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1. CMA Fighting Cost-Cutting Health Reform Proposals
that Would Punish Physicians in High-Cost Regions
Congress returns to Washington this week and the future of health reform is still very much in question. Congressional negotiations continue to center on cost-cutting proposals, such as the “value index” currently being discussed in the Senate Finance Committee. The value index, being proposed under the guise of encouraging efficiency and reducing “unnecessary” geographic variation in spending, would effectively shift billions in Medicare funding from higher-cost places like California to lower-cost places like Minnesota, Wisconsin, and Iowa. The California physician payment cuts could be 10 to 15 percent.
CMA vehemently opposes this money grab that is being pushed by representatives from rural states. These proposals are based upon an oversimplified analysis of regional spending differences in Medicare – fostered by data from the Dartmouth Atlas and propelled by the Obama administration. What these measures would actually do is undercut health care for the poor and minorities.
CMA believes it is unacceptable to consider fundamental changes to the Medicare payment formula without further study to understand what accounts for the differences in medical practice costs by region, such as practice costs, ethnic diversity of the population, and socioeconomic status of patients.
“Increasing efficiency and eliminating overspending are laudable goals that doctors support,” says CMA President Dev GnanaDev, M.D. “But directing funding away from entire regions with lots of poor minorities who did not have access to care will not achieve those goals.”
The biggest source of health care spending is lack of access to care, not regional overspending. When patients don’t see a primary care physician, health problems can develop and fester into more-expensive-to-treat maladies.
CMA believes health reform should focus on proactive, cost-saving, preventive care. Congress should promote primary care, prevention, and care coordination to reduce unnecessary ER visits and hospitalizations.
In contrast, the value index and proposals like it would reward doctors and patients with the least challenges and short-change the regions with the biggest health care needs. This short-sighted approach would do nothing to improve efficiency and reduce costs.
CMA is aggressively fighting the value index and other similar proposals. CMA and others in organized medicine were successful in removing a simlar cost-cutting proposal from HR 3200, the House health reform legislation. The bill as currently written would instead give the Institute of Medicine (IOM) one year to complete a study on regional variations in costs and quality of care, including an analysis of practice costs and patient socioeconomic and health status factors, and make recommendations to the Department of Health and Human Services.
Click here for more health reform information, including CMA’s analysis of HR 3200.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
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2. Physicians Urged to Pre-Register for H1N1 Vaccine
The California Department of Public Health (CDPH) is urging physicians to preregister for the Influenza A (H1N1) vaccine, the first doses of which are expected to be available in mid to late-October. Even if you are not ready to place an order, you must register now to inform CDPH of your interest in being a vaccinator.
Unlike the seasonal flu vaccine, the H1N1 vaccine will not be distributed through regular suppliers. Due to the uncertainty of the supply and capacity, CDPH is serving as a central distribution point so that the vaccine is available to those who need it most.
Although the Centers for Disease Control and Prevention (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 at least initially. California is expected to receive 8 million doses by late October, with an additional 2 million doses per week thereafter.
Physicians are being asked to register as vaccinators so that CDPH can get a realistic assessment of physician capacity and interest in vaccinating. When registering, be prepared to submit your National Provider Identification number, the projected number of doses of the vaccine your practice expects to use, and the number of patients your practice has that fit into the high risk groups. (See last issue of CMA Alert for information on who is at high-risk for H1N1-related complications.) By registering, you are not making a commitment to administer the same quantity of vaccine.
To register, or for more information, visit http://www.CalPanFlu.org. Physicians who are ready to order vaccine can also do so at that webpage. You should be aware, however, that vaccine will not be distributed on a first come, first served basis.
The H1N1 vaccine does not protect against the seasonal flu. Because of the dual flu threat and the impact of the increased patient volume is expected to have on physician practices, you are urged to start administering the seasonal flu vaccine as soon as possible before the arrival of the H1N1 vaccine in October.
Click here for more information.
Contact: Veronica Ramirez, 916/551-2887 or vramirez@cmanet.org.
3. Senate to Vote this Week on Bill to Stop
Unjust Health Insurance Cancellations
The Senate will vote this week on a CMA-sponsored bill (AB2) on Friday that will prevent the practice of health plans and insurers wrongfully rescinding coverage for patients after they become seriously ill.
