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1. Medical Liability Issues on the Front Burner in Washington
Medical liability issues are receiving increased attention in Washington as President Obama and Congress pursue health system reform. Many physicians and health policy experts have argued that the threat of medical liability lawsuits have forced doctors to practice defensive medicine, driving up the costs of health care.
President Obama has ruled out caps on non-economic damage awards, like the $250,000 cap on non-economic damages in California’s landmark medical malpractice reform law MICRA. Obama has, however, indicated that he supports pilot projects to explore how to reduce the financial impact of medical liability lawsuits. Last week, the Administration took initial steps on this approach, when the U.S Department of Health and Human Services unveiled a modest plan that would examine ways to discourage frivolous medical malpractice lawsuits. Under the plan, the federal government would provide $25 million in grants to identify practices that would reduce medical errors, lower malpractice insurance premiums, and prevent frivolous lawsuits.
There is also growing concern among physicians about the liability implications of “comparative effectiveness” research, which will attempt to objectively demonstrate the effectiveness of medical treatments. CMA and others in organized medicine are working hard to ensure that physicians are protected if they deviate from any clinical guidelines produced through the clinical effectiveness research that is mandated through the health reform legislation. CMA believes that physicians must be allowed to deviate from practice guidelines when in their clinical judgment it is in their patient's best interest, without being exposed to increased liability. CMA believes that data gleaned from such research must not be independently used to establish standards of care or deny coverage, or be used as evidence in medical malpractice cases.
Additionally, CMA’s federal advocacy on medical liability issues is focused on protecting MICRA. MICRA was enacted in 1975 by 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. MICRA’s cap on non-economic damages has reduced and stabilized medical malpractice insurance costs in California by reducing the incentive to litigate weak claims.
The law has kept malpractice premiums in California relatively reasonable, compared to those in other states without such laws. Once the highest in the nation, California malpractice premiums fell 12 percent from 1986 (the year the constitutional challenges to MICRA were exhausted) to 2000, while rising 55 percent nationally. Today, the average California physician saves $58,000 a year in malpractice insurance premiums when compared to colleagues in Florida, New York, and Michigan. In high risk specialties the savings are even more dramatic.
One of CMA’s main priorities over the past three decades has been to protect this forward-thinking law. Not surprisingly, the main source of the attacks on MICRA have been from the personal injury lawyers, who would see a windfall if MICRA were overturned. The law not only limits non-economic damage awards, but also limits attorney fees in malpractice cases.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
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2. Alfred Gilchrist Named New CMA CEO
 Alfred D. Gilchrist, the CEO of the Colorado Medical Society (CMS) and former longtime director of state and federal governmental advocacy for the Texas Medical Association (TMA), has been named the new chief executive officer of CMA.
Mr. Gilchrist brings to CMA 30 years of forward-thinking advocacy and strategic innovations, including groundbreaking achievements in patient rights, medical liability, and tobacco control measures. During his five year tenure in Colorado as the medical society’s top executive, Mr. Gilchrist was recognized on two separate occasions in the Denver Business Journal’s “Power Book” as one of the most influential state leaders in health care. On his watch, CMS broke new ground in reforming managed care contracting practices, physician profiling and rating systems, and transparency and disclosure to Colorado’s health plan merger and acquisitions statute, as well as significant expansions and reforms in Medicaid.
“Alfred Gilchrist’s invaluable experience and demonstrated talents at the state and federal level could not come at a more crucial time, as our nation discusses how to improve our health care system,” said Dev GnanaDev, MD., President of the California Medical Association. “Alfred’s leadership and vision will greatly enhance our efforts to expand access to quality health care, improve the public health, and maintain practice viability for the physicians of California.”
“I am honored and humbled to step into this role in this great state. It has been my privilege to advocate for the medical profession for three decades, and I have never seen greater opportunity nor greater risk for physicians and the patients they serve”, Gilchrist said.
Gilchrist will take over as CEO on November 16, 2009. He will attend the entire 2009 CMA House of Delegates in Anaheim, where he will briefly address the attendees.
3. Senate Finance Finally Unveils Health Reform Bill
Last week, the Senate Finance Committee finally released its long-anticipated health care reform bill. The proposal does not include a public insurance option to compete with private insurers, but instead would create a network of not-for-profit health insurance cooperatives and state-based insurance exchanges.
The bill unfortunately does not eliminate or rebase the Medicare Sustainable Growth Rate. It would stop the 21 percent Medicare SGR cut scheduled to take effect on January 1, 2010, and provide a 0.5 percent update. However, this would be financed by increasing the cut in 2011 to 25 percent. While the bill does provide a 10 percent Medicare primary care bonus, the bonus is paid for by a 0.5 percent cut to specialists’ pay.
