1. CMA Fends off Trial Lawyers' Attack on MICRA; Appeals Court Upholds Constitutionality of Landmark Law
The 5th District Court of Appeal has unanimously upheld the constitutionality of California's landmark Medical Injury Compensation Reform Act (MICRA). It was enacted in 1975 by overwhelming bipartisan support in response to a crisis of runaway medical liability costs and the resulting shortage of health care providers, most predominately in high-risk specialties.
In this case, James Van Buren v. Sian Evans, M.D. and Yosemite Surgery Associates , the trial attorneys argued that MICRA's $250,000 cap on recoverable noneconomic damages deprived Mr. Van Buren of his constitutional rights to a jury trial.
CMA along with its coalition partners filed an amicus brief opposing this attack on MICRA and presented oral arguments before the appellate court. CMA told the court that MICRA's limit on noneconomic damages is a key component of a complex and balanced legislative plan that has ensured the availability of medical care in California.
Under our forward-thinking law, injured patients are entitled to unlimited medical and economic compensation, which often amount to millions of dollars to cover true damages, such as lost wages, medical expenses, and long-term care costs. Physicians support such full compensation of injured patients.
And under MICRA, patients can also recover an additional quarter of a million dollars in noneconomic or “pain and suffering” awards. The law also limits contingency legal fees so that that seriously injured patients get more (and their attorneys get less) of the award.
In its ruling, the appellate court agreed with CMA and rejected each of the trial attorneys' constitutional arguments. As the court noted, the legitimate state interest is to limit medical malpractice insurance costs because without MICRA insurance rates pose “serious problems for the health care system in California, threatening to curtail the availability of medical care in some parts of the state and creating the very real possibility that many doctors would practice without insurance, leaving patients who might be injured by such doctors with the prospect of uncollectible judgments.”
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Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
2. CMA Calls Health Cuts Ill-Advised and Fiscally Reckless
On May 19, California voters rejected five of the six special election propositions, leaving California with a $21.3 billion budget deficit. Governor Schwarzenegger has proposed a number of extreme cuts in an attempt to close the ballooning gap. In total, the proposed health cuts total over $2.2 billion.
In addition to the previously-proposed cuts to Medi-Cal eligibility, benefits, and payments, the governor has also proposed cutting all state funding for Healthy Families. This would in turn shut off more than $700 million in federal matching funds, effectively defunding the entire program and leaving 900,000 children from low income families without health insurance.
CMA believes that the governor’s call to slash health care for millions of California’s poor and unemployed is ill-advised and fiscally reckless.
“We know that less funding for Medi-Cal would further reduce primary and preventative care and result in more people ending up in overcrowded and expensive emergency rooms – at an increased cost to all taxpayers,” said CMA President Dev Gnanadev, M.D. “The governor’s proposal could cost California an additional $750 million in federal matching funds at a time the state needs every dollar it can get.”
The State Legislature has convened a conference committee to address the budget shortfall. Legislative leaders have indicated a very optimistic intent to come up with a solution by June 15. Experience suggests this timeline may not be practical. Legislative leaders have indicated that severe cuts will be part of any budget solution, although they haven’t yet offered specifics.
Contact: David Ford, 916/551-2554 or dford@cmanet.org.
3. CMA Legislative Victory: Legislature Orders Audit of
Medi-Cal TAR Process
On Wednesday, the Joint Legislative Audit Committee voted unanimously to approve CMA’s request for an audit of the Medi-Cal Treatment Authorization Request (TAR) process. The request was co-authored by Assemblymembers Ted Lieu (D-Torrance) and Jim Beall (D-San Jose).
CMA has been advocating for a more efficient TAR process for many years. Over the last five years, the TAR process has been a target for review; however, changes have yet to materialize. The need to change the TAR system was recognized by a 2003 Medi-Cal Policy Institute report and in the 2005 California Performance Review. Both stated that the process was slow, inefficient, inconsistent and outdated.
The TAR program costs the state $1.5 billion to administer and creates considerable added paperwork for physicians serving Medi-Cal patients. Since 92 percent of TARs are granted, the process does little more than delay treatment and increase administrative costs in nine out of 10 cases.
CMA is advocating that those funds be spent on providing actual health care, like maintaining the state’s Healthy Families program, rather than wasteful administration, particularly given the state’s budget situation.
