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1. Fate of Health Reform Uncertain
The nature and outcome of health reform was thrown into turmoil this week with the election of Massachusetts Republican Scott Brown to fill the Senate seat of the departed Ted Kennedy, longtime liberal lion of the U.S. Senate. Brown will be the 41st Republican Senator when sworn in sometime in the next week or so, depriving Democrats of their filibuster-proof majority.
It is difficult to overstate the impact that this one election has on health reform. Up until now, discussions were taking place entirely between House and Senate Democrats with no virtually no Republican involvement. With Brown’s election, Republicans now have the ability to stop the current version of health reform in Congress, unless Democrats pursue one of several unpalatable and unpopular alternatives to avoid the Senate. (For more details, see CMA President J. Brennan Cassidy’s letter to physicians on this issue.)
The ultimate impact of the new paradigm in Washington is as of yet uncertain. While the slowed pace may present an opportunity for CMA to fight for our priority issues, the retrenching may also cost us some of the provisions in the health reform proposals for which we successfully fought. We will know more about the plans of congressional leaders and the Obama Administration in the days to come, as they figure out their response.
Bottom line: any health reform legislation that makes it to the President’s desk will very likely be either markedly scaled down from the House or Senate bills, or a combined proposal.
Regardless of the new direction reform efforts may take, CMA remains committed to expanding meaningful access to care while preserving and protecting the doctor-patient relationship.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
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2. CMA CEO Alfred Gilchrist Steps Down
Alfred Gilchrist has resigned as CEO of the California Medical Association to return to Colorado. Gilchrist submitted his letter of resignation on Tuesday, citing personal and professional reasons for accepting an offer from the Colorado Medical Society to return to his former capacity as CEO there.
Alfred has made clear that all the factors related to his decision are external to CMA and that he hopes and expects to work with CMA on many issues on the national stage in the future. He praises CMA for its rich history of accomplishment as well as its regard in legislative, legal and advocacy arenas.
Dustin Corcoran, CMA's deputy CEO and former vice president of government relations, will serve as acting CEO. The Board of Trustees will take up the issue of a new CEO at its January 29 meeting.
Contact: Ned Wigglesworth, 916/444-5532 or nwigglesworth@cmanet.org.
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3. CMA Updates Medicare Consultation Code Billing Guide
As recently reported in CMA Alert, Medicare is no longer recognizing inpatient and outpatient consultation codes. Effective January 1, physicians must instead bill using E&M codes from the Office and Other Outpatient Services, Initial Hospital Care, and Initial Nursing Facility sections of the 2010 CPT.
CMA has updated its consultation code billing guide to provide some additional clarity on this understandably confusing and complex issue. Since final adoption of the rule we have received additional information. Please discard any previous version that you may have downloaded, and download the new file. You may also request a hard copy by contacting our Member Help Center at 800/786-4CMA (4262) or memberservice@cmanet.org.
CMA is also surveying major payors in California to find out which ones will be changing their own payment policies as a result of this change. The data that we have gathered thus far is available to members on the member-only website. The chart will be updated regularly as new information becomes available.
If you have any additional questions about these new rules, please do not hesitate to call our member help center at 800/786-4262 (4CMA) and ask to speak with a reimbursement specialist.
Contact: CMA Member Help Center, 800/786-4CMA (4262) or memberservice@cmanet.org.
4. DMHC Finalizes Timely Access Regulations
The California Department of Managed Health Care (DMHC) recently finalized regulations that require HMO patients to be seen in a timely manner. The primary intent of these regulations and the underlying legislation is to require HMOs to ensure that their networks of providers have the capacity and availability to provide care to enrollees within certain timeframes for various levels of care.
As you may recall, CMA supported the underlying legislation, AB 2179, which was signed into law in 2002 and directed the state to develop regulations to ensure that HMO enrollees have timely access to health care services. CMA supported that legislation because it promised to improve the adequacy of provider networks. The regulatory effort to implement AB 2179 has taken eight years to complete, during which time we have seen at least a dozen proposals from DMHC.
Over the last year, CMA obtained several concessions from DMHC to address our major concerns with these regulations, such as:
- a provision that allows a patient’s wait time to be extended if the physician has determined that delay will not have a detrimental impact on the patient’s health;
- a “provider’s bill of rights” that requires HMOs to provide physicians with advance notice of any contractual changes and the right to negotiate those changes;
- a provision stating that these regulations do not create additional physician liability;
- a requirement that HMOs demonstrate they have an adequate physician network before implementing the regulation.
"We are hopeful that these new regulations will work as intended," says CMA President Brennan Cassidy, M.D. "As doctors, our No. 1 priority is our patients. We want to be sure that HMOs meet these requirements without forcing doctors to shorten patient visits or meet unrealistic quotas that would comprise the quality of care."
Both the regulations and the underlying law impose requirements on HMOs, not physicians. However, to comply with the regulations, HMOs will very likely pass on these requirements contractually to physicians and other providers. This in turn may require modification of existing physician office procedures to comply with the additional scheduling or reporting requirements.
As part of the regulations, HMOs are required to meet the minimum physician-to-patient ratios established in the Knox-Keene Act. The Knox Keene Act already requires HMOs to maintain provider networks with certain ratios of physicians to enrollees, but very little recent information on network adequacy is available because the state does not regularly monitor compliance.
