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1. State Rejects Regulations that would
Expand Scope of Practice for Nonphysicians
The California Office of Administrative Law has rejected regulations proposed by the California Department of Public Health (CDPH) that would have expanded the scope of practice of psychologists and potentially all other health care practitioners working in licensed health care facilities.
CMA vigorously fought the proposed regulations through the regulatory process to ensure that the state understood the severe impact that these regulations would have on patient care and medical staff independence.
The regulations—which were intended to clarify state law as it applies to medical staff membership and privileges for psychologists—would have weakened medical staff self-governance rights and could have been broadly interpreted to allow unqualified health care professionals to carry out the duties of a physician or surgeon.
The proposed regulations could have, among other things, allowed nonphysician practitioners to admit patients, perform medical examinations, place patients in restraints, complete medical records, coordinate care, and order transfers. The regulations would have also circumvented the self-governance rights of medical staffs to establish and enforce the rules, regulations, criteria, and standards for medical staff membership and privileges.
Click here for more information.
Contact: Veronica Ramirez, 916/551-2887 or vramirez@cmanet.org.
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2. CMA Urges Investigation of Chiropractor
Unlawfully Practicing Medicine
CMA recently asked the Medical Board of California and the California Board of Chiropractic Examiners to investigate a California chiropractor who appears to be unlawfully practicing medicine and engaging in misleading advertising practices. In a solicitation sent to diabetic patients, the chiropractor not only is actively discouraging them from seeking care from physicians, but also suggests he will engage in a number of diagnostic activities that fall outside the scope of chiropractic practice.
Diabetes is a serious disease, with devastating complications if not properly treated and monitored. While chiropractors may legitimately provide chiropractic treatment to patients who happen to suffer from diabetes, CMA does not believe that it is within their lawful scope of practice to diagnose and treat diabetic patients independently.
CMA has asked both agencies to closely examine the conduct at issue in this case and take appropriate action to ensure patient safety.
Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
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3. House Introduces New Health Reform Bills
House Democratic leaders unveiled their latest version of health reform last week, in HR 3962, "America's Affordable Health Choices Act of 2009" and HR 3961 "Medicare Physician Payment Reform Act of 2009." These bills are a combination of the three versions of HR 3200 that had passed out of the Ways and Means Committee, Energy Commerce Committee and the Education and Labor Committee.
CMA is still reviewing the bill, but will likely continue to support some provisions and oppose others. CMA is continuously working to improve the bill and indeed, several improvements were made to HR 3962 (see below).
The two bills continue to include the $400 billion in physician-related payment fixes for Medicare and Medicaid services, including a repeal of the Medicare sustainable growth rate formula, increases for primary care physicians and the California geographic locality payment fix. House leaders were forced to move the physician payment provisions to a separate bill because President Obama asked that the health reform bill not increase the deficit. By doing so, the remaining health reform provisions come in well under the $900 billion limit set by President Obama and would reduce the deficit by $30 billion over 10 years.
Other notable changes include a new "millionaires tax" that would tax couples with gross incomes above $1 million at a rate of 5.4 percent to help pay for health reform. The bill also repeals anti-trust exemptions for the health insurance industry and clearly prohibits the use of "comparative effectiveness research" to make coverage or payment decisions or to interfere with the physician-patient relationship.
HR 3962 also expands the Medicaid program to cover families making up to 150 percent of the federal poverty level ($33,000 for a family of four). HR 3200 only covered families up to 133 percent. CMA supports this coverage expansion, but is strongly advocating that Medicaid payment rates must be raised so that this promise of coverage is not an empty one. While the bill does increase Medicaid payment rates for primary care physicians, we believe that specialty rates must also be raised.
The House reforms remain more favorable for physicians than the Senate reforms. CMA will continue to fight to improve both bills, and to ensure that the physician-friendly provisions in HR 3962 do not get lost when these bills get to conference committee.
Most predictions are that health reform will happen this year. Physicians must let Congress and the public know that the coverage expansions are an empty promise unless patients can find a doctor.
For more information, see CMA's health reform page.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
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4. CDC Study: For Every Confirmed Case
of H1N1, There Are Likely 79 Infections
As many as 5.7 million Americans were infected with H1N1 influenza during the first few months of the pandemic, according to a study published Thursday in the online journal Emerging Infectious Diseases. Although there were only 43,677 laboratory-confirmed cases of H1N1 between April and July, epidemiologists from the Centers for Disease Control and Prevention and the Harvard School of Public Health used computer models to estimate the actual number of people who contracted swine flu during that period.
