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1. Don’t Be Caught Off Guard by Health Plan Contract Changes
Physicians are urged to carefully review all notices from their contracting health plans, as these may include material modifications to contract terms that could significantly impact their practices. You should also be aware that you have the right to terminate an agreement if any such material change is not beneficial to your practice.
There have been a number of recent developments that demonstrate the importance of such vigilance by physicians and their staff.
1. MultiPlan/Private Health Care Systems (PHCS) merger
Although MultiPlan and PHCS will continue to market their products under different names, physicians were recently notified that effective May 1 the PHCS agreement will supersede any other agreement in place. In other words, physicians’ relationships with MultiPlan will be governed by the PHCS agreement. Physicians were also notified that effective May 1 the newly merged entity will adopt MultiPlan’s practice of tying fee schedules to the current year’s RBRVS. This new policy will significantly decrease the current PHCS fee schedule.
2. First Health Acquisition of Community Care Network
Physicians were recently notified that Community Care Network (CCN) would be absorbed into the First Health network. Physicians should be aware that the First Health physician contract supersedes the CCN contract and physicians treating CCN patients will be paid according to the First Health fee schedule for dates of service on or after January 1, 2007. (CCN patients will eventually be issued new First Health cards.) Because there was no change to the First Health fee schedule, the plan was not required to give physicians advance notice or the option to terminate.
Physicians should be aware that they do have the right to terminate any health plan contract “without cause” with advance written notice. (The amount of advance notice will depend on the terms of the contract.)
3. Blue Cross Prudent Buyer Plan Fee Schedule Changes
CMA recently learned that Blue Cross recently updated its Prudent Buyer Plan physician contract and the new contract becomes effective June 1. According to a notice recently mailed to physicians, payment levels for many codes have been modified, some increased and some decreased. Physicians are urged to assess the impact these changes will have on their practice. The new fee schedule will be available on the Blue Cross provider website on April 15. In the meantime, fee schedule questions should be directed to Blue Cross at 800/933-6633 (select option 3).
To help physicians analyze proposed fee schedules and negotiate and manage complex third-party payor agreements, CMA has published a contracting toolkit, “Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations—A Focus on Payor Contracting.” This toolkit is available free to members at the members-only website Nonmembers can purchase the toolkit for $100 in the CMA bookstore.
CMA has also created a financial impact worksheet to help physicians assess the impact fee schedule changes will have on their practices based on their most commonly billed CPT codes.
Click here for more information on these and other practice management resources from CMA.
Contact: Reimbursement Help Line, 888/401-5911.
2. You Wanted to Know: Does State Law Prohibit
Physicians from Performing ER Triage?
There has been some confusion as to whether state law prohibits physicians from performing emergency department (ED) triage. The simple answer is there is nothing in the state Department of Health Services (DHS) regulations that prohibits physicians from doing ED triage. However, the regulations do specify that general acute care hospitals must have at least one registered nurse (RN) assigned to the ED to triage patients at all times. So as long as a hospital meets that minimum nursing services requirement, it can also assign triage duties to physicians or physician assistants. (PAs are authorized by law to evaluate situations that call for immediate physician attention and initiate procedures necessary to protect the life of the patient when necessary.)
If, however, a hospital wanted to use physicians or PAs for triage in place of RNs, that would require prior written approval (a.k.a. “a program flex”) from the state DHS.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
3. Governor Schwarzenegger to Keynote
CMA’s Legislative Leadership Conference
Governor Arnold Schwarzenegger has accepted CMA’s invitation to give the keynote address at CMA’s Legislative Leadership Conference, Tuesday, April 24. The governor will address the more than 500 physician attendees just prior to their afternoon legislative meetings.
The governor’s participation in CMA’s annual legislative conference will give physicians an opportunity to hear about his health care reform proposal. This is a unique event for California physicians and is free of charge to all CMA members.
A revamped schedule will include more time than ever to meet with your elected officials in the State Assembly and Senate. Attendees will receive a CMA health policy briefing and a short course on “Lobbying 101,” which will train them to become strong physician advocates and prepare them for the legislative meetings later in the day.
Attendees will also listen in as two of the state’s top political strategists – Democratic political consultant Richie Ross and Republican strategist Dan Schnur – discuss the political landscape and the potential for real health reform.
There is no charge to attend this conference, but registration is required.
Click here for more information.
Contact: Marlon Cuellar, 916/444-5532 or mcuellar@cmanet.org.
4. Panel to Address Physician-Hospital Tensions
Tensions between physicians and hospitals related to emergency room call, medical staff self-governance, peer review due process, and the emergence of physician-owned specialty hospitals will be the focus of a presentation and panel at the 10th Annual California Health Care Leadership Academy, April 13-15 in Monterey.
Joseph S. Bujak, M.D., vice president of medical affairs at Kootenai Medical Center in Idaho and a consultant with Kaiser Consulting Network, will address these and other medical staff issues and engage in an open discussion with a respondent panel and audience members. Joining Dr. Bujak as panelists will be Howard Lang, M.D., CMA past president and former chair of AMA’s Organized Medical Staff Section, and Ellen Pryga, director of policy at the American Hospital Association.
The conference also features presentations on quality improvement and patient safety, professionalism in medicine, health system reform, and more. Breakout workshops will focus on an array of practice management topics. The conference is approved for up to 14 AMA PRA Category 1 Credits™.
To register, visit http://www.cmanet.org/leadership or call 800/795-2262.
5. Essentials for Medical Staff Leaders – a How-To Program
The CMA’s Institute for Medical Quality invites you to participate in its new and improved “Essentials for Medical Staff Leaders” program, Thursday, April 12, in San Francisco. The newly redesigned program will provide a variety of “how-to” solutions for medical staff leaders including:
- how physician leaders and hospital executives can effectively function as a team;
- how to conduct performance improvement;
- how to appropriately credential, appoint, and reappoint using 2007
- credentialing standards;
- how to perform effective peer review; and
- how to successfully manage legal requirements and principles of medical staff self-governance.
Early-bird registration deadline is March 22. CMA members pay $360 (nonmembers $385). After March 22, CMA members pay $380 (nonmembers $405). This program has been approved for 5.75 AMA PRA Category 1 Credits™.
Attendance is limited to provide more personal interaction.
Click here for more information.
Contact: Leslie Anne Iacopi, 415/882-5167 or liacopi@imq.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-acceptance insurance is available to actively practicing physician members under age 60. (“Actively practicing” means working 30 hours per week for at least 90 days prior to the effective date of coverage.) Additional coverage requires a supplemental application and will be medically underwritten.
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. 2087
