Take action NOW to stop radical physician rate regulation bill Assemblymember Ash Kalra (D-San Jose) last week announced a radical proposal that would increase patient out-of-pocket costs and result in a dangerous government intrusion into the health care market by creating state-sanctioned rationing of health care for all Californians. Assembly Bill 3087 would establish an undemocratic, government-run commission with nine political appointees who would unilaterally set the price for all medical services that are not already controlled by the government, essentially eliminating commercial health care markets in California. None of the political appointees are required to be patient-focused or have any tangible experience in the delivery of health care to patients. AB 3087 will be heard in the Assembly Health Committee on April 24. Physicians are urged to visit actnow.io/PriceFixing to email their legislators and ask them to stop this dangerous bill. Sample messaging is provided. If you’re active on social media, please also click on the Twitter/Facebook icons to voice your opposition on these platforms. We are also encouraging ALL physicians to register their opposition to this bill with Assemblymember Kalra’s office via phone. To do so, visit actnow.io/PriceFixing, click on the phone icon and enter your information when prompted. You will immediately receive a call from (408) 752-5387 that will provide guidance on what to say and patch you directly to the author of this bill. More Ways to Take Action CMA is also asking physicians to answer a few questions about how AB 3087 will impact their practices. The survey results will help in our legislative efforts to fight this dangerous bill. And, if you are among California's physicians that will be forced into early retirement or out of state if AB 3087 passes, we want to tell your story. Drop us a line at communications@cmanet.org. “No state in America has ever attempted such an unproven policy of inflexible, government-managed price caps across every health care service,” said California Medical Association (CMA) President Theodore M. Mazer. “It threatens to reverse the historic gains for health coverage and access made in California since the passage of the Affordable Care Act.” Despite fundamentally altering how health care services are provided in California, the bill explicitly prohibits health care professionals from participating on the commission. This commission—constructed to view patient care simply as a cost center—would have the unprecedented authority to ration the timing and quality of care California patients receive by fixing the prices of the commercial health care market. This bill does nothing to ensure that patient out-of-pocket costs are decreased and moves California away from the goal of value-based care backwards to an antiquated fee-for-service model. It would also have the consequence of dramatically reducing consumer choices. “AB 3087 is a poorly conceived, monumental threat to patient access to health care that goes against the Assembly’s own expert recommendations,” said Dr. Mazer. “This dangerously flawed legislation would result in government-sanctioned rationing of care and higher out-of-pocket costs for patients.” The bill would also put additional cost pressure on the California health care delivery system by allowing lawyers and lobbyists to be reimbursed by the Commission for lobbying the Commission. This process mirrors existing intervenor fee models that have not reduced overall consumer cost—but have served as a means for special interests to, as one former State Insurance Commissioner alleged, get “fat off the public trough.” Brazenly, the bill also creates a direct funding mechanism that would financially benefit one of the bill's sponsors. AB 3087 also ignores the recommendations from the University of California, San Francisco’s report—commissioned by the Assembly—to achieve universal access to health care, which includes implementing a comprehensive strategy to overcome the physician workforce shortage in the state by removing barriers that prevent physicians and other clinicians from specializing in primary care and practicing in underserved areas. Currently, six of nine California regions are already facing a primary care provider shortage, and 23 of California’s 58 counties fall below the minimum required primary care physician-to-population ratio. The state needs 8,243 additional primary care physicians by 2030—a 32 percent increase. “AB 3087 would cause an exodus of practicing physicians, which would exacerbate our physician shortage and make California unattractive to new physician recruits,” said Dr. Mazer. “The legislature should reject AB 3087, and instead, focus on real solutions that further value-based care, ensure a patient can access a physician when they need one and tackle California’s physician shortage.” Historically, policies of inflexible and arbitrary price caps are viewed as ineffective in controlling costs and detrimental to access to health care. During federal health reform discussions, both the Obama and Clinton administrations considered price-cap proposals, but ultimately rejected them on the basis that they posed too many direct and indirect risks to the overall health care delivery system. Visit actnow.io/PriceFixing to take action today. April 24, 2018 General Grassroots Advocacy, Physician Workforce, Rate Regulation, State Legislation, State Legislative Advocacy 0 0 Comment Read More »
