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1. Senate Fails to Advance Bill to Repeal Medicare SGR
Today's United States Senate vote for cloture on S. 1776, the Medicare Physician Fairness Act of 2009, failed by a vote of 47 to 53. The bill would permanently repeal the Medicare sustainable growth rate (SGR) and would lay the foundation for establishing a new Medicare physician payment system. A cloture vote would have made the bill filibuster-proof and cleared the way for a floor vote on this critical bill. In the Senate, a three-fifths majority is required for cloture.
CMA has many serious concerns with the Senate health care legislation, one of the biggest being its failure to address long-term cuts to Medicare payments. Although the House bill does contain a physician payment fix, the Senate bill would increase doctors' payments by 0.5 percent in 2010, but it would leave doctors facing a 25 percent cut in 2011.
S. 1776 not only would repeal the SGR formula, but also would eliminate all debt that has been accumulated under the current payment system, setting future physician payment updates at zero. Importantly, the Senate leadership made it very clear that Congress does not intend to implement a permanent physician payment freeze and call it Medicare payment reform.
Rather, by passing a separate bill that repeals the SGR and eliminates the accumulated spending target debt, budget constraints will be eased, allowing a new physician payment update system to be incorporated into a broader health system reform bill.
California Senators Dianne Feinstein and Barbara Boxer continue their strong support for physicians and voted in favor of cloture.
However, because the legislation is not offset by other spending cuts or revenue increases it will add to the federal budget deficit, making supporting votes difficult for some senators.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
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2. CMA Sues State to End Medical Board Furloughs
CMA filed a lawsuit in state Superior Court last week seeking to end furloughs for the staff of the Medical Board of California, which is backlogged with physician license applications and other important administrative work affecting the quality and accessibility of medical care.
Because the Governor has furloughed state employees three days per month, the medical board can no longer maintain adequate staffing, resulting in an unprecedented buildup of license applications and disciplinary investigations and enforcements. Qualified physicians who are unlicensed but ready and able to immediately practice medicine must sit idle.
"There is already a physician shortage in California," says CMA President Dev GnanaDev, MD. "Because the Medical Board cannot keep up with current licensing demand, communities lacking access to health care will have to wait even longer to attract new physicians. The consequences of the furloughs and transfer of Medical Board funds to the state's General Fund harm all Californians."
The lawsuit, filed in San Francisco, says the Governor's furlough order is illegal for the Medical Board's staff because the Medical Board is funded by physician fees. CMA is also objecting to the fact that the state has redirected $6 million of the medical board's contingency funds into the state's general fund. By statute, these funds are to be spent only for medical board purposes.
Click here for more information, including a copy of the lawsuit.
Contact: Clarissa Sanchez, 916/551-2867 or csanchez@cmanet.org.
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3. Physicians' Personal Data Stolen
More than ten thousand California doctors contracted with Anthem Blue Cross and Blue Shield of California are being notified that their personal information, including Social Security, taxpayer ID, and NPI numbers, may have been compromised when a laptop containing sensitive data was stolen. While there have been no reported misuses of this information, physicians are urged to take steps to protect themselves from identity theft.
The theft occurred in late August in the Chicago area when a Blue Cross-Blue Shield Association employee's laptop was stolen from a car. The breach involved a data set containing information on as many as 800,000 physicians, including names, addresses, tax ID numbers, and NPI numbers. Physicians who use their Social Security numbers as their taxpayer ID numbers should have received a letter notifying them of the data breach, urging them to take advantage of the free credit monitoring services being offered to affected physicians by the insurers.
To take advantage of the free credit monitoring offer, you must enroll by the end of the year using the unique activation code provided in the letter. The program offers $25,000 in identity theft insurance with no deductible and provides alerts to changes in credit reports.
Physicians are encouraged as always to be vigilant in protecting themselves from those who may try to use their identity as a physician to submit fraudulent prescriptions or claims. If you suspect that your personal information is being used fraudulently, you should take immediate action. For more information on what you should do if you believe you are a victim of identity theft, see CMA On-Call document #0608, "Whose Got Your Number? How Physicians Become the Victims of Identity Theft." On-Call documents are free to CMA members at the members-only website. Nonmembers can purchase On-Call documents for $2 per page in the CMA bookstore.