At the hearing, CMA Trustee and San Diego physician Ted Mazer, MD, told committee members how he had been forced to stop treating new Medi-Cal patients due to the continued hassles of TAR’s. The overly burdensome TAR process, on top of Medi-Cal’s persistently abysmal reimbursement rates, has forced many physicians like Dr. Mazer to stop seeing new Medi-Cal patients, or forced them out of the Medi-Cal program entirely.
State Auditor Elaine Howle will do a cost-benefit analysis of this program and make specific recommendations on how to streamline the TAR process. Howle said she expected the audit would take four months to complete.
Contact: Dave Ford, 916/551-2554 or dford@cmanet.org.
4. Physicians Have Opportunity to Verify Accuracy of California Physician Performance Initiative Demographic Data Online
Physicians who treat PPO or HMO patients insured by Anthem Blue Cross , Blue Shield of California, HealthNet, and United Healthcare may receive quality performance results from the California Physician Performance Initiative (CPPI) this summer. The quality measures are based on insurance claims data from patient care provided in 2007-2008. Physicians will be provided with a percentile rank compared to their physician peers, as well as performance results by measure and by patient group. CPPI is a project of the California Cooperative Healthcare Reporting Initiative (CCHRI), which received federal funding in 2006 to develop a system for measuring and reporting the quality of health care provided by physicians. CPPI collected data on approximately 25,000 physicians for a limited set of nationally-endorsed quality measures. These quality measures generally involve adult care provided by primary care physicians, cardiologists, endocrinologists, obstetricians/gynecologists, allergy/immunologists, pulmonologists, gastroenteronologists, and rheumatologists.
In the fall of 2008, CCHRI completed the third cycle of CPPI reports, which exposed numerous problems in the accuracy of the data on which physician performance results were based. For example, some doctors were given credit for treatment they did not provide, and conversely, other doctors were not given credit for treatment they did provide. Also, some patients were attributed to the wrong physicians and some doctors had incorrect specialty designations.
Physicians interested in helping CCHRI improve the data will have two opportunities to do so for the 2009 round of reports. Right now, physicians can verify their demographic information—including name, specialty, and mailing address—at the CPPI website. Your California State License Number is needed to login. Please provide corrections no later than June 12 so that they can be incorporated in this cycle of performance reporting.
Later this summer, Physicians will have an opportunity to correct their quality data, on which the actual performance ratings are based.
CMA continues to have a number of concerns about the validity and accuracy of the data that has been collected and has communicated those concerns to CCHRI.
Armand Feliciano, 916/551-2552 or afeliciano@cmanet.org.
5. Medical Board Backlog Leads to Licensing Delays
CMA recently learned that the Medical Board of California is experiencing a significant backlog in processing applications for new medical licenses. This delay has caused some concern among certain physicians with time-sensitive needs for California medical licensure, including medical residents that will be starting or continuing residencies in California hospitals and need to be licensed by July 1, 2009.
The medical board has agreed to expedite the applications of residents and others with time-specific needs. Physicians without time-specific needs will continue to experience delays. Currently, it can take as long as six to nine months to obtain a medical license in California.
Physicians with impending licensure deadlines are encouraged to call CMA so that we can track the process of your application, and further expedite the review process, if necessary.
Practices planning to hire a physician who is not already licensed in California, should work with the physician to initiate the licensing process at least 90 days before the planned start date. Applicants are encouraged to read the application instructions very carefully before submitting an application. Common reasons for licensing delays include failure to submit original documentation related to postgraduate education, malpractice claims, and past disciplinary action. Failure to follow the application instructions carefully can lead to significant delays.
Contact: Yvonne Choong, 916/551-2884 or ychoong@cmanet.org.
6. New Congressional Health Reform Proposals Expected in June
Four key congressional committees are expected to introduce health reform proposals this month. These proposals will serve as the primary vehicles for health system reform legislation this year. Legislative leaders have indicated they hope to get bills to the floor in their initial houses for a vote before the August recess, an ambitious timeline given the complexity of the issues at hand.
CMA physician leaders have been meeting and talking all year with members of these key committees as they have been drafting the forthcoming proposals. CMA has also been coordinating with the county medical societies to ensure that Congress is hearing from physicians at the grassroots level. During the congressional recess last week, physicians met with elected officials in their home districts, focusing on ways to ensure real access to doctors and fix the Medicare payment formula and increase Medi-Cal rates to Medicare levels.
Increasing the difficulty of financing health reform, congressional budget committees recently voted to uphold the pay-as-you-go rules for all programs, meaning any sustainable growth rate (SGR) fix must be paid for in full. That means that despite President Obama's proposal to eliminate the SGR this year, Congress will have a difficult time finding the $285 billion it will cost to do so.
