|
ADVERTISEMENT
1. New PacifiCare/United Health Contract Still Has Problems
After receiving a number of physician complaints, CMA earlier this year analyzed the PacifiCare/United Healthcare physician contract and found that it in many ways violated state laws and regulations, including the Knox-Keene Act.
CMA reported these findings to the Department of Managed Health Care (DMHC), and the department gave PacifiCare 10 days to modify the contract so that it complied with state laws. Although PacifiCare did make some changes to the contract, CMA continues to have concerns with its provisions.
A detailed analysis of the contract, and its flaws, is available to members at the members-only website. There you will also find objective written analyses of a dozen other major health plan contracts.
CMA reminds physicians that before signing a health plan contract, it is important to know what value that relationship will bring to your practice. Physicians do not have to accept bad contracts or contracts that are not mutually beneficial.
Click here for more information.
Contact: Aileen E. Wetzel, 916/444-5532 or awetzel@cmanet.org.
BACK TO TOP
ADVERTISEMENT
2. DHS Develops New Name-Based HIV Reporting Form
On April 17, 2006, a new California law took effect requiring physicians and other health care providers to report cases of HIV infection to health officials using patients’ names. Previously, such cases were reported using alphanumeric codes created from birth dates, gender, and elements of patients’ last names.
This change was the result of a CMA-supported “urgency” bill (SB 699), which passed unanimously in both the Senate and the Assembly and was signed by the governor in April. Although the regulations implementing this law have not yet been finalized, the bill’s urgency clause required
California physicians to immediately begin using patient names when reporting HIV cases.
In response to the new law, the California Department of Health Services (DHS) has developed a modified HIV/AIDS reporting form. The revised form, which reflects the new HIV reporting law and the anticipated requirements of the new regulations, can be downloaded from the DHS website, http://www.dhs.ca.gov/aids.
DHS has one year to develop and implement the regulations. Until the regulations are implemented, physicians can continue using the old case report form with the addition of the patient name. Use of the modified reporting form will be mandatory once the regulations take effect.
The code-based reporting system was created in 2002 to ensure patient confidentiality, but it proved to be a bureaucratic nightmare for health officials and the resulting data was unreliable. California was one of just seven states that had not already switched to a confidential name-based reporting system. The Centers for Disease Control and Prevention does not consider code-based HIV reporting to be accurate, and federal officials have said they will withhold funds from states that use code-based reporting rather than names-based reporting.
Click here for more information.
Contact: Robin Flagg, 415/882-5110 or rflagg@cmanet.org.
BACK TO TOP
3. Physicians Tell DMHC that Health Plans
Must Fairly Pay Noncontracted Physicians
Dozens of physicians from CMA and the California Chapter of the American College of Emergency Physicians (Cal/ACEP) last week descended upon a Department of Managed Health Care (DMHC) hearing in Burbank, demanding that DMHC drop proposed regulations that would stop physicians from billing for services rendered.
The regulations were filed in response to an executive order issued by Governor Schwarzenegger earlier this summer that directed DMHC to stop physicians from billing for emergency care.
Jim Hindsdale, M.D., vice chair of CMA’s Board of Trustees, and Brennan Cassidy, M.D., board chair, ably represented CMA at the hearing, imploring the committee to drop the proposed regulations and engage DMHC to “do its job” as health plan regulator by requiring plans to contract with adequate physician networks and stopping the chronic underfunding of emergency care by insurance companies.
Dozens of physicians delivered personal stories of hours spent providing lifesaving care in the emergency room, only to receive pennies-on-the-dollar reimbursement from insurance companies. Steven Kim, M.D., assistant medical director of the Department of Emergency Medicine at Inland Valley Medical Center in Widomar, told the committee about a patient who came into the ER with a serious hand injury. “I had a patient who came in the other day who sliced his hand, three or four fingers and down the palm with some tendon injuries,” said Dr. Kim. “It took me about an hour to fix it. And I was just wondering if the committee had any thought on what you think a fair reimbursement for that would be.” Dr. Kim told the committee that he billed $180 for saving the patient’s hand and the health plan paid just $40.
Testifying physicians delivered a strong and consistent message: Physicians don’t want to bill patients and DMHC should ensure that insurance companies—whose profits continue to soar—pay fair and legitimate ER bills.
DMHC will hold two more hearings on these regulations, Monday, September 25, in San Diego, and Wednesday, October 4, in Sacramento. Physicians interested in testifying at either hearing should contact Susan Bassett at 916/444-5532 or sbassett@cmanet.org.
The regulations are also open for written public comment until October 4. It is critical that DMHC hear from physicians, county medical societies, and specialty societies so that state officials understand the severe economic impact 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).
Click here for more information.
Contact: Susan Bassett, 916/444-5532 or sbassett@cmanet.org.
BACK TO TOP
4. Governor Signs CMA-Sponsored Bill Creating State Dept. of Public Health
Governor Schwarzenegger this week signed a CMA-sponsored bill that establishes a new California Department of Public Health, effective July 1, 2007. The governor will appoint a State Public Health Officer to head the department. The public health officer must according to the law be a licensed physician or surgeon.
The Department of Public Health will be able to more effectively address pressing public health concerns, such as bioterrorism, emergency response, and the prevention and detection of communicable diseases.
CMA has long championed a proactive public health policy. In 1870, California became the second state to establish a public health department. It was disbanded in the 1970s under then-Governor Reagan.
