ADVERTISEMENT
1. Supreme Court Upholds Constitutionality of
California’s Landmark Malpractice Reform Law
The California Supreme Court last week declined to review an appeals court ruling that upheld the constitutionality of California's landmark Medical Injury Compensation Reform Act (MICRA). Under MICRA, patients can recover up to a quarter of a million dollars in noneconomic or “pain and suffering” awards. Injured patients are also 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.
CMA sponsored and won passage of this forward-thinking law in 1975 with 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 personal injury attorneys argued that MICRA's $250,000 cap on noneconomic damages deprived Mr. Van Buren of his constitutional rights to a jury trial. They also argued that the cap violates constitutional provisions that prohibit the legislature from exercising judicial powers, as well as the equal protection clauses of the state and federal constitutions.
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.
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.”
Click here for more information.
Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
2. Health Reform Remains Hot Topic Over August Recess
When Congress returns from its August recess after Labor Day, health reform will undoubtedly continue to be the front burner issue. Legislators have been in their home districts this month, many of them holding health reform town halls and meeting with constituents to discuss this contentious issue. CMA’s county medical societies have been organizing meetings between member physicians and their local representatives, to ensure that the voice of physicians is heard. CMA continues to strongly urge Congress to expand coverage to the uninsured.
CMA supports the coverage expansions, market reforms, and physician payment fixes in this bill, but we continue to have misgivings about a number of provisions in HR 3200. Although last minute amendments delinked the public plan payment rates from Medicare and allow negotiated physician payment rates with Medicare as the floor, CMA continues to have concerns about a number of provisions related to the public plan option, scope of practice expansions, and other issues. To protect patient choice and ensure competition among public and private health plans within the exchange, CMA believes that it is imperative that the health plan market share be closely monitored. If market domination emerges, consideration must be given to countervailing market principles, such as anti-trust relief for physicians to jointly negotiate with the health plans.
CMA remains concerned about HR 3200’s scope of practice expansions for nurse practitioners. We have also asked for Medicaid rate increases for specialists in addition to those for primary care and for improvements in the Medicare formula. Additionally, CMA believes that all patients should have the fundamental right to privately contract with physicians – in the private sector, in the public plan, and in the Medicare program. All of these concerns were outlined in a letter we recently sent to Congress, which is available online.
CMA has, however, urged Congress to support forward movement of HR 3200. As you may be aware, it includes nearly $400 billion in Medicare and Medicaid physician payment fixes, including rebasing the Medicare Sustainable Growth Rate formula to eliminate future cuts, a five percent bonus for Medicare E&M services, and increasing Medicaid rates to Medicare levels for primary care doctors. By providing these important fixes, HR 3200 achieves many goals that we have been working on for years. CMA has urged members of the California delegation to move the bill to the next stage of the process, so that these important provisions might be protected.
Please keep in mind that we are in the first quarter of a long legislative battle to change our health care system. We must maintain these favorable provisions now to continue to fight for the best possible end-game outcome.
The biggest fight California physicians are facing is a proposal from providers in the Midwest states to implement a “value index.” The value index, which is being proposed in the name of controlling costs and improving efficiency, would effectively shift billions in funding from higher-cost places like Los Angeles to lower-cost places like Minnesota. The California physician payment cuts could be 10 to 15 percent. CMA believes it is unacceptable to consider such fundamental changes to the Medicare geographic payment formula without further study to understand what accounts for the differences in medical practice costs by region, such as practice costs and socioeconomic status of patients.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
3. Best Practices: Understanding Your Revenue Stream
In today’s increasingly complex health care environment, it is imperative for physician practices to understand and proactively manage their revenue stream. Financial crises, even short-term ones, can jeopardize the viability of your practice and impact the quality of care you are able to provide to patients. The key to preventing revenue shortfalls is actively monitoring what is coming in the door.
Chapter 5 of CMA’s Best Practices toolkit will help physicians understand how to manage accounts receivable through proven best practices in a number of areas: measuring and minimizing days in accounts receivable, managing self-pay revenue, and benchmarking key financial indicators.
CMA published the 140-page toolkit, with generous support from the Physicians’ Foundation, to help physicians improve the efficiency, and in turn the quality, of their practices. In addition to learning how to manage your revenue stream, the toolkit will also teach you:
- What every physician needs to know about running a practice;
- How to find and keep qualified staff;
- Why your receptionist can make or break your business;
- How to build a defensible fee schedule;
- When it makes sense to cancel a payor contract;
- And much more.
The Best Practices toolkit, available free to all physicians, is organized into nine chapters that can be read sequentially or on an as-needed basis. Download the toolkit today.
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-5911 or fnavarro@cmanet.org.
4. Reminder – New Blue Shield Rates Take Effect 10/1
As reported in the last issue of CMA Alert, Blue Shield of California recently announced changes to its standard physician fee schedule that will take effect October 1. A number of physicians have reported difficulty locating the updated fees on the Blue Shield website. Below are step-by-step instructions for locating the new fees.
