1. CMA Urges State to Investigate Administrative Delays
by PacifiCare/United Healthcare
CMA has received a number of calls from physicians complaining about administrative delays by PacifiCare/United Healthcare, particularly in regard to physician contracting. The delays are causing significant confusion as to physicians’ participation status and negatively impacting patient access to care.
Among the complaints are charges of chronic delays processing new contracts and contract terminations. These delays not only have caused patients to be misinformed about physicians’ participation status, but also have resulted in significant administrative hassles for physician offices. Physicians are also reporting that the insurer has failed to load contracted rates correctly and has been unresponsive to their phone calls, letters, and e-mails.
CMA has asked the Department of Managed Health Care (DMHC) and the Department of Insurance (DOI) to investigate the situation and determine whether the delays are the result, as CMA suspects, of a significant lack of administrative capacity.
“After the PacifiCare/United Healthcare merger, physicians in California encountered a poorly equipped, disorganized corporation,” wrote Aileen E. Wetzel of CMA’s Center for Economic Services in a letter to DMHC and DOI.
Click here for more information, including a link to CMA's PacifiCare "Survival Kit."
Contact: Aileen E. Wetzel, 916/444-5532 or awetzel@cmanet.org.
2. CMA Comments on Joint Commission’s
‘Disruptive Behavior’ Standard
CMA recently submitted comments on the Joint Commission’s proposed “disruptive behavior” standard (LD.3.15). The proposed standard would require medical staff and hospital leaders to develop a single code of conduct applicable to the medical staff and all hospital personnel. This is a critical acknowledgement that there must be rules for handling disruptive behavior by anyone within the hospital organization, not just medical staff members.
Unfortunately, the proposed standard also seems to indicate that discipline of medical staff members for disruptive behavior would no longer be handled through the peer review process, but rather would be subject to a separate disciplinary process agreed to by the hospital and medical staff leaders. CMA told the Joint Commission, among other things, that medical staffs throughout the nation are already structured to police their own, and that medical staff peer review bodies must retain the authority to handle cases of disruptive physician behavior.
Click here for more details, including the text of the proposed standard and a copy of CMA’s comments.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
3. Health Care Politics Behind the Scenes:
New Leadership Academy Session
CMA’s 10th Annual California Health Care Leadership Academy is April 13-15 at the Monterey Convention Center. CMA CEO Joe Dunn will host a special session at the conference, “Health Care Politics Behind the Scenes.” Mr. Dunn, a California state senator from 1998 to 2006, will provide insights into what is really going on behind the scenes as health system reform takes center stage in the state legislature this year. The presentation will follow a panel discussion on the access-to-care initiatives being proposed by the governor and the legislative leadership. Mr. Dunn will also speak, at another point in the conference, on the need for physicians to be proactive in the political arena as advocates for their patients and their profession.
The final conference agenda was mailed to all CMA members this week. The agenda and registration information can also be viewed on the conference website.
Early-bird tuition is $595 for members, $895 for nonmembers. After March 16, tuition is $695 for members, $995 for nonmembers. Attendees can receive up to 14 AMA PRA Category 1 CreditsTM.
Click here for more information or to register.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
4. Implementation of New Law Prohibiting
Patient SSNs on Medi-Cal Claims Delayed
The California Department of Health Services (DHS) recently announced that it would delay until further notice implementation of a new law that requires physicians to use patients’ 14-digit benefits identification card (BIC) numbers instead of Social Security numbers (SSNs) when billing Medi-Cal. The law, originally scheduled to take effect March 1, also prohibits using patients’ Social Security numbers to verify eligibility.
This law is intended to prevent identity theft and protect patients’ private health information by eliminating unnecessary use of SSNs.
The purpose of the delay is to allow DHS more time to educate patients and providers about the new rules. In the meantime, physicians are encouraged to avoid using patients SSNs whenever possible.
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-5911.
5. What’s New at CMA ON-CALL: Economic Credentialing Update
During the past decade, a disturbing trend has accelerated: Health policy and practices are increasingly being driven by economic pressures. While containment of health care costs is a worthy endeavor, it is the physician’s responsibility to ensure that patient care is not compromised in the process. This can only be achieved by ensuring that medical staff quality assurance mechanisms are supported, not circumvented, so that physicians can continue to work in their patients’ best interests.
The term “economic credentialing” has long been used to describe the use of economic criteria to determine a physician’s qualification for medical staff membership or privileges. CMA ON-CALL document #1212, “Economic Credentialing and Exclusive Contracts,” discusses the rights and responsibilities of hospital medical staffs to ensure that economic considerations do not negatively impact access to and quality of medically necessary patient care. The document includes a discussion of the recent Arkansas Baptist Health case, in which the Arkansas Supreme Court decided, in a first-of-its-kind ruling, that business interests of a hospital cannot interfere in the physician-patient relationship.
Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
6. Member Benefit of the Week: Guaranteed-Issue Term Life Insurance
Between now and March 31, CMA members can get $50,000 of term life insurance at discounted group rates. This special guaranteed-issue insurance is available to actively practicing physician members under age 60. (“Actively practicing” means working 30 hours per week for at least 90
More information, including an application, is available at http://www.marshaffinity.com or call 800/842-3761.
Click here for more information on your membership benefits.
Contact: CMA’s membership hotline, 888/233-2937 or lgodward@cmanet.org.
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No. 2084
