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1. Quality Matters: Institute of Medicine Urges All
Prescriptions Be Written Electronically by 2010
Medication errors are among the most common medical errors, harming at least 1.5 million people and costing more than $3.5 billion every year, according to a new report from the Institute of Medicine (IOM). The problem is so serious that the average hospital patient is subject to one medication error per day.
The 17-member expert panel cited a variety of causes for the problems, including unexpected drug interactions, confusion over similar drug names, bad handwriting of physicians, nurses giving patients drugs meant for other patients, and patients not understanding how to take the drugs.
The report—requested by Congress and funded by the Centers for Medicare & Medicaid Services—is a follow-up to a 1999 IOM report that found that as many as 98,000 people were killed each year as a result of medical errors, 7,000 of them as a result of medication errors.
The new study lays out a series of recommendations for minimizing the risk of medication errors. Among these recommendations are to have all prescriptions written electronically by 2010 and to improve the naming, labeling, and packaging of prescription drugs to reduce confusion. Crucial to reducing medication errors, according to the report, is establishing and maintaining strong partnerships and effective communication between health care providers and patients.
Click here for more information.
Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.
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2. Blue Cross Continues to Spend Less than 80% of Premiums on Patient Care
CMA this week released its 13th annual Knox-Keene Health Plan Expenditures Report, detailing the financial status of California’s HMOs. This year’s report shows that for the fifth year running, Blue Cross of California has spent less than 80 percent of premium dollars on patient care. Just 78.9 percent of its revenue went to patient care in fiscal year 2004-2005, with 21 percent going to profits and administration.
“Vital patient care is being short-changed by for-profit HMOs that send ever-increasing portions of premiums to Wall Street instead of spending it on patients,” says CMA President Michael Sexton, M.D. “If a substantial part of these profits were kept in the health care system, it would help make Californians healthier, stabilize the endangered emergency care system, and ensure that all patients get access to the care they expect and deserve.”
State law requires, under the Knox-Keene Act, 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. Because the vast majority of health plans at the time were nonprofit and it was expected that the nonprofit model would prevail, the law did not include language regarding profits. 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.”
CMA this year sponsored a bill that would have barred health plans from spending more than 15 percent of premium dollars combined for profit and administration. Although the bill (SB 1591) died, the issue has considerable support in the Legislature and CMA will continue to pursue such legislation.
A change in the law would provide an enormous benefit to patients and the health care system. Blue Cross and Aetna alone collected $12 billion in premiums from patients. If just these two immensely profitable insurance companies were required to spend another 6 percent on health care, an additional $720 million would be available for patient care in California.
In addition to Blue Cross, several other plans do not meet the 85 percent threshold. Aetna Health Care, for instance, spent only 78.7 percent of its premium dollars on patient care. Blue Cross insures more than 4.5 million Californians; Aetna fewer than 300,000. Many health plans do spend at least 85 percent of premium on patient care. Kaiser Foundation Health Plan scored the highest of the major plans, spending 93 percent of its funds on patients. Molina Medical Center/American Family Care, also noteworthy, spent 88.4 percent of its funds on patient care, a 5 percent increase from the previous year.
Click here for more information.
Contact: CMA Media Relations, 916/551-2069 or knikos@cmanet.org.
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3. DMHC Proposal Would Prevent Physicians
from Billing for Services Rendered
The Department of Managed Health Care (DMHC) this week proposed new regulations that would inhibit physicians’ ability to bill for services rendered, potentially devastating the delivery of emergency care in California. While CMA understands that patients do not want or expect to be billed because their insurance companies don’t pay reasonable physician charges, these regulations attack the future viability of physician practices, while doing nothing to solve the real underlying issue of for-profit HMOs refusing to pay fairly for emergency care.
The proposed regulations were filed in response to an executive order issued last month by Gov. Arnold Schwarzenegger, which directed DMHC to stop physicians from billing patients for emergency care.
DMHC had last week filed emergency regulations, which would have gone into effect within 10 days. Thanks to strong and immediate CMA advocacy, the emergency regulations were withdrawn. However, DMHC decided to pursue the matter through the formal permanent regulation process, which involves public comment and review. That process includes a minimum 45-day comment period and physicians will be encouraged, at the appropriate time, to provide professional comment on the potentially devastating impact these regulations would have on the emergency care system.
CMA believes that a unified and strong physician message must be delivered to the Governor. The Administration should abandon any plans for regulating physicians ability to bill for services rendered. The proposed regulations are a direct attack on physicians and their ability to pursue payment for lifesaving care.
The Governor can be reached by phone (916/445-2841), fax (916/445-4633), or e-mail (http://www.govmail.ca.gov).
CMA’s policy on this issue is to oppose any proposed ban on so-called “balance billing,” while advocating for insurance reforms to protect fair funding for emergency care. CMA has developed a legislative package that would help stabilize California’s emergency care system by ensuring that HMOs contract with sufficient numbers of physicians to provide care for all their insured, and requiring that they spend at least 85 cents of every premium dollar on health care.
Click here for more information, including a copy of the proposed regulations.
Contact: Susan Bassett, 916/444-5532 or sbassett@cmanet.org.
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4. Deadline to Submit Resolutions to CMA’s 2006 House of Delegates Is Aug. 29
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 is August 29. 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.
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5. There’s Still Time to Register for CMA’s Pain Conference,
September 8-9 in San Francisco
California law (AB 487) requires physicians to complete 12 hours of continuing medical education (CME) in pain management and the care of terminally ill and dying patients. Physicians have until December 31 to satisfy this requirement.
One way to fulfill the requirement is by attending CMA’s pain management conference, “Pain, Palliation, & Politics: Pain Management and End-of-Life Care in California’s Regulatory Environment.” This practical two-day CME program will be offered September 8-9 at the San Francisco Marriott Hotel and again December 1-2 at the Disneyland Hotel in Anaheim. CMA tailored this program to meet the needs of physicians who do not specialize in pain medicine. Offering 14 hours of Category I CME, this program completely fulfills California’s AB 487 mandate.
Members pay $335 (nonmembers $600).
Click here for more information.
Contact: CMA’s pain management seminar hotline, 415/882-3330 or kdefabrique@cmanet.org.
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6. CMA Member Benefit of the Week: Magazine Discount Program
The CMA Magazine Program gives members up to 50 percent off subscriptions to hundreds of popular magazines. The same low rates apply to new subscriptions and renewals. Renewals with the discount are available no matter how your subscriptions were originally ordered.
If you find a lower advertised price for any magazine offered through this program, simply send in the promotional offer with your order and pay the lower amount. Subscriptions for both office and personal use are available through this membership program.
For more information, call 800/603-5602, e-mail cma@BUYMAGS.com, or visit
http://www.buymags.com/cma.
Click here for more information about the benefits and discounts available to CMA members.
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7. 150th Anniversary Trivia: Did You Know?
Did you know that CMA has a major exhibit at the State Fair at Cal Expo in Sacramento this month? The historical exhibit runs August 11 to September 4 and feature medical equipment, pharmaceuticals, scientific theories, and famous CMA
physicians from the 1850s through today. The 800-square-foot exhibit is in the main hall of the counties building.
CMA is celebrating its 150th birthday!
Visit http://www.cmanet.org/150 for other interesting information about CMA history.
Contact: Karen Nikos, 916/444-5532 or knikos@cmanet.org.
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No. 2060 