CMA survey finds rampant health plan payment abuses Despite a California law passed in 2000 to address widespread payment abuses by health care service plans, many payors continue to flout the law. A recent survey by the California Medical Association (CMA) confirms that health plans regularly engage in unfair payment practices, with two-thirds of physician practices reporting routine payment abuses in violation of state law. The Department of Managed Health Care (DMHC) has been slow to address provider complaints and has taken few enforcement actions against health plans that unlawfully underpay providers. When DMHC has acted, the penalty amounts have been small in relation to the economic injury to consumers and providers. Because of this, some health care service plans make economic decisions to violate the law, knowing that any penalty amount that may be imposed will be outweighed by the extra revenue the health plans will generate by, for example, underpaying medical care. Last month, CMA, along with its county medical societies and several specialty societies, surveyed physicians to obtain feedback on the health plans that are routinely engaging in unfair payment patterns, the types of violations and the results of physician efforts to resolve the issues both through internal plan processes as well as through DMHC. In a period of nine days, 741 physician practices representing thousands of physicians responded to the survey. Key survey results include: Two-thirds of physician practice respondents report routine problems with plans engaging in various unfair payment patterns, defined as a practice, policy or procedure that results in repeated delays in the adjudication and correct reimbursement of provider claims, as outlined in 28 C.C.R. §1300.71. More than half of practices report that health plans attempt to rescind or modify authorizations after the physician renders the service in good faith. Sixty-two percent report that Anthem Blue Cross is the most problematic when it comes to unfair payment practices; Blue Shield of California was second most problematic (52 percent). The health plan provider dispute resolution processes are largely ineffective, with 32 percent of practices indicating disputes are resolved only half of the time, and 29 percent indicating disputes are rarely resolved through the plans’ internal processes. Though most practices do utilize the health plans’ internal processes to attempt to resolve issues, 63 percent report that plans routinely fail to respond to their appeals within 45 business days of receipt, as required by California law. Anthem Blue Cross is identified as the most problematic (66 percent), with Blue Shield the second most problematic (61 percent). When health plans do respond to physician appeals, 74 percent of practices state the health plan responses do not include a clear explanation for the plans’ determination. These survey results confirm that health plans overwhelmingly continue to engage in unfair payment practices, despite the legislation that passed 18 years ago attempting to stop these abuses. It further demonstrates that, although plans are required to maintain fast, fair and cost-effective provider dispute processes, their processes are largely ineffective. To view the full survey results, click here. To address this issue, CMA is sponsoring AB 2674 (Aguiar-Curry), which would require DMHC to investigate provider complaints that a health care service plan has underpaid or failed to pay the provider in violation of the Knox-Keene Act. If DMHC finds that a health plan has unlawfully underpaid a provider, AB 2674 would require the penalty amount to, at a minimum, equal the amount of the underpayment plus interest. Furthermore, AB 2674 would protect the health care delivery system by ensuring providers are made whole when health care service plans violate the law. The bill would also deter future violations of the law, thereby saving providers and the state vital resources that should be invested in patient care. CMA can help you get paid Physicians are reminded that members have access to CMA’s practice management experts for free one-on-one help with contracting, billing and payment problems. Need assistance? Contact CMA's reimbursement helpline, at (888) 401-5911 or economicservices@cmanet.org. April 5, 2018 CMA, General, Managed Care Department of Managed Health Care, DMHC, Payors, State Legislation, State Legislative Advocacy, Unfair Payment Practices 0 0 Comment Read More »
