelosi www.pelosi.house.gov. USE THE AMA GRASSROOTS HOTLINE at (800) 833-6354 to call your Representative and Senators Boxer and Feinstein. Key in your zip code and you will be connected to your Senator/Representative. Please state your name, specialty and city/county in which you practice, and urge them to:

Repeal the Medicare SGR in the deficit committee legislation
Stop further Medi-Cal physician payment cuts
Protect access to care for California’s most vulnerable patients: Seniors, military families, the disabled, pregnant women and children

Click here for background information about this issue.

Click here for a list of talking points.

Click here for a sample letter to your Representative or Senator.

Click here for legislators' contact information.

List of SFMS Resolutions Submitted to 2011 CMA House of Delegates

Tue, 27 Sep 2011 15:16:09 GMT

By Stephen Follansbee, MD and Steve Heilig, MPH The California Medical Association can be a formidable force in Sacramento health policy. The CMA House of Delegations meeting, scheduled for October this year, is the opportunity for physicians to guide the CMA on important issues and set the priority for these efforts. Your elected SFMS delegates have introduced a roster of policy resolutions to be debated at the meeting. As your representatives, we thought you might like to see what we will be addressing – along with the many other resolutions introduced from other delegations throughout the state. The SFMS is a relatively small but relatively “loud” presence each year, with a good track record of successful policies; here is our list. In November we will publish a scorecard on what we were able to get adopted; and then the real work begins in the halls of politics, translating these words into something that benefits patients, the public, and physicians all over our state – and beyond as some of these would then be referred on to the AMA.

SFMS Proposed Policies for 2011 (authors in italics):

Reduction of Subsidies of Tobacco in Films (Fung): Did you know that the movie industry gets big tax credits for filming, including when they portray tobacco use? UCSF researchers have shown this is true – that taxpayers subsidize tobacco marketing, in effect – and we hope to stop that. Unethical Rebates from Pharmaceutical Companies (Susens): Some drug makers still offer money to doctors who prescribe their products. Some doctors take that money. This is against ethical codes and we hope to stop that. Deceptive Pregnancy ‘Crisis/Counseling’ Centers (Lopato): As reported in the Chronicle, certain “clinics” are in fact “pro-life" centers which seek to divert women from considering abortion with misinformation and fear. We would require full disclosure of what is and is not offered at such places. Regulation of Electronic Cigarettes (Fouras, Aragon): These nicotine delivery devices may have their place as harm reduction, but they need more regulation for both users and the public, and this resolution would require that. Supporting The California Cancer Research Act (Margolin): The CRCA will be on the ballot, increasing tobacco taxes for cancer research, and we ask the CMA to join the full-court press to help it pass in this "no new taxes” era. Clinical Research - Banning "Seeding" and Similar Marketing Trials (Susens): Pharmaceutical companies do marketing in the guise of “research” even after the medication is approved, with unwarranted cost and safety implications; we hope to stop that. Healthy Food Marketing for Children (Desai, Schickedanz, Udovic-Constant): The obesity epidemic too often starts in childhood, and better “selling” of healthy food is indicated; this would encourage that on various fronts. Opposing Legal Prohibition of Circumcision (Tabas): This intrusion was blocked from the state ballot, but will likely be back, and we want CMA and AMA on record in opposition for next time. Firearms and Censorship (Follansbee): Another intrusion, courtesy of the gun lobby, prohibits Florida physicians from even talking with patients about the risk of guns in the home. We hope to stop this there and before it spreads. Contraception as a Fully-Covered Health Insurance Benefit (Silverman, Desai, Myers): This has now been adopted as national policy, but attempts to overturn it are already promised. We want CMA and AMA on record in support of full coverage. Increasing Organ Donation via Presumed Consent (Follansbee, Margolin): The waiting lines for organs get longer, and more people die while waiting. It is time for some changes in organ policy and we are asking CMA to weigh in, based upon evidence, ethics, and what some other nations are doing. Clinical Sense and Costs at the FDA; Generic vs. Brand Medications (Susens): When a generic medication mysteriously goes back to “brand," and the price skyrockets, that seems wrong, and we think the FDA should take a closer look. Vision Screening for School-Aged Children (Leung): Too much pediatric poor vision is missed, and schools may be a good place to screen for that and refer to early intervention. Emergency Department Overcrowding (Maa, Curran): When emergency departments get too crowded, some hospitals have “triaged” based on financial considerations. That’s not good; there must be better ways, and we'll ask CMA to try to find them. As you can see, it's a full and diverse roster. As already mentioned, there will be much more from other delegates around the state; any CMA member can propose a resolution, and perhaps we can help you bring good ideas forward next year. As for this year, stay tuned. Stephen Follansbee is an SFMS past-president, chairs the SFMS delegation to the CMA, and is an infectious disease specialist at Kaiser San Francisco and a clinical professor at UCSF. Steve Heilig is on the SFMS staff.

HPV Vaccine Safety: Debunking the Myth

Thu, 15 Sep 2011 14:00:40 GMT

The medical community issued swift criticism Tuesday after Rep. Michele Bachmann dragged the safety of the vaccine against the human papillomavirus (HPV) into the political spotlight, reigniting the controversy over the risks and necessity of vaccinating children. “The American Academy of Pediatrics would like to correct false statements made in the Republican presidential campaign that HPV vaccine is dangerous and can cause mental retardation,” the American Academy of Pediatrics said in a statement released Tuesday afternoon. “There is absolutely no scientific validity to this statement. Since the vaccine has been introduced, more than 35 million doses have been administered, and it has an excellent safety record.” Last year, the American College of Obstetricians and Gynecologists recommended the HPV vaccination for all girls and young women between the ages of 9 and 26. The Centers for Disease Control and Prevention (CDC) suggest that doctors “strongly recommend” that all 11- or 12-year-old girls be vaccinated against HPV, which is the cause of almost all cases of cervical cancer. The vaccine is a series of three shots, and is approved for use in males and females from ages 9 to 26. A reality check: more than 95 percent of Americans have premarital sex, and more than 50 percent of sexually active Americans contract HPV at some point in their lives. The disease can cause genital warts in men, and a small percentage of affected women will develop cervical cancer. This is a vaccine that truly can save lives. Click here for more information about the HPV vaccine and why it’s safe and effective, written by SFMS Member Jennifer Gunter, MD, FRCS(C), FACOG, DABPM, board certified ob/gyn in the U.S. and Canada. Click here for information about HPV Vaccine from the CDC.