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1. Highlights from CMA’s 2008 House of Delegates
Hundreds California doctors convened in Sacramento last week for the 2008 House of Delegates, CMA’s annual meeting. Each year, physicians from all 53 California counties, representing all modes of practice meet to discuss issues related to health care policy, medicine, and patient care, and to elect CMA officers. The following are summaries of some of the resolutions that the House adopted as policy.
Prescription Data Mining: Resolution 104-08 reaffirms existing policy that CMA support legislation preventing patient and prescriber identifying data from being sold or used for advertising, marketing, promotion or any activity intended to influence sales or market share of a pharmaceutical product.
Forced Deportation of Patients: The delegates voted (Resolution 105a-08) that CMA
oppose forced deportation of patients and referred this issue to AMA for national action.
Alcohol Industry Fund for Indigent and Unfunded Patients: Resolution 207a-08 requires CMA to urge the alcohol industry to voluntarily form a fund that would adequately reimburse hospitals and physicians for the direct and spillover costs to the health care system caused by alcohol use.
Tax Deduction for Uncompensated Care: The delegates directed CMA (Report B-3-08) to continue to explore alternative methods of compensation for physicians who treat the medically indigent, uninsured, or underinsured and to support legislation to amend the current tax code to allow deductions for uncompensated care.
Payor Fee Schedules and Medicare Rates: Resolution 403a-08 requires CMA continue to undertake all appropriate and necessary measures to delink all private payors’ fee schedules from Medicare rates.
Referrals to Noncontracted Providers: The delegates asked (Resolution 409a-08) that CMA continue to take all appropriate steps to eliminate PPO insurance contract clauses that either prohibit or penalize contracted physicians from referring patients to noncontracted physicians or facilities.
California School Nurses: Resolution 601a-08 calls on CMA to support improved school health program policies, including but not limited to the Healthy People 2010 goal that there be a minimum of one school nurse to every 750 students and/or one school nurse per school.
Retail Health Clinics: The delegates reaffirmed their support (Resolution 610a-08) of the requirement that retail health clinics must be owned by physicians or legally organized physician corporations. The resolution also calls for regulations requiring retail health clinics to disclose the level of training, qualifications, certification, and degree of physician supervision of providers of medical services prior to the provision of services.
Smoke Free Gaming Venues: The delegates voted (Resolution 708-08) that CMA support legislation mandating 100 percent smoke-free gaming venues as a prerequisite for issuing/renewing licenses.
Tobacco Sales in Pharmacies: Resolution 719-08 declares CMA’s support for prohibitions on the sale of tobacco products in any store that contains a pharmacy.
2. CMA Advocacy Works:
Blue Cross Agrees to Amend Physician Contracts
Last year, CMA analyzed Anthem Blue Cross’s standard physician contract (the Prudent Buyer Plan Participating Physician Agreement) and found that it was in many ways inconsistent with California law. In September 2007, CMA sent a letter to the Department of Managed Health Care (DMHC) expressing our concerns with the contract, and formally requested that DMHC take action to bring the contract into compliance with state laws and regulations. We are pleased to report that Blue Cross has removed the most problematic provisions from its contracts.
The deleted provisions, among other things:
Gave Blue Cross the authority to unilaterally decrease contracted payment rates if a physician refers patients to out-of-network providers.
Required physicians to agree to follow the utilization review requirements of not just Blue Cross, but also of all “other payors” that access the Blue Cross network.
Required physicians to agree to treat injured workers and prepare complicated Worker’s Compensation reports, even if they do not have the qualifications to engage in this activity. (The new contract allows physicians to opt-out of treating Worker’s Compensation patients.)
Authorized Blue Cross to apply a physician’s discounted rates to all practice locations and settings (e.g. rural, urban, academic etc), not just to the tax ID number under which the contract was signed.
Allowed Blue Cross under certain circumstances to disregard physicians’ requests to terminate their contracts.