Gov. Brown signs CMA-sponsored responsible beverage service training bill On Sunday, October 15, Gov. Jerry Brown signed a bill sponsored by the California Medical Association (CMA) and introduced by Assemblywoman Lorena Gonzalez Fletcher, requiring individuals who sell or serve alcoholic beverages to undergo responsible beverage service training. “The purpose of this law is simple: to help educate bartenders about how to serve alcohol responsibly and how to recognize when a customer’s had enough to drink,” Assemblywoman Gonzalez Fletcher said. “This law will mean fewer drunk drivers on the road, which will reduce the risk of future tragedies. It will also help reduce all the other problems caused by someone drinking too much at a bar.” The bill (AB 1221) is the result of a tragic drunk-driving accident that killed two UC San Diego medical students in 2015. In the wake of the accident, classmates of the victims worked with Assemblywoman Fletcher and CMA to develop legislation that would better equip servers and bartenders to identify signs of overconsumption and intervene before tragedy strikes. California is now the 19th state, along with the District of Columbia, to require that bartenders and servers receive mandatory training on alcohol responsibility. Oregon mandated responsible beverage service training three years ago and estimated a 23 percent decrease in fatal single-vehicle nighttime crashes. “Responsible beverage service training can't bring back our brilliant, compassionate classmates, but it can prevent other communities from having to mourn the senseless loss of loved ones to drunk drivers,” said Daniel Spinosa, one of the victims’ classmates at the UCSD School of Medicine. “This bill will empower bartenders and servers to save lives. We wish it had been law years ago." November 14, 2017 CMA, General Medical Students, State Legislation, State Legislative Advocacy 0 0 Comment Read More »
State suspends clinical lab license fees for two years Governor Brown signed a bill (AB 658) on Sept. 28 that suspends the state's clinical laboratory license renewal fees for two years, 2018 and 2019. The bill is a result of an audit that found that the California Department of Public Health (CDPH) had collected millions more in laboratory fees than it had spent operating the Laboratory Field Services (LFS) branch. The fund’s current reserves exceed $22 million. Under existing state law, however, CDPH could not suspend or refund these fees. This bill only suspends renewal fees and will not apply to other fees like multiple site, personnel licensure, new lab or delinquency fees. Fees will be reinstated in 2020, but going forward CDPH will only be permitted to collect enough fees to operate its LFS branch, as spelled out in the current law. Labs in California—including physician operated labs—should see significant savings over the next few years as licensing fees paid to the state are lowered after the freeze. Did you know? Did you know that COLA Laboratory Accreditation is a California Medical Association (CMA) member benefit? COLA a physician-directed organization whose purpose is to promote excellence in laboratory medicine and patient care through a program of voluntary education, consultation and accreditation. This member benefit provides a 20 percent savings on COLA’s Laboratory Accreditation Program. COLA is approved by LFS under state law as well as the federal CLIA program. By enrolling, your one COLA survey every two years will meet both state and federal regulations. CMA members also receive free online support and a complimentary basic quality lab course and may be eligible for a discount on AAFP and ACP proficiency testing programs. Click here to learn more about COLA and to access the CMA member discount code. October 13, 2017 General Accreditation, Clinical Laboratories, State Legislation, State Legislative Advocacy 0 0 Comment Read More »
CMA urges Gov. Brown to sign responsible beverage service bill Educating beverage servers in bars and restaurants is a key part of reducing drunk-driving fatalities. The California Legislature has passed a bill sponsored by the California Medical Association (CMA) that would require California bartenders, servers and managers to receive responsible beverage service training based on a curriculum developed by the Department of Alcoholic Beverage Control. The bill—AB 1221 (Gonzalez Fletcher)—now heads to Governor Brown for his signature. Contact the governor’s office today and urge him to sign this important bill! The bill is the result of a tragic drunk-driving accident that killed two UC San Diego medical students in 2015. In the wake of the accident, classmates of the victims worked with Assemblywoman Gonzalez Fletcher and CMA to develop legislation that would better equip servers and bartenders to identify signs of overconsumption and intervene before tragedy strikes. “Responsible beverage service training can't bring back our brilliant, compassionate classmates, but it can prevent other communities from having