1. State Supreme Court Outlaws Balance Billing,
Increases Burden on Stressed ER System
The California State Supreme Court on Thursday struck down the practice of “balance billing,” forcing physicians and hospitals to eat the cost of emergency medical care that HMOs refuse to cover.
When HMOs don’t pay the full cost of ER care for their policyholders – a growing trend – doctors must bill for the outstanding balance, creating an awful burden for both physician and patient. The practice is known as balance billing.
CMA supports a solution that protects doctors and patients by requiring HMOs to pay the bill for emergency services. By outlawing balance billing without a realistic remedy, however, the court has placed another strain on financially struggling emergency rooms and the physicians who work there.
“As a trauma surgeon, my number one priority is to save lives and protect the health of my patients,” said CMA President Dev A. GnanaDev, M.D. “This court ruling basically says if I do my job as I see fit and HMOs don’t want to pay, tough luck, go to court. I signed up to be a doctor, not a lawyer.”
The court’s failure to solve the underpayment problem will stress the already beleaguered emergency care system. More than 70 California ERs have closed since 1990. In addition, the state’s emergency rooms performed more than $1 billion in uncompensated care in the year ending June 30, 2007, the most recent statistics available, according to the Office of Statewide Health Planning and Development.
“There is no doubt this ruling adds to the growing woes of California’s emergency rooms,” Dr. GnanaDev said. “Sadly, this will reduce the availability of emergency care throughout the state.”
CMA is exploring all of its options to ensure physicians have adequate recourse when HMOs fail to pay reasonably for emergency services. Organized medicine remains steadfast in its efforts to ensure that noncontracted physicians are properly paid for services provided to patients. To assist in these efforts, CMA will be distributing a survey this week on the issue of underpayment for out-of-network services. All physicians are urged to complete the survey as soon as possible.
Click here for more information, including a copy of the ruling and a link to the survey when it becomes available
Contact: 800/786-4CMA (4262) or info@cmanet.org.
2. Have You Checked Your Medical Board Profile Recently?
Physician profiles have been available to the public on the Medical Board of California’s website since 1997, as required by Business and Professions Code sections 2027 and 803.1. CMA encourages physicians to check their profiles for accuracy and advise the board of any corrections, especially changes to their addresses of record.
The board cautions physicians against using their home addresses, because the addresses become widely available to the public on the Internet. You may designate a post office box as your address of record but, by law, you also must provide the medical board with a street address. In this case, the street address remains confidential, and all official correspondence, such as license renewal notices, go to the post office box.
Click here for more information, including a change-of-address form.
Contact: Yvonne Choong, 916/551-2884 or ychoong@cmanet.org.
3. Anthem Blue Cross Pulls Out of Healthy Families in 11 Counties
Effective February 1, Anthem Blue Cross will no longer provide coverage for 65,000 Healthy Families patients in Alameda, Contra Costa, Fresno, Monterey, Sacramento, San Francisco, San Mateo, Santa Barbara, Solano, Stanislaus, and Yolo counties. Patients were notified in November and given the opportunity to select a new plan. If they did not select a new plan by the December 31 deadline, they were automatically transferred to the default “community provider plan” for their county. (Click here for a list of CPPs by county.)
Physicians in these counties are encouraged to verify their Healthy Families patients’ coverage status before submitting claims with dates of service on or after February 1. Blue Cross will continue to reimburse physicians for eligible Healthy Families Program claims with dates of service up to and including midnight of January 31, 2009.
Under state “continuity of care” laws, Blue Cross must continue to provide coverage for patients if a change in coverage would interrupt an ongoing course of treatment. Patients that might qualify include, but are not limited to, women who are pregnant, children under age 3, and patients with cancer or other chronic disease who are undergoing a regiment of care. To request or inquire about a continuity of care plan, contact Blue Cross’s Utilization Management department at 877/273-4193. All other questions about this transition can be directed to Blue Cross Member Services at 800/845-3604.
Click here for more information, including a copy of Blue Cross' notice to physicians on this issue.
Contact: David Ford, 916/551-2554 or dford@cmanet.org.
4. Governor Proposes Cuts and Taxes to Address $40B Shortfall
The Schwarzenegger Administration recently unveiled a new budget proposal to address the $40+ billion shortfall facing California over the next 18 months. The proposal is a mix of roughly $14.3 billion in increased taxes, $17.4 billion in spending cuts, $5 billion in projected increased revenues from a revamped state lottery, and an additional $5 billion from borrowing. While the Administration continues to honor the injunction against Medi-Cal provider rate cuts that CMA helped obtain earlier this year, there are some cuts which may be of interest to physicians:
- $275 million saved by eliminating the California Children and Families Commission (First 5 Commission) and redirecting all state Prop 10 funds and half of local Prop 10 funds to children’s programs under the Department of Social Services.
- $298 million saved by eliminating certain optional Medi-Cal benefits for adults, including dental, optometry, and psychology.
- $85 million shifted from the 2008-9 fiscal year to the 2009-10 fiscal year by delaying checkwrite payments to Medi-Cal fee-for-service providers one month in June 2009. This is in addition to a previously authorized two-week delay.
- $52.4 million saved by reducing Medi-Cal reimbursements to public hospitals, with an increase in the same amount in federal funds to unspecified public health programs.
The Governor’s proposal also includes $14.3 billion in new tax revenue, including a temporary increase in the state sales tax, expansion of the sales tax to cover some previously untaxed services (does not include health care), a nickel-a-drink alcohol tax, a new tax on oil production, a $12 hike on vehicle registration fees, and reduction of the dependent care exemption on state income tax returns.
This and other legislative budget proposals continue to be subject to much debate at the Capitol. CMA will continue to monitor the budget discussions and provide updates when relevant.
Contact: Ned Wigglesworth, 916/444-5532 or nwigglesworth@cmanet.org.
5. Make Your Voice Heard:
CMA Needs Physician Feedback on Critical Health Care Issues
The input of members like you is critical to our ability to protect the viability of the practice of medicine in California. Over the next few months, CMA will be asking members to provide feedback and input on a variety of issues, including underpayment for out of network services, how the economic downturn is affecting your practice, and what CMA can do to better serve its members.
We understand that completing these surveys take time, but they play an invaluable role in our advocacy efforts. Thank you in advance for taking the time to provide us with the data we need to protect and serve the interests of California physicians in 2009 and beyond.
In the meantime, if you have comments or questions about your CMA membership, please call our member help center at 800/786-4CMA (4262).
Contact: Ned Wigglesworth, 916/444-5532 or nwigglesworth@cmanet.org.
6. Congress to Vote on Health Care Coverage for Kids
Congress is expected to vote this week on a bill to reauthorize the federal State Children’s Health Insurance Program (SCHIP). This extremely successful program, which provides affordable health coverage for more than 900,000 California children (and 6.6 million children nationwide), will run out of funding in March if the program is not reauthorized.
CMA has been active in the fight to support Healthy Families at the state and national levels. This program is even more critical in these tough economic times. Due to the national economic recession, 1.2 million children have lost employer-sponsored insurance in the past year alone. California’s Healthy Families program has been enrolling over 27,000 new eligible children each month, the highest level in its history.
Physicians are urged to call their representatives and ask them to vote to reauthorize this invaluable program. Contact information is available at http://www.house.gov.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
7. 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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