1. CMA Opposes Expansion of Chiropractic Scope of Practice
CMA has submitted objections to proposed regulations that would allow chiropractors to perform manipulation under anesthesia (MUA). MUA involves chiropractic manipulation of the spine of an individual that has first been sedated. CMA believes that MUA raises important patient safety concerns and the regulations, as proposed by the Board of Chiropractic Examiners, would allow chiropractors to perform a procedure that is not authorized under current law.
CMA believes that the introduction of anesthesia as part of a treatment qualitatively transforms the procedure into the practice of medicine. While the proposed regulations require the anesthesia to be administered by a physician, it is CMA’s contention that because the use of anesthesia is integral to the technique itself, MUA is not explicitly authorized under current law.
Beyond the legal concerns about scope of practice, spinal MUA is considered experimental by all major health plans and the safety, efficacy, and long term effects of the treatment have not been adequately studied.
CMA’s comments also point out that chiropractors’ scope of practice is limited by the Chiropractic Act, an initiative measure passed by California voters in 1922. Accordingly, the scope of chiropractic practice can only be expanded through the initiative process.
Click here for more information, including a copy of CMA's comments.
Delilah Clay, 916/551-2568 or dclay@cmanet.org.
2. U.S. Supreme Court Rules Against Drug Maker in Liability Case
The United State Supreme Court last week upheld a $6.7 million ruling against the pharmaceutical manufacturer Wyeth for failure to provide adequate warning about the dangers of its antinausea drug, Phenergan. This was an important case for doctors: had the Court ruled for Wyeth, pharmaceutical companies would have been protected from many state-based failure-to-warn claims, potentially increasing the risk that doctors would get sued for harm caused by pharmaceutical products.
CMA had filed a brief in this case, Wyeth v. Levine, telling the justices that preemption of pharmaceutical failure-to-warn claims would obstruct physicians’ access to complete and truthful information about prescription drug safety and efficacy and would compromise patient safety.
“In order to best serve patients, physicians must have complete and truthful information about the risks and benefits of the drugs they prescribe,” said Francisco Silva, CMA vice president and general counsel. “This ruling protects patient safety and allows doctors to do their jobs.”
Wyeth was appealing the Vermont Supreme Court’s decision to uphold a jury award to Diana Levine after the drug caused serious complications and ultimately resulted in the amputation of her arm. The issue on appeal focused on whether FDA approval of a drug should preempt state legal actions against the pharmaceutical company for failure to warn of known risks.
Click here for more information, including a copy of CMA's brief.
Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
3. CMA Sponsors Bill to Protect Children’s Access to Vaccinations
CMA is co-sponsoring a bill that would require health plans to fully reimburse physicians for the costs of immunizations. Assembly Bill 1201 (Manuel Perez, D – Coachella) would also bar health plans from charging patients out-of-pocket expenses for vaccines, a practice that can be an obstacle for parents immunizing their children.
California law already requires health plans to cover recommended inoculations. However, health plans typically do not reimburse physicians for the entire cost of providing the vaccines. AB 1201 remedies this by requiring health plans and insurers to fully reimburse physicians for the direct and indirect costs to acquire and administer recommended vaccines.
For more information on this and other bills of interest to physicians, sign up to receive CMA’s Legislative Hot List by emailing jwilliams2@cmanet.org.
Contact: Teresa Kline, 916/444-5532 or tkline@cmanet.org.
4. Obama Gets the Health Reform Ball Rolling; Promises SGR Fix
President Obama has in recent weeks taken several steps towards his goal of achieving comprehensive health reform. The president’s recently released 2010 budget proposal directs $634 billion to a “health care reserve fund” over the next decade to finance expanded health insurance coverage and other health care investments. Of particular importance to physicians, the budget proposal includes $330 billion to “…effectively eliminate the enormous deficit and scheduled Medicare physician payment cuts of 40 percent over the next seven years.”
The proposed budget also signals the Administration’s willingness to consider further modifications to the Medicare sustainable growth rate (SGR) formula, stating that “as part of health care reform, the Administration would support comprehensive, but fiscally responsible, reforms to the payment formula,” adding that “Medicare and the country need to move toward a system in which doctors face better incentives for high-quality care rather than simply more care.” The President made a significant commitment to physicians to fix the Medicare physician payment system this year.