Because many cases are not reported to public health officials, the researchers used well-known models of disease spread to estimate the true prevalence of H1N1 infections. Similar techniques are used each year to estimate seasonal flu infections. The researchers estimate that for every confirmed case of H1N1, there are probably 79 cases that went unreported.
According to the study, as many as 20,000 people were hospitalized and as many as 1,300 people died from their infections between April and July. Officially, 1,000 U.S. deaths have been attributed to H1N1 since April.
According to the California Department of Public Health, there have been over four thousand H1N1 hospitalizations in the state so far this year. Extrapolating from the researchers' data, this would put the total number of H1N1 cases in California at well over 1 million.
These latest numbers will undoubtedly create more angst among patients and physicians, as the vaccine remains scarce. As of Thursday, California had only received 2.8 million doses of the vaccine, less than 50 percent of initial projections. State public health officials have also released their stockpiles of N95 respirators, as health care providers have reported difficulty finding these protective masks. The CDC recommends that health care workers in close contact with patients with suspected or confirmed H1N1 wear fit-tested disposable N95 respirators.
Distribution of respirators and the vaccine continue to be handled by local public health officials. For more information on the situation in your area, please contact your local health department.
For more information, visit CMA's H1N1 page.
Contact: Veronica Ramirez, 916/551-2887 or vramirez@cmanet.org.
5. H1N1: What Questions Are Your Patients Asking?
There is understandably a lot of confusion and misinformation circulating among the public about H1N1. CMA wants to know what questions you are being asked most often, and what the most common misperceptions are among patients about H1N1. CMA will use this data, in conjunction with the California Department of Public Health, to develop materials and information to help educate the public about H1N1. Please let us know via e-mail (vramirez@cmanet.org), fax (916/444-5689), or phone (916/551-2887).
Contact: Veronica Ramirez, 916/551-2887 or vramirez@cmanet.org.
6. CMA Publishes H1N1 Billing Guide for Physicians
To help physicians understand how to bill for H1N1 vaccine, CMA has reached out to all the major payors in California for clarification on their H1N1 billing policies. We have compiled this information into an easy to read chart available to members. You may also request a copy of the chart using the contact information below.
Contact: CMA's reimbursement help line, 888/401-5911 or jblack@cmanet.org.
7. Blue Cross Fails to Provide Adequate
Network for Healthy Families Patients
CMA has asked the Department of Managed Health Care to investigate Blue Cross's failure to provide an adequate network of physicians to care for the almost 3,400 Humboldt County children and expectant mothers enrolled in the insurers' Healthy Families and AIM programs.
Based on individual reports from physicians in Humboldt County and the physician directory posted on the State of California's Healthy Families website, it appears that the Blue Cross Healthy Families/AIM program only has only primary care physicians and only three specialists (all ophthalmologists) within 15 miles or 30 minutes of Humboldt County, leaving patients with little to no access to care other than the emergency room. And although not yet confirmed, we have also received reports that there are access issues in other California counties. State law requires insurers are required to have an adequate network of contracting health care providers to ensure access to care to all of its enrollees.
The network inadequacy appears to be a direct result of the Blue Cross's Healthy Families "recontracting" initiative, which became effective September 1, 2009. As part of this initiative, Blue Cross notified 53,000 physicians that they had to sign a new agreement and accept significantly reduced rates in order to continue treating Blue Cross Healthy Families/AIM patients. As is evident from the Healthy Families physician directory, many physicians chose not to sign the new contract. Most physicians have reported to CMA that the new rates do not cover the cost of providing medical care, leaving them no choice but to leave the Blue Cross Healthy Families network.
CMA is urging DMHC to quickly investigate these apparent violations and take all steps necessary to prevent Blue Cross from jeopardizing the physician-patient relationship and engaging in practices that may reduce patient access to medical care.
Click here for more information.
Contact: CMA's reimbursement help line, 888/401-5911 or jblack@cmanet.org.
8. CMA Publishes Toolkit to Help You Understand the
Impact Blue Cross Changes Will Have on Your Practice
Over the past several months, Anthem Blue Cross has announced several changes that will impact physicians. The changes include fee schedule, payment policy, and claims editing software updates, a switch to paperless EOBs, as well as a requirement that physicians sign new contracts and accept reduced rates to continue treating Healthy Family and AIM patients.
To help physicians understand the impact these changes will have on their practices, CMA has published a Blue Cross tool kit. The tool kit contains information on each of these changes, including important dates and links to important documents and sample letters.
The tool kit is available free to members-only at the members-only website.
