1. Federal Court Rules Budget Cuts Unlawfully Jeopardize
Health Care for Millions of Californians
On August 18, a federal court in Los Angeles ordered the State of California to reverse the 10 percent Medi-Cal reimbursement cut that took effect on July 1, finding that the cuts would irreparably harm access to health care for nearly 7 million Californians. When fully enforced, the ruling will restore more than $1 billion to California’s health care system, including $121 million to California physicians who provide care to the poor, due to CMA’s legal efforts.
“This is the third court in five years to find that the state of California has put at risk the access to health care for millions of Californians by underfunding the Medi-Cal program,” says CMA President Richard Frankenstein, M.D. “Hopefully, lawmakers get the message that they cannot balance the budget on the backs of the state’s poor or those who provide their health care. The state safety net needs to be strengthened, not weakened.”
“This decision is a critical step towards ensuring sufficient funding for Medi-Cal, but we still have a ways to go,” says Dr. Frankenstein. Even prior to the cuts, California ranked at the bottom of the country in Medi-Cal funding, and spent less per Medi-Cal beneficiary than any other state. Since the cuts took effect, many providers have been forced to reduce or completely stop services for Medi-Cal beneficiaries, costing many Californians critical access to health care.
In an emergency budget session in early 2008, the state legislature and governor agreed to a 10 percent cut to reimbursement rates for Medi-Cal providers to take effect July 1. Health care providers filed at least three different lawsuits in May, alleging that the state had failed to set Medi-Cal reimbursement rates at a level that ensures access to health care for Californians on Medi-Cal, in violation of state law. The other lawsuits are still pending.
Although a legislative conference committee voted to reduce or eliminate some of the cuts in June, Medi-Cal still faces a 10 percent reimbursement rate cuts and additional cuts in the proposed FY 2009 budget. The preliminary injunction is just a first step in stopping the continuing decline of services to Medi-Cal beneficiaries in the state of California. While this is a small victory for residents of California, we continue to face challenges of providing health care for the most vulnerable in California.
The State has appealed the ruling and a hearing to consider the appeal is scheduled for September 15.
Click here for more information.
Contact: Ned Wigglesworth, 916/444-5532 or nwigglesworth@cmanet.org.
2. CMA Files Brief with U.S. Supreme Court in Case that Could
Increase Physician Liability for Prescription Drug-Related Injuries
CMA has filed a brief with the United State Supreme Court in Wyeth vs. Levine. Pharmaceutical manufacturer Wyeth is appealing a decision by the Vermont Supreme Court to uphold a jury award to Diana Levine after her use of Wyeth’s anti-nausea drug Phenergan caused serious complications and ultimately resulted in the amputation of her arm. The issue on appeal focuses on whether FDA approval of a drug should preempt state legal actions against the pharmaceutical company for failure to warn of known risks.
CMA in its brief told the justices that preemption of pharmaceutical failure-to-warn claims would obstruct physicians’ access to complete and truthful information about prescription drug safety and efficacy and would compromise patient safety. “Because preempting failure-to-warn claims would make FDA approval the final word on a drug’s safety, it would significantly weaken manufacturers’ incentives to conduct new safety studies, to monitor their drugs in the marketplace, to improve them post approval, and to supply FDA and doctors with new or revised safety information,” wrote CMA legal counsel in the brief. “Preemption would then leave these patients without recourse for injuries and put physicians at risk by potentially allowing drug manufacturers to shift liability for such injuries to doctors…This potential for new liability would undermine longstanding efforts to protect doctors from suit and could well drive some physicians from the profession.”
The Texas Medical Association and North Carolina Medical Society have also filed a joint brief opposing federal preemption of failure-to-warn cases against pharmaceutical companies.
Click here for more information.
Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org
3. Proposed Regulations Would Expand Health Professionals’
Scope of Practice and Weaken Medical Staff Self-Governance
The California Department of Public Health (CDPH) recently proposed regulations that would expand the scope of practice of psychologists and potentially all other health care practitioners working in licensed health care facilities. The regulations—intended to clarify state law as it applies to medical staff membership and privileges for psychologists—would weaken medical staff self-governance rights and could be broadly interpreted to allow unqualified health care professionals to carry out the duties of a physician or surgeon.