If you have questions about the Blue Cross/Blue Shield data breach, please call the Blue Shield Provider Liaison Unit at 800/258-3091 or Blue Cross Provider Services at 800/933-6633.
Contact: CMA's reimbursement help line, 888/401-5911 or jblack@cmanet.org.
4. Orange County Physician Becomes CMA President
Orange County physician Brennan Cassidy, M.D., took over as CMA's 142nd president at the close of the association's Annual House of Delegates, which concluded on Monday in Anaheim.
In his address to nearly 1,000 physicians in attendance, Dr. Cassidy implored physicians to use "time, patience and persistence" to educate the public and lawmakers about what is needed to provide the best care for patients. He said doctors should "never give in" when fighting for patients and the medical profession.
"As doctors, we take care of people 24/7," said Dr. Cassidy. "It's our mission to restore the health of our patients. As the national debate on health care reform moves forward, it's crucial that physicians communicate clearly and loudly about what we need to do our jobs and provide the high quality of care that is today's standard."
Dr. Cassidy is a past president of the Orange County Medical Association and has participated on many committees throughout his 36 years as a member of CMA, including serving as chair of the CMA Board of Trustees.
The delegates also elected trauma surgeon James Hinsdale, M.D., president-elect, a post he will hold for one year before succeeding Dr. Cassidy. Dr. Hinsdale is a past president of the Santa Clara County Medical Association, director of trauma at Marin General Hospital and executive director of trauma at Regional Medical Center in San Jose. He has been serving as chair of CMA's Board of Trustees for the past year.
Contact: Amber Beck, 916/551-2551 or abeck@cmanet.org.
5. Highlights from CMA's 2009 House of Delegates
Hundreds of California doctors convened in Anaheim last week for the 2009 House of Delegates, CMA's annual meeting. Each year, physicians from all 53 California counties, representing all modes of practice meet to discuss issues related to health care policy, medicine, and patient care, and to elect CMA officers. The following are summaries of some of the resolutions that the House adopted as policy.
Health System Reform (Resolution 203a-09): The delegates voiced their support for health system reform that (1) is directed to help the truly uninsured, (2) helps those who are eligible for coverage to obtain it, (3) allows total deductibility of all health care expenses, and (4) enacts tort reform nationally, as has been done in California. The delegates also restated their support for the "Guiding Principles of Health Reform" that they passed at last year's meeting.
Immunization for Health Care Workers (Resolution 701a-09): The delegates voted to support universal seasonal influenza vaccination for all health care workers with direct patient contact; and recommended vaccination against H1N1 and other pandemic influenza strains for health care workers according to CDC guidelines.
Nutrition Labeling of Saturated and Trans Fats (Resolution 709a-09): The delegates expressed strong support for changing nutrition labeling requirements so that saturated fat and trans fat contents are accurately reported to a 0.1 gram level per serving.
Soda Tax (Resolution 721a-09): The delegates directed CMA to support increased taxes on sodas and other sugar sweetened beverages, with the revenues to be utilized for public health education efforts and other health purposes. The delegates voted that physicians should educate their patients about the health risks associated with the consumption of food and beverages containing high amounts of processed simple or refined sugars such as high fructose corn syrup.
Online Defamation of Health Care Providers (Resolution 415a-09): The delegates voted to support legislation requiring vendors who operate online forums that review physician performance to require users to agree to terms of use that include, but are not limited to: agreeing to only post factual statements; attesting that they are a current or former patient of any physician they are reviewing; and disclosing within their posts any conflicts of interest or business relationship they have with the vendor of the online forum. The delegates also asked CMA to seek federal guidance on misleading or false statements regarding physician performance posted online or on other public venues, particularly when the false statements involve patients' protected health information (PHI).
Medical Practice Guidelines (Resolution 504a-09): The delegates urged CMA to advocate that members of practice guideline development committees must disclose any possible conflict of interest and that such guidelines should be peer reviewed by independent reviewers prior to publication to ensure that guidelines are evidence-based and that all conflicts have been disclosed. The delegates also agreed that medical and specialty associations should not receive any money for sponsoring, underwriting or promoting practice guidelines from drug, device or equipment manufacturers.
