The SBCMS Board would like to get a handle on what the Pacific Foundation for Medical Care (PFMC) is doing for the doctors in San Bernardino County. The Board doesn't feel the FMC has been visible in San Bernardino County since 1995. They voted to put the PFMC on notice. They would like to see 3,000 FMC patients in San Bernardino County by November 1, 2003. If that is not possible they would like to be released from the PFMC agreement.

Dr. Bangasser reported on the 2003 AMA Annual Meeting. RCMA's Dr. Rebecca Patchin was elected to the AMA Board of Trustees. Resolution 111, the CMS Pharmaceutical Reimbursement Method, was adopted. This will work to exclude pharmaceutical costs from the Sustainable Growth Rate (SGR) formula, which will make calculations more accurate, and is a good first step in examining the issue of pharmaceutical reimbursement with regard to the SGR. Resolution 703, Definition of Medical Necessity, was expanded to include an item that would not allow health plans to use utilization review standards for economic benefit. Full Disclosure in PPO Contracts (Res. 704) would allow physicians to know how and when they are going to be paid for claims submitted as well as to require a physician's prior written authorization before a contract can be changed.

The AMA also adopted Resolution 614, Preservation of Medical Staff Self-Governance, that would provide assistance for appropriate cases regarding the protection of medical staff self -governance and to support any hospital staff whose rights of self-governance are being threatened by the hospital administration or the governing body (as in the case of San Buenaventura Hospital in Ventura, California). The board approved sending a letter to the Ventura County Medical Association to reaffirm SBCMS' support for physician independence and to let VCMA know we will contact our members and the Chief of Staffs of San Bernardino County hospitals to encourage them and their medical staffs to make a contribution to CMA's Legal Defense Fund.

In terms of the proposed 4.4% Medicare cut for next year, AMA has developed a strategy with the House leaders to include a provision that would eliminate the cut for the next two years and provide for a small increase instead. The fix would provide a minimum 1.5% increase in physician reimbursements in 2004 and 2005. They approved passage of policy that would continue to allow IMQ to be the reviewer with the JCAHO for the CALS Survey Process. Discussions are still ongoing between IMQ and the CHA related to them renewing their contract. If this doesn't occur soon, CMA and IMQ will work with the State of California to institute a parallel accreditation program to JCAHO through a reorganized contract with DHS and IMQ---this would be required by state law if CALS is not renewed.

The Council on Medical Services has prepared a report that would be a long-range reform on Medicaid. It would federalize the acute care portion of Medicaid and standardize it across the US. The cost would be less than what Medicaid in California cost the State of California now on a per patient basis.

Dr. Bangasser reported that the SB2 (John Burton's Health Access bill) is moving along. They are trying to figure out the best way to get the most people covered. There are seven million uninsured in California. The final bill would include a combination of individual and employer mandates. Workers' Comp reform is currently on the table. California's Workers' Comp is the most expensive in the U.S. for premiums with the least return on that investment to physicians and health care. The majority of the money goes to administration. Currently there is a mandate in the legislature to give 31% to administration, which is far higher than the worst health plan. CMA is looking at ways to increase the amount of money that would be paid to physicians. The mechanism that would be used to pay the monies is where the problem lies. The Department of Workers Comp (DWC) would like to pay on a Medicare RBRVS system, which would shift a lot of money into a primary care pool and would take away approximately $750 million a year from specialists. CMA has convened with the specialty groups to come up with a compromise approach, which would move some money to the E & M code calculations, which are about 80% below Medicare rates. CMA wants to make sure that access to Workers Compensation is maintained, and that can only happen if overall reimbursements are increased significantly, bringing up primary care, industrial medicine, mental health, and pain management reimbursement; but without reducing more reasonably reimbursed codes in surgery and other specialty areas (which haven't been increased for two decades). They will work steadfastly to bring new dollars into the system, including working on reducing over-utilization. They are opposing the current Alarcon bill until it is modified toward improved viability for all concerned. Dr. Bangasser reported there will be no cuts to Medi-Cal rates for next year.

District 2 Board member Dr. Philip Carney has been appointed Regional Medical Director of Kaiser Permanente's Mid Atlantic Region and is relocating to the Washington DC area in early July. The board will ask Dr. Rick Murray to complete Dr. Carney's unexpired term. Dr. Carney also serves as District 2 CMA Alternate Delegate. The board will ask Dr. Paul Lui to complete Dr. Carney's unexpired term as District 2 CMA Alternate Delegate. The board extended gratitude to Dr. Carney for his years of service on the board and delegation and wished him well in his new position.

Dr. Ron Bangasser has represented the SBCMS on the Desert Sierra Cancer Surveillance Program Advisory Committee for a number of years. Because of the demands as CMA President, Dr. Bangasser can no longer serve on the Advisory Committee. Dr. Sehra nominated Leyla Akanli, M.D. who practices at Loma Linda University Department of Pediatrics. With Dr. Akanli's approval, the board will submit her name to the DSCSP to replace Dr. Bangasser. The board agreed to ask all SBCMS representatives who serve on committees and commissions representing the medical society to provide quarterly reports to the board.

The board approved re-applying for a $50,000 Medical Reserve Corp grant from the Office of the Surgeon General. Dr. Randolph reported there is more funding available in 2003 than 2002 and he feels SBCMS has a good chance to be funded. He and Ms. Stratton will work on rewriting the 2002 grant to include community activities through IWIN's programs (AAHI, Healthy Lifestyles, etc.) and submit the application prior to the July 18th deadline. The board canceled the July 28th board meeting.

The board reviewed a draft proposal developed by representatives from IEHP and Mark Gamble of the Healthcare Association of Southern California (HASC) regarding expanding the IEHP board to include providers. The latest proposal revises the current Provider Advisory Committee to have more effective interaction with IEHP's CEO, its management, and its Governing Board. The PAC would include a physician from each medical society (Riverside and San Bernardino), a hospital representative from each county, an optometrist, an IPA representative, and a pharmacist representative. There would be a 2-year term limit. The board voted to table this issue until a presentation can be made to address the proposal. The IEHP board will be asked to postpone voting on the proposal until the presentation is made to the SBCMS board.

A copy of the 2003 Legislative Hot List (as of June 20, 2003) was provided to board members. These CMA-sponsored bills can be viewed on CMA's website www.cmanet.org. The board was provided a copy of the AMA's Fact Sheet on the Monkeypox Outbreak June 2003. For the most up-to-date information on this outbreak, visit the CDC's website at www.cdc.gov/ncidod/monkeypox/.

In accordance with HIPAA, a final rule in the "Federal Register", established new standards, requirements, and implementation specifications for health plans, health care clearing houses, and health care providers who transmit any health care information in an electronic form. Effective for dates of service on or after October 1, 2003, ICD-9-CM diagnosis codes must be included on all Medicare electronic and paper claims billed to Part B carriers, with the exception of ambulance carriers. Providers and suppliers rely on physicians to provide a diagnosis code or narrative diagnostic statement on orders and referrals. This guidance serves as a reminder that physicians must provide a diagnosis on all orders and referrals. Failure to do so will result in processing delays and nonpayment of covered services.

The board was encouraged to attend the upcoming "HIPAA Transaction & Code Sets Workshop" to be held in the Medical Society conference center on August 6the sponsored by CMA, RCMA, and SBCMS. Remember the deadline to be in compliance with HIPAA is October 16, 2003.