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1. Congress Fails to Stop Medicare Cuts by July 1;
Physician
Payment Rates Drop to 1994 Levels
The Senate again last week blocked legislation that would have stopped the 10.6 percent Medicare physician payment cuts that took effect July 1. A procedural vote to advance HR 6331 – the bill that overwhelmingly passed the House a few days earlier – failed in the Senate by only one vote. HR 6331 would have stopped the Medicare payment cuts in 2008 and 2009 and funded a small physician rate increase through tweaks to the Medicare Advantage program. Senate leaders have pledged to try try another vote on HR 6331 after they return from the July 4th recess.
CMA is outraged that some Senators chose to block the bill. Such cuts will force physicians to make difficult choices about limiting the number of Medicare and TriCare patients they can accept, which will further exacerbate the access to care problems in California. There are more than 5 million Medicare and Military TriCare patients in California, many of whom are already reporting difficulty finding a doctor.
President Bush continues to threaten to veto any Medicare physician payment fix that is financed by reforming Medicare Advantage. It is unclear whether seven more Republicans will buck their party and the powerful insurance industry to achieve a veto-proof margin. However, given the recent overwhelming vote in the House, many believe it is possible.
If President Bush vetoes the bill, as he is expected to, it will go back to the House and Senate for veto override votes. Although California Senators Dianne Feinstein and Barbara Boxer are firmly on the side of doctors and their patients, physicians must keep the pressure on California’s House Republicans, particularly those who voted no on HR 6331, so that we can maintain the two-thirds margin necessary to override a presidential veto. (Voting no: Reps Doolittle, Lungren, Herger, Nunes, Radanovich, Royce and Campbell.)
Physicians should also call Senators Feinstein and Boxer and the members of Congress who voted yes and thank them for protecting seniors’ access to doctors.
Call AMA’s grassroots hotline at 800/833-6354 to be connected with your members of Congress.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
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2. Physicians Urged to Carefully Review Beech Street Agreement
A number of California physicians recently received notices from Beech Street, a rental network, informing them of changes to its Individual Participating Provider Agreement. The notice, sent via FedEx, includes the revised contract and advises physicians that it will take effect August 27 unless they object in writing within 30 days of receiving the letter.
As Beech Street is a rental network, not an insurer, and is not regulated in the State of California, many of the protections physicians have under state law, including California’s prompt payment and disclosure requirements, may not apply. CMA advises physicians to review the proposed agreement carefully.
Physicians should pay close attention to the details of the proposed contract, particularly, but not limited to the following:
- The agreement authorizes Beech Street to “lease, rent, or otherwise grant access” to the physician’s negotiated discount to nearly 1,000 other payors, including third-party administrators, self-insured employers, workers’ compensation and automobile insurers, health plans, and other insurance companies. A list of the payors to which Beech Street leases its network can be downloaded from network’s website http://www.beechstreet.com. Physicians are encouraged to carefully review the list and monitor EOBs to ensure that unauthorized discounts are not being taken.
- The agreement states that physicians will be paid according to the “Beech Street Market Fee Schedule;” however, the fee schedule itself is not provided. Before signing this or any contract or amendment, physicians should request and carefully review complete fee schedule and payment rule information.
- The agreement provides no timeline under which physicians can expect to be paid, nor does it include penalties for late payment.
If you are not contracted with Beech Street, you do not need to do anything. Absent a signed and executed agreement, Beech Street cannot force you to participate in the network.
If you are contracted with Beech Street and you do not agree with the terms of the proposed amendment, you must notify Beech Street within 30 days of receipt. Send correspondence certified mail, return receipt to: Attention: Contract Support Administrator, Beech Street Corporation, 25500 Commercentre Drive, Lake Forest, CA 92630.
If you wish to terminate your contract with Beech Street, send a notice of termination to the address above and to the address of notice located on the signature page of your existing contract.
CMA has also published a “Silent PPO Action Guide,” which contains an overview of physician discount contracts and discusses the laws that regulate PPO network leasing. The guide is available through CMA ON-CALL (document #1907). ON-CALL documents
are available free to members at CMA’s members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in the CMA bookstore.
Click here for more information, including a copy of the proposed agreement.
Contact: Aileen Wetzel, 916/551-2037 or awetzel@cmanet.org.