to mourn the senseless loss of loved ones to drunk drivers,” said Daniel Spinosa, one of the victims’ classmates at the UC San Diego School of Medicine. “This bill will empower bartenders and servers to save lives. We wish it had been law years ago.” Responsible beverage service training provides bartenders and servers with tools to effectively identify when a patron has had too much to drink, and how to safely intervene if necessary. Eighteen other states and the District of Columbia already require such training. Three years after Oregon mandated responsible beverage service training, fatal single-vehicle nighttime crashes decreased by an estimated 23 percent. AB 1221 is supported by health and public safety organizations including Alcohol Justice, California Academy of Preventive Medicine, California Chapters of the American College of Physicians, California Restaurant Association and Mothers Against Drunk Driving. October 13, 2017 General Medical Students, State Legislative Advocacy, Alcohol, State Legislation 0 0 Comment Read More »
CMA publishes 2016 Legislative Wrap-Up The delivery of health care, and its costs, remains at the forefront of California politics. Dramatic changes, such as the Affordable Care Act, escalating health care premiums, consolidation of health plans, rising drug costs and the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), continue to create uncertainty in the marketplace, causing a relatively new state legislature to question nearly every aspect of health care delivery in California. The result during the 2016-2017 legislative session was a record number of significant legislative challenges to the core policy beliefs of the California Medical Association (CMA). CMA Senior Vice President of Government Relations Janus Norman has published his annual Legislative Wrap-Up, which provides an insider's take on what went down this session—including the great opportunities, great threats and great compromises faced by the House of Medicine. "Change is happening, and change will continue to happen," said Norman. "CMA's charge must be to look into the future and act boldly to shape the world of health care in a way that is most favorable for all physicians and their patients." CMA's 2016 Legislative Wrap-Up, "Yet Again, We Rise," also includes a comprehensive list of all the major bills that CMA followed this year and their outcomes. The wrap-up is available to members only in CMA's online resource library. October 13, 2016 General State Legislative Advocacy, State Legislature, State Legislation 0 0 Comment Read More »
CMA Capitol Insight: April 26, 2016 CMA Capitol Insight is a biweekly column by veteran journalist Anthony York, reporting on the inner workings of the state Legislature. __________________________________________________________________________________________________________________ The Legislative Scramble Last week was a frantic one inside the Capitol as lawmakers faced a key deadline to pass bills out of policy committee. Measures that did not receive committee approval last week were shelved for the year. A number of major proposals lived to fight another day, but many efforts were left on the prominent pile of abandoned bill ideas that accumulates each and every year. Among those bills that were put on hold for the year was a measure by Assemblywoman Lorena Gonzalez to find new ways to help gig workers strengthen their collective voice in dealing with management. As income inequality has increased across the nation, there has been a simultaneous reduction in union representation – a fact that many union proponents say has been a contributing factor to the gap between the haves and have-nots. Gonzalez is one of a growing group of Democrats looking for new ways to give workers a voice in our changing economy. Unions have had their own problems over the last several decades, and Gonzalez’s bill was an effort to allow contract workers to bargain collectively, if not necessarily through a formal union. The measure had opponents on the right and the left, with many in organized labor raising concerns about the limits and structures of this new gig-worker representation. While the bill has failed for the year, the concept is sure to be one that lawmakers will be forced to wrestle with as they continue to try to find ways to tweak public policy to stem some of the troubling workplace trends of the last four decades. The winnowing of the legislative agenda also included the end of efforts to impose new taxes on soda and other sweetened beverages. The effort by Santa Monica Assemblyman Richard Bloom was shelved after failing to generate support in the lower house. The end of the soda-tax campaign marks the latest setback for the statewide and national efforts to impose soda taxes. While some localities in California (most notably Berkeley) have passed local levies on sugary drinks, the effort has yet to gain traction statewide. This year’s defeat begs the question of when, if ever, the legislative