CMA Urges Physicians to Tell DMHC that ER System Will Collapse Under Weight of Proposed Regulations
[Posted 08/31/06]

The Department of Managed Health Care (DMHC) recently proposed new regulations that put California’s emergency care system at risk of collapse by inhibiting physicians’ ability to bill for services rendered. The proposed regulations were filed in response to an executive order issued last month by Gov. Arnold Schwarzenegger, which directed DMHC to stop physicians from billing patients for emergency care.

The regulations are open for public comment until October 2. It is critical that DMHC hear from physicians, county medical societies, and specialty societies so that the state understands the severe economic impact that these regulations will have on physicians and the health system in general. Comments may be sent either to DMHC directly or to CMA for inclusion in the association’s formal comments.

CMA has posted on its website templates that organizations and individual physicians or physician groups can utilize when preparing their comments. Please keep in mind that these templates are only models, and you should tailor your comments to reflect your particular circumstances and explain in your own words how these regulations will affect your practice. Even if you submit your comments to DMHC directly, please also send a copy to CMA by e-mail (legalinfo@cmanet.org) or fax (415/882-5143).

These regulations attack the future viability of physician practices. They do not address the key underlying problems of unfair contracts, which result in inadequate physician networks, and chronic and pervasive underfunding of emergency care by insurance companies. Physicians don’t want to bill patients. This only happens because insurance companies each year don’t pay millions of dollars of fair and legitimate ER bills from individual physicians, and don’t put enough money into ER risk through capitation to medical groups.

With health insurance profits soaring, these regulations reward for-profit HMOs that underfund emergency care for their insureds. This will further discourage insurers from contracting with physicians and capitated medical groups at fair rates.

CMA is prepared to fight the proposed regulations through the regulatory process and the association will sue DMHC if the regulations are adopted as proposed. CMA is collaborating with a media advocacy expert to craft an aggressive public relations strategy. CMA is also developing a grassroots campaign and will be working with county medical societies to coordinate physician media interviews, community presentations, and letters to the editor. Additionally, CMA is crafting a legislative package that would help stabilize California’s emergency care system (to be introduced in 2007-08 legislative session).

Click here to read the proposed regulations.

Contact: Susan Bassett, 916/444-5532 or sbassett@cmanet.org.