3. CMA Medi-Cal Lawsuit Moves Forward; Hearing Set for 7/25
Last week, the Department of Health Care Services (DHCS) cut Medi-Cal payment rates by 10 percent. This cut was proposed by the Schwarzenegger Administration and agreed to earlier this year by the State Legislature in an emergency budget session as part of their efforts to address the $15 billion shortfall facing the state. Because current political dynamics make it unlikely the legislature will roll back the cut, CMA filed a lawsuit in May to stop the state from unlawfully slashing Medi-Cal reimbursement rates. The suit alleges that the state has failed to set rates at a level that ensures Medi-Cal patients have access to physicians and other health care providers. The suit also alleges that the state failed to follow the public hearing process required under state and federal law for changing Medi-Cal rates, instead making the change in secret so that the public had little or no input.
The lawsuit was temporarily delayed when the Attorney General’s office improperly removed the case to federal court in late May. The case has since been remanded back to state court, where the judge has set the hearing for CMA’s preliminary injunction motion for July 25. CMA will also seek retroactive recovery of any discounted payments paid to physicians since the cuts took effect on July 1.
CMA is aware how difficult it was for physicians to participate in the Medi-Cal program prior to the cuts, given the program’s perilously low reimbursement levels. We will continue to fight on behalf of physicians and their patients to make sure physicians are reimbursed fairly for the services they provide to Californians covered by Medi-Cal.
Click here for more information.
Contact: Contact: Ned Wigglesworth, 916/444-5532 or nwigglesworth@cmanet.org.
4. How the New Cell Phone Law Affect Physicians
On Tuesday, July 1, a new state law goes into effect that prohibits most drivers from using a handheld cell phone while operating a motor vehicle.
While the law broadly excludes “emergency services professionals,” the exception only applies while they are operating an “authorized emergency vehicle” as defined in Section 165 of the Vehicle Code. That exception does not include physicians’ vehicles with the CHP-approved emergency situation driving emblem. (State law allows physicians to exceed speed limits when driving to emergencies if the physician’s vehicle displays the CHP-approved emblem. The emblems are available free to members in the CMA bookstore.
The law does, however, allow anyone (physicians included) in an emergency to place an outgoing call to contact a law enforcement agency, health care provider, fire department, or other emergency services entity. You cannot, however, answer an incoming call on a handheld device at any time while driving.
Click here for more information.
Contact: Samantha Pellon 916/551-2872 or spellon@cmanet.org.
5. AAHIVM, AMA Release Coding Guide for Routine HIV Testing
The American Academy of HIV Medicine (AAHIVM), in partnership with AMA, recently released a new coding guide to help health care providers and their billing staff understand how to properly submit claims for routine HIV testing. This guide was developed and published as part of a grant from the Centers for Disease Control & Prevention (CDC) to help implement the agency’s new testing guidelines.
The revised guidelines, released in 2006, recommend that physicians offer voluntary HIV testing to all patients 13 to 64 as part of routine medical exams. Since that time AAHIVM, AMA, and several other national partners have worked to help health care providers understand the importance of routine testing, and to help them incorporate routine HIV testing into their practices.
One of the challenges identified by the workgroup is uncertainty regarding the proper billing and coding requirements for routine HIV testing, so the workgroup developed the coding guide to help providers and their staff navigate this often confusing process. Physicians should also be aware that a CMA-sponsored law took effect this year in California. The law (AB 682) streamlines the HIV testing process so that HIV screening can become a routine part of medical checkups in California. The law also removes the written informed consent requirement and instead requires providers to tell a patient that an HIV test is planned, provide information about the test, explain that treatment options are available for a patient who tests positive, and advise the patient that he or she has the right to decline the test. Physicians must also inform patients who test negative for HIV that they should continue to be routinely tested. If the patient declines the test, the physician must note that fact in the patient’s medical file.
The new law is expected to result in earlier detection of the virus and better care for patients. It is estimated that over 40,000 Californians are unaware they are HIV positive.
Click here for more information.
Contact: Teresa Kline, 916/444-5532 or tkline@cmanet.org.
6. Register Now as a California Medical Volunteer
to Provide Care in a Disaster
Physicians or other health care providers willing to volunteer their services in the event of an emergency or disaster can register with the State of California to become a California Medical Volunteer.