Approximately half of the health care reserve fund would be generated by increasing taxes on couples earning more than $250,000 a year and individuals earning more than $200,000. Other funding would come from Medicaid and Medicare cuts. Physicians, however, would come away largely unscathed compared to the rest of the health care sector. The proposed budget would cut Medicare Advantage funding by an expected $177 billion over 10 years by establishing a “competitive bidding” process for health plans that want to participate in the Medicare Advantage program. Hospitals, home health care, and pharmaceutical companies are also slated for multi-billion dollar cuts. Unfortunately, the proposal would ban future physician-owned hospitals.
Obama also last week convened 120 stakeholders − including physicians, hospitals, senior citizens, labor, business, Republicans, and Democrats − to begin the discussion of how to overhaul the nation’s health care system, citing it as the key to shoring up the economy. Obama is setting an ambitious timeline to enact “comprehensive health care reform” by year’s end. Although he has not offered up a specific reform plan, Obama has outlined general principles that he believes are central to health care reform, which include increasing coverage, improving quality, and controlling costs.
CMA continues to ensure the voices of physicians and patients are heard and considered as new health care policies are developed. CMA physician leaders will be in Washington D.C. next week to meet with key Congressional representatives, including California Committee Chairmen Pete Stark and Henry Waxman and House Speaker Nancy Pelosi who will be writing the Medicare and Health Reform legislation.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
5. HealthNet Clarifies Prepayment Review Policy for Consultations
HealthNet recently notified physicians about new prepayment review requirements intended to “identify miscoded consultations billed in an office setting.” According to the notice, claims for consultations (CPT codes 99241 to 99245) performed at the request of another physician must be accompanied by copies of the consultation report and progress notes from the patient’s chart.
After CMA expressed concerns about the administrative burden this would place on physicians providing consultative services, HealthNet immediately clarified that documentation would only be required if the patient was evaluated for the same or similar condition within the previous 12 months by the same physician or physician of the same specialty in the same practice.
HealthNet will be mailing the clarified policy to contracting physicians within the next couple of weeks.
Contact: Reimbursement Help Line, 888/401-5911 or awetzel@cmanet.org.
6. New Law Limits Markup for Radiologic Services
CMA On-Call has been updated to discuss a new California law that restricts the circumstances under which physicians may bill for diagnostic imaging services. Effective January 1, 2009, physicians may no longer bill patients or insurers for the technical component of diagnostic imaging services (CT, PET, or MRI) that were not rendered by the physician or someone under his or her supervision. This means that radiologic facilities or imaging centers must now directly bill the patient or the responsible third-party payor.
Physicians are also reminded that it is a violation of law to allow physician assistants or other staff to perform x-rays without proper certification. The California Department of Public Health strictly enforces this provision and physicians found to be in violation will be cited and may be subject to additional enforcement action.
For more information, see CMA On-Call document #1335, “Mammography Facilities and X-rays.” On-Call documents are free to members. Nonmembers can purchase On-Call documents for $2 per page in the CMA bookstore.
On-Call is CMA’s online library of medical-legal information. It contains most of the content available in the California Physician’s Legal Handbook (CPLH). This book, an annual publication written by CMA’s legal department, the seven-volume book contains legal information on a variety of subjects of everyday importance to practicing physicians. CPLH is available in a 7-volume softbound format or on an interactive CD-rom. To order the 2009 CPLH, call 800/882-1262 or visit the CMA Bookstore.
Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
7. Webinar: HIT and the Economic Stimulus Package -
Practical Considerations for Physicians
Qualifying physicians stand to receive as much as $65,000 for the use and purchase of electronic health records under the economic stimulus package recently passed by Congress. This will be the topic of CMA’s next webinar, Thursday, March 19, from 12:30 pm to 1:15 pm. CMA’s associate director of policy, David Ford, will discuss new federal funding for Health IT, clarify who is eligible, and explain how to apply for these funds.
To register, visit http://www.cmanet.org/calendar. Space is limited so register soon.
Contact: Shannon Navarra-Lujan, 800/786-4CMA or slujan@cmanet.org.
8. Deadline for 2009 Medical School
Loan Repayment Program Is March 24
Applications are now available for the 2009 Steven M. Thompson Physician Corps Loan Repayment Program. Physicians selected for the program, created under a CMA-sponsored law in 2002, will receive medical school loan repayment grants of up to $105,000 in exchange for a three-year service commitment in a medically underserved area of the state.
The program is open to newly licensed physicians who commit to serve a minimum of three years in the approved geographic areas, which include official “health professionals shortage areas” (HPSAs) and federally qualified “health center look-alikes,” community health centers, migrant health centers, and public housing centers.
Applications are due by March 24 and can be downloaded at http://www.healthprofessions.ca.gov.