“Reestablishing a public health department has been a high priority for the CMA for years,” says CMA President Michael Sexton, M.D. “We believe a separate department will provide the resources and attention that are required to maintain the health of Californians. Not long ago, California was in the forefront of public health innovations with some of the nation’s leading programs in disease detection, epidemiology and maternal and child health programs. We can be there again.”
Governor Schwarzenegger has a number of other CMA-supported bills on his desk for consideration. He has until Saturday, September 30, to sign or veto the bills, or allow them to become law.
Among those bills:
Reporting Lapses of Consciousness (SB 212). This bill would repeal the requirement that mandates physicians report to the county health officer the name of individuals diagnosed as having a disorder characterized by lapses of consciousness, and instead allows for discretionary physician reporting, except for dementia-related disorders.
Medi-Cal Provider Enrollment (SB 1353). This bill would expedite the Medi-Cal provider enrollment process. There is currently a backlog of more than 11,000 physicians waiting for Medi-Cal approval. Specifically, the bill shortens the time that DHS has to process provider applications, and authorizes Medi-Cal to expedite enrollment using a new short-form application for Medicare providers and physicians with privileges at acute care hospitals.
Electronic Advance Health Care Directives (AB 2805). This bill would update California’s advance health care directive law to allow living wills to be filed and signed electronically.
Also on the governor’s desk is a CMA-opposed bill (SB 438) that would expand oral and maxillofacial surgeons’ scope of practice. Similar to legislation vetoed last year by the governor, this CMA-opposed bill would allow oral and maxillofacial surgeons to perform elective facial cosmetic surgery procedures. CMA is urging the governor to again veto this bill. CMA believes that patients are put at risk when nonphysician practitioners provide care for which they are inadequately trained. CMA has endorsed the idea of an expedited residency program for oral and maxillofacial surgeons who wish to become qualified plastic surgeons.
Click here for more information.
Contact: Susan Bassett, 916/444-5532 or sbassett@cmanet.org.
BACK TO TOP
5. CMA Physician Leader Named JCAHO Commissioner
 M. Nicole Jamali, M.D., Organized Medical Staff Section delegate to CMA House of Delegates, has been appointed to the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) Board of Commissioners. Dr. Jamali, one of CMA’s most active and enthusiastic young physicians, was chosen for this position by AMA, one of JCAHO’s organizational members.
“[Dr. Jamali] is a physician committed to serving her patients with the best care possible; a physician willing to speak up and fight when she sees the potential for compromised care; a physician willing to get involved and participate in organized medicine,” wrote CMA-OMSS Chair John Hill, M.D., in CMA’s nomination letter. “I believe that, although young and perhaps without the lengthy resume of other candidates for this position, Nicole is a future physician leader and one who would well serve our AMA on the JCAHO Board.”
As the nation’s principal health care accreditation organization, JCAHO evaluates and accredits more than 15,000 hospitals and health care organizations to evaluate compliance with its quality and safety standards and other accreditation requirements.
Dr. Jamali will serve for three years on JCAHO’s 29-member Board of Commissioners, which includes physicians, nurses, consumers, medical directors, administrators, providers, quality experts, educators, and others.
Click here for more information.
Contact: Robin Flagg, 415/882-5110 or rflagg@cmanet.org.
BACK TO TOP
6. PreCALS PLUS, IMQ’s Medical Staff Issues and Answers Conference,
Is November 2–3 in Burlingame
The Institute for Medical Quality’s PreCALS PLUS Medical Staff Issues and Answers Conference will be November 2 to 3 at the San Francisco airport Doubletree Hotel in Burlingame. Medical staff teams (chiefs of staff, committee chairs, quality-management personnel, and medical staff directors and coordinators) are encouraged to attend.
The conference will focus on changes to JCAHO’s standards for 2007, with special attention to medical staff and credentialing standards. Also discussed will be California’s Title 22 regulations, 2007 national patient safety goals, and areas of concern for California hospitals identified by JCAHO surveyors in 2006.
This year’s conference also includes an expanded program on dealing with disruptive/stressed physicians, including guidelines for physician well being committees and information on conducting effective peer review. Among the presenters will be a case manager from the medical board diversion program.
Click here for more information.
Contact: IMQ, 415/882-5167 or liacopi@imq.org.
BACK TO TOP
7. Don’t Forget to Complete Pain CME Before December 31 Deadline!
CMA’s Pain Conference Is December 1-2 at the Disneyland Hotel
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 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). Register by November 1 and get a $40 early-bird discount.
Click here for more information.
Contact: CMA’s seminar line, 415/882-3330 or kdefabrique@cmanet.org.
BACK TO TOP
8. 150th Anniversary Trivia: Did You Know?
Did you know that Santa Monica ophthalmologist and CMA Trustee Kenneth J. Hoffer, M.D., in 1974 founded the American Intra-Ocular Implant Society, which is today known as the American Society of Cataract and Refractive Surgery?
CMA is celebrating its 150th birthday! Visit http://www.cmanet.org/150 for other interesting information about CMA history.
BACK TO TOP
9. Member Benefit of the Week: ON-CALL Medical-Legal Information Library
CMA ON-CALL is an online library that contains over 3,000 pages of medical-legal, regulatory, and reimbursement information. The searchable library contains all the information available in the
California Physician’s Legal Handbook, an annual publication by CMA’s Center for Legal Affairs.
ON-CALL documents are available free to members at CMA’s members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in CMA’s online bookstore.
If you haven’t taken advantage of this extraordinary resource, spend a few minutes browsing the ON-CALL index, and see what you’ve been missing.
Click here for more information.
BACK TO TOP
|
No. 2063 
