The Southern California Physician, May, 2002

Board Briefs
March 25, 2002

The Board of Directors viewed a video, "Physician to Physician Recruiting - There is a Better Way." The presentation was prepared by CMA for the House of Delegates during Annual Session. Board members shared their experiences and ideas for recruiting nonmembers. Suggestions included developing members-only value programs, actively encourage medical students and particularly House Officers to join SBCMS, possibly through a mentor program, and to invite nonmembers to the May 9th High Desert General and the June 26th Installation of Officers meetings where the value of membership will be promoted.

Ms. Stratton encouraged Board members to support the Alliance by purchasing tickets to their sponsored bus trip to The Fabulous Palm Springs Follies on Saturday, May 18.

San Bernardino County Public Health Officer Thomas J. Prendergast, Jr., M.D. announced that he has provided statistical data on four basic health areas, chronic diseases, communicable diseases, birth outcomes, and bioterrorism to SBCMS Director of Communications Sue Bradshaw, and interested board members should contact her for copies. The Public Health Department expects to receive funding from the Federal government, channeled through the state and local governments, to enhance the health department's capability to perform health surveillance. The Health Department has been doing influenza surveillance this year, and the Coroner's Office is performing nasopharyngeal swabs of patients who die outside of the hospitals to look for evidence of flu and other diseases. A late influenza season is expected this year.

Dr. Randolph expressed concern that the county's emergency rooms, already crowded and understaffed, are not prepared to handle a big disaster or even a severe flu season, and a sufficient number of beds will not be available. He suggested that the Medical Society take the step to examine our local response and assist in developing a crisis plan that would support the Public Health Department and the law enforcement response in the event of a catastrophe. The plan would identify treatment facilities outside of the hospitals that would be prepared to handle emergency room overflow. The plan would also address the need for additional staffing and medical equipment, such as ventilators. Dr. Prendergast said that the County of San Bernardino does not have a formal plan in place. Following discussion, Dr. Randolph agreed to draft a summary that he will present at the April 29 SBCMS Board of Directors meeting that will outline how SBCMS could assist the Board of Supervisors to create a county disaster response plan.

IEHP Medical Director Dr. Bradley Gilbert announced that total IEHP membership is 228,564. Medi-Cal enrollment is 207,185 with 21,379 enrolled in the Healthy Families program. The auto assignment percentage in January was approximately 27 percent.

On February 27, 2002, SBCMS Board sent a letter to the IEHP Board urging IEHP to pay for the services to Tower and WAPA patients prior to August 1, 2001. Dr. Gilbert reported that the IEHP Board of Directors refused to pay for the services prior to August 1st. In fact, the Board was unhappy with Dr. Gilbert and Mr. Bruno for paying $1.4 million for claims after August 1st. Dr. Gilbert reported that IEHP would seek reimbursement from Tower for the $1.4 million IEHP has paid physicians for claims left unpaid by WAPA. If the action is successful, Dr. Gilbert will ask the IEHP Board of Directors for the authority to pay additional claims.

Dr. Randolph pointed out that the IEHP Board of Directors lacks a physician member. Following discussion, board members agreed to send a letter to the San Bernardino County Board of Supervisors recommending that they appoint a San Bernardino and a Riverside County physician to the IEHP Board.

Reporting on the February 22-26, 2002 CMA House of Delegates, CMA President Elect and AMA Delegate Dr. Ron Bangasser listed the important actions taken by the HOD during this session, including passage of resolutions regarding voluntary participation in emergency call panels, payment of provider claims, health care finance reform, and restricting the Medical Board from posting accusations and judgments on their website. Only six resolutions were referred for study. Dr. Horace Orr received the Frederick K.M. Plessner Memorial Award on Sunday, February 24 and former SBCMS President Dr. Jerome Taurek was honored with the Gary Krieger, M.D. Speaker's Award.

Dr. Bangasser announced that the Coalition to Preserve Emergency Care (CPEC)) has decided not to go ahead at this time with a ballot proposition on the November ballot. The coalition intends to stay together and continue to press the issues that caused consideration of a ballot proposition. They will move forward to solve the problem with a different approach.