The rest of the resolutions can be viewed at the members-only website.
Contact: Roger Purdy, 916/551-2067 or rpurdy@cmanet.org.
6. State Temporarily Exempts H1N1 from
Mercury-Free Vaccine Law
California's Department of Public Health (DPH) last week announced it would temporarily exempt the H1N1 vaccine from the state law banning the use of mercury-containing vaccines for pregnant women and small children. Exemptions to the ban are allowed in the event of potential public health emergencies, including an epidemic or vaccine supply shortage. DPH agreed to waive the ban for six weeks because there are not enough doses of thimerosal-free vaccine to comply with the law and the health threat from H1N1 outweighs the worries about mercury-containing vaccines.
CMA is also encouraging all health care workers with patient contact to get the H1N1 vaccine. At CMA's annual meeting this week, the delegates voted to recommended vaccination against H1N1 and other pandemic influenza strains for all health care workers according to CDC guidelines.
See CMA's H1N1 page for the latest information.
Contact: Veronica Ramirez, 916/551-2887 or vramirez@cmanet.org.
7. 2009 State Legislative Wrap Up
Despite the paralyzing impact of the state's $40 billion budget deficit on legislation in 2009, CMA put three sponsored bills on Governor Schwarzenegger's desk this year – AB 2 (rescission), AB 120 (peer review), and SB 606 (medical school loan repayment). While the Governor signed SB 606, he vetoed both AB 2 and AB 120, undermining CMA efforts to protect patients from insurance companies and to improve the peer review process.
AB 2, authored by Assemblymember Hector De La Torre, would have required insurers to get approval from an independent panel prior to rescinding health insurance coverage. The bill was aimed at stopping the practice of insurance companies looking for excuses to cancel an enrollee's coverage after they get sick and run up expensive medical bills. Despite more than a year of rhetoric from the Governor decrying rescissions and strong editorial support for AB 2, he vetoed the bill, abandoning California patients who lose health care when they need it the most.
"The insurance industry has made billions of dollars from its practice of rescission by unfairly canceling health insurance policies with little to no oversight," says De La Torre, who plans on reintroducing similar legislation next session. "Currently, there are no protections for consumers. Californians no longer can afford to allow the health insurance industry to be the judge and the jury."
Governor Schwarzenegger also vetoed AB 120 (Hayashi), legislation designed to strengthen California's robust system of peer review. While nearly all peer review done in California is done efficiently, timely, and in a manner that protects patients from quality of care deficiencies, the current peer review system can be strengthened. Instead of taking advantage of an opportunity to strengthen a vital part of California's system of ensuring quality patient care, the Governor chose to veto these important improvements.
The Governor did sign SB 606 (Ducheny), which extended the Steve Thompson Loan Repayment Program to D.O.s. The program offers loan repayment assistance to doctors who agree to work in underserved areas for at least three years. Since its inception in 2003, more than 100 physicians have participated in the program, which plays an important part in CMA's efforts to expand access to care to the underserved.
CMA also defeated every bill that we opposed, including attempts to erode California's bar on the corporate practice of medicine and to expand the scope of practice of allied health professionals.
Over the next few months, CMA will be setting its legislative priorities for next year, guided by the policies and priorities set this week by CMA's House of Delegates.
Contact: Teresa Stark, 916/444-5532 or tstark@cmanet.org.
8. CMA Announces HIT List Program
The federal stimulus package passed earlier this year included billions of dollars to help physicians purchase and transition to electronic health records (EHRs). As part of CMA's efforts to help physicians adopt and become "meaningful users" of health information technology (HIT), we will soon be launching the CMA HIT List program. The HIT List will provide CMA members with objective and transparent physician reviews of products, an online vendor-neutral comparison tool, a secure online community for physicians to discuss products/technology and the success or failures of implementation, and direct assistance to select, implement, and become "meaningful users" of HIT.
