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.

SFMS/CMA support SB 301 (DeSaulnier) and AB 826 (Swanson), which would reinstate the Medi-Cal Managed Care Organization (MCO) Tax and the Healthy Families Program. Both bills have support from Republicans and Democrats in both houses.

In June, Governor Brown signed the proposal to transition all of the children currently enrolled in Healthy Families to Medi-Cal. If approved by the Centers for Medicare & Medicaid, the move would have an enormously negative impact on the 900,000 children that rely on Healthy Families for heath care coverage.

“The proposal signed in June puts the health of millions of California’s children at risk, as Medi-Cal already faces serious challenges in providing access to care for its enrollees,” said CMA President James T. Hay, MD. “SB 301 and AB 826 will ensure that California’s children have access to the care they need and deserve.”

When the MCO Tax was created in 2009, it was to address persistent funding shortfalls that plagued the Healthy Families Program. Since the creation of the tax, Healthy Families has been stable and successful in providing care for the nearly 900,000 children it serves.

Click here to download a sample letter supporting legislation to restore Healthy Families (SB 301 and AB 826) to send to your local legislators.

The Department of Health and Human Services (HHS) postponed the use of ICD-10 diagnostic codes until October 1, 2014.

The 1-year delay comes in response to complaints by organized medicine about the administrative burden of converting to ICD-10. SFMS, CMA, AMA, and other medical societies told HHS that converting to the more voluminous and complicated set of diagnostic codes could cost medical practices tens of thousands of dollars and interfere with their migration to electronic health records and electronic prescribing.

ICD-10 stands for the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. The Centers for Medicare and Medicaid Services (CMS) mandated the switch from ICD-9 to ICD-10 as part of implementing the Health Insurance Portability and Accountability Act (HIPAA). HHS considers ICD-9 outdated and imprecise.

ICD-10 contains 68,000 diagnosis codes, which is roughly 5 times the number in ICD-9. The new codes also run to a maximum of 7 characters compared with 5 in the current codes.

HHS also announced establishing a standard format for health plan identifier (HPID) codes that is designed to simplify billing for clinicians and hospitals. Identifiers for health plans now in use differ in format, and that variety invites errors, leading to misrouted transactions, rejected claims, and problems determining patient eligibility, according to HHS. The department estimates that implementing a standard HPID will save the healthcare industry up to $6 billion over the course of 10 years.

Click here for more information on the HHS announcement.

The Department of Health and Human Services (HHS) has released an interim administrative simplification final rule for electronic funds transfers (EFT) and remittance advice (ERA) transactions­­. The rule is open for public comment until October 9.  The implementation and use of these newest operating rules is expected to encourage electronic payments and to reduce administrative inefficiencies associated with paper and manual processes.

The rule calls for the adoption of Phase III Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for InformationExchange (CORE) EFT & ERA Operating Rule Set, including the CORE v5010 Master Companion Guide Template, for health care EFT and ERA transactions, but does not adopt the acknowledgment requirements. This is a tremendous victory for physicians, since it enables them to determine the patient’s financial responsibility when care is provided, and allows them to settle payment before the patient leaves the office.

The highlights of the EFT and ERA operating rules include the following requirements:

• Health plans must provide standardized and streamlined paper-based and online EFT and ERA enrollment forms.

• Physicians must work with their banks to ensure all the EFT information sent by the health plans is transmitted to the practice so that the EFT can be re-associated with the ERA.

• Health plans must transmit the EFT within three days of the transmission of the ERA.

• Health plans that issue proprietary paper claim remittance advice must continue to offer paper remittance advice for a minimum of 31 days from the implementation of ERA to ensure a smooth transition.

• Health plans must use standard claims adjustment reason and remark codes for four common business scenarios. The four business scenarios include:

  1. Additional Information Required—Missing/Invalid/Incomplete Documentation

  2. Additional Information Required—Missing/Invalid/Incomplete Data from Submitted Claim

  3. Billed Service Not Covered by Health Plan

  4. Benefit for Billed Service Not Separately Payable

Health plans must use a standardized and streamlined companion guide to describe any health plan–specific rules associated with the EFT and ERA transactions.

UCSF is currently recruiting pediatricians to act as preceptors for UCSF second year medical students, and hope you will consider serving in this critically important teaching role. As part of the "Foundations of Patient Care" course, students have four sessions this fall during which they are introduced to clinical Pediatrics. These are the only opportunities many students have to gain experience with children in the clinical setting prior to starting clerkships.   

Physician preceptors will be asked to precept four half-day sessions, on either Tuesday/Thursday afternoons or Wednesday mornings. The dates are:

• Tuesday afternoons (Dates: 10/9, 10/23, 11/6, 11/27)
• Wednesday mornings (Dates: 10/10, 10/24, 11/7, 11/28) - San Francisco based offices only
• Thursday afternoons (Dates: 10/11, 10/25, 11/8, 11/29)

Help make a lasting impression on a medical student with minimal time commitment! To learn more about the preceptorship program or to become a preceptor, please contact Patricia Ramirez in the Clinical Learning Unit at ramirezp@medsch.ucsf.edu or call (415) 476-5169.