AAHI Health Planning Project Coordinator V. Diane Woods provided a fact sheet about the 2-year $268,620 grant from The California Endowment (TCE). The project is to engage in countywide community based participatory health planning. Its aim is to identify and assess prevention programs and treatment services offered to the Black/African American population related to heart disease, high blood pressure, HIV/AIDS, breast cancer and prostate cancer. The expected outcomes include a county-wide inventory of healthcare providers, a survey of 300 African American San Bernardino County residents; conduct nine focus groups among African Americans; conduct three public forums for the general population's input; and develop a comprehensive strategic plan to address the findings. A copy of the first interim report to TCE for the AAHI Health Planning Project was provided to the board as well as a copy of the project timeline.

Ms. Woods reported she has met with many Black community leaders and solicited their input for the project. She reported 60 people applied for the outreach worker positions; three were hired. Data collection tools are currently being worked out, and collection by the outreach workers should begin by year's end. In the last few months over 75 have participated in the process of the project. A calendar of upcoming work group meeting dates will be posted on the AAHI section of the IWIN web site.

Ms. Woods has prepared a media coverage binder for the AAHI Health Planning Project. She invited the board to view it. She reported 60 people attended the first public meeting for the Health Planning Project on August 22, 2003 at New Hope Family Life Center. Ms. Woods stated an evaluation team comprised of different professionals would evaluate immediate impact and the long-range outcomes. The end product will be a comprehensive countywide plan to enhance organizational provider capacity, service coordination, and preventive and treatment services.

Dr. Gnanadev reported on the Coalition to Preserve Emergency Care (CPEC), a top priority for CMA. The Trauma and Emergency Care Act, a ballot initiative, will appear on the November 2004 ballot. The initiative will produce between $500-600 million annually for trauma and emergency care. The initiative will result in the average residential user contributing about $.50 a month, and slightly higher for businesses. CMA has committed $900,000 to ensure the initiative qualifies for the ballot. CMA is working with component medical societies to organize outreach and fundraising for the initiative. Most medical societies have added a $95 PIC contribution on their 2004 CMA dues statements. Letters will be sent to medical staffs and non-members soliciting contributions to the initiative. CMA will update the component medical societies on fundraising successes as well as direct mail and other outreach efforts. For San Bernardino County, the initiative is likely to produce $10 million in additional income for on-call and ER physicians. The initiative also establishes physician oversight of the administration of the fund to ensure that every dollar is fully utilized for physicians, eliminating many of the inefficiencies of the current Maddy fund.

Dr. Gnanadev reported on the upcoming Medi-Cal cuts. This year's Budget Act, due to the significant state budget deficit, directed that payments be reduced by 5% for Medi-Cal services beginning January 1, 2004. The Act also authorizes equivalent rate reductions to managed care plans. Because of the extreme hardship the Act will impose on beneficiaries and providers, CMA's Executive Committee recently authorized the filing of a lawsuit. Physicians are urged to help CMA's legal efforts to enjoin these cuts and sign declarations that tell the court about the negative consequences of the Medi-Cal fee cuts.

Public Health Officer Dr. Tom Prendergast reported cases of aseptic meningitis increased substantially in San Bernardino, but it looks like they are now on their way down. There were 90 cases within a three-month period. With the cold weather upon us, he reported it could be an end to the West Nile virus season. The virus was detected in three birds in the county, as well as a couple of horses. There have been some human cases in California, but not in San Bernardino. The Public Health Department's concern is respiratory illnesses due to the flu season. The CDC is in the process of coming up with tests for common pathogens. He reported visiting most of the shelters in San Bernardino County for fire victims. He stated nearly 60,000 were evacuated from their homes, but the most that were sheltered at one time was 3,500. The vast majority of people found other locations to stay rather than the shelters. The medical care for the various shelters differed widely. At the Norton AFB shelter, Loma Linda University had a full clinic operation and Costo provided free prescriptions to those who lost homes by the devastating fires. Unfortunately, at the high desert shelter they only had a paramedic and emergency technician on hand for medical care.