- Go to Blue Shield and enter your login.
- Once logged in, click on the tab at the top labeled, "Claims."
- Scroll down and click the link labeled "Professional Fee Schedule" under “Resources.”
- Click "Search the Claims Fee Schedule."
- Enter the date of service as "10/01/2009."
- Enter the procedure codes and click "Search."
If you do not have internet access, you can request the information by fax using the “provider allowance form” that was enclosed with the notice from Blue Shield.
CMA reminds physicians that they do not have to accept bad contracts or contracts that are not mutually beneficial. You should also be aware that you have the right to terminate an agreement if any “material change” to the contract terms is not acceptable to your practice.
If you have questions about the new fee schedule, call Blue Shield Provider Services Department at 800/258-3091.
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-5911 or awetzel@cmanet.org.
5. Friday Is the Last Day to Request Your CPPI Patient Data
Recently, some 13,000 California physicians received letters from the California Physician Performance Initiative (CPPI). These letters contain raw and relative performance scores for physicians on 16 quality measures based on claims data from United Health, Anthem Blue Cross, and Blue Shield PPOs as well Anthem Blue Cross and Blue Shield HMOs. The letters do not contain the underlying data.
CMA continues to have concerns about the accuracy and integrity of the data used to establish these scores and the potential use of these scores by payors for pay-for-performance, economic profiling, or tiered networks. In order to address some of CMA’s concerns and to improve the quality of the data, CPPI has provided a reconsideration process that physicians can use to verify their data.
CMA urges all physicians who receive the letter to request their data from CPPI and verify its accuracy. (Instructions for doing so are available at here.) The deadline to request your patient data is August 28, but CMA urges you to do so as soon as possible. Physicians must submit their corrected data by September 11.
CPPI provided CMA with a list of the member physicians who are impacted by this report. If you are one of them, you should have received a letter from CMA last week alerting you to that fact. Included with the letter were the step-by-step instructions for requesting and reviewing your patient data.
We understand that this may be a time-consuming process, but it is critical for physicians to take the time to verify their data. If you do not raise concerns now, payors could use this data in the future to adjust your reimbursements and change the flow of patients to your practice.
Click here for more information.
Contact: Armand Feliciano, 916/551-2552 or afeliciano@cmanet.org.
6. Proposed Optometrist Regulations Would
Compromise Patient Safety
On August 24, the California State Board of Optometry will consider draft regulations regarding glaucoma certification for optometrists. These regulations stem from SB 1406, 2008 legislation that mandated development of new certification requirements for optometrists who want to medically treat primary open-angle, exfoliative, and pigmentary glaucoma.
SB 1406 as initially written would have permitted optometrists to perform ophthalmic surgeries and administer eye injections. But thanks to CMA and a coalition of specialty stakeholders, the bill was severely limited through the amendment process. After extensive negotiations, SB 1406 was amended so that it no longer contained scope expansions specific to surgery or any procedure involving a scalpel or injections and under no circumstances allowed optometrists to treat closed angle glaucoma. The amended bill also included referral requirements and patient safeguards and required the development of certification standards for optometrists seeking certification to treat certain types of glaucoma. Additionally, the new law required that these standards be developed by a committee made up of three physicians and three optometrists.
CMA has grave concerns about the proposed certification standards and the process through which they were developed. Though neutrality of the process was clearly the intent of the legislation, the Department of Consumer Affairs, which oversees the optometry board, hired the former president of the state optometric association to make recommendations on the standards, casting doubt on the integrity and safety of the regulations that are being proposed.
The standards as proposed would require an optometrist seeking certification to treat 25 glaucoma patients under the supervision of an ophthalmologist over the course of 1 year. However, 15 patients of this requirement can be satisfied by a 16-hour classroom course (without any treatment of patients), and the remaining 10 can be fulfilled by completing a course utilizing live patients presented in a "grand rounds" fashion with undefined "follow-up." CMA does not believe these standards are sufficient to ensure patient safety.
Also, since SB 1406 was passed, tragic events at the Veterans Administration (VA) hospital in Palo Alto have occurred that raise serious questions about the treatment of glaucoma by optometrists. At the VA hospital, a review of 381 medical charts found that due to the failure of timely referral by the treating optometrist, seven veterans suffering from glaucoma had gone blind, 16 more had experienced “progressive visual loss,” and 87 others were at high risk of losing their sight. As a result of the probe, the chief of optometry was put on administrative leave and all glaucoma cases were moved to the ophthalmology department, which now supervises the optometry department.
CMA believes that a higher level of education and training than what optometrists receive is required to safely treat glaucoma, and that the proposed regulations pose a serious risk to glaucoma patients. We are strongly urging the optometry board to postpone hearing the regulations until there has been a thorough investigation of the Veterans Administration Hospital blindness cases. CMA is also urging that the Department of Consumer Affairs investigate possible procedural violations in the standards development process.