The proposed regulations could, among other things, allow nonphysician practitioners to admit patients, perform medical examinations, place patients in restraints, complete medical records, coordinate care, and order transfers. The regulations also circumvent the self-governance rights of medical staffs to establish and enforce the rules, regulations, criteria, and standards for medical staff membership and privileges.
CMA believes that these regulations exceed what is required by state law. The regulations would require that medical staff membership be available to psychologists if the hospital provides clinical psychology services. However, state law requires medical staff membership be open to psychologists in state hospitals only and limits their participation to specific medical staff committees.
CMA is prepared to fight the proposed regulations through the regulatory process by teaming with specialty groups to ensure that the state understands the severe impact that these regulations will have on patient care and medical staff independence. CMA is also exploring legal options should the regulations be adopted as proposed.
Click here for more information.
Contact: Delilah Clay, 916/551-2658 or dclay@cmanet.org
4. At Least 1,200 Physicians Experiencing Medicare
Payment Stoppage
CMA has been contacted by over 1200 physicians who are experiencing Medicare payment stoppages caused by problems with NHIC’s internal computer billing system, some related to NPI. NHIC vowed to resolve all 1200 cases prior to today’s transition to new Medicare carrier, Palmetto.
If your practice continues to experience problems, please call CMA’s reimbursement help line and one of our reimbursement advocates will help ensure that your case is resolved as soon as possible.
If your practice is experiencing financial hardship because of a Medicare payment stoppage, you can request a payment advance from Medicare. Advance requests must be submitted in writing via mail or fax to:
J1 MAC - Palmetto GBA
Attn: Vicki Bowers AG-325
"MSC J1-4084"
17 Technology Circle
Columbia, SC 29203-9591
Fax: 803/763-5575.
Be sure to include your name, NPI, legacy ID, average monthly Medicare income, how long your payments have been stopped, and the advance payment amount requested.
Click here for more information, including detailed instructions on submitting an advance payment request.
Contact: CMA’s reimbursement help line, 888/401-5911 or mkelly@cmanet.org.
5. CMA Files Brief in Peer Review Case Before State Supreme Court
On August 27, CMA filed an amicus brief in a case before the California Supreme Court to protect the integrity of the peer review process and prevent a peer review hearing officer from unlawfully usurping the clinical decisions of the peer review body.
Hearing officers are usually lay people, who don’t have the power or expertise to make decisions on medical disciplinary charges. In the case at hand, a hearing officer’s decree to terminate a peer review hearing led directly to the restriction of the physician’s privileges. This in turn caused the filing of legally required disciplinary reports to state and federal agencies purporting to confirm the veracity of the medical disciplinary charges levied but never proven.
In essence, by terminating the hearing, the hearing officer made a clinical judgment as to what clinical evidence was necessary to determine the physician’s medical competency; thus making the medical determination that the physician is medically incompetent to practice at the hospital, and thus depriving the physician of a fair hearing before his medical peers.
CMA’s amicus brief, which was joined by the American Medical Association, argues forcefully that the granting of such powers to a hearing officer unlawfully deprives physicians of a fair hearing before his medical peers, and deprives patients of access to their physician of choice.
Oral arguments have not yet been scheduled. Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
6. CMA Urges CMS Not to Release Unvalidated
Physician Quality Data
The California Cooperative Healthcare Reporting Initiative (CCHRI) is operating a Medicare quality reporting pilot project called the California Physician Performance Initiative (CPPI). CPPI received federal funding in 2006 to develop a system for measuring and reporting the quality and cost of health care provided by physicians. CCPI is collecting data for a limited set of cost and quality measures for both Medicare patients and private PPO patients from Blue Cross, Blue Shield, and United Healthcare.
CMA has a number of concerns with the validity and accuracy of the data that has been collected and has communicated those concerns to the Centers for Medicare & Medicaid Services (CMS). CPPI was set to release top-line data and physician “grades” to all California physicians last month. However, due to the concerns raised by CMA, CCHRI and CMS have agreed not to release the data until there is a process in place for physicians to verify its accuracy. CCHRI expects to have a process in place for physicians to verify the accuracy of the private PPO data by October. CMA is working with CCHRI and CMS on a process for verifying the Medicare data.