Contact: Shannon Navarra-Lujan, 800/786-4CMA or slujan@cmanet.org.
9. Concerns with Health Insurers? Tell CMA.
As part of our ongoing efforts to address physician concerns and issues with health insurance plans and companies, CMA is conducting a survey. To ensure the quality and confidentiality of this study, the CMA is working with EMC Research, an opinion research firm based in Oakland, California.
Your involvement is critical to keeping us informed of the insurer issues facing you and your practice, so please take a moment to share your opinions.
Click here to take the survey.
10. Early Bird Deadline for CMA's 12th
Annual Leadership Academy Is March 24
Physicians can now register for CMA’s 12th annual Health Care Leadership Academy, April 24-26 in Anaheim. This year’s conference will feature presentations on health system reform in a new era of Washington politics, the “medical home” and other emerging models for the delivery of quality care, the promises and perils of hospital EHR initiatives, health disparities, and more.
Attendees will also have the opportunity to select from 14 breakout workshops on topics ranging from survival strategies for practicing in a turbulent economy, to mitigating malpractice risk, developing leadership skills, and more. Physicians can earn up to 17.75 AMA PRA Category 1 CME credits.
Register by March 24 and save $100. Early bird registration is $645 for members, $945 for nonmembers, and $245 for allied health professionals. Tuition for practice managers and other non-MD staff is $295 for CAMGMA members, $395 for nonmembers.
All registered attendees will receive a voucher redeemable for free admission to the park of their choice – Disneyland or California Adventure – on Saturday evening during the conference. Additional tickets will be available for $38 – almost half off the regular $69 ticket price. Physicians are urged to bring their families and take advantage of this recession-busting opportunity.
For more information or to register, visit the Leadership Academy Website.
Contact: Roger Purdy, 916/551-2067 or rpurdy@cmanet.org.
11. First Statewide POLST Conference Is March 30 in Sacramento
Effective January 1, California law gives “Physicians Orders for Life-Sustaining Treatment” (POLST) forms equal status to “Do Not Attempt Resuscitation” (DNR) orders. The POLST form, used for patients with a serious illness or whose life expectancy is a year or less, outlines a plan of care reflecting the patient’s wishes concerning care at life’s end. The form compliments an advance directive by turning a patient’s treatment preferences into actionable medical orders.
Join statewide leaders, health care experts, and leading authorities in advance health care planning and policy to learn more about POLST at the California Coalition for Compassionate Care’s first statewide POLST conference, March 30 in Sacramento.
For details and to register, visit the California Coalition for Compassionate Care's website.
Also, for more information on POLST, see CMA On-Call document #0445, “Decisions Regarding Life Sustaining Treatment: Advance Directives and POLST.” On-Call documents are free to members. Nonmembers can purchase On-Call documents for $2 per page in the CMA bookstore.
Contact: 916/552-7642 or info@finalchoices.org.
12. Essentials for Medical Staff Leaders – a How-To Program
The CMA’s Institute for Medical Quality invites you to participate in its “Essentials for Medical Staff Leaders” program, April 2, in San Francisco. Whether you are a seasoned leader or a newly appointed chief or chair, this program will provide invaluable information for medical staff leaders, including:
- how physician leaders and hospital executives can effectively function as a team;
- the ins and outs of ongoing professional practice evaluation;
- how to conduct effective medical executive meetings;
- how to appropriately credential and privilege medical staff members; and
- your role in the accreditation and licensure survey process.
Early-bird registration deadline is March 12. CMA members pay $385 (nonmembers $412). After March 22, CMA members pay $400 (nonmembers $435).
Attendance is limited to provide more personal interaction. Download a registration form at the IMQ website.
Contact: Leslie Anne Iacopi, 415/882-5167 or liacopi@imq.org.
13. Benefit of the Week: Reduced Loan Administration Fees
For more than 20 years, Bank of America has served the needs of physicians by offering financial products tailored to meet the needs of the medical community.
Whether you own a practice or are just getting started, Banc of America Practice Solutions™ can provide customized financial solutions for your short- and long-term needs. Their financial specialists can even help you secure equipment and electronic medical record financing in as little as three hours. For more information, call Banc of America Practice Solutions™ at 800/497-6076.
A members-only code is needed to take advantage of this discount. Visit CMA’s members-only website, or call the member service center at 800/786-4CMA (4262) to get your code.
Click here for more information on your membership benefits.
Contact: CMA’s member help line, 800/786-4CMA or twilson@cmanet.org.
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