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1. United Healthcare Amends Physician Contracts to Include
Medicare Advantage; Gives Physicians 30 Days to Opt Out
Physicians in some Northern California counties were recently notified that they would automatically be included in United Healthcare’s Medicare Advantage network effective January 1 unless they opt out in writing within 30 days. Physicians are advised to review the proposed addendum and fee schedule carefully as some physicians have reported that some fees are significantly below Medicare fees. The notice contained a “representative” fee schedule and informed physicians that they can obtain an expanded Medicare Advantage fee schedule by contacting the insurer.
Physicians who wish to opt out of United’s Medicare Advantage network must do so in writing. Opt-out letters should be sent certified mail with return receipt to United Healthcare, Centralized Physician Contracting, 8800 Grand Oak Circle, STE 100, Tampa, FL 33637.
Physicians should be aware that although United Healthcare’s notice states that the physicians must opt-out of the Medicare Advantage product within 30 days of receipt, California law requires insurers to provide contracted physicians with at least 45 days' notice of a material change to the contract and the opportunity to terminate the contract.
CMA has created a simple worksheet to help physicians analyze this and other proposed fee schedules and assess the financial impact on their practices based on their most commonly billed CPT codes. The worksheet is available to members at the members-only website.
CMA has also published a contracting tool kit, to help physicians analyze proposed fee schedules and negotiate and manage complex third-party payor agreements. The tool kit, “Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations—A Focus on Payor Contracting,” is available free to members at the members-only website. Nonmembers can purchase the tool kit for $100 in the CMA bookstore.
Click here for more information, including a sample opt-out letter.
Contact: Reimbursement help line, 888/401-5911 or drice@cmanet.org.
2. Appeals Court Reverses Ruling that Would Have Required
Clinic Licenses for Physician-Owned Surgery Centers
The California Court of Appeals recently reversed a decision that would have required physicians who own surgery centers to obtain a surgical license from the California Department of Health Services (DHS)if nonowner physicians would also be practicing in the facility. Currently, physician-owned surgery centers are exempt from DHS licensing requirements. If this ruling had been allowed to stand it would have had profound implications for ambulatory surgical centers.
CMA earlier this year filed an amicus curiae brief urging the Third District Court of Appeals in Sacramento to reverse its original ruling.
This ruling “would have subjected [physicians] to unwarranted and costly regulation, given the fact that physicians who own ambulatory surgical centers already are subject to stringent regulation by their licensing agency, the Medical Board of California,” stated CMA in the brief. “Further, it would essentially force physicians to practice in a partnership, as opposed to a medical corporation—the form of practice most commonly chosen by physicians, and therefore could increase physician liability for those physicians who must become partners in order to practice. The net effect of this opinion will be a needless increase in health care costs.”
The court agreed with CMA and vacated its earlier ruling.
Click here for more information.
Contact: CMA legal department, 916/551-2033 or legalinfo@cmanet.org.
3. CMA’s Annual House of Delegates
Convenes this Weekend in Anaheim
At this year’s House of Delegates, physicians from across the state will debate and set policy on important health care issues including health system reform, universal health care, and health care information technology. The House of Delegates convenes October 27 to 29 in Anaheim.
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.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
4. El Centro Physician Who Started Region’s First
Dialysis Center to Receive CMA’s Rural Doctor Award
Horacio Rodiles, M.D., was enjoying the urban doctor’s life in Orange County when he learned that kidney dialysis patients in remote Imperial Valley had to travel hundreds of miles to receive treatment.
As a kidney specialist, he knew that too many of these patients would forgo treatment and die prematurely. He couldn’t let that happen.
For a few years, he traveled hundreds of miles to the patients, but in 1978, he moved his wife, Sandra, and four children to the Imperial Valley, where he opened the region’s first dialysis clinic. He and his associates today oversee four dialysis centers in the region – including clinics in Blythe, El Centro, Calexico, and Brawley, serving 300 patients currently on dialysis and dozens of others who’ve had kidney transplants or are in other stages of renal disease.
Dr. Rodiles will be recognized on Saturday, October 27, with CMA’s Frederick K.M. Plessner Memorial Award for rural physicians. The award is presented annually to a physician who best exemplifies the ethics and practice of a rural practitioner. Dr. Rodiles will receive the award during ceremonies at the CMA’s Annual House of Delegates at the Disneyland Hotel in Anaheim, where a documentary video on his work will be shown to the nearly 900 in attendance.
Contact: Karen Nikos, 916/551-2069 or knikos@cmanet.org.
5. Have You Checked Your Medical Board Profile Recently?
Physician profiles have been available to the public on the Medical Board of California’s website since 1997, as required by Business and Professions Code sections 2027 and 803.1. CMA encourages physicians to periodically check their profiles for accuracy and advise the board of any corrections, especially changes to their addresses of record.
The board cautions physicians against using their home addresses as their address of record, because the addresses become widely available to the public on the Internet. You may designate a post office box as your address of record but, by law, you also must provide the Medical Board with a street address. If you designate a P.O. box as your official address, the medical board will not make public your street address.
Click here for more information, including a change-of-address form.
Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.
6. Help Prevent Childhood Obesity:
Become a Physician Champion Today!
CMA Foundation’s Physicians for Healthy Communities Initiative trains physicians to become “physician champions” who advocate for healthy eating and physical activity in their local schools and communities. Physician champions are given the tools, resources, and support needed to carry out successful obesity prevention campaigns in their communities.
The foundation is holding two training sessions next week in the Los Angeles area. The first is Thursday, November 1, 6 p.m. to 9 p.m., at the Los Angeles County Medical Association. The second is Saturday, November 3, 9 a.m. to noon, at the Glendale Memorial Hospital and Health Center. Participants will also receive free Continuing Medical Education units.
If you would like to schedule a Physician Champion training in your county, contact the foundation at the number below.
For more information visit http://www.calmedfoundation.org.
Contact: Tiffanie Sherrer, 916/551-2031 or tsherrer@cmanet.org.
7. Watch the Mail for CMA’s Annual Report
CMA members will soon be receiving a copy of the association’s 2006-2007 annual report. In it, you will get some insight into the inner workings of CMA. You will read about some of your colleagues who tell why CMA membership is important to their practices and their lives. We hope you will be reminded why you are a CMA member and why you want to be part of this incredible force for good on behalf of patients in California.
 We encourage you to share this annual report with your nonmember colleagues and tell them what membership means to you and your patients. CMA can also provide you with “Wish You Were Here” note cards (pictured here) that you can use to encourage your fellow physicians to join CMA in its mission to preserve the physician-patient relationship, improve the public health, and protect the profession of medicine in California.
Contact: CMA’s member service center, 800/786-4CMA (4262) or info@cmanet.org.
8. Member Benefit of the Week:
$105 Off Part B News from Decision Health
CMA members receive $105 off a subscription to Part B News, the largest independent source of news and guidance for Medicare Part B billing and reimbursement issues. Regular subscription rate for 48 weekly issues is $509, but as a CMA member you pay a discounted price of $404.
A members-only discount code is needed to take advantage of this discount. Visit CMA’s members-only website or call the member service center at 800/786-4CMA (4262) to get your code.
Click here for more information on your membership benefits.
Contact: CMA's membership hotline, 800/786-4CMA (4262) or lgodward@cmanet.org.
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No. 2115