CMA has selected 10 best-in-class EHR vendors and HIT service providers to participate in the HIT List program. These vendors, selected via a thorough, physician-directed vetting process, will work with CMA to help physicians assess and implement EHRs and other HIT products. The selected vendors include: Allscripts, athenahealth, Cerner, eClinicalWorks, e-MDs, GE Healthcare, Greenway Medical Technologies, McKesson, NextGen, and Sage.
Through the HIT List program, CMA members will receive preferred pricing and members-only discounts from participating vendors. Members will also be guaranteed fair market practices on product upgrades, support, and maintenance fees, and have access to model EHR vendor contracts, as well as ongoing EHR educational seminars and webinars.
Contact: Enid Gallegos, 916/551-2030 or egallegos@cmanet.org.
9. Next Week is Health Care Decisions Week; Physicians
Urged to Talk to Patients About End-of-Life Wishes
October 25 - 31 is California's annual "Health Care Decisions Week." The yearly event was established to encourage Californians to think and talk with loved ones about their wishes for end-of-life medical care, before a serious illness or injury occurs.
Health Care Decisions Week is the perfect opportunity to talk with your patients about Advance Health Care Directives and Physician Orders for Life Sustaining Treatment.
An Advance Health Care Directive enables individuals to make sure that their health care wishes are known in advance and considered if for any reason they are unable to speak for themselves. An advance directive also allows a patient to appoint a health care "agent" who will have legal authority to make health care decisions in the event that patient is incapacitated, or immediately upon appointment if the patient expressly grants such authority.
Physician Orders for Life Sustaining Treatment (POLST) this year became a legally recognized document, similar to the widely used "Do Not Resuscitate" (DNR) orders. The POLST form, used for patients with a serious illness or whose life expectancy is a year or less, outlines a plan of care reflecting the patient's wishes concerning medical treatment and interventions at life's end. The POLST form compliments an advance directive by turning a patient's treatment preferences into actionable medical orders.
For more information, see CMA's Advance Health Care Directive and POLST kits at http://www.cmanet.org. The kits include legal forms and wallet identification cards, and answer many of the most frequently asked questions about these issues.
CMA encourages physicians to keep a supply of forms in their office for patient use. The Advance Health Care Directive and POLST kits can be purchased for $5 each at CMA's online bookstore. Members receive a 15 percent discount on orders of 10 to 200 copies. Members who order 500 or more copies receive another 10 percent off the nonmember price. To receive your member discount, be sure to log in before you place the items in your shopping cart.
Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
10. Best Practices: Monitoring Financial Benchmarks
In today’s challenging health care environment, it is critical for physicians – particularly those in solo and small group practices – to monitor their revenue streams. One way to do this is by using comparative benchmarks of industry best practices.
Chapter 5 of CMA’s Best Practices tool kit will show physicians how to use financial benchmarks to help identify and address inefficiencies that impact your practice overhead, staffing productivity, and ultimately, your income.
CMA published the 140-page Best Practices tool kit 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 perform an EHR needs assessment, the tool kit will also teach you:
- 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;
- How to improve the patient experience;
- And much more.
The Best Practices tool kit, available free to all physicians, is organized into nine chapters that can be read sequentially or on an as-needed basis. Download the tool kit today.
Contact: CMA’s reimbursement help line, 888/401-5911 or fnavarro@cmanet.org.
11. CMA's Annual CEO Report Available Online
All physicians are invited to download and read CMA's annual CEO report. The document, presented to the delegates at CMA's annual House of Delegates meeting, provides a brief overview of the work CMA has done on behalf of the physicians of California over the past year.
Click here to download the report.
Contact: Ned Wigglesworth, 916/444-5532 or nwigglesworth@cmanet.org.
12. Featured Member Benefits
Staples: Members get Up to 80% off office supplies and equipment from Staples. The Staples Advantage program allows CMA members to leverage group purchasing power for all of their office supply and furniture needs.
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.
RxSecurity: Members get 15% off tamper-resistant security prescription pads and printer paper. Even Rx Security's nonmember prices are superior to the public pricing posted by most other approved security printers.
For more information on these and other member benefits, visit http://www.cmanet.org/benefits or contact CMA at memberservice@cmanet.org or 800/786-4CMA.
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