effort to tax soda may gain critical mass. Perhaps a budget slowdown will give the soda tax – and other taxes – the momentum they need. The tax haul from April is typically crucial in the state budgeting process, and data from the state controller’s office shows that income tax revenues – which account for two-thirds of all general fund revenues – are about $3 billion lower than the forecast in Gov. Jerry Brown’s January budget. If those numbers don’t improve, it could have dire consequences for everything from Medi-Cal spending to other state services. We’ll be watching as the governor’s May Revision approaches… But supporters of additional revenues did get some good news last week. A survey from the Public Policy Institute of California shows 62 percent of likely voters say they are in favor of extending the higher income taxes for upper earners. In 2012, when Prop. 30 was on the ballot, there was no real concerted effort to combat the income tax hike. With these strong poll numbers, and the higher tax rates already in place, it seems increasingly less likely that there will be well-funded opposition against the measure. What remains unclear is the role of the governor in this campaign. When Brown pushed for higher taxes in 2012, he was the spokesman and champion of the effort to get it passed. But he also promised voters the tax was temporary, and he has been lukewarm, at best, about the prospects of an extension. We’ll see if the slow income tax numbers change his tune. Over the next couple of weeks, we expect ballot-measure proponents to begin submitting signatures to county elections offices as the race for the November ballot enters its final phase. Next time, we’ll have a more in-depth budget preview and a look ahead at how the November ballot is taking shape. April 28, 2016 CMA, General CMA Capitol Insight, Anthony York, State Legislation 0 0 Comment Read More »
CMA-sponsored beverage training bill receives committee approval A bill sponsored by the California Medical Association (CMA) that would require all restaurant and bar employees who sell or serve alcoholic beverages to undergo responsible beverage service training was approved on a bipartisan 18-0 vote by the Assembly Committee on Governmental Organization on Wednesday. Assembly Bill 2121 would make Department of Alcoholic Beverage Control (ABC) responsible beverage training mandatory statewide for anyone serving alcoholic beverages. Educating beverage servers in bars and restaurants is a key part to reducing drunk-driving fatalities. Currently, the ABC has a free and voluntary program. The bill is the result of a tragic drunk-driving accident that occurred last year. In May 2015, two UC San Diego medical students were killed by a drunk driver going the wrong way, causing a collision that killed the two students and injured three others. In the wake of the accident, classmates of the victims worked with Assemblywoman Lorena Gonzalez and CMA to develop legislation that would better equip servers and bartenders to identify signs of overconsumption and intervene before tragedy strikes. “Responsible beverage service training can't bring back our brilliant, compassionate classmates, but it can prevent other communities from having to mourn the senseless loss of loved ones to drunk drivers,” said Daniel Spinosa, one of the victims’ classmates at the UCSD School of Medicine. “This bill will empower bartenders and servers to save lives. We wish it had been law years ago.” According to the National Highway Traffic Safety Administration, more than 10,000 people in the United States die on our roadways due to drunk driving every year, the equivalent of one fatality every 53 minutes. Even though training is not currently mandatory at the state level, many local governments have made Licensee Education on Alcohol and Drugs training mandatory. Additionally, 18 other states and the District of Columbia have already established a mandatory responsible beverage training course. AB 2121 is coauthored by Senator Richard Pan, M.D., (D-Sacramento) and supported by health and public safety organizations including the California Police Chiefs Association; Mothers Against Drunk Driving; American Academy of Pediatrics, California; County Health Executives Association of California; and San Diego Police Officers Association. April 22, 2016 General Advocacy, Alcohol, State Legislation 0 0 Comment Read More »