Further complicating matters, the Congressional Budget Office recently rescored the potential savings from proposed coordinated care models much lower than had been anticipated. The combined effect of these two developments is increased financial pressure on all health care issues, including Medicare and health reform.
With Congress discussing expanded Medicaid eligibility, CMA is strongly advocating that it is imperative to increase Medicaid provider rates to Medicare levels. Medicaid enrollees in California already face severe barriers to access to health care due to the program's woeful funding. Increasing the number of enrollees in the program without fixing the funding would be disastrous. CMA is making sure Congress understands that to expand coverage, they must increase reimbursement rates so that patients have access to a doctor. Otherwise, the coverage will be illusory.
Contact: Elizabeth McNeil, 415/882-5176 or emcneil@cmanet.org.
7. Webinar: How the Stimulus Bill Impacts Your HIPAA Obligations
The American Recovery and Reinvestment Act of 2009 (the “Stimulus Bill”) has added new HIPAA requirements. These will affect existing HIPAA policies and procedures and in some cases require new forms and compliance tasks. The stimulus bill also creates a national standard for detecting identity theft and reporting security breaches.
CMA is hosting a live one-hour webinar on Thursday June 4 at 12:30 pm to review the key points and provide physicians with practical steps to update their compliance programs.
This webinar is free to CMA members. Space is limited, so register soon. For more information or to register, visit http://www.cmanet.org/calendar.
If you’re unable to participate in the live webinar, it will be available for on-demand playback shortly following the live presentation in the webinar archives at CMA’s members-only website.
Contact: Shannon Navarra-Lujan, 800/786-4CMA or slujan@cmanet.org.
8. Have 10 Minutes? You Can Help the CMA Foundation Promote
Appropriate Antibiotic Use
The CMA Foundation’s Alliance Working for Antibiotic Resistance Education (AWARE) project supports physician efforts to promote appropriate antibiotic use and decrease the incidence of antibiotic resistance. The project brings together physicians, pharmacists, health plans, and key health care stakeholders to develop the AWARE provider toolkit and other educational materials for physicians and patients.
The CMA Foundation is asking physicians take a brief survey to help ensure that AWARE continues to be a useful source of information for California’s health care professionals. The survey should take no longer than 10 minutes to complete, and participants will be entered into a drawing for a $100 Visa gift card.
To take the survey, or get more information about the AWARE project and provider toolkit, visit the AWARE website.
Contact: Sandra Navarro, 916/779-6637 or snavarro@thecmafoundation.org
9. June 30 Is the Deadline to Nominate a Colleague for the
CMAF Leadership Awards
The deadline to submit nominations for the CMA Foundation’s 2009 Leadership Awards is June 30. These awards celebrate the efforts of individuals or organizations that make a difference in the health of Californians.
The Robert D. Sparks, M.D., Leadership Award, the Ethnic Physician of the Year Award, and the Adarsh S. Mahal, M.D., Access to Health Care and Disparities Award recognize the compassion and commitment of California’s health care professionals.
Nomination information and packets for each award are available at the CMA Foundation website.
Contact: Carol Lee, Esq., 916/779-6622 or clee@thecmafoundation.org.
10. Featured Member Benefits
30-35% off Epocrates Clinical Reference Guides: CMA members receive 30 percent off one-year subscriptions and 35 percent off two-year subscriptions to any Epocrates product. Students and residents receive 50 percent off all Epocrates products. Group discounts are also available. Epocrates provides physicians with point-of-care access (via PDA, desktop computer, or the Internet) to up-to-date information on drugs, diseases, and diagnostics. Epocrates allows physicians to make better clinical decisions, saving time and improving quality of care. To receive your discount, log in to the CMA members-only website, and follow the links to the Epocrates website. Webinar: Long Term Planning in a Recessionary Environment: Wondering if your long term care strategy still makes sense, or if you need to start thinking about one? Marsh is hosting a live one-hour CMA members-only webinar on Wednesday June 17 at 5:30 pm to discuss the recession's impact on long-term care from a personal risk-management perspective. Until recently, many investors were planning to use their retirement assets to self insure the cost of long term care. With recent economic turmoil, those plans may need to be revisited. This webinar is free to CMA members. Space is limited, so register soon.
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Contact: CMA’s member help line, 800/786-4CMA or memberservice@cmanet.org.
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