|
Advertisement
1. CMA Prevents Erosion of Corporate Medicine Bar in California
With help from grassroots physician support at a critical juncture, CMA stopped a bill (AB 1944) that would have eroded 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.
In other legislative news, the Assembly Health Committee unanimously passed a bill that would create permanent funding for the Steven M. Thompson Physician Loan Repayment Program (SB 1379). Participants in the program are eligible to receive up to $105,000 in loan repayment in exchange for practicing medicine in an underserved area for three years.
Click here for more information.
Contact: Brett Michelin, 916/444-5532 or bmichelin@cmanet.org.
ADVERTISEMENT
2. Blue Cross Continues to Spend Less than
80% of Premiums on Patient Care
If California’s health plans spent at least 85 percent of premiums on actual patient care, the state’s health care system would see an infusion of over $1 billion dollars, according to CMA’s 15th annual Knox-Keene Health Plan Expenditures Report, detailing the financial status of California’s HMOs. This year’s report shows that for the seventh year running, Blue Cross of California has spent less than 80 percent of premium dollars on patient care. Just 79 percent of its revenue went to patient care in fiscal year 2006-2007, with 17 percent going to profits and administration.
California’s Knox-Keene Act requires that no more than 15 percent of insurance company revenues go to administrative costs, including marketing. When the act became law in 1975, the intent was to require insurers to spend 85 percent of premium directly on medical care. For-profit health plans have since interpreted this to mean that profits are an expense that can come from the 85 percent intended for patient care. In an irony that reflects the industry view of health care, insurance companies universally refer to what they spend on patient care as “medical loss” and they call the percentage “the medical loss ratio.”
In addition to Blue Cross, 11 other plans did not meet the 85 percent threshold last year. Aetna Health Care, for instance, spent only 81.4 percent of its premium dollars on patient care. Blue Shield spent 82.1 percent.
CMA is sponsoring a bill (SB 1440) that would bar health plans from spending more than 15 percent of premium dollars combined for profit and administration. A change in the law would provide an enormous benefit to patients and the health care system. Blue Cross and Aetna alone collected $20 billion in premiums from patients. If just these two immensely profitable insurance companies spent 85 percent on health care, an additional $933 million would be available for patient care in California.
CIGNA HealthCare of California and Kaiser Foundation Health Plan scored the highest of the major plans, spending 94.3 and 90.6 percent respectively on patients.
Click here for more information.
Contact: David Ford, 916/444-5532 or dford@cmanet.org.
3. House to Vote Tuesday on Critical Medicare Bill
Call Congress and Urge them to Act Before July 1 Deadline
With action stalled in the Senate, the House of Representatives is scheduled to vote Tuesday on a bill to stop the Medicare cuts to physician reimbursements scheduled to take effect July 1.
In a procedural vote on June 13, the Senate blocked a bill by Senate Finance Chairman Max Baucus (D-MT) that would have stopped the Medicare cuts scheduled to take effect July 1. Although nine Republicans voted for the bill, it fell six votes short of passing. This defeat has sent both sides back to the negotiating table. With only five legislative working days left before the July 1 deadline, all of medicine is working very hard to get legislation passed to stop these devastating cuts.
The House vote is extremely important and could be one of the last chances to pass legislation before the July 1 deadline. The bill will be considered on the suspension calendar. This process limits debate, but requires a two-thirds majority to pass. We are asking all physicians to call their representatives TODAY and urge them to vote yes on HR 6331. (Call AMA grassroots hotline at 800/833-6354
to automatically be connected to your member of Congress.)
While CMA continues to be extremely frustrated that Congress has not yet been able to enact a long-term fix, we are pleased to see that Congress is trying to pass legislation to stop the 15 percent cuts. Both Democrats and Republicans are quick to assure physicians that it is their intent to enact long-term reform next year.
Physicians are also urged to keep the pressure on the Senate. Call California Senators Dianne Feinstein (202/224-3841) and Barbara Boxer (202/224-3553), thank them for their continued support of physicians, and tell them how devastating these cuts will be to your practice and to health care in general. Please also urge the senators to continue fighting to include CMA’s GPCI fix in the final bill.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
4. Legal Delay Tactics by State Undermine CMA Chance to Stop the 10% Medi-Cal Cut before it Takes Effect July 1
On May 5, CMA and a coalition of health care providers filed a class action lawsuit seeking to stop the state from unlawfully slashing Medi-Cal payment rates by 10 percent. The suit was filed in state court and seeks injunctive relief to prevent the implementation of the illegal rate cut.
The first hearing in the case is scheduled for today, June 23, in federal district court in Los Angeles. The case is in federal court because the Attorney General’s Office removed the case from state court in the hopes that the 10 percent rate reduction would take effect before the merits of the case could be heard. Removal is automatic, and postpones any hearing of the merits of the case, so is an effective delay tactic. On Monday, the federal court must rule on CMA’s motion to remand the case back to state court so that the state court can consider our motion to stop the cuts.
CMA’s legal team intends to file motions to expedite the judicial process so that we can stop the cuts prior to their July 1 effective date. However, there is a significant possibility that we may not get a hearing until late July. If we are unable to stop the cuts before they take effect, CMA will request that the judge enjoin the cuts retroactively, so that physicians receive no reduced reimbursement for Medi-Cal services provided.