These and other problematic provisions will not be included in new and renewing physician contracts, and Blue Cross has informed CMA that it will not enforce these provision in existing contracts.
Although the new contract continues to include some problematic provisions, the more offensive provisions have been deleted. CMA will continue to work with Blue Cross to address our outstanding concerns.
Physicians are reminded that before they sign a health plan contract, it is important to know what value that relationship will bring to their practice. You do not have to accept contracts that are not mutually beneficial.
To help physicians negotiate and manage complex third-party payor agreements, CMA has published a contracting tool kit, “Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations—A Focus on Payor Contracting.” The tool kit is available free to members at the members-only website. Nonmembers can purchase the tool kit for $100 in the CMA bookstore.
3. Proposition 4 Creates New Legal Liabilities for Doctors
Proposition 4 – the parental notification measure on the November 2008 California ballot – contains provisions that would expose physicians to new legal liabilities and require onerous new record-keeping.
Proposition 4 creates liability for a physician performing an abortion on a teen and “knowingly or negligently” failing to comply with the extensive notice requirements set forth in the initiative. Notably, Prop 4 subjects physicians to this liability for time indefinite, allowing a parent “wrongfully denied notification” to commence a civil action against the physician up to four years after the date the parent discovers or should have discovered the failure to comply with the Proposition’s notification requirements.
This creates additional burdens on physicians’ record retention policies because physicians must be able to produce “written or documentary evidence” to convince a jury that the physician complied with Prop 4’s notification requirements. If documents are destroyed and the physician is sued much later, the physician is unlikely to be able to present an adequate defense to the allegations.
The initiative also poses potential liability for physicians because it propels physicians squarely into the child abuse reporting system and domestic relations arena, yet revokes physician anonymity. In those instances where a pregnant teen fears abuse by a parent notified of the requested abortion, the physician must take a written statement from the teen, make a report of abuse to the appropriate authorities and notify an adult family member. Although the physician acts in good faith and in reliance on the accuracy and veracity of the information provided by the teen, the physician may later be subpoenaed to produce records or to testify or may find themselves the target of threats to their personal safety or of claims of making a false report, of defamation or of violation of privacy rights.
CMA opposes Prop 4 for these reasons and because it undermines the safety and health of teens.
4.
Feds Temporarily Extend Family PACT Program
Recently, the Centers for Medicare & Medicaid Services (CMS) notified state officials that it would shut down California’s Family PACT program on October 3 unless the state was able to meet new strict eligibility documentation rules. At CMA’s urging, the Administration has agreed to extend the program for at least two weeks to allow time for California and CMS to work out their differences and continue this successful, cost-effective, patient-centered program. The administration has also agreed not to terminate the program without adequate notice. Stay tuned for more information.
5.
Physicians Still Facing Severe Medicare Payment Problems
Thousands of California physicians continue to face problems getting paid for the care they provide to Medicare patients.
The transition to NPI numbers earlier this year, followed by the switch in September from NHIC to Palmetto as the Medicare carrier for California, has created a bureaucratic nightmare of red tape and rejected claims for doctors, delaying Medicare payments for months for some doctors.
CMA and our county societies are working with Palmetto and CMS to resolve these problems. Palmetto vice president and J1 director Mike Barlow recently held a Medicare payment workshop at the 2008 House of Delegates, and also addressed the CMA County Medical Executives and the CMA Board of Trustees as part of Palmetto’s efforts to address these issues. Our Economic Services team has already helped hundreds of doctors fix their Medicare problems and get paid, so that they can get back to doing what they do best: taking care of their patients. CMA is also holding weekly calls with CMS and members of Congress weekly to resolve the systemic issues.
CMA has compiled a list of common problems and fixes and posted it online at http://www.cmanet.org/palmetto. Physicians who are still experiencing payment problems are encouraged to review this list to see if their issues are addressed. If after doing so you still have questions or problems, please contact your county society or CMA’s.
