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1. CMA Calls Blue Cross a Leader in Profits, Not Patient Care
CMA on Tuesday asked the Department of Managed Health Care to take action against Blue Cross of California for jeopardizing the physician-patient relationship and engaging in unlawful business practices that have reduced patient access to care.
CMA testified at a public hearing in Los Angeles that Blue Cross has violated the promises it made to California patients when it merged with Anthem Health Care in 2004. Since that merger, Blue Cross has consistently increased premiums, while reducing the amount of money spent on patient care. The insurer is now dangerously close to not having enough physicians available to serve the 8.3 million Blue Cross patients in California.
With the consolidation of the health plan industry, both nationally and in this state, competition among the insurance companies has been severely diminished, if not eliminated, much to the detriment of the very individuals these plans promise to serve patients and their treating physicians, CMA said in its written testimony. The turmoil created by Blue Cross has taken its toll on everyone It must be remembered that it is physicians who provide medical care to patients, not health plans.
DMHC called the hearing to review commitments made by Blue Cross when it merged with Anthem three years ago. DMHC this year alone has initiated 18 enforcement actions against Blue Cross, including multiple fines a significant increase from previous years.
CMA contends that among a vast collection of misdeeds, Blue Cross has:
- reimbursed physicians at unconscionably low levels, at times below the actual cost of care;
- increased consumer premiums at a much higher rate than any other major health insurer, raising rates as much as 10 percent in a single year;
- rescinded authorization and refused to pay for care provided in good faith;
- reduced reimbursement levels without appropriate notice;
- retroactively canceled individual health insurance coverage after policyholders got sick.
For at least a decade, Blue Cross has consistently spent less on medical care than the 85 percent required by law, at the same time raising premiums and increasing profits.
While Blue Cross seems averse to paying physicians fairly and spending adequately on health care, the insurer plans to spend $2 million this year trying to defeat health reform proposals designed to increase access to care in California.
Blue Cross's misbehavior shows significant signs of diminishing the supply of physicians, already a growing problem in California. CMA and its county component medical societies have received a number of calls from physicians who have determined that they can no longer financially and ethically provide medical care under the dictates of Blue Cross and are being forced to terminate their contracts altogether.
CMA recently surveyed members about this issue. The CMA survey gathered data from 495 practices representing 1,566 doctors in 31 counties. Of those who responded, 24.4 percent have decided to end their contracts and 48 percent have not yet decided. These terminated contracts affect 91,000 patients. With numbers such as these, it is hard to imagine that Blue Cross can be a trusted choice as its marketing materials claim, said CMA in its written testimony.
Click here for more information.
CMA’s Reimbursement Help Line, 888/401-5911 gfonseca@cmanet.org.
2. Some Medi-Cal Providers and Patients
Feeling Pinch of Budget Stalemate
Many Medi-Cal providers are going without payment as the state legislature struggles to come to terms on a spending plan for 2007-2008. Most impacted are institutional providers, such as clinics, managed care plans, regional centers for the developmentally disabled, nursing homes, and hospitals. Unlike physicians and other noninstitutional providers who will continue to be paid as required by federal prompt pay laws, these facilities are dependent on a state contingency fund that was exhausted weeks ago.
While physicians in Medi-Cal fee-for-service will be reimbursed through the budget stalemate, their patients’ access-to-care may be negatively impacted as hospital and other institutions begin to exhaust their reserve funds and start closing their doors.
Medi-Cal managed care plans have thus far been able to continue payments to physicians by spending down reserves, however, if the budget stalemate continues, managed care plans may not be able to continue to pay physicians and also maintain fiscal solvency requirements.
Before the budget can be sent to the governor for his signature, it must pass by a two-thirds vote in each house. The state Assembly passed a budget in the early morning hours of July 20, but the spending plan failed in the Senate. We are now more than seven weeks past the June 15 deadline. The Senate needs two Republican votes to pass the plan and has so far only been able to garner one. The state has been running without a spending plan since July 1, the start of the new fiscal year.
Unfortunately, it does not appear that the budget issues will be resolved for some time. Once the Senate approves a spending plan (assuming it is different than what the Assembly has already approved), it will have to go to the Assembly for approval. Both houses do not plan to return to the capitol until the end of their summer recess the week of August 20. As a result, there is a very real possibility that many Medi-Cal providers will continue to go without reimbursement, perhaps forcing them to close their doors or limit service.
Contact: Lisa Folberg, 916/444-5532 or lfolberg@cmanet.org.
3.CMS Delays Launch of NPI Lookup Tool
The Centers for Medicare & Medicaid Services (CMS) will soon make physicians’ National Provider Identifier (NPI) data publicly available online via a searchable database.
The agency has, however, decided to delay the launch to allow physicians and other covered entities additional time to ensure that their information is accurate before it is disclosed by CMS.
Physicians can review their information at the NPI enumerator’s website, http://nppes.cms.hhs.gov
The new deadline to make changes is this August 20. The data will be made public on September 4.
The online lookup will return NPIs and relevant demographic information, but it will not disclose Social Security numbers, dates of birth, or IRS taxpayer identification numbers, according to CMS
Click here for more information, including a memo from Medicare on this issue.
Contact: CMA’s Reimbursement Help Line, 888/401-5911 or gfonseca@cmanet.org.
4. Help Shape the Future of Organized Medicine:
Submit a Resolution to the 2007 House of Delegates
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. This year’s annual meeting is October 27 to 29 in Anaheim.
The deadline to submit resolutions to this year's House of Delegates is August 28. 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 to make sure that the association is not already addressing the issue.
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 members-only website.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
5. Benefit of the Week: Innovative Retirement Income Strategy
Professionals' Retirement Strategy is offering a series of educational dinner programs to introduce physicians to its California Physicians Retirement Strategy product, a tax-efficient approach that allows physicians to monetize the value of their practice today to provide retirement income for tomorrow.
These events are hosted and spouses are welcome. The next dinner is August 22 in Lafayette. Registration is required. Sign up online at http://www.prsplan.com.
Contact: Blaine Ung, vice president of CPRS, 877/225-7771 or blaine@prsplan.com.
Click here for more information on your membership benefits.
Contact: CMA's membership hotline, 800/786-4CMA (4262) or lgodward@cmanet.org.
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No. 2106