Once the merits of our lawsuit are finally heard, CMA is fairly confident in our ability to stop the cuts. The perceived strength of our case was reflected by a recent action by the Senate Budget Committee, which reduced the 10 percent cut to a 5 percent cut in an effort to lessen the financial blow to the state when we win.
CMA continues to work on other fronts to stop the cuts. We have been working with the media and legislators to educate them and the public about the severe impact these cuts will have on the health care system in California.
Click here for more information.
Contact: Samantha Pellon 916/551-2872 or spellon@cmanet.org.
5. CMA Urges DMHC to Stop Health Plan Attempts
to Circumvent Rescission Law
CMA has requested that the Department of Managed Health Care (DMHC) protect physicians from inappropriate and abusive payor practices that have cropped up in an effort to circumvent a state law that prevents insurers from taking away a patient’s health insurance after treatment has already been authorized.
CMA-sponsored Assembly Bill 1324 took effect this year and clarifies existing law that prohibits the recession or modification of treatment authorization after the treatment has been provided in good faith.
CMA has found that some insurers are skirting the law by requiring physicians to give “advance notification” rather than “preauthorization,” without a guarantee of payment, and in some instances reverify eligibility 5 days before treatment.
CMA has urged DMHC to interpret the law as the legislature intended – to protect physicians and patients from abusive insurance company practices.
CMA is also this year sponsoring a bill (AB 1945) that would require insurers to get approval from the state before rescinding a policy. This bill was passed by the Assembly last month and is currently making its way through the Senate.
Click here for more information.
Contact: Astrid Meghrigian, 916/444-5532 or ameghrigian@cmanet.org.
6. AMA Sets Policy on Air Pollution, Pain Management,
Internet Marketing to Children on Health, and More
The California delegation to AMA’s House of Delegates presented a number of important resolutions at the association’s annual meeting in Chicago last week. The following are summaries of some of the California resolutions that the AMA House adopted as policy.
Promotion of Better Pain Care: The delegates adopted a resolution asking AMA to express its strong commitment to better access and delivery of quality pain care through the promotion of enhanced research, education, and clinical practice in the field of pain medicine. (Res. 321)
Rating System for Processed Foods: The delegates passed a resolution asking AMA to support the concept of a simplified, uniform nutrition rating system to be used in addition to the current food label. (Res. 407)
Air Pollution and Public Health: The delegates directed AMA to support increased physician participation in regional and state decision-making regarding air pollution across the United States and urge authorities in all states to expeditiously adopt and implement effective air pollution control strategies to reduce emissions. (Res. 408)
Internet Marketing to Children on Health: The delegates adopted a resolution asking AMA to seek opportunities to partner with other organizations to study and promote Internet marketing strategies to educate children across the United States about healthy habits and lifestyles. (Res. 410)
Elimination of the 48-Hour Signature Rule: The delegates voted to support elimination of the federal requirement that verbal orders for prescription drugs be authenticated with the prescribing physician’s signature within 48 hours. (Res. 503)
Click here for more information.
Contact: Ginnie Yee, 415/882-5170 or gyee@cmanet.org.
7. Blue Shield Posts New Fees Online
As reported in the last issue of CMA Alert, Blue Shield of California recently notified physicians of changes to its standard physician fee schedule set to take effect July 1.
CMA is pleased to report that Blue Shield has agreed to provide electronic access to the new rates via its secure website. Physicians are now able to access the new rates electronically at http://www.blueshieldca.com/provider/announcements. Please be aware that only the rates that will change are listed. If a code is not listed, it is not being changed.
We realize that this is not the perfect solution, but given Blue Shield’s willingness to work with us and commitment to make this information available electronically so quickly, we believe it is a fair solution. Blue Shield has also agreed that going forward physicians will be given electronic access to any future fee schedule changes no less than 45 days prior to the effective date.
To Access the New Rates
- Go to http://www.blueshieldca.com/provider/announcements Click "Blue Shield Allowances for Services (Codes) with New Rates Effective July 1, 2008." If you are already logged in, you will be directed to New Rates page. If you are not logged in, you will be asked to log-in first, and then will be directed to New Rates page.
- Click on link to applicable region.
Note: Clinical lab allowance changes are based on North and South and are listed at the bottom.
CMA encourages physicians to log on to the Blue Shield website as soon as possible to begin assessing the impact the changes will have on their practices. To help, CMA has published a toolkit available free to members. Included in the toolkit is CMA’s financial impact worksheet, which will help physicians calculate the impact of the fee schedule changes based on their most commonly billed CPT codes.
Contact: Jodi Black, 916/551-2863 or jblack@cmanet.org.
7. Member Benefit of the Week: Up to 25% Off Avis Car Rental
CMA members receive up to 25 percent off on car rentals from Avis. To make a reservation, visit http://www.avis.com or call 800/331-1212.
You will need CMA’s AWD (Avis Worldwide Discount) number to receive your CMA discount. Log in to CMA’s members-only website or call CMA’s member helpline (800/786-4CMA) to get your discount code.
If making a reservation online, be sure to both select “lowest rate” and enter the AWD when prompted to ensure you receive the lowest rate available.
Click here for more information on your membership benefits.
Contact: CMA’s member service center, 800/786-4CMA or info@cmanet.org.
| 
No. 2135