CMA is also urging CCHRI and CMS not to release the results to the general public unless and until all data has been validated for accuracy.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
7. State Supreme Court Rules Noncompetition Clauses Unenforceable in California
The California Supreme Court has recently and unequivocally ruled that noncompetition clauses in employment contracts are unenforceable in California. Therefore, a physician employed by a medical group, with no financial interest in that medical group, cannot be contractually prohibited from competing with his or her employer after leaving that employment.
For more information on this ruling and related issues, see the newly updated CMA ON-CALL document #0275, “Patient Retention: Restrictive Covenants.” ON-CALL documents are free to CMA members at the members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in the CMA bookstore.
Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
8. Members Invited to Participate in the House of Delegates Discussion Forum
CMA invites all members to visit its online forum to discuss or comment on the resolutions and reports that will be considered by the 2008 House of Delegates (HOD). The delegates, your elected representatives, meet annually to establish CMA policies on key issues that affect the practice of medicine, from medical ethics to critical matters of public health.
The HOD functions very much like our state and federal legislative bodies. Prior to debate of resolutions on the floor of the HOD, the proposals are discussed and debated in one of seven reference committees. Members of the reference committee will consider these comments along with the oral testimony presented at the House of Delegates meeting, October 4-6 in Sacramento.
To participate in the online discussion, log in to the members-only website and click on House of Delegates Forum under CMA Spotlight. You do not need to register to view read the resolutions or other members comments, but you will be required to register if you would like to reply or submit your own comments. Registration is quick and simple.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
9. All Physicians Invited to Attend CMA’s OMSS Annual Assembly,
October 3 in Sacramento
CMA’s Organized Medical Staff Section (OMSS) will hold its Annual Assembly and Education Conference Friday, October 3, at the Sacramento Convention Center. All CMA physicians interested in the role of strong self-governing medical staffs in improving patient care and safety are encouraged to attend. The conference takes place the day before the 2008 CMA House of Delegates meeting, also in Sacramento.
Attendees will learn about legal and legislative issues affecting medical staffs, the roles and responsibilities of medical staff leaders, new Joint Commission recommendations on disruptive physicians, and how to use adverse events data to reduce liability and improve patient safety.
All CMA physicians and medical staff professionals are invited to attend, but seating is limited. Registration is free for medical students and for physicians and representatives from OMSS member hospitals. Members of CMA’s Hospital Based Physicians’ Forum pay $50, and all other CMA members $100. The registration deadline has been extended to September 12. Click here to download a registration form.
Contact: Valerie Satt, 916/551-2053 or vsatt@cmanet.org.
10. Please Support CMA’s Medical Student Charity
Basketball Tournament
CMA’s medical students are hosting Hoops for Health, a charity basketball tournament designed to raise awareness and funds for the newly established CMA Student-Run Free Clinic Grant Program. The event will take place on Sunday, September 21 from 10 a.m. - 3 p.m. at UCLA’s Student Activities Center.
All money raised will be managed by the CMA Foundation, a 501c3 organization, and will be used to improve access to care for underserved populations. To register a team or make a tax deductible donation, visit http://www.hoopsforhealth.org.
Contact: Adam Dorsey, 916/551-2056 or adorsey@cmanet.org.
11. Tickets Now on Sale for CMA Foundation Annual Dinner
The CMA Foundation’s 12th Annual President’s Dinner and Awards Gala is October 5 in Sacramento, during CMA’s annual meeting. Proceeds will support CMA Foundation, a charitable organization that links physicians and their communities to raise awareness about important public health issues.
Tickets are $125 per person, or $1,000 for a table of 10.
Even if you will not be able attend, please consider placing an ad in the dinner program. The foundation is a nonprofit charitable organization, and all ads are tax deductible.
Click here for more information.
Contact: Brittany Ridley, 916/779-6639 or bridley@thecmafoundation.org.
12. Member Benefit of the Week: 30 - 50% off Epocrates
CMA members receive 30 percent off one-year subscriptions and 35 percent off two-year subscriptions to any Epocrates product. Students and residents receive 50 percent off all Epocrates products. Group discounts are also available.
Epocrates provides physicians with point-of-care access (via PDA/smartphone, or online) to up-to-date information on drugs, diseases, and diagnostics. Epocrates allows physicians to make better clinical decisions, saving time and improving quality of care. To receive your discount, log in to the members-only website and follow the links to the Epocrates website.
Click here for more information on your membership benefits.
Contact: CMA’s member help line, 800/786-4CMA or vsatt@cmanet.org.
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