California Physician

1. New Member Benefit for Physicians, Their Families, and their Staff: the CMA Health Savings Account —Take control of your health care finances and earn federally tax-free interest and investment income
CMA is pleased to announce the new CMA Health Savings Account (HSA) Program for members, their families, and their office staff. An HSA is a tax-exempt account used to pay for current health care expenses and save money for future expenses.

To open an HSA, you must be covered by a qualified high deductible health plan (HDHP). Since HDHPs generally cost less than traditional health plans,
he money you save on monthly premiums can be deposited to your tax-exempt HSA. Not all “high deductible” plans qualify; the policy must conform to the HSA design specified by Congress.

CMA has partnered with Marsh Affinity Services and UMB Bank to simplify the HSA process, combining all of the necessary elements into one product. Whether you need a qualified HDHP or just want to open an HSA, you can do it all at CMA’s HSA Access Point, http://www.cmanet.org/hsa.

The CMA HSA has several unique features, including online enrollment and online account access. (You will be issued a digital certificate that will enable you to securely access your HSA online.) You will also be issued a special CMA HSA debit card.

There is no setup fee to open a CMA HSA. Monthly account fees are low and there is a broad array of options for investing your account balance. HSAs are fully portable and there is no rollover fee to move your account balance from another bank.

To maximize your federal tax deductions for 2006, you must complete the enrollment process by December 15.

2. CMA Survey of Physicians finds 75% Still Don’t Have
Flu Vaccines for All Patients, 54% Haven’t Received Any
CMA this week released the results of its flu survey, which found that 75 percent of responding physicians had not received their full vaccine supply by November 3. Fifty-four percent of physicians reported that they had not received any vaccine at all.

At a press conference Tuesday at CMA headquarters in Sacramento, CMA and the California Academy of Family Physicians (CAFP) urged public health officials to investigate this season’s vaccine distribution failures and ensure in the future that physicians get their vaccine supply before the “large box” retailers, including pharmacies and grocery stores. Such businesses have been dispensing shots since early fall.

“Despite being assured each year that supplies will be adequate and delivered to physicians on time, here we are again—we have high-risk, sick, and elderly patients being left unvaccinated,” says CMA CEO Jack Lewin, M.D. “This is intolerable. We need a fair, equitable, and efficient distribution system.”

Distribution has been sporadic, physicians report, with larger medical groups as well as high-volume distributors such as grocery chains receiving their supplies before private family physicians. The larger distributors are now reporting they are running out. “We have no quarrel with large distributors such as grocery stores and pharmacies giving shots, but these places should not have priority over your family doctor,” says Dr. Lewin. “All of this leaves patients confused, leading to fewer immunizations.”

Federal recommendations called for high-risk patients—the elderly, frail and those with chronic illness—to get their vaccinations by October 24 this year, with others following. But physicians report that even as the holiday season approaches, they have not been able to vaccinate their high-risk patients.

“This vaccine shortage has been especially bad for elderly and other vulnerable patients in rural California, where there are no chain stores,” says CAFP President Eric Ramos, M.D. “In more populated regions, these stores have no way of identifying who needs the vaccine most—they take all comers and that is bad for our most vulnerable patients.”

Dr. Ramos, who practices in Modesto, reported receiving just 10 doses of vaccine for his practice, which includes 1,500 high-risk patients.

CMA and CAFP encourage physicians to vaccinate all patients into January and February, as the flu season often peaks in late winter.

3. Medical Board Bill Eliminates Disciplinary
‘Cost Recovery,’ Raises Physician Licensing Fees
The Medical Board of California will no longer be able to coerce physicians into settlements with threats that they could be held financially liable for the cost of an investigation if they choose to exercise their due process rights and bring their case to hearing. The medical board reauthorization bill (SB 231) recently signed by Governor Schwarzenegger eliminates the medical board’s authority to charge physicians for investigation costs in disciplinary cases. CMA has been advocating for this change for more than 10 years.

“CMA has long believed that cost recovery inappropriately inhibits a physician’s right to pursue a defense vigorously, and this is a significant victory,” says CMA President Michael Sexton, M.D. “The bill allows the board to recoup lost revenue through increased licensing fees. Spreading the costs among all physicians will protect innocent ones who are forced to settle cases under the threat of huge financial penalties if some form of discipline is eventually imposed.”

The medical board has also been authorized to raise the biannual licensing fees from $600 to $790, an increase of 32 percent. (For comparison, California attorneys pay $780 in licensing fees every two years.) After many failed attempts to raise physician-licensing fees, the medical board was able to convince the legislature that increasing fixed costs would lead to a budget deficit within 2 years. CMA was, however, able to reduce the board’s proposed fee increase from $300 to $190.

