Dr. Ron Bangasser discussed the heroic efforts made by CMA in regard to the issue of Medicare funding and the reduction in physician Medicare fees in 2003 due to an error in calculation by Centers for Medicare and Medicaid Services (CMS). Under the current law, Medicare payments to all physicians will be cut by another 12% over the next three years.

Dr. Bangasser and a delegation from CMA flew to Washington D.C. on November 11-12. They were unsuccessful in their efforts to convince the members of the Senate to follow the House of Representative's approach. The Bush Administration supported the House approach. But since the Senate chose not to act, the Administration has done one critically important thing: they authorized CMS to delay the implementation of the next 4.4% cut until February 1, 2003. This gives the CMA and the AMA the month of January to solve the problem, without a further reduction taking effect.

Dr. Bangasser said that CMA is crafting two resolutions to take to the AMA Interim meeting on December 7-11 in New Orleans: 1. That physicians march on Washington during January and express our concerns and our patients' concerns, and 2. That CMA adopt the AMA's strategy and proceed with an injunctive lawsuit against CMS until they fix the error in calculation. It is expected that many state medical associations will jump on this bandwagon, including the important states of Texas, Florida and New York. Dr. Bangasser is making calls to secure support for these emergency resolutions.

Other issues that will be discussed at the AMA Interim meeting in New Orleans December 7-11 include removing objectionable legislation attached to the Federal MICRA-like bill, HR 4600, and reorganization of the AMA. Dr. Rebecca Patchin is campaigning for a seat on the AMA Board of Trustees and has a good chance of winning. There will also be discussion about the AMA leadership in Washington, whether state medical associations will have their own lobbyists in Washington and whether they will work in concert with AMA.

Dr. Ron Bangasser will be installed President of the CMA on March 24, 2003 at the House of Delegates. The CMA President's Reception will be held that evening. The reception will be supported with funds donated by CMA, Beaver Medical Group, Redlands Community Hospital, Keenan and Associates, (NORCAL's broker), RCMA and SBCMS.

San Bernardino County Public Health Officer Thomas J. Prendergast, M.D. reported that the American Heart Association has developed guidelines for treating patients with proven atherosclerotic disease. The purpose of "Get with the Guidelines" is to ensure that patients leave the hospital with appropriate management, resources and advice. There is evidence that these guidelines result in a 70% difference in the likelihood of patients having recurrences within a relatively short period of time.

On November 13 the state issued an order making respiratory interstitial virus, the major cause of disease in nursing home patients, reportable. In the first week the health department had ten reports. The CDC and the state have upped the ante considerably about smallpox preparation, and the health department must develop a smallpox plan. They are expected to start immunizing people in mid-December. They are required to develop a list of the numbers of hospitalized patients that need to be immunized and the number of health department employees who will be part of the initial evaluation teams and will be involved in working with smallpox cases should they occur. There is risk in immunizing for smallpox as 30% of people who receive the vaccine may have to restrict their activities due to side effects of the vaccine.

The Health Department is forming a bioterrorism advisory committee, which will convene soon. Frank Randolph, MD has been named as SBCMS' representative on the advisory committee.

Board members approved the SBCMS Advertising Guidelines. Dr. Edward Hess, Chair of the SBCMS Electronic Communication Committee, reported that the committee developed the guidelines, which will apply to SBCMS publications and websites, to protect SBCMS' reputation, reduce the risk of potential liability and better assure the quality of the products and services that are advertised.

Board members also discussed a recommendation from the Electronic Communication Committee that SBCMS participate in a joint collaboration between SBCMS and the San Bernardino County Health Department to disseminate information to physicians (both members and non-members) through broadcast fax announcements, the SBCMS section of the Southern California Physician magazine, and the Medical Society's website, sbcms.org. Dr. Hess reported that the Electronic Communication Committee met with Alison Rue, an epidemiologist with the County Department of Public Health, on November 13 to discuss the project. The information would be useful for the healthcare community, particularly regarding bioterrorism. The committee will add to the SBCMS main web page a DPH link that would go to a DPH announcement page. Ms. Rue will develop an agreement between the Health Department and SBCMS that would allow SBCMS to bill the Health Department for any expenses incurred for the web page announcements or broadcast faxes. Board members approved the concept of the agreement with the Public Health Department and will await further development pending the approval of the County Board of Supervisors.

As SBCMS' representative, Dr. Guillermo Valenzuela attended an informational meeting of the SBCMS/RCMA Task Force on the proposed UCR Medical School. There was positive interest on the part of the community and the Riverside County Board of Supervisors were mildly interested. They were concerned about the possibility of another medical school opening in the central valley. Dr. Bangasser said CMA will support both a four-year medical school at UC Riverside and a second medical school in the central valley. Funds have been committed for a feasibility study, and further discussion will take place with the two county hospitals and Eisenhower Medical Center. The Board agreed to support ongoing discussion and relationship with UCR as they work through this process.

Board members recognized Dr. Lisa Perry-Gilkes, current SBCMS Secretary, Board member and Director of the African American Health Initiative. Dr. Perry is relocating to Atlanta, Georgia in December. Dr. Randolph presented her a resolution from the Board of Directors. Board members expressed their regrets on her leaving and their best wishes for her future.

In October 2002, the Centers for Medicare & Medicaid Services (CMS) launched a national collaborative to improve the quality of care in hospitals. As the state's Medicare Quality Improvement Organization, CMRI is leading this initiative in California through the development of statewide collaboratives. Board members were provided the following documents: Recognition Leads to Rewards - Opportunities to lead a statewide quality improvement collaborative, CMRI Physician and Clinical Champion Network, CMRI Hospital Collaboratives - Clinical Areas and Quality Indicators, and Nursing Home Public Reporting Quality Initiative in California. In November 2001, SBCMS signed a Partnership for Quality with CMRI. SBCMS will function as a liaison between CMRI and SBCMS members who choose to become more involved in the quality projects by serving as team leaders. "Clinical Champions" will work closely with CMRI to promote quality improvement and encourage the adoption and use of performance improvement tools and practices. Board members agreed to seek physician volunteers who support the idea of rapid cycle improvement, understand the CMRI project goals, and contribute to the development of processes to improve quality of care. Board members agreed to send a broadcast fax to physicians soliciting nominations and to make their selections at the January Board meeting.

Board members approved the nomination of Gerald R. Greene, M.D., a board certified Pediatric Infections Disease Specialist at Arrowhead Regional Medical Center, for The Unforgettables Foundation Top Doctor Award. The award will be presented (for the second year) on December 31, 2002 at the Third Annual Lights for Little Lives March.

On September 24, 2002, Inland Global Medical Group, Inc. (IGMG) an IPA in Upland, announced they were closing their doors due to financial insolvency. The CMA and SBCMS went to work immediately to assist the 160+ physicians involved. Ms. Stratton said that our goal was to help physicians maintain existing patient relationships, ensure payment during the transition, and help physicians obtain payment for unpaid services provided prior to IGMG's closure announcement. Over 48,000 patients were involved in this insolvency. Physicians were owed approximately $4 million. The CMA and SBCMS worked feverishly to find ways to make available the reserve monies that the health plans were holding ($800,000) to distribute to physicians to pay past claims. A town hall meeting is scheduled in January at San Antonio Community Hospital. Representatives from the Department of Managed Health Care and the CMA will attend.