1. CMA and IMS Launch Pilot Study on Physician Prescribing Data
CMA and IMS Health will soon launch a pilot program that will give physicians access to detailed reports of their personal prescribing patterns. The program is intended to improve quality of care by helping physicians evaluate their prescribing habits and compare them to regional and national patterns.
This pioneering study is the result of more than four years of negotiations and discussions on the use of physicians' prescribing data, which is routinely sold to pharmaceutical companies and shared with government agencies and research institutes. Until now, however, physicians themselves were unable to access that information.
California has for years wrestled with prescription data tracking issues, twice sponsoring legislation that would have banned the sale of prescription data for commercial purposes. CMA decided to participate in this pilot program so that we might find a thoughtful compromise that will help physicians, patients, and pharmaceutical research. CMA and AMA understand, however, that some physicians are concerned about the misuse of prescribing data by overzealous pharmaceutical sales representatives.
Responding to these concerns, AMA in July launched the Prescribing Data Restriction Program, which allows physicians to deny access to their prescribing data to all pharmaceutical sales representatives and to health information organizations, such as IMS, that compile and sell physician prescribing data. Physicians can restrict access to their prescribing data for three-year periods, regardless of their membership status in AMA.
CMA is seeking 100 physicians who have not restricted access to their prescribing data to participate in the pilot program, which will focus on the treatment of migraine headaches. Participants will receive an educational newsletter that will explore the condition, national treatment practices, major drug therapies, and physician prescribing patterns on a state and national level. Accompanying the newsletter will be the physician's own prescribing data for purposes of comparison.
Click here for more information.
Contact: Joe Greaves, 916/444-5532 or jgreaves@cmanet.org.
2. Dysfunctional Congress Again Fails to
Stop
Medicare Physician Payment Cuts
Congress will adjourn on Friday without having fixed the Medicare physician payment problems. Although Congress will briefly reconvene after the November elections, these lame-duck sessions have historically been short and unproductive, making it unlikely that they will agree to a solution in time to avoid the 5 percent physician payment cut scheduled to take effect January 1.
"We are extremely disappointed and angry that Congress failed to stop the 5 percent physician payment cut while the hospitals and health plans get their 3 to 7 percent increases,” says CMA President Michael Sexton, M.D.
"CMA, the county medical societies, and California's physician grassroots did everything humanly possible to convince Congress to stop the cuts and institute a payment update. Despite the efforts of Ms. Johnson and other California Republicans, the Republican leadership didn't come through and does not apparently see this issue as a priority to address before the November elections,” says CMA CEO Jack Lewin, M.D. "They don't believe that physicians will really pull out of the program, and none of the recent national studies have demonstrated significant access problems in the Medicare program. Moreover, the cost to fix the problem is more than $200 billion. These perceptions about access combined with the enormous cost to the federal budget spells inaction.”
Unfortunately, the Republican leadership in the House and Senate could not agree on a plan to stop the physician payment cuts. In September, a number of congressional leaders—including Bill Thomas (R-Calif.), Nancy Johnson (R-Conn.), and Charles Grassley (R-Iowa)—developed last-minute proposals to stop the cuts, but none provided a viable solution to the broken payment system. The proposals included minimal payment updates (0.5 to 2.5 percent), payment reductions for providers who do not meet major new quality reporting requirements, and financing schemes that would have subjected physicians to cuts of up to 10 percent annually in future years.
CMA urges physicians to meet with their members of Congress to express their outrage and extreme disappointment that the Republican-led Congress again failed to fix the physician payment problem. They need to understand that this is an urgent issue and that failure to reform the Medicare payment formula will force physicians to stop accepting new Medicare patients or withdraw from the program entirely. Also tell them that any credible pay-for-performance quality-reporting program must provide for strong physician input on how "quality” is defined and measured, ensure that physicians are appropriately reimbursed, and provide IT support so that physicians can afford to participate in such a program.
Although fixing the SGR is CMA's top Medicare priority, the association continues to urge Congress to fix the outdated geographic payment localities and to do so before the geographic practices cost index is updated next year.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
3. State Supreme Court to Reconsider Noncontracting
Physicians' Right to Bill for Emergency Services
The California Supreme Court recently agreed to reconsider the historic Prospect case, which upheld the right of noncontracting physicians to bill patients if an HMO fails to fairly reimburse them for services provided to its enrollees.
In this case, the plaintiff, Prospect Health Service Medical Group (a capitated IPA), argues that when a physician bills and is paid by an HMO or its contracting intermediary, an "implied contract” has been created whereby the physician is prohibited from balance-billing the patient under the Knox-Keene Act.
The plaintiffs argue, in effect, that alone among all health care providers, physicians are always and automatically "contracting providers” when they provide emergency services. The trial and appellate courts in this case rejected that argument.
The plaintiff's brief makes unfounded accusations that physicians' billed charges are "almost always” unreasonable and that physicians use "impermissible strong-arm tactics to force payment of an unreasonable amount.”
"These unsupported allegations of unethical behavior are deplorable,” wrote the defendant emergency medical groups' attorneys in their answer brief, filed last week with the state supreme court.
Although CMA attorneys assisted the medical groups' attorneys in preparing the answer brief, CMA will also file its own "friend of the court” brief, explaining that nowhere in California law are noncontracting physicians required to accept health plans' discounted payment as payment in full and that any attempt to deny noncontracting physicians the right to bill patients for the outstanding balance violates constitutional protections ensuring a "fair and reasonable return.”
Click here for more information, including a copy of the defendants' brief.
Contact: CMA's legal information line, 415/882-5144 or legalinfo@cmanet.org.
4. Young Physicians Invited to Attend YPS Assembly, Oct. 27 in Sacramento
CMA's Young Physicians Section (YPS) will hold its Annual Assembly and Education Conference Friday, October 27, 9 a.m. to 4 p.m., at the Hyatt Regency in Sacramento.
This year's assembly, Making Change: From Idea to Action, includes advocacy and media training and features presentations from many of CMA's physician leaders and staff experts. Attendees will learn tangible skills that will help them become an effective advocate for patients. Participants will also discuss the YPS resolutions that will be introduced at the 2006 CMA House of Delegates, which is October 28-30 at Sacramento Convention Center.
Registration is free, but space is limited.
Click here to register.
Contact: Joe Greaves 916/444-5532 or jgreaves@cmanet.org.
5. 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.
6. 150th Anniversary Trivia: Did You Know?
Did you know that in 1957 a CMA-sponsored law made California the first state in the nation to make it legal for individuals to donate their bodies or body parts for transplants? It wasn't until 1972 that a similar national law was enacted, the Uniform Anatomical Gift Act, which established a uniform organ donor card.
CMA is celebrating its 150th birthday! Visit http://www.cmanet.org/150 for other interesting information about CMA history.
7. CMA Member Benefit of the Week: Free Portfolio Checkup
CMA members get a free portfolio checkup—a $250 value—from CMA's affinity partner, Mercer Advisors.
Mercer Advisors manages over $3 billion in assets, most of it for health care practitioners like you. Because Mercer is fee-based rather than commission-based, you can rest assured that Mercer's financial experts have your best interests at heart.
Members also get $500 off Mercer's "Economic Freedom Program,” a comprehensive program that includes financial planning, investment management, and retirement and estate planning.
To schedule your free portfolio check up, call 800/898-4642.
Click here
for more information.
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