CMA is opposed to these provisions. With the President and the House of Representatives both agreeing to rebase the SGR this year, the opportunity to eliminate future SGR cuts has never been so promising. Physicians must keep pressure on the Senate over this issue.
The finance committee bill would also create an independent commission charged with “slowing cost growth and improving quality of care.” This commission would be required to recommend payment cuts if health care spending outpaces the consumer price index. These “recommendations” would automatically take effect unless Congress took action to reverse the cuts.
These provisions would make it unaffordable for many physicians to continue participating in Medicare program. CMA is working hard to make Congress understand that failing to fix the broken Medicare formula now will make it more difficult for seniors to find a physician and jeopardize seniors’ access to care — which is the opposite of the intended effect of their health reform efforts.
The finance committee bill also includes a complicated feedback program that would penalize physicians who spend more than their peers caring for patients with similar conditions. Although it also requires data adjustments to account for demographic, health status, and geographic practice cost factors, CMA is concerned that the feedback program data will not accurately reflect the clinical reality. CMA believes that clinical information must be used to supplement claims-based cost data and that patient compliance with physician-recommended treatment be taken into consideration. CMA also believes that physicians must be given the opportunity to verify the data for accuracy and file appeals.
While CMA is opposed to many of the provisions in this bill, we continue to support health reform and expanding coverage to the uninsured. The Senate must pass a health reform bill in some form for the issue to get to conference committee, where the two houses of Congress would hammer out the differences in their bills. CMA is hopeful that the conference committee will adopt the more favorable physician payment fixes in the House health reform bill (HR 3200).
A more detailed analysis of the Senate Finance Committee bill will be available soon.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
4. CDC Encourages Swift Use of Antivirals in
High Risk H1N1 Patients
With H1N1 influenza cases on the rise, the Centers for Disease Control and Prevention is advising physicians not to wait for lab tests to confirm the presence of the H1N1 virus before prescribing antivirals for high risk patients with flu symptoms. The drugs work best when started within 48 hours of the onset of symptoms. To prevent a repeat of the overuse, hoarding, and shortages of antivirals that was seen during the spring outbreak of swine flu, the CDC is also discouraging physicians from prescribing antivirals to low-risk individuals.
To keep physicians up-to-date on this rapidly changing H1N1 situation, both the Centers for Disease Control and Prevention (CDC) and the California Department of Health have released updated H1N1 guidance for physicians. Links to the latest information have been posted in CMA’s H1N1 resource center.
In related news, the Food and Drug Administration last week approved four H1N1 vaccines. California is expected to receive 5.5 million doses by mid-October and 9 million doses by early November, which is slightly more than previously expected. Preservative-free formulations, for children 3 years old and younger, are expected to arrive later in the season.
If you have not yet preregistered for the vaccine, you can do so at http://www.CalPanFlu.org. 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.
Click here for more information.
Contact: Veronica Ramirez, 916/551-2887 or vramirez@cmanet.org.
5. Hospital Outpatient Clinics: Legal Considerations for Physicians
In recent years, California hospitals have begun operating outpatient clinics and affiliating with physicians to provide outpatient services. Because the outpatient clinic model is a relatively recent development, neither the legislature nor the courts have addressed this new health care delivery model through regulations or statutes. Given this legal vacuum, some hospitals have structured their outpatient clinics in ways that could run afoul of several federal and state laws, including antitrust, anti-kickback, and the corporate practice of medicine prohibitions. Physicians should be aware that participation in any such improper transaction could constitute unprofessional conduct and expose them to disciplinary action by the Medical Board of California.
To help physicians understand the pros and cons of the outpatient clinic model, CMA has published a new On-Call document, #0214, “Hospital Outpatient Clinics – Legal Considerations Impacting Physicians.”
On-Call documents are free to members at the members-only website. Nonmembers can purchase On-Call documents for $2 per page in the CMA bookstore.
Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
6. Blue Cross Physicians: Don’t Forget to Review New Fees
Before 11/11
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 decreased and others being increased. The new fee schedule also incorporates a site of service rate differential.
Physicians are reminded that before accepting a new health plan contract or a material change to an existing contract, it is important to know what value it will bring to their practice. You do not have to accept contracts that are not mutually beneficial. If you have questions about the new contract terms, contact Blue Cross Provider Relations at 800/933-6633.