Tragic deaths of two medical students at the hands of drunk driver inspires sponsored legislation for 2016 session The California Medical Association (CMA) has announced its sponsored bill package for the 2016 legislative session. Among them is a bill inspired by the tragic deaths last year of two medical students from the University of California, San Diego (UCSD), at the hands of a drunk driver. In May 2015, two UCSD medical students were killed by a drunk driver going the wrong way, causing a collision that killed two medical students and injured three others. In the wake of the accident, classmates of the victims worked with Assemblywoman Lorena Gonzalez and CMA to develop legislation (Assembly Bill 2121) that would better equip servers and bartenders to identify signs of overconsumption and intervene before tragedy strikes. “Responsible beverage service training can't bring back our brilliant, compassionate classmates, but it can prevent other communities from having to mourn the senseless loss of loved ones to drunk drivers,” said Daniel Spinosa, one of the victims’ classmates at UCSD School of Medicine. “This bill will empower bartenders and servers to save lives. We wish it had been law years ago.” More details about CMA's sponsored bill package are below: AB 2121 (Gonzalez) – Responsible Beverage Service Training This bill seeks to help reduce alcohol service to intoxicated individuals and to reduce drunk driving by requiring establishments that serve alcohol to employ servers and managers who have received responsible beverage service training. AB 2209 (Bonilla) – Prohibiting Secret Treatment Plans This bill prohibits health insurance plans from developing and implementing clinical care "pathways" that dictate how medical professionals practice medicine. SB 867 (Roth) – Emergency Medical Services Current law requires a portion of certain infractions and fines to be donated in the Maddy Emergency Medical Services Fund, which provides reimbursement to physicians who treat uninsured patients. This bill would remove the sunset date on the program, making it a permanent program. SB 1177 (Galgiani) – Physician and Surgeon Health and Wellness Program This bill will reestablish a Physician Health and Wellness Program for California physicians suffering from substance abuse, mental and behavioral health issues. For more information on these and other bills of interest to physicians, subscribe to CMA’s Legislative Hot List at www.cmanet.org/newsletters. March 31, 2016 General Advocacy, Emergency Services, Physician Wellness, State Legislation, Alcohol 0 0 Comment Read More »
National 'Match Day' largest on record, but many California students must study elsewhere The National Resident Matching Program announced today that the 2016 Match Day for graduating medical students was the largest on record, with 42,370 registered applicants and 30,750 positions filled. The number of United States medical school seniors grew by 221 to 18,668, and the number of available first-year positions rose to 27,860, which is 567 more than last year. "Match Day," an annual rite of passage for future physicians, is the system through which medical school students and graduates obtain residency positions in U.S. accredited training programs. Despite the high numbers of candidates matching with residency programs this year, hundreds of qualified California students must leave the state to study elsewhere due to a lack of funding for graduate medical training, highlighting the need to pass Senate Bill 22. “Each year, California is fortunate to have thousands of ambitious medical students apply for residencies across the state, eager to improve the health of their communities,” said Steven E. Larson, M.D., MPH, president of the California Medical Association. “Many of these physicians-in-training will one day be the backbone of health care in our state. But sadly, some will be forced to head elsewhere, since current funding levels are not high enough to ensure enough residency spots in California. The data tells us that if a medical student is forced to leave the state to complete his or her training, it is more likely they will stay and practice out of state, despite our desperate need for more physicians, particularly in primary care.” California has lost tens of millions of dollars in funding for primary care physician training. In 2016 alone, more than $40 million of funding for the training of California’s primary care physicians is expiring. To help combat a physician shortage in the state and protect patients’ access to care, the state legislature is currently considering SB 22, which would direct state funds to new and existing graduate medical education primary care physician residency positions and support training medical school faculty. “Solving California’s dire physician shortage is critical to the health care for all Californians,” said Senator Richard Roth, author of SB 22. “I introduced Senate Bill 22 to fund additional medical residency positions throughout our state’s medically underserved areas, especially in Inland Southern California and the Central Valley. Studies have shown that if we train tomorrow’s doctors in the areas that need them most, they are more likely to continue serving those areas, helping alleviate critical physician shortages and ensuring equal access to health care.” SB 22 has passed the Senate and is expected to be taken up by the Assembly Health Committee in June. March 31, 2016 General Match Day, Medical Students, Residents and Fellows, State Legislation, Graduate Medical Eduction 0 0 Comment Read More »