There will be no action on AB 1600 until after the legislature's Spring break. Dr. Bangasser said that the key players are working on new amendments to handle the concerns of Kaiser Permanente and group physicians. CMA will move closer toward arbitration or negotiation with health plans rather than allowing people wide latitude in suing. Another important bill in the legislature that is being promoted by CMA is AB 1776. It would basically prohibit HMOs to use contract practices that are unfair and illegal.

Dr. Bangasser also reported the Riverside County Medical Association and SBCMS have formed a new committee called Save Our Seniors (SOS). The committee was initiated to work on a local solution to the senior health plans' withdrawal from certain areas and/or the significant changes to the benefit structures which are adversely affecting seniors' abilities to either pay or remain in the program. Dr. Bangasser cited the potential loss of the Medicare Plus Choice benefit. In California, senior citizens eligible for Medicare Plus Choice represent 47% of the entire over 65 population and 78% in Riverside. This would adversely affect a very large number of patients in San Bernardino and Riverside counties who would lose this prescription benefit.

SOS has met twice, once as a committee and the other time with the CEO and/or medical directors of the Senior Health Plans including Blue Shield, Blue Cross, Pacific Care, SCAN, and Aetna. Dr. Bangasser and Dr. Steve Larson of RCMA are the chairs of the committee. Dr. Bangasser and SOS committee representatives, including health plan representatives, will travel to Washington, D.C. at their own individual expense to meet with CMS and elected officials April 8-10 to try and influence changes. Dr. Bangasser asked the board members to support SOS and inform their patients. He will provide a follow up report at the April 29 Board meeting.

Dr. Bangasser will attend the Vaccine Summits on May 13 in Oakland and May 22-23 in Atlanta this year. He also mentioned that CMA won a victory in the lawsuit against the Department of Managed Health Care. DMHC cannot collect or publicize financial date from the medical groups. Dr. Bangasser attended a meeting with Mr. Zingale and the Financial Solvency Board and proposed two regulations that they could implement in light of the judge's ruling: 1. allow collection of financial data but keep it confidential, and 2. provide the information that was agreed to all along which was already published. Most important, the DMHC is to begin working on a collective action plan that would help the groups that are already having trouble and give them the opportunity to improve.

Board members received a report from Historical Committee Chair Dr. Roger Smith on the successful Medical Museum Open House held on February 3, 2002. There was excellent publicity from the event.

Board members were provided the following CMA documents: "Top 10 Legislative Accomplishments for 2001," "CMA's Victories in the Courts (1995-present)," and CMA's Education Plan for HIPAA." Dr. Shankar encouraged them to use this information in their membership recruitment/retention efforts. He also suggested that they obtain the document, "Benchmark Capitation Rates: The Physician's How-to Guide for Calculating Fee for Service Equivalents" from the CMA website, www.cmanet.org.

Board members reviewed a Professional Liability Update prepared by Ms. Stratton. Her memo addresses the considerable upheaval in the malpractice industry, locally and nationwide. Physicians all over the country are experiencing huge rate increases, lack of available coverage or denial of coverage because many large insurers have gone out of business or have stopped writing professional liability coverage altogether. Although NORCAL was affected by increased reinsurance premiums related to September 11th and the 2001 stock market, it has positioned itself well to continue providing coverage to California physicians. She said that NORCAL would carefully control their growth and look cautiously at assuming any new business that could adversely impact their ability to provide full and adequate coverage to their existing customer base. NORCAL's first priority will be to protect its current policyholders.

Ms. Stratton also provided the Annual MICRA Savings chart that is developed by the CMA and modified to include San Bernardino County NORCAL rates for comparison. The MICRA savings for San Bernardino County physicians, in all specialties listed on the chart, is $40,155.

Dr. Shankar reminded the members to return their nominations for the SBCMS 2002 Annual Outstanding Physician and Citizen Awards to the Medical Society staff by April 14, 2002.

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