AB 2 requires insurers to obtain approval from an independent review organization before rescinding a patient’s health insurance.
Over the last few years, rescissions have become an all too common way for HMOs and insurers to cut costs. This practice has produced lawsuits, fines, legal settlements and a congressional investigation – all after the fact. The problem, however, still remains that patients can get their health coverage pulled out from under them just when they need it most, when they are severely sick and their medical bills are mounting.
Rescissions cause immense emotional and financial suffering for those involved. AB 2 takes a proactive approach, continuing insurance coverage until an independent board reviews the matter and makes a decision as to whether it is legal.
This issue first received widespread attention through an investigative series by the Los Angeles Times about California insurers’ practices. A subsequent congressional investigation found that three insurers used rescissions to cancel more than 20,000 policies over five years, saving the companies $300 million in claims.
Once the Senate passes the bill, it will go back to the Assembly for a concurrence vote before landing on the desk of Governor Schwarzenegger, who vetoed similar legislation sponsored by CMA last year.
Click here for more information.
Contact: Teresa Stark, 916/444-5532 or tstark@cmanet.org.
4. We Need Your Help to Protect the Ban on the Corporate
Practice of Medicine
SB 726 (Ashburn), a bill that would erode the ban on the corporate practice of medicine in California by allowing certain hospitals to hire physicians, will soon be heard on the Assembly Floor. CMA is vigorously opposing this bill, which is sponsored by AFSCME, a labor union interested in unionizing doctors, and the California Hospital Association, whose members want to hire and control doctors.
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.
Physicians are urged to call, e-mail, or fax your assemblymembers and urge them to vote no on SB 726. (Contact information for your legislators is available here.) Phone calls are most effective, but e-mails and faxes are important too.
Please be advised that the unions and hospitals are urging their members to call to register support so your participation is absolutely necessary so that legislators know the true impact this bill would have on the quality of care their constituents receive in California hospitals.
Click here for more information, including a sample letter and talking points. Log in to the members-only section, and click on “Take Action” on the right side.
For more information on this and other bills of interest to physicians, see CMA’s Legislative Hot List.
Click here for more information.
Contact: Brett Michelin, 916/444-5532 or bmichelin@cmanet.org.
5. Blue Cross Will Continue to Pay Claims from Physicians
Who Have Not Signed New Healthy Families Contract
As you may recall, Blue Cross announced earlier this year that it would require physicians to sign a separate contract and accept reduced rates if they want to continue treating Blue Cross-insured Healthy Families and AIM patients. The new rates vary, but generally they are slightly higher than Medi-Cal rates.
The effective date on the new contracts is September 1, and the insurer had said claims with dates of service on or after that date would not be paid without a new signed Healthy Families contract. As the result of CMA advocacy, Blue Cross has decided to allow physicians with Prudent Buyer contracts to continue to treat Blue Cross Healthy Families patients through at least the end of October. In lieu of a newly signed Healthy Families contract, physicians will for most services be paid 125 percent of Medi-Cal.
CMA hopes that this interim policy will ensure a smooth transition for patients and allow more time for physicians to review the new contracts. (Click here for more details.)
Blue Cross has also clarified, at CMA’s request, how physicians will be paid for vaccines under the new contract. Physicians will be reimbursed at either the current market-based rates (which represent Blue Cross’s cost to acquire the vaccine through its group purchasing arrangement), or the official Healthy Families fee schedule rate, whichever is greater. To ensure physicians are not out of pocket for the cost of vaccines, Blue Cross-contracted physicians can purchase vaccine at the reduced group rate from the insurer’s preferred vaccine vendors. It remains unclear how/if physicians will be reimbursed an additional amount for vaccine administration. (Click here for more details.)
Physicians are reminded that before they sign a health plan contract, it is important to know what value that relationship will bring to their practice. You do not have to accept contracts that are not mutually beneficial.800/933-6633 If you have questions about the new contract terms, contact Anthem Blue Cross at or ssbrecruit@wellpoint.com.
Physicians who have decided not to sign the new contract can refer patients to Blue Cross for help locating a participating provider. Healthy Families patients can call 800/845-3604, AIM patients 877/687-0549.