Palmetto’s provider hotline will be closed Monday, October 13 as Palmetto trains the service representatives it has recently brought on to help handle these problems.
Despite the vigorous efforts of organized medicine, the Department of Managed Health Care (DMHC) regulation that prohibits “balance billing” of HMO patients for out-of-network emergency services becomes effective on October 15. CMA has published a toolkit to help physicians deal with the uncertainty caused by this regulation and to answer any questions they have about their rights and responsibilities. The toolkit is available to members only at http://www.cmanet.org.
As we reported in the last issue of CMA Alert, CMA and a coalition of provider groups have filed a lawsuit against DMHC arguing, among other things, that the regulation is unlawful and unenforceable not only because DMHC lacks the authority to regulate doctors, but also because it violates the intent of the Knox Keene Act, which is to ensure that HMOs provide adequate physician networks to provide care for their enrollees.
7.
Physicians Urged to Verify Accuracy of CPPI Quality Data
The California Cooperative Healthcare Reporting Initiative (CCHRI) will begin soliciting feedback from physicians as part of the California Physician Performance Initiative (CPPI). Affected physicians will be notified via mail beginning this week. The quality measure scores are based on claims data from patient care provided in 2007. Physicians will be provided with a percentile rank compared to their physician peers, performance scores by measure, and performance scores by patient group.
Physician-specific Medicare scores will not at any time be released to the public by either Medicare or CCHRI. Although CCHRI has no current plans to publicly release physician-specific quality scores related to the treatment of private PPO patients, it is possible that the private health plans could use this information in the future. However, the private health plans would only be provided the scores of their network physicians. CMA will be working closely with CCHRI to vigilantly protect the use of physician information.
We encourage physicians to verify the accuracy of the data used to calculate their scores by requesting their private PPO patient lists at the CCHRI website. Beginning on Friday, October 17, you can visit http://www.cchri.org/cppi to download and complete the “Request for Patient List and Appropriate Data Use” form. The completed forms will be sent to Thomson Reuters (the vendor contracted to collect, standardize, and score the data in strict compliance with HIPAA regulations. Requests must be submitted no later than December 5 and will be processed within five business days of receipt. Additional information about CPPI, including the scoring methodology, can be found at http://www.cchri.org/cppi.
Physicians who review their patient lists and believe their scores to be in error can submit correction requests (with supporting data) within 30 days. Thomson Reuters will log the physician’s request and tabulate the frequency and nature of corrections. A letter acknowledging receipt of the correction request will be mailed to each physician. At the end of the comment period, CCHRI will review the nature of corrections with its Physician Advisory Group and Steering Committee to determine appropriate use of the physician scores.
CPPI received federal funding in 2006 to develop a system for measuring and reporting the quality of health care provided by physicians. CPPI collected data on approximately 25,000 physicians for a limited set of nationally-endorsed quality measures for both Medicare patients and private PPO patients from Anthem Blue Cross, Blue Shield of California, and United Healthcare.
8. San Bernardino County Physician Installed as CMA’s 141st President
Dev GnanaDev, M.D., 58, took office as CMA’s new president at the close of the association’s Annual House of Delegates, which concluded last week in Sacramento.
“This is an important time for health care in California,” says Dr. GnanaDev. “As physicians, we must be a voice for the patients we serve. Our first and most important goal is to ensure that Californians have access to the care they need. The doctors of the California Medical Association will be doing everything in our power to make that happen.”
Dev GnanaDev, M.D., 57, has been active in the CMA for 27 years and is past president of the San Bernardino County Medical Society. He also founded the New Beginnings Gang Tattoo Removal program, which provides free tattoo removal for reformed gang members, and founded a cardiac rehabilitation program for indigent patients.
A founding board member of the Inland Empire Burn Institute, Dr. GnanaDev has a special interest in rehabilitation of children with burns. He has worked with local firefighters to raise money to send children who are recovering from the traumatic effects of burn injuries to Burn Camp and to educate children about the dangers of fire.