The secure web-based registry allows you to indicate your volunteer preferences and enter information about your skills. During the online registration process, you will enter information regarding your license, the best way to contact you, and other relevant background information. Once you’ve registered, your credentials will be validated so that you can be deployed quickly and efficiently. Your information will only be viewed by authorized system managers.
During a state or national disaster, this system will be accessed by authorized medical/health officials who will match your skills with the needs required in each emergency situation. If a decision is made to request your service, you will be contacted using the information you enter on the site. If you agree to deploy, your information will be forwarded to the appropriate field operational officials. At that point, if you receive a call, you will have the chance to accept or decline the volunteer call-up. If you accept, you will receive further information giving specific instructions on where and when to report, and what is needed for the incident. There is no obligation to participate in an activation.
This registry is managed by the California Emergency Medical Services Authority, in partnership with the California Department of Public Health. Volunteers deployed through California Medical Volunteers receive liability protection and workers’ compensation.
For more information visit https://medicalvolunteer.ca.gov.
Contact: Teresa Kline, 916/444-5532 or tkline@cmanet.org.
7. Deadline to Submit Resolutions to 2008
House of Delegates Is 8/5
The most effective way an individual member can influence CMA’s policies and activities is to submit resolutions to the House of Delegates, the association’s legislative body. The delegates meet annually to debate and act on resolutions and reports dealing with myriad medical practice, public health, and CMA governance issues.
The deadline to submit resolutions to this year’s House of Delegates (HOD) is August 5. Any CMA member may author a resolution, but a delegate, alternate delegate, component medical society, or specialty delegation must submit the resolution.
Before authoring a resolution, physicians are strongly encouraged to review CMA’s Policy Compendium (available at CMA’s members-only website), to determine whether policy already exists on a particular topic.
Resolutions must be submitted by e-mail to resolutions@cmanet.org by August 5. For more information on submitting a resolution, contact your county medical society.
Detailed instructions (including required format, allowed subject matter, and submission rules), are available at CMA’s HOD website.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
8. CMA Legislative Update
Physician Health Program Bill Advances:
On July 1, the Medical Board’s Physician Diversion program officially ended. Since the medical board voted to sunset this program, CMA and other stakeholders have been working to fashion a program that ensures physicians with mental health or substance abuse problems have a pathway to get the help they need. The product of this workgroup is CMA-sponsored AB 214.
The bill would create a new Physician Health Program that will provide confidential treatment and monitoring to physicians with mental health and substance abuse problems. AB 214 passed out of Senate Business and Professions and Health committees, and will be heard next in Senate Appropriations.
Contact: Brett Michelin, 916/444-5532 or bmichelin@cmanet.org.
Bill Expanding Scope of NPs Defeated:
A bill that would have significantly expanded the scope of nurse practitioners was defeated when it failed to receive a single vote in the Senate Business and Professions Committee. Among other things, the bill attempted to recognize nurses as independent practitioners, and to provide comprehensive health care, including diagnoses and the initiation of emergency procedures.
Contact: Jodi Hicks, 916/444-5532 or jhicks@cmanet.org.
For more information on these and other bills of interest to physicians, see CMA's Legislative Hotlist.
9. Let United Healthcare Know What You Think
Physicians contracted with United Healthcare recently received an invitation from the insurer to participate in a physician satisfaction survey. The survey, which asks physicians to rate their satisfaction with United Healthcare, can be accessed by going to https://surveys.surveynetwork.com/providerservice and entering the PIN provided on the postcard.
If you have misplaced your PIN, call 800/328-5979, ext. 25636, to get a new one or to request a paper copy of the survey. The survey deadline is July 18. Responses will be kept confidential.
Contact: Aileen Wetzel, 916/551-2037 or awetzel@cmanet.org.
10. Member Benefit of the Week: 6% off athenaCollector
CMA members receive 6 percent off athenaCollectorSM, athenahealth’s unique web-based billing and practice management service, through the CMA’s participation in athenahealth’s PartnerWise Affinity Program. athenaCollectorSM combines software, a continually updated database of payer rules and a state-of-the-art billing, collections, and service center.
To find out more about athenaCollectorSM, check out the CMA - athenahealth webinar. Participants will learn about the CMA – athenahealth relationship and how athenahealth can help to improve and optimize performance and reverse the negative trends impacting physician practices
today.
Click here for more information on your membership benefits.
Contact: CMA’s member service center, 800/786-4CMA or info@cmanet.org.
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