My Year in Review

My year as SBCMS President began June 26, 2002 with my installation at the Redlands Country Club. On June 26, 2003 I will step back and assume the duties of the immediate Past-President. Greater than 99% of the accomplishments I might lay claim to in the interim came about through the efforts of a great staff lead by our Executive Director Linda Stratton and via the superb camaraderie and focus of our medical society's officers and Board of Directors.

Local Problems and Progress
Facing losses of member growth in the past several years, our membership efforts since June 2002 resulted in the addition of 94 new members including the addition of four new medical groups (La Salle, California Emergency Physicians, Loma Linda University Department of Pediatrics, and St. Mary Choice Medical Group) and 76 new medical students. Our committees have met regularly to carry out their specific projects and activities to benefit the membership, the Medical Society, and the community. Their suggestions and recommendations were greatly appreciated and valued by the Executive Committee and Board of Directors.

Inland Wellness Information Network continues with challenging initiatives that have contributed significantly to the quality of life in the Inland Empire. The African American Health Initiative received grants from The California Endowment and the Office of Minority Health that will enable the Initiative to make significant progress. Throughout the year, AAHI sponsored medical screenings and referrals, community walks, participated in numerous health education and prevention venues, and held a series of community gatherings "Breaking Bread & Building Bridges" of Inland Empire and High Desert groups involved in African American health issues. AAHI co-sponsored the Jumpstart series to respond to the dramatic shifts of HIV infection, influx of new diverse populations and the current economic climate by maximizing cultural competence in service delivery. We promoted Healthy Lifestyles to elementary schools and received grants from NORCAP and GlaxoSmithKline that enabled IWIN to increase the cash awards to the winning classes from $100 to $300. In April, in recognition of National Donate Life Month, Live & Then Give placed organ donor displays in four Inland Empire hospitals. We also deployed our second three-month cinema advertising campaign at seven Krikorian Theatres throughout Southern California, reaching nearly two million moviegoers. We promoted organ donor awareness at the Rancho Cucamonga Epicenter - home of Quakes baseball. In August we will take our organ donor awareness program to Arrowhead Credit Union Park in San Bernardino - home of the Inland Empire 66ers baseball.

We channeled our concerns about disaster preparedness into a series of local meetings culminating in our appointment to the local disaster planning advisory committee, to extensive website publishing of physician education on related matters, and to the proposal of a Medical Reserve Corps unit penciled into a grant application to the Surgeon General. Although it did not get funded, our public health officer Dr. Thomas Prendergast recently informed us that the funding will be referred to public health which will in turn help us with the effort outlined in our grant application. We continue to participate in disaster preparedness meetings and planning. We participated with CMA legal counsel in an effective effort to rally round the physicians in the West End whose practices were greatly impacted by the bankruptcy of Inland Global Medical Group, a local IPA.

Challenges for California Physicians
In 2002 Medicare rates were cut by 5.5%, with a threat to cut another 4.4% this year. Health insurance premiums increased by over 15%, but remain, on average 20% lower here than national averages, and 40% lower than east coast rates. Most of the money from those increases went to hospitals and drug costs. Medi-Cal reimbursements remain at the near bottom of state averages. Workers' Comp physician reimbursements are also among the lowest in the nation and haven't increased in a decade. Physician and health care bankruptcies were plentiful, claiming non-profit HMOs, Health Plan of the Redwoods and Lifeguard. Malpractice premiums, while more stable than elsewhere in the nation thanks to MICRA, nonetheless rose over 6% on average and much faster in some counties. There were a record number of million dollar malpractice judgments in 2002, and the trial lawyers are mounting an assault on MICRA to offset the growing demand for a national MICRA bill.

California has over six million uninsured persons. Increasing uncompensated care threatens the viability of emergency, on-call, and trauma care statewide. Over 50 trauma and ER facilities have closed due to funding shortfalls over the past decade. SBCMS and CMA are involved in finding solutions to these problems.

CMA Accomplishments
CMA worked with the AMA to reverse the RBRVS cuts. The impending 4.4% additional cut for 2003 was blocked as a result of these efforts. Beyond preventing the additional cut, AMA and CMA were able to engineer a $54 billion dollar increase in physician reimbursements over the rest of the decade. For 2003 alone, the per capita difference for each California physician between the proposed 4.4% cut and the subsequent 1.6% actual increase that began March 1, is $15,000 per physician. For those with considerable Medicare volume, the difference will be multiples of that. These actions amount to the equivalent of CMA dues for the rest of the average physician's practice life.

When our Governor proposed a $1.6 Billion cut last year, CMA engineered a complete reversal of that cut during the final moments of the Legislature. Now, facing the threat of even more horrendous proposed 2003 state cuts, CMA has formed a coalition of 60 constituencies to reverse this.

Another access victory last year was the passage of the California Physicians' Corps program, which will use MBC reserves dollars and hopefully Endowment funds to provide loan payback for residents who elect to work in underserved areas.

With respect to commercial reimbursement, CMA's RICO lawsuit, the AB 1455 efforts, the Patient's Bill of Rights bill, and countless other efforts and bankruptcy mediations were all aimed at getting fair compensation and fair contracts.

Another 2002 win was the revision of SB 1950 into a compromise bill which actually produced major improvements in how the Medical Board will treat physicians in future years. CMA also successfully defeated a number of scope of practice assaults and achieved passage of the Patient's Bill of Rights bill, which strengthens state contracting protections for physicians.

The CMA reimbursement hotline secured over $3,000 per physician who used the service and provided reimbursement and practice management member workshops around the state with hugely positive member evaluations. Our hassle factor line documents physician payment and contract abuses, allowing for more objective documentation of the plight for legal and legislative relief.

CMA has advocated nationally to fix the absurdities in the current HIPAA rules, and at the same time preparing members to effectively prepare their offices to comply with HIPAA, reduce admin costs, and move toward paperless practices.

CMA also successfully prevented trial lawyers from forging new exceptions to MICRA for medical groups, IPAs, or academic faculties and leveraged our Congressional delegation in partnership with the AMA to actually get the Greenwood-Cox bill passed by the House of Representatives in 2002. CMA continues to work with Senator Feinstein to introduce a national MICRA proposal.

CMA cut nearly one million dollars out of its operating costs in 2002 to balance the budget. CMA membership increased by several hundred at the end of the 2002/2003 year. Young Physician Section members have increased by 17%. CMA has institutionalized bi-annual meetings with Specialty Society Presidents and Execs and recently crafted a unified strategy with California specialties toward solving the Worker's Compensation payment methodology dilemma.

Conclusions
I am happy to reflect upon our progress in the past year. I will soon relinquish the Presidency to Dr. Sam Wilson. He and his physician wife Arlene Braham contribute a powerful and humanistic addition to the high desert physician primary care workforce. He has worked tirelessly on behalf of our medical society in the past year, guiding our executive decisions with an inquisitive, honest and open thought process, and assuming Dr. Lisa Perry-Gilkes' work in providing leadership on our behalf to the African American Health Initiative. I will do my best to help Sam, our staff, and our leadership in representing the interests of San Bernardino County physicians and their patients in the coming year. Thank you all for the opportunity to serve.