HMOs still need to develop the contractual amendments necessary to comply with these regulations, so there will not be a full picture of what physicians need to know regarding contracting or implementation for some time. HMOs have until October 17, 2010, to file a compliance plan with DMHC, by which point we should have a more fully developed picture of what physicians need to know and do. CMA will be in contact with HMOs during this process to provide physician perspective. HMOs must fully comply with the regulations by January 17, 2011.
For more information on these regulations, see the newly updated On-Call document #1005, "Access to Physicians." On-Call documents are available free to members. Nonmembers can purchase On-Call documents for $2 per page in the CMA bookstore.
CMA has also scheduled two webinars on this topic with Armand Feliciano, CMA Associate Director of Medical and Regulatory Policy. The first webinar is Thursday, January 28 from 12:15-1:15 p.m., and the second Wednesday, February 3 from 12:15-1:15 p.m. Registration is free to members, but space is limited, so reserve your space today. If you are unable to participate in the live webinar, it will be available for on-demand viewing beginning the following day.
Click here for more information.
Contact: Member Help Line, 800/786-4CMA or memberservice@cmanet.org.
5. New Orders for H1N1 Vaccine Now Being Accepted
The California Department of Public Health is now accepting supplemental orders for H1N1 vaccine. Requests will be filled on a first-come, first-serve basis while supplies last.
6. Pharmacy Board Proposes Patient Centric
Prescription Labeling Regulations
The California Board of Pharmacy recently issued proposed regulations intended to make prescription labels easier for patients to understand. The regulations are the result of a 2007 CMA-supported law that called on the board to standardize prescription labels to reduce medication errors and help patients take their medications as intended by the prescriber.
The proposed regulations would create standard directions for use and a "patient centric" format for displaying prescription drug information on container labels. Specifically, the regulations would require pharmacists to provide usage and dosage instructions using standardized words and phrases on prescription container labels. Pharmacists would also be required to include on the label the drug's purpose or the condition the drug is intended to treat, "if desired" by the patient. Additionally, the pharmacy board would be required to publish language translations of the standard directions for use into at least five languages other than English on its website.
While CMA continues to strongly support the pharmacy board's efforts to improve health care literacy and reduce errors associated with the delivery of prescription medications, we are concerned that the regulations as written are unclear and might expose prescribers to additional liability. For example, labeling requirements based on patient "desire" could subject prescribers to potential liability if it is later found that such a desire existed, even if it was not explicitly expressed by the patient.
CMA is also concerned that some of the standardized language detailed in the regulations is too general and poses a threat to patient safety.
CMA has detailed these concerns in comments submitted to the pharmacy board on the proposed regulations.
Click here for more information.
Contact: Veronica Ramirez, 916/551-2887 or vramirez@cmanet.org.
7. CMA’s 2010 Model Medical Staff Bylaws Now Available
CMA's 2010 Annotated Model Medical Staff Bylaws are now available. These model medical staff bylaws are the definitive guide for medical staffs, providing details on professional and legal structures to support effective medical staff operations. The model bylaws are fully annotated to provide background information on critical provisions, including explanations of relevant state and federal laws, hospital accreditation standards, and other explanatory information.
The 2010 bylaws include new sections on disruptive behavior and medical staff governance. The 2010 bylaws also include extensive provisions on developing a code of conduct, reforming the medical staff nomination and election process, increasing the transparency of Medical Executive Committee activities, establishing a stronger role for the medical staff in the development of hospital policy, and identifying and resolving potential conflicts of interests among medical staff leaders.
The bylaws are free for members of CMA's Organized Medical Staff Section (OMSS) and are just one of the many benefits of OMSS membership. The bylaws are also available for purchase in the CMA bookstore for $1000.
For more information on OMSS membership, visit the OMSS webpage or contact Yvonne Choong at 916/551-2884 or medstaffhelp@cmanet.org.
8. Register Today for the 2010 California
Health Care Leadership Academy
Registration is now open for CMA's 13th Annual California Health Care Leadership Academy, April 9-11 in San Diego.
This year's conference, "The Era of Health Reform: Harnessing the Currents," will assess the status and impact of federal health reform efforts, including provider payment incentives that may change the organizational forms of medical practice.
The 2010 Academy, approved for 18.25 hours of Category 1 CME, will also feature three main breakout tracks: health information technology, leadership skills development, and practice management.
Register by March 9 and save $100. Early bird registration is $645 for members, $945 for nonmembers, and $295 for allied health professionals. Early-bird tuition for practice managers and other non-MD staff is $295 for CAMGMA members, $395 for nonmembers. Discounts for multiple registrations are available.
For more information or to register, visit the Leadership Academy website.
Contact: Roger Purdy, 916/551-2067 or rpurdy@cmanet.org.
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Heartland Payment Systems: Members receive exclusive discounts and a three-year rate guarantee on Heartland Payment System’s suite of financial services, which includes credit card processing, payroll services, check management and real time health benefits eligibility verification. Heartland offers a full suite of services to meet the needs of the health care market, including ConfirmPaySM, a payment portal that processes credit card and ACH transactions with real time insurance verification and patient responsibility estimator for over 400 insurance carriers. Heartland Payment Systems also has local sales and service professionals who specialize in the health care industry and a 24/7/365 live customer service team. For more information, call 866/941-1477 or visit www.heartlandpaymentsystems.com.
For more information on these and other member benefits, visit http://www.cmanet.org/benefits or contact CMA at memberservice@cmanet.org or 800/786-4CMA.
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