1. Medical Board Changes Licensing Fees for Physicians
Physician licensing and renewal fees assessed by the Medical Board of California will increase by $3, from $805 to $808, effective July 1. The increase is the result of a $22 licensing fee decrease associated with the termination of the Diversion Program and a new $25 licensing fee increase to fund the Steven M. Thompson Physician Corps Loan Repayment Program.
Prior to its termination, the medical board’s Diversion Program had been funded by a $22 surcharge on physicians’ licensing fees. Although the diversion program ended on June 30, 2008, the medical board postponed the effective date of the associated licensing fee reduction to July 2009. In August, CMA objected to the delay, arguing that medical board was violating state law by continuing to collect this surcharge to support a nonexistent program. In response to CMA’s concerns, the medical board has now agreed to refund “diversion surcharges” collected between July 1, 2008, and July 1, 2009, in the form of a licensing fee credit. The credit will be applied at physicians’ next renewal application.
The $22 licensing fee reduction resulting from the closure of the Diversion Program will be offset by a new $25 licensing fee increase, which will be used to fund the Steven M. Thompson Physician Corps Loan Repayment program. The loan repayment program provides newly licensed physicians with medical school loan repayment grants of up to $105,000 in exchange for three-year commitments to serve in medically underserved areas of the state. The $25 fee increase will be incorporated into the total renewal fee paid by any physician (including retired physicians) whose license expires on or after April 30, 2009.
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Contact: Yvonne Choong, 916/551-2884 or ychoong@cmanet.org.
2. CMA Publishes Red Flag Rule Toolkit for Members Only
The Federal Trade Commission (FTC) has implemented a new regulation known as the Red Flag Rule, which requires “creditors” – including many physicians – to develop and implement identity theft detection and prevention programs by May 1, 2009. CMA has published a toolkit to help physicians and their staff understand the scope and requirements of the Red Flag Rule.
The toolkit provides guidance on designing and implementing an identity theft detection and prevention program for the physician practice. It also explains how the Red Flag Rule interacts or overlaps with other legal requirements governing the safeguarding of patient information, particularly the federal Health Information Portability and Accountability Act (HIPAA).
CMA’s Red Flag Rules Toolkit is free to members at the members-only website.
Due to popular demand, CMA has also scheduled a second presentation of CMA's Red Flag Rules webinar on Thursday April 23, 12:30 pm to 1:15 pm. The webinar is free to members. Nonmembers can register for $125 (includes a copy of the toolkit). If you are unable to participate, members can access CMA’s last week's Red Flag Rule webinar, in the webinar archives at the members-only website.
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Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
3. State Supreme Court Sides with CMA in Peer Review Case
The California Supreme Court on April 6 issued a ruling that protects the integrity of the peer review process by preventing peer review hearing officers from unlawfully usurping the clinical decisions of the peer review body. CMA filed an amicus brief with the Supreme Court in this case. In the brief, CMA urged the justices to uphold the appellate court’s ruling, which placed limits on the authority of hearing officers in the medical peer review process.
Hearing officers are usually lay people, who don’t have the power or expertise to make decisions on medical disciplinary charges. In the case at hand, a hearing officer’s decree to terminate a peer review hearing led directly to the restriction of the physician’s privileges. This in turn caused the filing of legally required disciplinary reports to state and federal agencies purporting to confirm the veracity of the medical disciplinary charges levied but never proven.
In essence, by terminating the hearing, the hearing officer made a clinical judgment as to what clinical evidence was necessary to determine the physician’s medical competency. By doing so, the hearing officer essentially made a medical determination that the physician is medically incompetent to practice at the hospital, thus depriving the physician of a fair hearing before his medical peers.
CMA’s amicus brief, which was joined by the American Medical Association, argued forcefully that the granting of such powers to a hearing officer unlawfully deprives physicians of a fair hearing before his medical peers, and deprives patients of access to their physician of choice.
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Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
4. Highlights from CMA’s Annual “Doctor Day” in Sacramento
Four hundred physicians, medical students, residents, and medical executives from throughout the state gathered in Sacramento on April 14 for CMA’s annual Legislative Leadership Conference. Keynote speaker California Senate President pro Tem Darrell Steinberg (D-Sacramento) called for universal coverage in California, but recognized that getting there would not be an easy task in the current budgetary environment. “Small steps lead to big change,” Senator Steinberg told attendees. “The first step is to cover every child in California, regardless of immigration status.”
Participants were also briefed on major legislative issues affecting patients and physicians in California—including peer review, scope of practice, and the corporate bar. In the afternoon, hundreds of physicians and medical students descended on the capitol to meet individually with their legislators to discuss state and local health care issues.
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Contact: Jennifer Williams, 916/551-2548 or jwilliams2@cmanet.org.
5. Sign Up for CMA’s Legislative Hot List
CMA’s Legislative Hot List, distributed weekly during the legislative session, follows the progress of CMA-sponsored bills and other bills of interest to physicians as they move through the legislative process.
Among the bills being followed this year:
Unlawful Health Insurance Cancellation (AB 2): This CMA-sponsored bill requires insurers to obtain approval from an independent review organization before rescinding a patient’s health insurance. This review would use a clear legal framework to determine whether the rescission is appropriate, while protecting the patient’s rights during the review process. This is a reintroduction of AB 1945, which was vetoed in 2008.
Car-Pool Lane Access for Physicians (AB 497): This CMA-sponsored bill would allow physicians to use high occupancy vehicle (carpool) lanes on the freeway when responding to an emergency. This bill would expand current law, which allows physicians in certain circumstances to exceed speed limits when responding to emergencies.