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. (Log in to ProviderAccess and select the “Prudent Buyer Fee Schedule Update Effective 1/1/2010” link under the “What’s New” section.) You can also request the new rates via fax (click here for form or call Blue Cross Provider Relations at 800/933-6633).
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 choose to terminate, you must do so before November 11 (for a termination date of January 1, 2010). 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.
Contact: CMA’s reimbursement help line, 888/401-5911 or jblack@cmanet.org.
7. CMA-Sponsored Bills Pass Legislature;
Await Governor’s Signature
Three of CMA’s sponsored bills have passed the Legislature, and now await the governor’s signature. CMA also successfully averted a number of physician-unfriendly bills, including legislative attempts to erode the ban on the corporate practice of medicine and to expand the scope of practice of allied health professionals. All of these bills were defeated or were tabled until next year.
The CMA-sponsored bills on the governor’s desk are:
AB 2 (De La Torre): This CMA-sponsored bill would prevent the practice of health plans and insurers wrongfully rescinding coverage for patients after they become seriously ill. It would do so by requiring insurers to obtain approval from an independent review organization before rescinding a patient’s health insurance.
AB 120 (Hayashi): This CMA-sponsored bill would increase fairness and transparency in the peer review system. The bill would improve an already robust peer review system to make it even more effective in ensuring high quality care in California hospitals.
SB 606 (Ducheny): This bill would make osteopathic physicians eligible for the Steven M. Thomson Loan Repayment Program. The program, currently only open to M.D.s, provides medical school loan repayment grants of up to $105,000 in exchange for a three-year service commitment in a medically underserved area of the state.
A comprehensive legislative wrap-up will be available soon. Stay tuned to CMA Alert for details. For more information on these and other bills of interest to physicians, see CMA’s Legislative Hot List.
Contact: Michelle Burnette, 916/551-2054 or mburnette@cmanet.org.
8. Physicians: Don’t Miss Your Chance to Help Set CMA Policy
CMA’s legislative body, the House of Delegates, will convene October 17-19 at the Disneyland Hotel in Anaheim. The 800 delegates and alternate delegates meet annually to establish CMA policies on key issues that affect the practice of medicine, from medical ethics to critical matters of public health.
The resolutions and reports that will be presented to delegates are now available for viewing and downloading at CMA’s members-only website. There, you will also find an an online discussion forum where any CMA member can comment on the resolutions prior to the meeting.
All CMA members are also welcome to participate in live reference committee hearings on October 17, during which testimony for or against each proposed resolution will be heard. A complete schedule and tentative agenda for the 2009 House of Delegates is posted on the CMA website.
Contact: Roger Purdy, 916/551-2067 or rpurdy@cmanet.org.
9. Tickets Now on Sale for CMA Foundation Annual Dinner
The CMA Foundation’s 13th Annual President’s Dinner and Awards Gala is October 18 in Anaheim, during CMA’s annual meeting. Proceeds will support CMA Foundation, a charitable organization that links physicians and their
communities to raise awareness about important public health issues.
Honored at the dinner will be incoming CMA President J. Brennan Cassidy, M.D., and the foundation’s leadership award recipients, Frank E. Staggers, Sr., M.D. (Robert D. Sparks, M.D., Leadership Award) and Katherine Flores, M.D. (Adarsh S. Mahal, M.D. Access to Health Care and Disparities Award).
Tickets are $125 per person, or $1,000 for a table of 10.
Even if you will not be able attend, please consider placing an ad in the
dinner program. The foundation is a nonprofit charitable organization, and
all ads are tax deductible.
Click here for more information or to RSVP.
Contact: Leslie Barron, 916/779-6623 or lbarron@thecmafoundation.org.
10. Best Practices: Improving the Patient Experience
Like any other business, the most successful practices are ones that provide not only high quality care, but also excellent customer service. Whether it’s determining wait-time tolerance or finding out what patients think of your bedside manner, patient surveys are a simple and effective ways for you to assess — and if necessary improve — the customer service provided to your patients.
Chapter 4 of CMA’s Best Practices toolkit will help physicians understand how to effectively survey patients and use that data to improve the patient experience.
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 effectively survey your patients, 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 helpline, 888/401-5911 or fnavarro@cmanet.org.
11. Physician EHR Case Study Chapter 4:
At the Brink of E-Prescribing
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 4 of CMA’s EHR case study is now available.
12. Featured Member Benefits
MedicAlert: Patients of CMA members save $10 on new adult enrollments and $2.95 on Kid Smart enrollments.
MedicAlert provides 24-hour emergency identification and family notification services.
Click here for more details.
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