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1. Medicare Payment Delay Looming
Physicians should be aware Medicare will not pay any claims for the last nine days of the federal fiscal year (September 22-30, 2006). This one-time payment hold — mandated by the Deficit Reduction Act of 2006 — will defer $1.3 billion in FY 2006 claims to the FY 2007 budget.
Held claims will be paid on October 2. No interest or late-payment penalty will be paid to physicians or other health care providers whose payments are delayed by this one-time hold. Physicians with large numbers of Medicare patients should prepare now for this cash flow interruption.
Click here for more information.
Contact: Reimbursement Help Line, 888/401-5911.
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2. CDC to Host Influenza Conference Calls on 8/31 and 9/7
To help physicians prepare for the upcoming influenza season, the Centers for Disease Control & Prevention (CDC) will host two conference calls. The calls will provide you with the most up-to-date information on the vaccine supply and CDC recommendations for influenza vaccination.
The first call is TODAY, August 31, at 11:00 a.m. Pacific time, and will focus on vaccinating children (888/989-4612, passcode: 2823163). The next call is Thursday, September 7, also at 11:00 a.m., and will focus on vaccinating adults (888/459-3220, passcode: 2823163). The conference calls are scheduled to last no longer than 45 minutes, including time for questions.
Click here for more information.
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3. PacAdvantage to Shut Down December 31; CMA Partner
Can Help Affected Physician Practices Find Other Coverage
Pacific Health Advantage (PacAdvantage), a nonprofit health insurance purchasing alliance for small businesses, will cease operations at year-end because too many insurance providers have withdrawn from the voluntary program. The latest insurer to announce its departure was Blue Shield of California, which earlier this year said that it would withdraw from the program on December 31. Blue Shield was the eighth insurer to quit since the program was created in 1992.
PacAdvantage was created by the state so that small businesses with 2 to 50 employees could band together and negotiate lower health insurance premiums. PacAdvantage currently provides health insurance for 6,200 small businesses representing 116,000 people across California, who have four months to find other coverage.
CMA’s partner, Marsh Affinity Group, can help affected member physicians find alternative insurance options.
Click here for more information.
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4. CMA Urges Physicians to Tell DMHC that ER System
Will Collapse Under Weight of Proposed Regulations
The Department of Managed Health Care (DMHC) recently proposed new regulations that put California’s emergency care system at risk of collapse by inhibiting physicians’ ability to bill for services rendered. 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.
The regulations are open for public comment until October 2. It is critical that DMHC hear from physicians, county medical societies, and specialty societies so that the state understands the severe economic impact that these regulations will have on physicians and the health system in general. Comments may be sent either to DMHC directly or to CMA for inclusion in the association’s formal comments.
CMA has posted on its website templates that organizations and individual physicians or physician groups can utilize when preparing their comments. Please keep in mind that these templates are only models, and you should tailor your comments to reflect your particular circumstances and explain in your own words how these regulations will affect your practice. Even if you submit your comments to DMHC directly, please also send a copy to CMA by e-mail (legalinfo@cmanet.org) or fax (415/882-5143).
These regulations attack the future viability of physician practices. They do not address the key underlying problems of unfair contracts, which result in inadequate physician networks, and chronic and pervasive underfunding of emergency care by insurance companies. Physicians don’t want to bill patients. This only happens because insurance companies each year don’t pay millions of dollars of fair and legitimate ER bills from individual physicians, and don’t put enough money into ER risk through capitation to medical groups.
With health insurance profits soaring, these regulations reward for-profit HMOs that underfund emergency care for their insureds. This will further discourage insurers from contracting with physicians and capitated medical groups at fair rates.
CMA is prepared to fight the proposed regulations through the regulatory process and the association will sue DMHC if the regulations are adopted as proposed. CMA is collaborating with a media advocacy expert to craft an aggressive public relations strategy. CMA is also developing a grassroots campaign and will be working with county medical societies to coordinate physician media interviews, community presentations, and letters to the editor. Additionally, CMA is crafting a legislative package that would help stabilize California’s emergency care system (to be introduced in 2007-08 legislative session).
Click here for more information, including the model comments and talking points.
Contact: Susan Bassett, 916/444-5532 or sbassett@cmanet.org.
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5. QME Applications Due September 7
The Division of Workers’ Compensation (DWC) is now accpeting applications for Qualified Medical Evaluators (QME). QMEs are independent physicians certified by DWC to conduct medical evaluations of injured workers. To become a QME, physicians must take and pass the QME examination. The next QME exam is Saturday, October 28 and will be administered in both northern and southern California. (The exam sites will be chosen a month prior to the exam date, once the number of applicants is determined.)
Applications for the October 28 QME exam must be postmarked by next Thursday, September 7. Once your application is approved, you will have to take and pass the QME examination.
Click here for more information, including a QME application.
Contact: Division of Workers’ Compensation, 510/286-3700.
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6. Tell Your Member of Congress to Stop the
Payment Cut and Give Physicians a 2.8% Increase
Physicians, CMA needs you to turn up the heat on your members of Congress and motivate them to fix the Medicare payment problems before Congress adjourns in September. As you know, CMA has for years been fighting for long-term fix to Medicare’s flawed sustainable growth rate (SGR) formula.
If Congress fails
to act before the end of the year, physician rates will be cut 5 percent
on January 1 of next year, and rates will be cut by a total of 35 percent
during the next six years. The cuts are an unintended consequence of
a formula, established under laws passed in 1989 and 1997, that was
supposed to establish a “sustainable growth rate” for spending
on doctors’ services. The formula allows Medicare spending on physician
services to grow at the rate of the gross domestic product (GDP), but it
actually penalizes physicians because the cost of physician services rises
more rapidly than the GDP.