Click here for more information.
Contact: CMA's reimbursement help line, 888/401-5911 or jblack@cmanet.org.
9. New York Acts to Halt Insurers Manipulating
Data; CMA Lawsuit for California Still Pending
The New York Attorney General last week announced details of a new database that will help determine how much insurance companies in New York pay for out-of-network care. The announcement is part of a settlement reached earlier this year with more than a dozen insurance companies. The lawsuit accused the industry of conspiring to defraud consumers by manipulating reimbursement rates and shortchanging consumers by hundreds of millions of dollars over the past 10 years.
As part of the settlement, UnitedHealth Group agreed to pay $50 million toward the creation of an independent database of physician charges that would replace its controversial Ingenix database, long used by insurers to calculate what they pay for out-of-network care. Insurers often pay a percentage of what they calculate as "usual, customary and reasonable" fees for out-of-network claims, commonly relying on Ingenix for this data. New York Attorney General Andrew Cuomo called Ingenix a "defective and manipulated database" after an investigation showed that the data was intentionally manipulated to allow health plans to shortchange patients and physicians.
Under the new plan, a nonprofit company will be set up to work with a group of state universities to operate the new database and consumer website. The database and website are expected to be completed within a year.
This type of intentional manipulation of data by insurers is not limited to New York. It is taking place all over the nation and patients and physicians in other states are not protected by the New York settlement. Earlier this year, CMA joined with other medical associations to file a class action lawsuit in Los Angeles federal court seeking damages from WellPoint, Inc. The lawsuit alleges that WellPoint colluded with Ingenix on a price-fixing scheme that relied on an obscure database to set artificially low reimbursement rates for out-of-network care.
Click here for more information.
Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
10. Best Practices: Managing Call Volume
For many medical offices, the volume of phone calls received daily is overwhelming. During periods of heavy call volume, calls may be dropped and wait times may be long, frustrating patients and staff alike.
Chapter 3 of CMA's Best Practices tool kit will show physicians' practices how to reduce unnecessary call volume, by systematically evaluating the reason for the calls and creating a plan for change.
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 assess your call volume, 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 helpline, 888/401-5911 or fnavarro@cmanet.org.
11. In the Spotlight: Retail health Clinics
Retail health clinics are seeking an ever-increasing role in the health care system. But while the clinics hold themselves out as a cheap, convenient place to get health care, they present real risks for both patients and the viability of primary care practices such as family physicians, pediatricians, and gynecologists, as former CMA President Dr. Dev GnanaDev recently explained at a panel discussion in Los Angeles broadcast on radio.
The importance of a primary care physician to look after and coordinate a person's health care is tough to overstate. These physicians monitor their patients' health, encourage healthier lifestyles, and identify diseases or conditions early in order to provide treatment or coordinate care with specialists as quickly and effectively as possible. Steady access to a primary care physician improves people's lives and health and help keeps health care costs down by ensuring the continuity of care necessary to catch problems early.
Most retail clinics are staffed primarily by PAs/NPs and do not incorporate active and engaged primary care physicians. By encouraging episodic care – one-time visits for specific services like flu shots or for cough or cold symptoms – these clinics threaten to undermine the long term health of our communities. This episodic care may address a specific need of a patient, but can discourage patients from seeking the regular check-ups that are the optimal means of maintaining their health and treating illness or disease, thus avoiding the higher cost care required for advanced conditions or untreated disease.
The relationship of retail clinics with pharmacies also poses concerns for quality patient care. Proposed business ventures between retail medical clinics and pharmaceutical chains create a strong potential for conflict of interest in prescribing, writing and filling based on the financial relationship. The potential for corporate profit-seeking to influence health care decisions is one of the reasons CMA fights every year to protect the ban on the corporate practice of medicine, successfully defeating three separate attempts to weaken or eliminate the corporate bar this year.
If done correctly, with a strong relationship with primary care physicians in the community, retail health clinics can play a safe and effective role in the health care system. Without physicians, retail clinics may create a false sense that patients are receiving all the primary care they need, and the empty promise of cheaper care.
Contact: Jodi Hicks, 916/444-5532 or jhicks@cmanet.org.
12. Featured Member Benefits
Rental Car Discounts: CMA members receive discounts on car rentals from Avis and Hertz. Click here to find out how you can save up to 25 percent on your next car rental. Members-only codes are needed to take advantage of these discounts. Visit http://www.cmanet.org/benefits or call the member service center at 800/786-4262 (4CMA) to get your codes.
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. A members-only link is required to access this discount.
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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