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1. Blue Cross Withdraws Controversial Endoscopy Payment Policy
Blue Cross last week agreed to withdraw its controversial payment policy that cut physician reimbursement by 20 percent for endoscopic procedures performed in outpatient hospital settings and that gave 5 percent bonuses for procedures done in doctors’ offices or Blue Cross-contracting surgery centers.
CMA in May protested the new policy with state authorities, saying the rule places corporate profits ahead of patient care and safety and is likely illegal. CMA believes that it violates the state insurance code, which requires that medical decisions be “unhindered by fiscal and administrative management.”
California Hospital Association in June filed a lawsuit in Los Angeles County Superior Court, accusing Blue Cross of violating state law by inducing doctors to make medical decisions based on financial considerations rather than clinical judgment.
Blue Cross announced its decision to withdraw the policy after the Department of Managed Health Care (DMHC) filed a brief with the court, saying that the plan failed to obtain DMHC approval before making such a significant policy change, as required by state law. DMHC said in its brief that to obtain such approval, Blue Cross would have to justify why it should be exempt from Health and Safety Code section 1348.6, which outlaws payment incentives designed to deny, limit, or delay patient access to specific services.
“The legislature has determined that the potential harm to enrollees that could result from the granting of specific financial incentives outweighs the incremental reduction in health care costs that cost-containment strategies like the endoscopy policy would provide to California’s health care system,” DMHC explained in its brief.
CMA is urging Blue Cross to readjudicate claims for endoscopic procedures performed in outpatient hospital settings that were paid between July 1 and October 4 (the dates the policy was in effect).
Click here for more information.
Contact: Aileen Wetzel, 916/444-5532 or awetzel@cmanet.org.
2. Preview CMA’s 2006 House of Delegates Agenda Online
At this year’s House of Delegates, physicians from across the state will debate and set policy on important health care issues including universal health care, quality initiatives, and physician-assisted suicide. The House of Delegates convenes October 28-30 in Sacramento.
During the three-day meeting, the 500 delegates will address more than 100 resolutions on these and other key issues that affect the practice of medicine. The resolutions and reports presented to delegates are available online for viewing and downloading at the members-only website, http://www.cmanet.org/member.
Click here for more information.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
3. Bush Orders Transparent Health Price and Quality Data
President Bush in August issued an executive order directing federal agencies to collect more information about the quality and cost of health care they provide and to share that data with one another and with beneficiaries. Administration officials said the order is intended to bring greater transparency to the business of medicine. There is no current timetable for implementation.
The executive order affects four agencies—Medicare, the Federal Employees Health Benefits Program, the Indian Health Service, the Department of Veterans Affairs, and the Department of Defense TRICARE Program—and requires them to make public the prices that the agencies pay physicians and other health care providers for common procedures.
The order also requires the agencies to establish programs to measure and reward quality of care and use certified, interoperable health information technology to facilitate data tracking and sharing.
CMA will be working closely with the Centers for Medicare and Medicaid Services (CMS) and other federal officials to ensure physicians have input on how the executive order is implemented.
“CMA fully supports the President’s goals. But only if the implementation is reasonably constructed with physician input,” says CMA CEO Jack Lewin, M.D. “The specter of unfunded mandates could have catastrophic consequences for Medicare access. We will be watching carefully to represent the interests of physicians on how and when these ideas are implemented.”
CMA has told CMS that any credible 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.
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Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
4. Physician and Patient Action Needed to Avert Medicare Crisis
If Congress does not act before the end of the year, Medicare payments to physicians will be cut by 5 percent on January 1 and by a total of 37 percent over the next six years. 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 it did in 2001. By 2007, Medicare physician payment rates will effectively have fallen by more than 20 percent.
Congress needs to hear from both physicians and patients that inaction is not acceptable. Physicians, call, write, or visit with your members of Congress to express your outrage and extreme disappointment that the Republican leadership in Congress again this year 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.
Please urge your members of Congress to stop the 5 percent payment cuts during the post-election lame-duck session in November. Tell your members of Congress to dump the flawed SGR physician payment formula and replace it with a new formula based on the medical economic index, which would increase physician payments by 2.8 percent in 2007. Please also urge your representative to show the House leadership that he or she supports Medicare payment reform by cosigning the Medicare “Dear colleague” letters that are circulating in Congress.
To contact your members of Congress, please call AMA’s grassroots action hotline at 800/833-6354. You will be prompted to enter your zip code and will be automatically connected with your local representative.
AMA has also published a flyer that physicians can use to inform patients about the impending crisis and encourage them to call their members of Congress to demand immediate action.
Click here for more information, including talking points, sample letters, and AMA’s patient flyer.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
5. Help Make the CMA Foundation Annual Dinner and Silent Auction a Success
The CMA Foundation’s 10th annual dinner dance and silent auction is October 29 at the Sacramento Hyatt Regency, 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, including appropriate antibiotic use, childhood obesity, diabetes, smoking cessation, and health disparities.
Reception begins at 6:30 p.m., dinner and program at 7 p.m., and dancing at 9 p.m. Tickets are $125 per person and can be purchased by calling the foundation at 916/551-2054.
If you cannot attend, please consider donating an item or service for the silent auction. The foundation is a nonprofit charitable organization, and all donations are tax deductible.
Click here for more information.
Contact: Cherie Davis at 916/551-2556 or cdavis@cmanet.org.
6. Early Bird Deadline for CMA's Pain Conference is November 1;
Register Early and Save $40
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 the State Medical Society (now CMA) did not meet in southern California until 1890? That year, the association held its annual meeting in Los Angeles. Today, CMA alternates its annual meeting between northern and southern California. This year’s meeting is October 28-30 in Sacramento.
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: 5th Annual Coding Extravaganza
CMA members receive $115 off registration for DecisionHealth’s fifth annual Specialty Coding Extravaganza, February 6-7 in Las Vegas. Attendees at this two-day conference will learn how to reduce “kicked back” claims and denials and dramatically improve cash flow.
Log in to http://www.cmanet.org/member to get your discount code or call CMA’s member help line at 888/233-2937.
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No. 2066