This law follows a biased but highly publicized “audit” of the Medical Board Enforcement Program, which alleged that consumer protection was at significant risk if the board didn’t receive additional funds and adopt a wide variety of suspect “reforms.” Despite this hostile environment, CMA was able to remove most physician-unfriendly provisions from the reauthorization bill.

Increased Funds for the Diversion Program: Some of the fee increase will go to enhance the medical board’s Diversion Program, which monitors physicians with chemical dependencies or mental health problems. This important program has been seriously underfunded for years.

An Audit of the Medical Board: The medical board will undergo an independent financial audit next year so that the legislature can determine the appropriateness of the current physician licensing fee structure.

An Independent Medical Board: CMA defeated a proposal to eliminate the medical board investigation unit, and transfer to the attorney general’s staff the authority to investigate and prosecute cases of alleged physician misconduct. CMA opposed the so-called “vertical prosecution” model, which would have focused on developing a case for prosecution, rather than simply searching for the truth.

The Right to Appeal in Sacramento: CMA was also able to eliminate a provision that would have prevented most physicians from appealing a disciplinary action in Sacramento Superior Court. Physicians would have been forced to file appeals in their county, where judges can be less informed about regulatory issues and deference to state agencies is common.

4. Medicare Part D Resources Available at CMA Website
Medicare patients can begin enrolling in the new Medicare prescription drug coverage program this week. Because they trust you, your senior patients will inevitably come to you with questions about the program.

CMA has posted on its website (http://www.cmanet.org) a number of resources to help physicians and patients understand Medicare’s new prescription drug coverage. Click on “Medicare Part D Resources” under “CMA Spotlight.”

5. Your Blue Cross (Anthem/Wellpoint) Claim Form
Must Be Postmarked by November 17; That’s TODAY!
CMA reached a $135 million settlement with Blue Cross (Anthem/Wellpoint) in its class action RICO lawsuit. Most California physicians who bill insurance are due the maximum settlement payment. The maximum payment is expected to be at least $1,000, and could be as much as $3,000 or more!

The claim filing process is very simple. You do not need to submit receipts. All you need to do is check the box under “Section C” and select option 1, 2, or 3.

Even if you did not treat Blue Cross patients, you are still eligible for a share of the $135 million settlement. To be eligible, you need only have cared for any patients covered by any of the defendants in this case—CIGNA, Aetna, Anthem, Blue Cross, Coventry, Health Net, Humana, PacifiCare, Prudential, United Healthcare, and Wellpoint.

Don’t throw away money that is owed to you by this insurance company. If you have any questions, please call our legal information specialists at 415/882-5144 or e-mail them at legalinfo@cmanet.org.

6. Highlights from AMA Interim Meeting Available Online
AMA’s House of Delegates met in Dallas last week for its interim policy-making meeting. Click here for highlights of the actions taken by the delegates at that meeting.

Contact: Ginnie Yee, 415/882-5170 or gyee@cmanet.org.

7. Fighting Back: Holding Blue Cross and Other Health Plans Accountable;
What the RICO Settlements Mean to You and Your Practice
CMA, AMA, and the Santa Clara County Medical Society (SSCMS) are hosting a one-day seminar to educate physicians about the RICO settlements and what the settlements mean to their practices. The seminar will be Tuesday, November 29, 8 a.m. to 1 pm at the SCCMS offices in San Jose. Physicians in surrounding counties are also encouraged to attend.

To date, six major health plans (Blue Cross/Anthem/Wellpoint, Aetna, Cigna, Health Net, Prudential, and Humana) have settled CMA’s RICO lawsuit, which alleges that the health plan defendants have engaged in fraud and extortion in wrongfully denying payment to physicians, in violation of federal racketeering law.

Although the settlements have provided nominal cash payments to physicians, their true value lies in the prospective relief that is estimated to be worth more than $1 billion to physicians over the next few years.

Seminar participants will learn how to maximize their relief under the settlement by identifying inappropriate health plan business practices—including improper health plan claim denials—and holding the health plans accountable for failures to comply with the settlement terms. Under the settlement, the compliance process will be overseen by a court-appointed mediator.

Registration is $49 for CMA members, $149 for nonmembers.

Click here for registration information.

Contact: Aileen Wetzel, 916/444-5532 or awetzel@cmanet.org.

8. Free Online CME from CMA:
Medical and Health Disaster Preparedness and Response
CMA has converted the materials from its 8th Annual Disaster Preparedness Conference into a free downloadable CME program for physicians, nurses, and other allied health professionals. The program has been approved for one hour of CME.

Click here for more information.

Contact: Karen Nikos, 916/551-2069 or knikos@cmanet.org.