Contact: Jodi Hicks, 916/444-5532 or jhicks@cmanet.org.
7. CDC Issues H1N1 Vaccination Recommendations
The Centers for Disease Control has recommended that pregnant women, children, and health care workers be first in line to be vaccinated against H1N1 swine flu.
Although the CDC does not expect that there will be a shortage of the H1N1 vaccine, availability and demand can be unpredictable. There is always the possibility that the vaccine will be available in limited quantities. In the event of any such shortage, the CDC is recommending that top priority be given to:
- pregnant women,
- children 6 months through 4 years of age,
- children 5 through 18 years of age with chronic medical conditions,
- health care workers with direct patient contact, and
- people who live with or care for children younger than 6 months of age.
If there is ample supply, CDC is also recommending priority vaccinations for young adults aged 19-24 and adults aged 25 to 64 with chronic health disorders or compromised immune systems.
Once these high-risk groups have been vaccinated, the CDC recommends vaccinating everyone ages 25 to 64. Current studies indicate there is a lower risk of H1N1 infection among people age 65 or older. These individuals should be vaccinated once all other groups have been immunized.
The H1N1 vaccine is not intended to replace the seasonal flu vaccine. All high risk patients, including those 65 and older, should receive the seasonal flu vaccine as soon as it is available.
CMA is working with the CDC, the California Department of Public Health, and other stakeholders to facilitate a fair and smooth ordering and distribution process for the H1N1 vaccine. Stay tuned for more information.
Contact: Veronica Ramirez, 916/551-2887 or vramirez@cmanet.org.
8. State Legislative Update
The state legislature is back in session after the August recess and we expect a lot of movement on CMA-sponsored and opposed bill over the next 3 weeks as the session winds down. Among the bills we are closely following:
Corporate Bar (SB 726): CMA is vigorously opposing this bill, which would erode the ban on the corporate practice of medicine in California by allowing certain hospitals to hire physicians. Under current law, hospitals are generally 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. This bill passed the Senate earlier this summer, but has since been amended in the Assembly, requiring the Senate to pass it in its amended form. The bill must be heard in the Assembly Appropriations Committee by August 28.
Rescission (AB 2): Thousands of Californians have had their health insurance policies unfairly cancelled by insurance companies after they got sick. This CMA-sponsored bill, which would require that insurers be subject to an independent automatic external review before rescinding coverage, is a reintroduction of legislation that last year passed with bipartisan support through the Senate and Assembly, only to be vetoed by Governor Schwarzenegger. The bill passed out of the Assembly by a vote of 45 to 26 and is currently in the Senate Appropriations Committee.
Peer Review (AB 120): This CMA-sponsored bill would improve the peer review system in California. Although the peer review system currently works very well in most facilities, it can be open to manipulation and unreasonable delay in others. This bill will create increased fairness and transparency so that physicians and surgeons are continuously monitored and assessed to improve the quality of care provided to patients. This bill received unanimous bipartisan support in the Assembly and Senate, and is been sent back to the Assembly for concurrence with Senate amendments.
Click here for more information.
Contact: Michelle Burnette, 916/551-2054 or mburnette@cmanet.org.
9. Physician EHR Case Study Chapter 2: A Spoonful of Sugar
Physicians – particularly those in solo and small group practices – are grappling with some very important questions: Can I afford to purchase an EHR? Can I afford not to?
When President Obama signed into law the American Recovery and Reinvestment Act (ARRA) in February 2009, the news was greeted with mixed response from the physician community. ARRA included nearly $20 billion in financial incentives to encourage doctors to adopt Electronic Health Records (EHRs), but also contained the threat of reduced reimbursement for Medicare and Medicaid payments to those physicians who did not adopt EHRs by 2015.
In an effort to provide some real-world perspective on this issue, over the coming months we will be offering in CMA Alert a real-life case study of one physician’s experience tackling the question of whether to implement electronic health records in his practice. The study looks at the practice of Scott Wigginton, M.D., an Internal Medicine physician with a solo practice in Sacramento.
Chapter 2 of CMA’s EHR case study is now available.
Click here for more information.
10. Featured Member Benefits
EHR Best Practice Series Webinars: To help members begin to assess their HIT needs, CMA has partnered with Maxwell IT to provide members with complimentary registration to the EHR Best Practices Series webinars. To register for an upcoming EHR webinar, please visit CMA’s HIT Resource Center, and click on “HIT Webinars.
Members can register FREE for both “How to Best Select an EHR” and “E-Prescribing Best Practices.” A members-only discount code is required to access this discount. Visit the members-only website or call CMA's member help line (800/786-4CMA) to get the code.
Click here for more information on your membership benefits.
Contact: CMA's member help line, 800/786-4CMA or memberservice@cmanet.org.
|