Adding to the turmoil for Healthy Families patients are the recent devastating budget cuts. Faced with a 50 percent cut in funding, Healthy Families program in July indefinitely closed its doors to new enrollees. CMA is, however, supporting a bill (AB 1422) that would raise revenue for the program by creating a 2.35 percent tax on the gross premiums of Medi-Cal managed care companies. This bill passed the Senate last week and has been sent back to the Assembly for concurrence. For more information on this and other bills of interest to physicians, see CMA’s Legislative Hot List.
Click here for more information.
Contact: CMA’s Reimbursement Help Line, 888/401-5911 or jblack@cmanet.org.
6. Important Information for Blue Cross Contracted Physicians
Physicians contracted with Blue Cross should be aware of three important issues.
1. Blue Cross Fee Schedule Changes Take Effect January 1
Anthem Blue Cross last week notified physicians of changes to its Prudent Buyer physician fee schedule that will take effect January 1, 2010. In a letter to physicians on September 2, Blue Cross informed physicians that it would be modifying payment levels for many CPT codes, some being increased and others decreased.
Physicians are urged to calculate the financial impact the fee schedule changes will have on their practices. (Use CMA’s financial impact worksheet, available at the members-only website) The new rates are available at the Blue Cross website. You can also call Blue Cross Provider Relations at 800/933-6633.
If you do not agree with proposed changes, you can terminate the contract anytime before November 11. Termination letters can be mailed to Anthem Blue Cross, Prudent Buyer Plan Contract Processing, Mail Station 8A, P.O. Box 4330, Woodland Hills, California 91365-4330.
Click here for more information on the fee schedule.
2. Blue Cross Switches to Paperless EOBs; Doctors Can Still Opt to Receive Paper
Physician practices that have previously registered for Blue Cross’s online provider portal, ProviderAccess, will no longer receive printed EOBs with their checks. Effective October 6, you will be required to go to Blue Cross website to obtain claims information and to download or print out EOBs, if necessary. EOBs will be only available online for 18 months. Practices that have not registered for ProviderAccess will continue to receive paper EOBs.
Thanks to CMA advocacy, Blue Cross has agreed to allow physicians to opt-out of the paperless EOB program. If you would like to continue receiving paper EOBs, call Anthem Network Relations at 800/933-6633. Click here for more information.
3. Blue Cross to Change Claim Editing Software
Physicians should also be aware that Blue Cross is switching to a new claim editing software effective November 7. Because of this change, physicians may notice a difference in how certain codes and code pairs are adjudicated. Physicians will be able to prospectively and retrospectively screen claims via Blue Cross’s “Clear Claim Connection” portal to determine if and how the claim auditing rules impact their claims.
For more information, visit Blue Cross’s provider portal. Questions about any of these new policies should be directed to Blue Cross Provider Relations at 800/933-6633.
Click here for more information on the Claim Editing Software.
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-5911 or jblack@cmanet.org.
7. Best Practices: Hiring the Right Receptionist
Your receptionist can make or break your business. He or she is the frst person your patients and potential patients encounter. As the face and voice of your business, this is one of the most important members of your staff. A bad hiring decision for this position can have far-reaching consequences.
Chapter 1 of CMA’s Best Practices toolkit will help physicians understand how to examine a receptionist’s (or potential receptionist’s) core competencies and how to make sure you’ve got the right person for the job.
CMA published the 140-page Best Practices 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 hire the right receptionist, the toolkit will also teach you:
- What every physician needs to know about running a practice;
- How to find and keep qualified staff;
- How to build a defensible fee schedule;
- When it makes sense to cancel a payor contract;
- How to make sense of your revenue stream;
- 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.
8. Physician EHR Case Study Chapter 3: A Trip Up the Amazon
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?
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.
Click here for more information.
Chapter 3 of CMA’s EHR case study is now available.
9. Featured Member Benefits
Long Term Disability Insurance: CMA members pay reduced premiums on long term disability insurance from Marsh. Physician members age 59 or younger actively practicing full time (30+ hours a week) are eligible. Members under age 50 can receive coverage of up to $10,000 a month. Members age 50–59 can apply for up to $6,000 per month. For more information, call Marsh at 800/842-3761 or click here.
10% off Auto Insurance: CMA members receive 10 percent off auto insurance from Mercury Insurance. For more details, call Mercury Insurance Group at 888/637-2491 or click here.
Click here for more information on your membership benefits.
Contact: CMA's member help line, 800/786-4CMA or memberservice@cmanet.org.
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