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. 

Leading medical groups have called on the Department of Health and Human Services (HHS) to delay implementation of Stage 3 of meaningful use of electronic health records (EHRs), saying providers are still trying to implement Stages 1 and 2.

"Meaningful use" refers to provisions in the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which authorized incentive payments through Medicare and Medicaid to clinicians and hospitals that use electronic health records in a meaningful way that significantly improves clinical care.

The American Medical Association, which called for a delay in implementation, said the meaningful use program has helped kick start EHR use but noted there are still technical, financial, regulatory, and operational challenges that must be dealt with first.

The American College of Physicians wrote in its comments that Stage 3 measures don't focus enough on patient outcomes, although that was supposed to be their goal. Instead, HHS' measures are a growing collection of functional metrics.

The Association of American Medical Colleges wrote that Stage 3 requirements should strike a balance between imposing difficult measures without having a negative impact on patient care for those providers who don't meet such measures.

In its comments on proposed Stage 3 requirements issued by HHS, the American Academy of Family Physicians called for a delay in implementation until at least 2017, adding it also wants to delay or eliminate penalties for the third and final stage of the EHR incentive program.

HHS finalized its regulations for Stage 2 in August, requiring that physicians complete that stage by October 1, 2014 or face a 1% penalty from Medicare. That was a 9-month delay from its original deadline.

A finalized Stage 3 rule should be released later this year.

Source: Medpage Today, January 15, 2013.

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

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

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

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

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

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

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

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

In a strong show of broad support for medical staff independence and self-governance, 23 current and former chiefs of staff from throughout California have filed an amicus curiae brief with the California Supreme Court in El-Attar v. Hollywood Presbyterian Med. Ctr. SFMS/CMA and AMA have also filed a separate amicus brief in the case. The briefs argue that a hospital’s lay governing board is not qualified to engage in peer review and thus cannot directly or indirectly commandeer a medical staff’s peer review functions.

In this case, the hospital board at Hollywood Presbyterian Medical Center ignored and overrode the medical staff executive committee's (MEC) recommendation to reappoint a physician on staff. When the physician invoked his right to a joint review committee hearing to challenge the hospital’s termination of his privileges, the hospital unilaterally appointed the hearing officer and members of the review committee. Under the medical staff bylaws, however, only the MEC has authority to determine the joint review process, including the appointment of the hearing officer and joint review committee members.

CMA and AMA argued in their amicus brief that the medical staff bylaws here must be strictly enforced in order to uphold the systemic safeguards of a fair and just peer review system. Under California and federal laws, CMA and AMA explained, the professionals on the medical staff have primary responsibility for all of the functions necessary to ensure patient safety and the competence of practitioners at a hospital. These functions, which include peer review, fall within the medical staff’s right to self-governance and independence. Hospital governing bodies have oversight authority, but cannot unnecessarily interfere with the medical staff’s self-governance functions, including peer review.

The California Supreme Court decided to review this case last November. Briefing in the case is complete and a decision can be expected in the latter half of next year.