President's Page
Happy New Year!
In with the new and out with the old; the new millennium is undisputedly here. I greet you from a new location in the SBCMS’ center section of the inaugural issue of the Southern California Physician (SCP) magazine, which replaces the SBCMS Bulletin.
The SCP grew from the seeds of a vision planted by the executive directors of the San Bernardino, Riverside, Los Angeles, Orange, Ventura and Imperial county medical societies during discussions on ways to more efficiently and effectively serve their members. The vision took hold and was nurtured through considerable discussion, debate and planning on the part of the boards of directors and editorial boards of the Southern California county societies. Now in the capable hands of the SCP Editorial Advisory Board and Managing Editor Barbara Feiner and her staff, our combined efforts have culminated in this valuable member benefit you hold in your hands today.
SBCMS’ representatives to the SCP Editorial Advisory Board are Drs. Ron Bangasser, Thelma Korpman, and Rodney Willard. You are very welcome to call them when you have suggestions for articles, editorials and news stories. And feel free to critique the new publication. It is important that we hear from you.
Your annual membership dues – a valuable investment
You recently received your annual CMA dues statement and I encourage you to renew your membership today. CMA dues are $475. They are due January 1st. Medical Society dues are $350 and are due July 1st. You are invoiced twice per year to ease the burden of one large invoice. When you break down the $825 into a 365-day year, the investment in membership on the local and state level amounts to $2.25 per day.
These dues provide each physician with many benefits and services. SBCMS/CMA’s primary focus is on physician and patient advocacy. Our legal and legislative departments as well as our Medical Policy and Economics Center work diligently on your behalf. The legal department and legislative lobbyists carry dozens of bills through the California Legislature every year. Our professionals monitor government agencies, health plans, hospitals and other entities whose actions or policies appear to violate physicians’ rights. We are on alert around the state to help prevent or resolve problems caused for physicians when financial trouble strikes health plans, medical groups, and IPAs.
Examples of what your dues dollars have allowed us to do:
CMA Class-Action RICO Lawsuit vs. For-Profit Health Plans: CMA filed a class action lawsuit against California’s three major for-profit health plans. The lawsuit is about preserving the viability of California’s health care delivery system where the legislature, the courts, state regulators, and the market have failed to address critical issues. The lawsuit seeks to use civil racketeering statues (RICO) based on the fundamental notion that these plans have willfully underfunded the health care they pledged to purchasers and to our patients. CMA is only seeking injunctive relief wherein the plans agree to cease a host of unfair business, financial and related practices. CMA will withdraw from the suit if IPAs, medical groups, or nonprofit health plans become targets during the course of related litigation.
CMA-Sponsored AB 691 (Gallegos): Pharmaceutical Risk Restrictions: Bans health plan contracting practices that impose financial risk on physicians for providing medically necessary drugs to patients.
CMA-Sponsored SB 168 (Speier): Fee-for-Service Vaccine Reimbursement: Requires the health plans to reimburse any new vaccines on a fee-for-service basis until contracts can be renegotiated.
Medi-Cal Reimbursement Rate Increase for FY 2000-01: CMA won a Medi-Cal rate increase for physicians: 40% for ER and On-Call services, 30% for Neonatal Intensive Care services; 20% for EPSDT Screening, 20% for California Children’s Services, 11% for Perinatal Services and 16.7% across-the-board for all other services.
Medicare Rate Increases: CMA was successful in obtaining a change in the Sustainable Growth Rate Methodology (SGR) which will result in a 5% physician rate increase.
CMA thwarted a number of scope-of-practice encroachments from psychologists, acupuncturists, physical therapists, and midwives: The proposed midwife legislation would have allowed midwives to practice without supervision by a licensed physician. CMA was also successful in defeating legislation that would allow psychologists to prescribe drugs.
CMA-Sponsored SB 2136(Dunn): Health Care Providers: Quality Audits Requires the Department of Managed Health Care to design and implement a uniform medical quality audit process of physicians, replacing the plethora of multiple health plan audits.
CMA-Sponsored SB 2132(Dunn): Emergency Room Services: Co-sponsored with CAL/ACEP, this bill allocates $24.8 million for fiscal year 2000-01 to the Ken Maddy EMS Fund. The bill limits the use of those funds to the reimbursement of uncompensated emergency services. With the augmentation it is anticipated that 35% to 40% of physicians billings for the uninsured will be reimbursed.
Health Plans cannot offer "discounted" Physician Services: Defeated legislation that would allow health plans to offer "discounted" physician services for non-covered benefits.
CMA-Sponsored AB 1455(Scott) Insurance Claims: Dispute Resolutions: Secured passage of legislation adding tougher penalties for health plans for "slow or no" payments, and a requirement for health plans to have a dispute resolution process to resolve physician billing problems.
CMA-Sponsored AB 2611 (Gallegos) Physicians On-Call: Defeated legislation that would have deemed as unprofessional conduct a physician's refusal of hospital scheduled ER call, and that would have empowered hospital administrators to mandate ER call as a condition of hospital privilege.
AB2018 (Thomson) Schedule II Pharmaceuticals: Triplicate Prescriptions: This bill contains three provisions that would minimize the "hassle factors" associated with triplicates. These reforms include: lifting the cap of 100 scrips available to physicians at any one time; allowing for the completion of the prescription by an assistant (signed by the physician); and allowing for error corrections to be phoned in to the pharmacy, followed by a written confirmation within seven days.
Given this array of advocacy efforts and services, I am amazed that fewer than half of San Bernardino County physicians are SBCMS/CMA members. I hope the information I have supplied will help you appreciate the positive returns you can expect from the investment SBCMS/CMA asks you to make toward the future of our profession.
To have the best chance of regaining our role as the managers of the health care of our patients and our communities, physicians must "speak with one voice". Send in your membership renewal today. Ask a non-member to join. Expanded SBCMS/CMA membership can accomplish what individuals and small groups cannot.
Send mail to Bulletin Managing Editor with questions or comments about the publication.
