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1. Congress Postpones Medicare Payment Cuts for 6 Months
This week Congress passed a Medicare bill that postpones the 10 percent physician payment cut and instead provides a 0.5 percent increase for six months. The bill also extends the current State Children’s Health Insurance Program through March 2009. It does not, however, fix California’s geographic payment problems. The President is expected to sign it immediately.
But the reprieve is brief. Physicians are still faced with a 10 percent payment reduction on July 1, unless Congress revamps the hopelessly broken formula used to calculate physician pay (or acts again with another last-minute fix).
“Although CMA is relieved that Congress acted to stop the 10 percent physician payment cut, the association is extremely frustrated that Congress has been unable to fix the underlying problems, leaving physicians facing significant payment cuts in future years,” says CMA President Richard S. Frankenstein, M.D. CMA is also disappointed that the bill did not include a geographic payment fix for California.
Even though the Senate failed to pass a comprehensive Medicare payment reform bill, physicians gained a lot of important ground with the House-approved CHAMP Act. That bill, passed by the House in July, contained many physician-friendly provisions. It would have stopped the 10 percent SGR cut in 2008 and the 5 percent cut in 2009, replacing them instead with 0.5 percent increases in each of those years. It would also have updated California’s geographic payment localities and prevented any geographic payment reductions for three years.
CMA will continue to fight aggressively for physicians and patients by building on these advances. We will not relent until Congress reaches a long-term agreement to overhaul the physician payment system. Physicians cannot continue to practice in such an unstable environment, waiting year after year for Congress to act at the last minute to reverse such devastating cuts.
In addition to the provisions detailed above, the bill also:
- Continues the 1.5 percent bonus payment for physicians who
particpate in the voluntary quality-reporting system.
- Extends the 5 percent bonus for physicians practicing in federally-designated health professional shortage areas.
- Does NOT cut reimbursement for outpatient imaging services.
- Does NOT include a ban on physician-owned specialty hospitals.
Click here for more information, includind a summary of the bill's major provisions.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
2. Congressman Stark to Speak at CMA’s
11th Annual Health Care Leadership Academy
Congressman Pete Stark (D-Calif.), Chair of the Ways and Means Health Subcommittee, will address CMA’s 2008 Leadership Academy. Congressman Stark, an ally to physicians in the 2008 fight to fix Medicare’s flawed Medicare payment formulas, will discuss “The Future of Medicare.”
This year’s academy will be May 2-4 at Disneyland’s Grand Californian Hotel in Anaheim. Building on last year’s successful program, the 2008 academy not only will address leading-edge trends and developments in health care, but also will feature a slate of practical practice management-oriented workshops for physicians and office staff.
New for 2008 will be discounted registration fees for young physicians. Registration will open in February. Stay tuned for more information.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
3. California Assembly Passes Health Reform Bill
The State Assembly Monday passed AB 1X1, which would overhaul the health care system in California. This bill now goes to the Senate, where it will be considered at the earliest in mid-January.
CMA has been involved in intense health reform negotiations with Assembly Speaker Fabian Núñez and Governor Arnold Schwarzenegger over the past few weeks. These negotiations were successful on a number of issues. The bill did not expand scope of practice for PAs and NPs, as the governor had previously proposed. It also includes a $500 million Medi-Cal rate increase and, most importantly, an annual increase in perpetuity.
However, some issues of critical importance to physicians remained unresolved, including pay-for-performance, medical loss ratios, e-prescribing, transparency and quality measures, and adequate networks. There was also no financing language available for review. Despite these outstanding issues, the Speaker chose to send the bill to the floor for a vote.
Senate President pro Tem Don Perata is taking a more cautious approach to the bill. “When major legislation passes with great fanfare, it’s easy to get caught up in the moment, play to the cameras, and quickly go along,” Perata said In a statement issued on Tuesday. “It happened when the state enacted energy deregulation – only to create a crisis from which we’ve yet to fully recover. That’s not something I intend to repeat, especially on an issue as crucial to our state as the health of its citizens. The Senate will debate and act on healthcare reform when we have the facts to be sure we’re getting it right.”
CMA is already working closely with Senator Perata to address the deficiencies of the current proposal and make needed improvements.