If a Medical Reserve Corps (MRC) was in place during the fires, a site team could have been created for those areas where medical care is necessary and it would have helped out greatly. Lots of lessons can be learned for future emergencies. Also with a MRC in place, we would have a liaison to work with the American Red Cross. To be permitted to help the American Red Cross in times of disaster organizations need to have a MRC in place or have a contract with the Red Cross. Ms. Stratton reported that SBCMS just received notification that we were awarded a one-year $50,000 grant to develop a MRC for our county. She stated that if we perform satisfactorily, grant monies could be funded through 2006. Dr. Hess reported important numbers pertinent to those affected by the fires are now listed on the SBCMS website. The board approved waiving for one year both SBCMS and CMA dues for all members affected by the fires.

IEHP Medical Director, Dr. Brad Gilbert, reported total membership is over 270,000. Medi-Cal enrollment is 232,758 with 30,095 enrolled in the Healthy Families program. Healthy Kids enrollment for San Bernardino County is nearly 1,000. Riverside's Healthy Kids enrollment is 5,396. The auto assignment percentage in August was 28 percent. In terms of the state budget cuts, there was a 5% cut to Medi-Cal and the actuarial equivalent for Medi-Cal managed care would be less than 2%. That represents $5.1 million on an annual basis for IEHP. The cut took effect on October 1st. He stated IEHP lawyers have been assisting CMA with the TRO, specifically to make sure the language rescinds the overall cut and the cut to managed care. Although the cut to IEHP is already in effect, the IEHP board decided not to cut rates to their providers until January 1, 2004. If the TRO is successful, then the doctors would not be impacted by the rate cut. The IEHP board approved reductions in Medi-Cal rates and expenses at their October meeting. The five affected by the recommended reductions are: 1) reduction of the IEHP net surplus by covering the rate reduction by the State prior to the Medi-Cal fee-for-service reduction, 2) the Physician Incentive Program, 3) pharmacy fill fee reduction, 4) vision payment, and 5) reduction in capitated rates for IPAs. These cuts are being predicated on the Medi-Cal fee scheduled being reduced.

The CMA Foundation is seeking nominations for the Robert D. Sparks Leadership Award. The award honors an individual or organization that demonstrates outstanding concern for the health of communities in a manner consistent with the mission of the CMA Foundation. The deadline for submitting nominations is December 31, 2003. Ms. Stratton asked the board to send nominations to her. Dr. Wilson asked for volunteers from the board to make presentations at upcoming hospital medical staff meetings. The board approved canceling the December 29, 2003 board of directors meetings.

Linda Stratton updated the board on the Pacific Foundation for Medical Care (PFMC). San Bernardino County physicians have been with PFMC since 1995 when the San Bernardino FMC was sold to the San Diego FMC for $1. Unfortunately, PFMC has been unsuccessful in signing contracts to provide patients to doctors in our county. The majority of patients seen by San Bernardino County physicians, through the foundation connection, are a direct result of business through the Riverside FMC. A request was submitted to PFMC to terminate the CFMC related network in San Bernardino County and assign the membership agreements, contracts and credentialing files to the RFMC who would then be responsible for managing the San Bernardino County network as part of its relationship with CFMC. PFMC has since contacted the Riverside FMC to negotiate the selling price of the San Bernardino panel. The SBCMS Board indicated their interest in having a seat on the Riverside FMC Board when they manage the San Bernardino network.

Information on the Centers for Medicare and Medicaid Services (CMS) final rules regarding clarifications of the Emergency Medical Treatment and Labor Act (EMTALA was provided to the board. The final rule largely addresses concerns of the AMA, which worked in partnership with several national medical specialty societies to ensure that key EMTALA burdens would be lifted. Highlights of the rule include hospitals maintaining an on-call list of physician; hospitals permitting physicians to schedule elective surgeries during the time they are on-call and having simultaneous on-call duties among different hospitals in the community; and hospitals having written policies and procedures in place.

On October 3, the California Department of Insurance (CDI) strongly urged NORCAL Mutual Insurance Company to adopt a radically reduced 2004 rate increase that was inconsistent with the company's actuarial analysis. While in disagreement with CDI's stance, NORCAL's board of directors decided to accept the amended filing of 2.91% versus the original filing request of a 9.9% increase. NORCAL is emphatic that, for the foreseeable future, the amended filing will not weaken the company's claims defense posture or result in mass cancellations of its physician insureds.

The board supported Dr. Peggy Fritzsche candidacy for appointment to the American Medical Political Action Committee.