Dr. GnanaDev has received numerous awards, including the American Medical Association’s Pride in the Profession Award in 2007, the Medical Board of California’s Physician Recognition Award in 2005, and the Distinguished Executive of the Year Award from California State University, San Bernardino, this year.
Board certified in general surgery, vascular surgery, and surgical critical care, Dr. GnanaDev earned his Medical Degree in Kurnool, India, at Kurnool Medical College. After interning in his native India, he served his residency in Newark, New Jersey, and was a fellow in cardio-vascular surgery at Arizona Heart Institute in Phoenix, Arizona. He earned a master’s degree in business administration from California State University, San Bernardino, in 2001.
9.
Orange County Physician Elected CMA President-Elect
Brennan Cassidy, M.D. was elected CMA President-Elect at CMA’s annual House of Delegates. He will serve as president-elect for one year and become president in October 2009.
“As president-elect I will be working not just for physicians but for the patients we serve,” says Dr. Cassidy. “In concert with our patients, the physicians of the California Medical Association can steer the health care reform conversation towards solutions which improve access without compromising the quality of care people rely on from their doctor.”
Dr. Cassidy is a past president of the Orange County Medical Association and was named OCMA’s “Physician of the Year” in 2004. He has served on many committees throughout his 36 years as a member of CMA., most recently serving as Chair of CMA’s Board of Trustees.
He is board certified in emergency medicine and family practice, and has been on the staff of Hoag Memorial Hospital Presbyterian in Newport Beach since 1971. During his time at the Hospital, he has served as the founding chair and director of the Department of Emergency Medicine. Dr. Cassidy is currently in private practice at West Coast Laser Dermatology Medical Center in Santa Ana.
The CMA Board of Trustees met October 3-6, before and during CMA’s annual House of Delegates in Sacramento. A summary of the board’s major actions is now available online at http://www.calphys.org/html/board.asp
The board highlights offer a brief summary of major action and informational items discussed by the board. The highlights are not intended to be all-inclusive of items discussed, and these documents are not official CMA policy.
Members can access complete and official board-approved minutes at CMA’s members-only website. (Official board meeting minutes are not posted until approved at the following meeting.)
11. 2008 Legislative Wrap Up
CMA’s annual “Legislative Wrap-Up” by Dustin Corcoran, CMA’s vice president of government relations is now available. Click here to download.
If you would like a hard copy, please contact Jennifer Williams, 916-444-5532 or jwilliams2@cmanet.org.
12. CMA Seminars Train Physician Office Staff in Proper Billing and Collections Procedures
CMA’s Center for Economic Services is offering a series of “Back to Basics” seminars to train physician office personnel in proper billing and collections procedures. Whether you’re new to the field or just want a refresher course, this seminar will teach physicians and their office staff how to take greater control of the practice’s bottom line
The next seminar is October 23 in Sacramento. If you are interested in attending a Back to Basics seminar in your area, contact your county medical society.
13. Member Benefit of the Week: 6% off athenaCollector
CMA members receive 6 percent off athenaCollector, athenahealth’s unique web-based billing and practice management service. athenaCollector combines software, a continually updated database of payer rules and a state-of-the-art billing, collections, and service center.
To find out more about the benefits of athenahealth from one California practice’s perspective, view “Growing your Practice with athenahealth.” This on-demand webinar is presented by Thomas Mohr, M.D., the founder, president and CEO of Pediatric Partners Medical Group in Temecula.
Click here for more information on your membership benefits.
Contact: CMA’s member help line, 800/786-4CMA or vsatt@cmanet.org.
For previous editions of CMA Alert, visit our news archives.
Prepared by the CMA Communication Center
Katherine Gallia, Editor,
916/551-2074,
Patrick Harbison, Editorial Assistant
916/551-2072,
No. 2143