Education Disclosure for Health Care Practitioners (AB 583): CMA is cosponsoring this “truth in advertising” legislation with the California Society of Plastic Surgeons. It would require health care practitioners to display their educational degree, license type and status, and board certification on either their nametag or in their offices, to help patients better understand the credentials of their health care practitioner prior to receiving treatment.
Nurse Practitioner Scope of Practice (SB 294): CMA is opposing this bill, which would expand the scope of practice for nurse practitioners, allowing them to admit patients to the hospital and be designated as primary care providers.
Corporate Medicine Bar (AB 648 and SB 726): These CMA-opposed bills would erode the ban on the corporate practice of medicine in California by allowing certain hospitals to hire physicians. Under current law, hospitals are barred from hiring physicians as employees. This important law was created to prevent corporations or other entities from unduly influencing the professional judgment and practice of medicine by licensed physicians.
For more information on these and other bills of interest, see CMA’s Legislative Hot List.
Contact: Jennifer Williams, 916/551-2548 or jwilliams2@cmanet.org.
6. CMA Webinar: Best Practices – Improving the Efficiency and Quality of Your Practice
A practice cannot provide quality medical care unless it can keep its doors open, and even the most magnanimous physician can’t support an unprofitable practice forever. Physicians who work in well-run practices can spend less time worrying about making ends meet, which, in turn, affords them more time for patient care.
The “Best Practices” webinar – May 21, 12:30 to 1:15 pm – is based on CMA’s new toolkit “Best Practices: A Guide for Improving the Efficiency and Quality of Your Practice.” The webinar, presented by Frank Navarro, one of the toolkit’s creators, will highlight some of the important features of the document to help you understand how you can improve your practice.
Registration is free for members and their staff. Space is limited, so register soon. Visit the CMA Calendar for more information or to register.
Contact: Shannon Navarra-Lujan, 800/786-4CMA or slujan@cmanet.org.
7. Earn 17.75 Hours of CME at CMA’s Health Care
Leadership Academy
CMA’s 12th annual Health Care Leadership Academy — April 24-26 in Anaheim — has been approved for 17.75 AMA PRA Category 1 CME credits. Register today and join us for one of the country’s premier health care conferences.
Tuition is $745 for members, $1045 for nonmembers, and $345 for allied health professionals — a remarkable value for a program of this caliber. With the quality of content, the stature of the faculty, and the number of CME hours offered, the Leadership Academy rivals conferences that cost twice as much to attend.
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.
For more details or to register, visit the Leadership Academy website or call 800/795-2262.
Contact: Roger Purdy, 916/551-2067 or rpurdy@cmanet.org.
8. Family PACT Waiver Extended through September 30, 2009
California has been at risk of losing federal funding for its Family PACT Program because of a disagreement with Centers for Medicare and Medicaid Services (CMS) officials over eligibility verification for the program. California was recently granted another temporary waiver that will allow the state to continue providing comprehensive family planning services and preventive health screenings to eligible low income men and women through September 30, 2009.
Family PACT has operated since 1999 under a Medicaid waiver that was set to expire in September 2008, but was temporarily extended so that California could take up the issue with the new Obama Administration.
According to the state, it has served 1.6 million Californians, prevented 170,000 unintended pregnancies and saved the state and federal government over $1 billion annually. CMS notified the state last year that as a condition of renewal California must follow burdensome new eligibility and application requirements. CMA believes that the new rules will discourage low-income women from seeking family planning and prenatal care, ultimately increasing the costs to the state and federal government.
This latest waiver extension will hopefully allow time for California and CMS to work out their differences and continue this successful, cost-effective program. The Democratic leaders in the California Congressional Delegation are extremely supportive of the program and have vowed to help convince the new Administration to save it.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
9. Federal Officials Vow to Raise Medicare Reimbursement Rates
in Several of California’s High-Cost Counties
A summit called last week by House Speaker Nancy Pelosi and Rep. Sam Farr to address the long-standing Medicare geographic payment inequity for a number of California counties concluded with a commitment from federal officials to tackle the problem this year.
“This is a welcome breakthrough on a problem that has reduced access to care for years,” says CMA President Dev A. GnanaDev, MD. “As costs have risen in places like Santa Barbara and San Diego counties, Medicare reimbursements have not kept up, and that has resulted in fewer doctors being able to serve those patients.”
The Medicare payment formula includes a geographic adjustment factor (GAF) that adjusts the payment rate for local geographic market conditions. The goal is to base physician reimbursement on what it costs to provide care in a particular geographic region. The formula calculates a geographic adjustment factor for every California county, and assigns each county to one of nine of California’s Medicare regions, called payment localities. However, because of rapid growth and development in recent years, physicians in some California counties (Marin, Monterey, Riverside, Sacramento, San Bernardino, San Diego, San Luis Obispo, San Joaquin, Santa Barbara, Santa Cruz, Sonoma and Yolo counties) have practice costs that are up to 10 percent greater than the average costs of other counties in their Medicare localities.
Speaker Pelosi used the power of her office to bring together representatives of key House and Senate congressional committees, the Centers for Medicare and Medicaid Services, the Medicare Payment Commission, and CMA met to discuss the problem. The meeting represented a giant step forward, as participants acknowledged that something must be done but stopped short of agreeing on a solution.
CMA has spent the last 10 years exploring a variety of solutions to this problem. Because federal law requires that geographic payment changes be budget neutral, CMA physicians have been placed in an untenable situation of creating winners and losers within California. CMA will only back a resolution that holds California’s other rural counties harmless.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
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