Reimbursement for all other Medicare providers is calculated using the Medicare Economic Index (MEI), which is a market index of actual medical practice costs. Health plans, hospitals, and nursing homes are all seeing payment increases, while physician payments are being slashed.
The inequities are glaring:
| 2007 Medicare Provider Payment Updates |
| Health Plans: |
+ |
7 percent |
| Hospitals: |
+ |
3.6 percent |
| Nursing Homes: |
+ |
3.5 percent |
| Physicians: |
– |
5
percent |
Congressional leaders have hinted that they may only be able to freeze payments at 2005 levels. With practice costs increasing at a rate of 4 to 6 percent a year, a payment freeze would essentially be a pay cut.
Tell your members of Congress that a payment freeze is not acceptable and urge them to dump the flawed SGR physician payment formula and replace it with a new formula based on the MEI, which would increase physician payments by 2.8 percent in 2007. Tell them that failure to reform the Medicare payment formula will make it more difficult for seniors to find a physician and further jeopardize access to care.
Click here for more information, including talking points and sample letters.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
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7. CMA’s Past and Future Highlighted at 150th Anniversary State Fair Exhibit
 California State Fair patrons are not only being treated to a fascinating exhibit of CMA’s role in the past 150 years of medicine, but their children are offering everyone a glimpse into CMA’s future. Thousands of children wearing “future doctor” caps handed out at CMA’s 150th anniversary exhibit are visible all over the Sacramento fair grounds.
An 8-year-old girl wearing her CMA future doctor hat already had a specialty picked out—obstetrics. That caused a minor problem for her father, who rushed her past the 1920s physician’s office on display, complete with a vintage ob-gyn table. “Too graphic,” he said. She settled instead on watching a calf be born at the barnyard.
In the first two weeks of the fair, tens of thousands of visitors have come by the display, which is staffed daily by CMA staff and former staff and a number of physicians, including CMA President Michael Sexton, M.D., and CMA CEO Jack Lewin, M.D., and local physicians and volunteers from the Sierra Sacramento Valley Medical Society Museum.
Most popular among the hundreds of items on display at CMA’s exhibit are amputation kits used by pioneers on the trail west, an early 20th century doctor’s office, and a rare iron lung used to treat polio patients in the 1950s. Visitors even get to watch the iron lung in action. “I was in one of these for two weeks,” said one woman in her 50s. “All I remember is my grandparents standing outside the windows holding teddy bears up and thinking how sad that was—I couldn’t even touch them.”
Fair goers often express their appreciation for medical achievements that have benefited them. “I am a product of this progress,” said one young man in his 40s. “I had a kidney transplant last year, and I’ve never felt better.” He lifted his sleeve to show his arms misshapen by years of dialysis. Said another man to staff at the fair. “I had cancer. It’s all gone. There’s some great medication out there. I wouldn’t have wanted to live in these times,” he said, pointing to crude medications on display.
The exhibit highlights about a dozen areas of medicine through the ages, including pharmaceuticals, treatments of diseases and viruses, and even an ancient prescience medical theory known as “balancing the humors,” which employed blistering, bleeding and puking as “cures.”
The bulk of material comes from the Sierra Sacramento Valley Museum of Medical History. Other material support comes from CMA, the CMA Foundation and UC Davis Medical Center, as well as county medical societies, the archives of early medical schools and the Sacramento city archives.
State Fair visitors were also very interested in the public health information provided by the CMA Foundation. Many handouts—including hundreds of diabetes cookbooks and flyers on hand-washing techniques—were snapped up the first week, and more had to be ordered. Visitors also picked up end-of-life care leaflets that discussed how to complete an advance care directive and brochures on effective communication for patients and physicians. Most handouts were available in multiple languages.
The state fair runs through Labor Day.
Click here for more on CMA’s 150th anniversary, including photos from the exhibit.
Contact: Karen Nikos, 916/551-2069 or knikos@cmanet.org.
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8. 150th Anniversary Trivia: Did You Know?
Did you know that CMA is publishing a history book to commemorate the association’s first 150 years? All members will receive a copy by mail in mid-October. If you’ve moved recently, please make sure that CMA has your current mailing address so you don’t miss out on this fascinating keepsake publication.
Contact: CMA member helpline, 888/233-2937 or lgodward@cmanet.org.
CMA is celebrating its 150th birthday! Visit http://www.cmanet.org/150 for other interesting information about CMA history.
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9. CMA Member Benefit of the Week: Employment Practices Liability Insurance
This week’s featured member benefit is Employment Practices Liability Insurance. Through CMA’s group buying power, members receive significant premium discounts on a number of insurance products—including employment practices liability (EPL) insurance.
EPL insurance is a relatively new insurance product that provides protection against claims made by employees, former employees, or potential employees for harassment, discrimination, wrongful termination, or other employment-related allegations. Employers of all sizes face potential damage from EPL lawsuits, which can result not only in financial disaster, but in irreparable injury to reputation as well.
Marsh’s comprehensive employment practices liability program also includes web-based training for physicians and their staff and access to labor attorneys at no extra charge to discuss employment issues.
Special discounts for first-time buyers are available. Members will soon receive details in the mail about this new insurance program. If you have any questions, contact Marsh at 800/842-3761 or CMACounty.Insurance@marsh.com.
Click here for more information about the benefits and discounts available to CMA members.
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No. 2061 
