|
1. NHIC Loses Medicare Contract; Combined Part A, Part B
Contract Awarded to South Carolina-Based Palmetto
The Centers for Medicare & Medicaid Services (CMS) Friday announced that it awarded the contract for combined administration and payment of Part A and Part B Medicare claims in California to South Carolina-based Palmetto GBA. Palmetto will also administer Medicare claims in Hawaii, Nevada, American Samoa, Guam, and the Northern Mariana Islands. The new contract takes effect July 1, 2008.
Palmetto is one of five new Medicare Administrative Contractors (MACs) named by CMS as required by the Medicare Modernization Act of 2003. The MAC contracts, which combine administration of both Part A and Part B claims, are part of an effort to streamline the fee-for-service payment system.
As you know, NHIC has been California’s Medicare carrier for more than a decade, processing claims for physicians, laboratories and other practitioners under Medicare Part B. NHIC will continue processing Medicare claims for California through June 30, 2008, when its current contract expires.
Understandably, CMA is concerned about the impact this significant change will have on physicians and patients. The association is reviewing the situation and will work with CMS, NHIC, and Palmetto to help ensure a smooth transition. Stay tuned for more information.
Click here for additional details.
Contact: Frank Navarro, 916/551-2046 or gfonseca@cmanet.org.
2. State Regulator Declares Blue Cross Contracting Practice Illegal
The Department of Managed Health Care (DMHC) has found that Blue Cross of California has been using illegal contracting practices against physicians. The insurance giant has been forcing physicians to sign its contracts without consulting a legal or financial advisor, unless that advisor is approved by Blue Cross – a tactic only available to a company with the enormous market clout of Blue Cross.
Under the insurer’s mandatory “confidentiality agreement”, Blue Cross had the right to determine “at its sole and absolute discretion” whether or not a physician could use a particular attorney or negotiator. In February, CMA notified state insurance regulators of this unfair agreement, which not only violates laws protecting the confidentiality of attorney-client communications, but also prevented physicians from being fairly represented in managed care contract negotiations. CMA also urged Blue Cross to withdraw the unfair agreement.
At press time, DMHC was considering issuing a cease-and-desist order against Blue Cross to stop its illegal practice. Stay tuned to next week’s Alert for more details.
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-5911 or drice@cmanet.org.
3. CMA Calls for Renewed Focus on Health Care Reform
At a legislative hearing on Wednesday, CMA called for renewed focus on health care reform in California, noting the rare convergence of strong gubernatorial and legislative interest in an issue of such magnitude.
“We have been given a rare opportunity to improve access to health care for millions of Californians,” said CMA president Richard S. Frankenstein, M.D. “We are hopeful the governor and the legislature are able to resolve the current impasse and deliver on their promise of health care reform.”
Discussions about health care reform have largely centered on issues of payment: who will pay for increased coverage and how much additional coverage will be purchased? In testimony before the Assembly Health Committee, CMA pointed out that this approach can be misleading. Even more important than increased coverage – which can mean little more than increased profits for insurance companies – is increased access to health care.
“Insurance companies don’t provide health care; doctors do,” said Dr. Frankenstein. “The health care discussions that must occur over the next few weeks and months won’t mean much if only insurance companies benefit and people don’t get better access to their doctors.”
Contact: Karen Nikos, 916/551-2069 or knikos@cmanet.org.
4. Members Needed to Testify at DMHC Hearings
on Doctors’ Right to Fair Payment from HMOs
The Department of Managed Health Care has scheduled two additional public hearings on newly proposed regulations that would prevent noncontracted physicians from billing patients for emergency services. The hearings are scheduled for Nov. 13 in Sacramento and Nov. 14 in San Diego. Both hearings start at 10 a.m.
CMA encourages all members to submit written comments and to testify in opposition to these onerous regulations. These regulations attack the future viability of physician practices. They do not address the key underlying problems of unfair contracts, which result in inadequate physician networks and chronic and pervasive underfunding of emergency care by insurance companies.
It is critical that DMHC hear from physicians, county medical societies, and specialty societies so that regulators understand the severe economic impact that these regulations will have on physicians and the health system in general.
In addition to prohibiting noncontracted physicians from billing enrollees for emergency services (except for copayments, coinsurance, and deductibles), the new proposal creates a voluntary independent dispute resolution process to resolve payment disputes; requires HMOs in the event of a payment dispute to pay physicians an interim amount of 150 percent of 2007 Medicare rates; and modifies the Gould criteria (the nationally accepted standard for determining fair and reasonable payment for health care services) to include Medicare and contract rates.
Physicians interested in testifying at the Sacramento hearing should contact Francisco Silva at 916/551-2887 or fsilva@cmanet.org. Physicians interested in testifying at the San Diego hearing should contact Tom Gehring at 858/565-8597 or gehring@sdcms.org. DMHC is also accepting written comments on the proposed regulations until November 30.
