Survey: How would the AB 3087 price fixing proposal affect your practice? Assemblymember Ash Kalra (D-San Jose) last week announced a radical physician rate setting proposal (AB 3087) that would increase patient out-of-pocket costs, create state-sanctioned rationing of health care for all Californians and force physicians out of state or into early retirement. The California Medical Association is asking physicians to answer a few questions about how AB 3087 will impact their practices. The survey is anonymous and the results will help in our legislative efforts to fight this dangerous and irresponsible legislation. Take the survey now at: www.surveymonkey.com/r/ab3087. 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. April 24, 2018 General Rate Regulation, State Legislative Advocacy 0 0 Comment Read More »
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 »
CA Physicians Overwhelmingly Oppose Radical Health Care Price Fixing Bill FOR IMMEDIATE RELEASE: April 9, 2018 SOURCE: California Medical Association CONTACT: Charlie Lawlor, clawlor@cmanet.org CONTACT YOUR LEGISLATORS TODAY - CLICK HERE! Sacramento, CALIF. – Today, Assemblymember Ash Kalra (D-San Jose) released new details on a radical new legislative 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. “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 Administration 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. April 9, 2018 CMA, General, Press Releases Rate Regulation, 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 »
California grapples with 'severe' doctor shortage, study shows California doesn't have enough doctors to handle its primary health care demands and the problem is getting worse. A new study by UCSF Healthforce Center finds that California doesn’t have enough primary care physicians in most regions of the state. According to the study, the shortage is becoming more acute because of an aging physician workforce, a growing patient population and expanded coverage through the Affordable Care Act. According to the study, only two regions of California (the Greater Bay Area and Sacramento) have ratios of primary care physicians per population above the minimum ratio recommended by the Council on Graduate Medical Education (60 primary care physicians per 100,000 people). The study also found that two regions (the Inland Empire and San Joaquin Valley) have ratios of primary care physicians to population that are below the minimum required by California law for managed care plans (50 primary care physicians per 100,000 people). Some estimates show that California will need an additional 8,243 primary care physicians by 2030 – a 32 percent increase. In an effort to increase California's primary care physician workforce, the state legislature passed a budget in 2016 that included historic support for and expansion of primary care graduate medical education (GME)—committing to invest $100 million over three years to support primary care residency programs in medically underserved areas. Unfortunately, Governor Jerry Brown’s proposed 2017 budget takes a huge step backward, eliminating $33.4 million of that health care workforce funding and redirecting $50 million in Prop. 56 funding that was intended to go to GME programs. The California Medical Association (CMA) believes these budget cuts are irresponsible and make a bad situation worse. A robust and well-trained primary care workforce is essential to meeting the health care demands of all Californians. Inadequate funding for residency programs exacerbates access problems—every year hundreds of graduating medical students don't find a residency slot in California to continue their training, forcing talented, young doctors who want to stay and practice in California to other states and communities. CMA will be working through the budget negotiation process to restore this critical funding. We are also urging physicians, residents and medical students to ask their legislators to oppose Governor Brown’s budget proposal to eliminate physician workforce funding. For more information on the budget as it relates to health care, including GME funding talking points, see CMA's budget summary. Click here to read the UCSF study. March 2, 2017 General California State Budget, Graduate Medical Education, Physician Workforce, Primary Care, State Legislative Advocacy, Underserved Communities 0 0 Comment Read More »
Leading health care groups deeply concerned that Governor's budget proposal may decimate access to care In his 2017-18 budget proposal, Governor Jerry Brown eliminates $33.4 million in health care workforce funding that would begin addressing the primary care workforce crisis that is gripping California’s underserved communities. This is the first year of a three-year $100 million investment. The budget investment came at the urging of a broad coalition of statewide healthcare organizations including the California Academy of Family Physicians (CAFP), CaliforniaHealth+ Advocates, and the California Medical Association (CMA), who recognized that access to care challenges must be systemically and comprehensively addressed. “While our organizations recognize the health care challenges that may confront America and California this year, we are alarmed to see the Governor’s proposed elimination of health care workforce funding that has already been allocated to help address the dire access-to-care issues facing numerous regions in California,” said Carmela Castellano-Garcia, CaliforniaHealth+ Advocates President and CEO. “We are committed to working with the Legislature and the Governor to forge solutions that protect our state’s most vulnerable communities, but must not turn our back on those we have already committed to helping.” The $100 million appropriation in the 2016-17 State Budget currently is set to support and expand primary care residency training and programs in medically underserved areas through the Song-Brown Workforce Training Program and targeted investment in Teaching Health Centers. The goal is to create a reliable and continuous funding stream that primary care residency programs in California so desperately need. “The Governor’s proposed elimination of funding is of serious concern in California as our primary care residency programs have recently lost more than $60 million,” said CAFP President-elect Michelle Quiogue, MD. “Last year’s appropriation was intended to save these programs, but this proposed cut would be devastating, causing programs to close and exacerbating serious access problems for some of the state’s most vulnerable patients.” Without this appropriation, California primary care training programs cannot replace significant federal and private foundation grants that recently expired, including $18 million in federal Health Resources and Services Administration funding for the Primary Care Residency Expansion program; a $21 million California Endowment grant to the Song-Brown Program; $15 million allotted through the federal Teaching Health Center program; and a one-time $4 million California Health Data and Planning Fund appropriation to Song-Brown. Even if these cuts were replaced dollar for dollar, California would struggle to provide sufficient access to primary care. Only 36 percent of California’s active patient care physicians practice primary care and, according to the Council on Graduate Medical Education (COGME), 23 of California’s 58 counties fall below the minimum required primary care physician-to-population ratio. That’s why this new appropriation is so critical. “A robust, well-trained primary care workforce is essential to meeting the health care demands of all Californians,” said CMA President Ruth Haskins, MD. “The Legislature’s move to restore and stabilize funding for these programs is an important first step toward reversing our shortage of primary care physicians, particularly in the underserved communities that need it the most.” California faces a drastic shortage of primary care physicians. The federally recommended number of primary care physicians per 100,000 people is 70. According to the California Health Care Foundation, the number of primary care physicians participating in Medi-Cal per 100,000 enrollees is 42. With an increase of more than four million individuals in the Medi-Cal program, it has never been more important to fully support the training programs that bring primary care physicians to underserved areas. February 13, 2017 General California State Budget, Medi-Cal, State Legislative Advocacy 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 »