“The physicians of this state want to know that their issues have been addressed and that the underlying framework of this proposal is adequately financed to deliver on the promises it makes to patients,” says CMA VP of Government Relations Dustin Corcoran.
Contact: Dustin Corcoran, 916/551-2572 or dcorcoran@cmanet.org.
4. Highmark Blue Cross Blue Shield Settles RICO Lawsuit;
Deadline to Claim Your Settlement Share Is February 27
Highmark Blue Cross Blue Shield has agreed to a $10 million settlement in a class action lawsuit that affects over 900,000 physicians nationwide. This settlement is separate from the earlier Blues parties’ settlements and covers four out-of-state plans, including Highmark Inc., Keystone Health Plan West, Inc., Highmark West Virginia, Inc. (d/b/a Mountain State Blue Cross Blue Shield), and Parker Benefits, Inc.
Even physicians who did not treat patients covered by one of the settling insurers are eligible to claim a share of the $10 million settlement. The class includes all physicians who billed any of the Blue Shield companies or their contracted intermediaries (capitated medical groups, IPAs, etc.) for services provided between May 22, 1999 and November 19, 2007.
The case, Rick Love, M.D. v. Blue Cross Blue Shield Association, was filed in May 2003 in federal district court in Miami. The suit accused the insurers of a pattern and practice of denying and delaying care, including intentionally programming computer billing databases to automatically downcode physician claims. The suit was filed under the federal civil RICO (Racketeering Influenced and Corrupt Organizations) statutes.
Although CMA is not a plaintiff in the suit, the suit affects all physicians because of its class-action status.
The deadline to submit a claim is February 27. You do not have to provide documentation for individual claims. To receive a share of the settlement, you need only calculate the aggregate payments received from the settling Blue Shield companies from 2004 to 2006. Physicians with $5,000 or less in claims billed to the settling defendants are eligible for one pro rata share; those with $5,001 to $49,999 are entitled to five shares; and those with more than $50,000 will receive 10 shares. The share value will be determined once all claims have been received.
Claims submitted to Blue Shield of California should not be included in the calculations. As you may know, Blue Shield of California refused to settle this lawsuit. Because Blue Shield of California was unwilling to settle, most California physicians will only be entitled to one settlement share. Physicians who have treated a large number of out-of-state Blue Shield patients may be entitled to more.
Settlement notices, including claim forms and filing instructions, were mailed to physicians last week.
Click here for more information, including claim forms and filing instructions.
Contact: Desiree Rice, 916/551-2865 or drice@cmanet.org.
5. Free CME from CMA Foundation
The CMA Foundation is hosting a free obesity prevention CME program on Saturday, February 9, 10 a.m. to 1 p.m. at the Santa Clara County Medical Association. Physicians, residents, medical students, and other health professionals are invited to attend.
This “Physicians for Healthy Communities” training is a presentation of the foundation’s Obesity Prevention Project. Presenters will outline the nature of the obesity epidemic and discuss strategies for understanding its diverse social, political, and environmental factors. Attendees will learn advocacy strategies, establish partnerships with key community members and organizations, and carry out community and school-based educational programs that emphasize nutrition and physical activity as healthy behaviors inherent to obesity prevention.
Immediately following the training, participants are invited to attend a meeting to discuss chronic disease management in Santa Clara County.
For more information visit http://www.calmedfoundation.org.
Contact: Tiffanie Sherrer, 916/551-2031 or tsherrer@cmanet.org.
6. Member Benefit of the Week: Free Portfolio Checkup
CMA members get a free portfolio checkup — a $250 value — from CMA’s affinity partner, Mercer Advisors.
Mercer Advisors manages over $3 billion in assets, mostly for doctors. Mercer’s long-term investment strategy is firmly based on academic studies that identify the location of risk and return in capital markets.
Because Mercer Advisors is fee-based rather than commission-based, you can rest assured that its financial experts have your best interests at heart.
Members also get $500 off Mercer’s “Economic Freedom Program,” a comprehensive program that includes financial planning, investment management, and retirement and estate planning.
To schedule your free portfolio checkup, call 800/898-4642.
Click here for more information on your membership benefits.
Contact: CMA's membership hotline, 800/786-4CMA (4262) or info@cmanet.org.
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