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1. Judge Orders California Medical Board to Grant
Equivalency to American Board of Cosmetic Surgery
A California Superior Court judge recently ordered the Medical Board of California to grant specialty board equivalency status to the American Board of Cosmetic Surgery (ABCS). The court determined that ABCS’s requirements for board certification meet or exceed the training requirements of the American Board of Medical Specialties (ABMS).
State law allows physicians to advertise board certification only if the certifying board or association is recognized by ABMS or deemed equivalent by the medical board. This decision will allow California physicians who are ABCS certified to advertise that they are board certified in cosmetic surgery.
The medical board, which had previously denied ABCS’s petition for equivalency, has not yet decided whether it will appeal the ruling.
The only other boards currently deemed equivalent by the medical board are the American Board of Facial Plastic and Reconstructive Surgery, the American Board of Pain Medicine, the American Board of Sleep Medicine, and the American Board of Spine Surgery. The only other board that applied for and was denied approval by the medical board is the American Academy of Pain Management. The academy unsuccessfully sued the medical board a number of times in the late 1990s, challenging the CMA-sponsored law passed in 1990 that authorized the Medical Board of California to regulate physicians’ use of the term “board certified” for advertising purposes.
The 1990 law was passed in response to complaints that physicians were advertising themselves as “board certified” when they had only attended very brief courses offered by non-ABMS boards. Even though American Academy of Pain Management failed to meet the medical board’s equivalency standards, the academy argued that the law violates the First Amendment right to free speech. In 2004, the Ninth U.S. Circuit Court of Appeals upheld the statute.
Click here for more information, including a copy of the ruling.
Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.
2. New EMTALA Regulations Require Specialty Hospitals to Accept Transfers
The Centers for Medicare and Medicaid Services recently made some changes to the Emergency Treatment and Labor Act (EMTALA) regulations. The new regulations, which took effect October 1, clarify that all hospitals, even specialty hospitals without emergency departments, must accept patient transfers from other hospitals as required by EMTALA.
EMTALA was passed by Congress in 1986 in response to widespread concerns that hospitals were turning away or transferring patients who were in need of emergency medical care but unable to pay for those services. The law requires hospitals with emergency rooms to provide emergency medical services to anyone regardless of ability to pay. The law also requires hospitals to accept transfers from another hospital’s emergency department if it is within the capability of the facility. Previously, it was unclear whether specialty hospitals without emergency departments were required to accept patient transfers from other hospitals’ emergency rooms.
The new regulations also authorize nurse-midwives and other qualified personnel acting within their legally authorized scope of practice to certify false labor. Previously, the EMTALA regulations required a physician to certify that a woman was not in “true” labor.
Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
3. Quality Matters: IOM Report Finds that Medicare
Payment System Discourages Quality Improvements
Medicare’s current fee-for-service payment system rewards excessive use of health care services by paying health care providers for treating illnesses and injuries, but not for patient education or other measures that might reduce costs over time, according to a new report from the Institute of Medicine. The report recommends a gradual shift to a system that rewards quality, not quantity. Unfortunately, the report also recommends that such a program be funded, at least initially, by cutting base payments to physicians and other health care providers.
The Institute of Medicine’s report, "Rewarding Provider Performance: Aligning Incentives in Medicare," is the third in a series of quality improvement studies requested by Congress.
This is not the first time the institute has recommended Medicare move toward pay-for-performance, but this time, it also spelled out how the government should pay for it.
The institute recommended that Medicare initially cut base payments to physicians, hospitals, and nursing homes, and use the savings to create bonus pools from which to reward not only quality improvement, but also continued excellence. The report does, however, recognize that physician fees are already scheduled to be cut over the next 10 years because of the flawed sustainable growth rate formula and acknowledges that Congress may need to appropriate some new funds to ensure that the reward pool is sufficient to encourage participation by all physicians.
The report also recommends that large, institutional health care providers and organizations be required to participate, but that participation by small physician practices should be voluntary for at least the first three years.
Click here for more information.
Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.
4. Don’t Let Up: Tell Congress They Must Stop Medicare
Physician Payment Cuts During Lame-Duck Session
Congress adjourned last week without having fixed the Medicare physician payment problems. Despite bipartisan support from most members of the California Congressional Delegation, the Republican leadership in the House and Senate could not agree on a plan to stop the physician payment cuts. Although Congress will briefly reconvene after the November elections, these lame-duck sessions have historically been short and unproductive.
If Congress does not act before the end of the year, physician payments will be cut by 5 percent on January 1 and by a total of 37 percent over 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: |
+ 7.0 percent |
| Hospitals: |
+ 3.2 percent |
| Nursing Homes: |
+ 3.2 percent |
| Physicians: |
– 5.0 percent |
These cuts come at a time when medical practice costs are soaring. Over the last five years, the average cost to run a medical practice has gone up at least 18 percent, yet Medicare is still paying physicians the same rates they did in 2001. By 2007, Medicare physician payment rates will effectively have fallen by more than 20 percent.
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. Tell your members of Congress 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.
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.
5. CMA Calls Proposed DMHC Regulations Illegal and a Threat to Patient Care
CMA this week filed comments on proposed regulations that would prohibit billing patients for emergency services provided by noncontracting physicians, calling the proposals “flatly illegal” and a threat to the quality and availability of emergency care throughout the state. The regulations would also
establish an unproven and burdensome billing dispute resolution process
and impose other unwarranted rules that would undermine fair and timely physician reimbursement.
CMA on Wednesday delivered to the Department of Managed Health Care (DMHC) extensive written comments, supported by more than 4,500 pages of evidence. These comments supplement the compelling testimony presented by hundreds of CMA member physicians during three public hearings on the proposed regulations, including the third and final hearing Wednesday in Sacramento.
As was the case at the previous two hearings, more than 40 CMA 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.
Click here for more information.
Contact: Susan Bassett, 916/444-5532 or sbassett@cmanet.org.
6. 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.
7. 150th Anniversary Trivia: Did You Know?
Did you know that in 1929, 48 physician wives met and formed the Women’s Auxiliary to the California Medical Association during the association’s annual meeting in Coronado? Today the auxiliary, now called the CMA Alliance, has more than 2,200 members.
CMA is celebrating its 150th birthday! Visit http://www.cmanet.org/150 for other interesting information about CMA history.
8. CMA Member Benefit of the Week: Mercury Auto Insurance
CMA members receive 10 percent off auto insurance from Mercury Insurance. Even without the member discount, Mercury’s rates are some of the lowest around. California drivers report saving an average of $505 a year after switching to Mercury. Imagine what you can save with your member discount!
Call Mercury Insurance at 866/602-5259.
Click here
for more information.
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No. 2065