Click here for more information.
Contact: Francisco Silva, 916/551-2887 or fsilva@cmanet.org.
5. CMA’s 2007 House of Delegates
Hundreds California doctors convened in Anaheim this past week for the 2007 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 medicine, health care financing, and patient care, and to elect CMA officers.
While the backdrop for this year’s House was the health care reform discussions in Sacramento, the main issue was the steady erosion of doctors’ ability to take care of their patients. As incoming President Richard S. Frankenstein M.D. noted, doctors face an increasing number of intrusions into the doctor-patient relationship, most notably from for-profit insurance companies.
CMA delegates also dealt with a number of public health issues, including public vaccine programs, HIV testing, and the effects of chemicals on human health. The next House of Delegates will be October 2008 in Sacramento.
Visit CMA's members-only website for additional details.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
6. Santa Ana Physician Becomes CMA’s New President
 Richard S. Frankenstein, M.D., of Santa Ana, has been elected president of CMA. He took office Monday at the conclusion of the associations’ annual House of Delegates (HOD) in Anaheim. Dr. Frankenstein, 58, is a specialist in pulmonary medicine who has practiced in Garden Grove since 1980.
“While we’re ‘sticking to the knitting’ the conspirators have been unraveling the fabric of our profession,” said Dr. Frankenstein, who during his address to the delegates on Sunday, urged his fellow physicians to play a central role in protecting their patients by calling for needed health care reforms, including increased access to resources for health care, reform of Medicare Advantage private practice plans, and limits to insurance company profits. “We, our nation’s doctors, must make the doctor-patient relationship the principal decision-making mechanism for all health care questions,” he said.
Dr. Frankenstein has held numerous local, state and national positions in organized medicine. He is a member of the board of the CMA Foundation, the charitable arm of CMA. He is past president of the Orange County Medical Association and the California Society of Internal Medicine, a founding board member of CalOptima (the Medi-Cal managed care provider in Orange County), and is currently vice chair of CMA’s delegation to AMA. He has served since 1999 on the CMA Board of Trustees.
Contact: Karen Nikos, 916/551-2069 or knikos@cmanet.org.
7. San Bernardino County Physician Named
President-Elect of the California Medical Association
 San Bernardino County Physician Dev GnanaDev, M.D., was elected CMA president-elect earlier this week at the CMA’s Annual House of Delegates in Anaheim. He will serve as president-elect for a year before taking office as president in October 2008.
Dev GnanaDev, M.D., 57, has been active in the CMA for 26 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’s great interest in serving lower-income patients led to his receiving the Medical Board of California’s Physician Recognition Award in 2005 for contributions to care of indigent patients.
Dr. GnanaDev this year received AMA’s Pride in the Profession Award for his extraordinary efforts in the medical profession. The award is given to “recognize the contributions of exemplary physicians who work in underserved areas or sacrifice their time for volunteer or public service efforts.
Board certified in general surgery, vascular surgery, and surgical critical care, Dr. GnanaDev is chief of surgery and medical director at Arrowhead Regional Medical Center in Colton.
Contact: Karen Nikos, 916/551-2069 or knikos@cmanet.org.
8. CMA’s Young and Future Physicians Blog About
Their Experience at the 2007 House of Delegates
CMA invited some of its most active members and elected representatives to blog about their experiences at this year’s House of Delegates meeting.
The “Future of Medicine” blog, written by representatives of CMA’s Young Physician, Medical Student, and Resident Physician sections, will give you some insight into CMA’s democratic process and a behind the scenes look at CMA’s annual meeting.
The blog is available at the members-only website.
Contact: Katherine Gallia, 916/551-2074 or kgallia@cmanet.org.
9. Video Highlights from CMA’s Annual Meeting
Watch video highlights from this year’s House of Delegates online at the
members-only website.
Contact: Ron Lopp, 916/551-2042 or rlopp@cmanet.org.
10. Member Benefit of the Week: Health Savings Account
2007 Final Deadline! CMA has partnered with Marsh and UMB Bank to create the CMA Health Savings Account (HSA) Program.
An HSA is a federally tax-exempt account used to pay for current and future health care expenses.
Maximum annual contributions in 2007 are $2,850 for an individual and $5,650 for a family. (Individuals ages 55 to 64 can contribute an additional $800.)
Members who wish to open a health savings account and make their full 2007 contribution must make sure their qualified high deductible health plan is in effect no later than December 1.
Visit http://www.cmanet.org/hsa or call Marsh at 800/842-3761 for details.
Click here for more information on your membership benefits.
Contact: CMA's membership hotline, 800/786-4CMA (4262) or lgodward@cmanet.org.
|
No. 2116
