CMA - California Medical Association

Kent Yamaguchi, M.D., (right) recently received a Lifetime Achievement Award from Fresno Maderia Medical Society.
 

Featured member benefit:

PrivaPlan Associates: PrivaPlan Associates provides HIPAA solutions to California Medical Association (CMA) members. The nationally acclaimed CMA/PrivaPlan online compliance toolkit provides an easy-to-follow do-it-yourself program for HIPAA privacy, security, and breach compliance. Read More

(Photo courtesy of Santiago Mejia / The Chronicle)

Dr. Andre Campbell voices his frustrations about America’s epidemic of shootings after he and a trauma team at S.F. General cared for YouTube gunfire victims. Read More

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1. Take action NOW to stop radical physician rate regulation bill

Assemblymember Ash Kalra (D-San Jose) last week announced a radical proposal that would increase patient out-of-pocket costs and result in a dangerous government intrusion into the health care market by creating state-sanctioned rationing of health care for all Californians.

Assembly Bill 3087 would establish an undemocratic, government-run commission with nine political appointees who would unilaterally set the price for all medical services that are not already controlled by the government, essentially eliminating commercial health care markets in California. None of the political appointees are required to be patient-focused or have any tangible experience in the delivery of health care to patients.

AB 3087 will be heard in the Assembly Health Committee on April 24. Physicians are urged to visit actnow.io/PriceFixing to email their legislators and ask them to stop this dangerous bill. Sample messaging is provided. If you’re active on social media, please also click on the Twitter/Facebook icons to voice your opposition on these platforms. 

We are also encouraging ALL physicians to register their opposition to this bill with Assemblymember Kalra’s office via phone. To do so, visit actnow.io/PriceFixing, click on the phone icon and enter your information when prompted. You will immediately receive a call from (408) 752-5387 that will provide guidance on what to say and patch you directly to the author of this bill.

More Ways to Take Action

CMA is also asking physicians to answer a few questions about how AB 3087 will impact their practices. The survey results will help in our legislative efforts to fight this dangerous bill.

And, if you are among California's physicians that will be forced into early retirement or out of state if AB 3087 passes, we want to tell your story. Drop us a line at communications@cmanet.org.

“No state in America has ever attempted such an unproven policy of inflexible, government-managed price caps across every health care service,” said California Medical Association (CMA) President Theodore M. Mazer. “It threatens to reverse the historic gains for health coverage and access made in California since the passage of the Affordable Care Act.”

Despite fundamentally altering how health care services are provided in California, the bill explicitly prohibits health care professionals from participating on the commission. This commission—constructed to view patient care simply as a cost center—would have the unprecedented authority to ration the timing and quality of care California patients receive by fixing the prices of the commercial health care market.

This bill does nothing to ensure that patient out-of-pocket costs are decreased and moves California away from the goal of value-based care backwards to an antiquated fee-for-service model. It would also have the consequence of dramatically reducing consumer choices.

“AB 3087 is a poorly conceived, monumental threat to patient access to health care that goes against the Assembly’s own expert recommendations,” said Dr. Mazer. “This dangerously flawed legislation would result in government-sanctioned rationing of care and higher out-of-pocket costs for patients.”

The bill would also put additional cost pressure on the California health care delivery system by allowing lawyers and lobbyists to be reimbursed by the Commission for lobbying the Commission. This process mirrors existing intervenor fee models that have not reduced overall consumer cost—but have served as a means for special interests to, as one former State Insurance Commissioner alleged, get “fat off the public trough.” Brazenly, the bill also creates a direct funding mechanism that would financially benefit one of the bill's sponsors.

AB 3087 also ignores the recommendations from the University of California, San Francisco’s report—commissioned by the Assembly—to achieve universal access to health care, which includes implementing a comprehensive strategy to overcome the physician workforce shortage in the state by removing barriers that prevent physicians and other clinicians from specializing in primary care and practicing in underserved areas. Currently, six of nine California regions are already facing a primary care provider shortage, and 23 of California’s 58 counties fall below the minimum required primary care physician-to-population ratio. The state needs 8,243 additional primary care physicians by 2030—a 32 percent increase.

“AB 3087 would cause an exodus of practicing physicians, which would exacerbate our physician shortage and make California unattractive to new physician recruits,” said Dr. Mazer. “The legislature should reject AB 3087, and instead, focus on real solutions that further value-based care, ensure a patient can access a physician when they need one and tackle California’s physician shortage.”

Historically, policies of inflexible and arbitrary price caps are viewed as ineffective in controlling costs and detrimental to access to health care. During federal health reform discussions, both the Obama and Clinton administrations considered price-cap proposals, but ultimately rejected them on the basis that they posed too many direct and indirect risks to the overall health care delivery system.

Visit actnow.io/PriceFixing to take action today. 

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2. DOJ certifies CURES: Physicians must check database prior to prescribing effective October 2, 2018

The California Department of Justice (DOJ) has certified that as of April 2, 2018, the Controlled Substance Utilization and Evaluation System (CURES) – California’s prescription drug monitoring database – is ready for statewide use. The certification starts a six-month implementation period for the duty to consult requirements enacted by the Legislature in SB 482 (Lara, 2016).

Effective October 2, 2018, physicians must consult CURES prior to prescribing Schedule II, III or IV controlled substances to a patient for the first time and at least once every four months thereafter if that substance remains part of the patient’s treatment. Physicians must consult CURES no earlier than 24 hours or the previous business day prior to the prescribing, ordering, administering or furnishing of a controlled substance to the patient.

This law provides, however, that the requirement to consult CURES would not apply if doing so would result in the patient’s inability to obtain a prescription in a timely manner and adversely impact the patient’s conditions so long as the quantity of the controlled substance does not exceed a five-day supply.

Physicians are also not held to this duty to consult when prescribing controlled substances to patients who are:

• Admitted to a facility for use while on the premises;
• In the emergency department of a general acute care hospital, so long as the quantity of the controlled substance does not exceed a seven-day supply;
• As part of a surgical procedure in a clinic, outpatient setting, health facility or dental office, so long as the quantity of the controlled substance does not exceed a five-day supply; or
• Receiving hospice care.

In addition, there are exceptions to the duty to consult when access to CURES is not reasonably possible, CURES is not operational or the database cannot be accessed because of technological limitations that are beyond the control of the physician.

As of July 1, 2016, the law mandates that all California licensed physicians authorized to prescribe scheduled drugs and registered with the Drug Enforcement Administration be registered to access CURES.

For more information on CURES and the upcoming duty to consult, see CMA On-Call document #3212, “California’s Prescription Drug Monitoring Program: The Controlled Substance Utilization Review and Evaluation System (CURES)” or visit the DOJ’s website and CURES user guide.

CMA will continue to provide educational resources and work with the DOJ to ensure a smooth implementation of the new requirement. 

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3. California AG intervenes in lawsuit to dismantle ACA

California Attorney General Xavier Becerra, joined by 16 attorneys general, last week filed a motion to intervene in a lawsuit that seeks to dismantle the Affordable Care Act (ACA). The lawsuit, filed in federal district court in Texas, imperils health care coverage for all Americans, particularly more vulnerable groups like children and people with chronic medical conditions or disabilities.

In California, millions of people receive quality, affordable health care coverage under the ACA, many for the first time. The California Medical Association (CMA) applauds Attorney General Becerra for intervening in this lawsuit to defend the ACA. To roll back the clock and risk the health of millions of Americans is irresponsible.

“We cannot afford to go back to a time when Californians with pre-existing health conditions were priced out of the market, stuck on waiting lists for care or told that they were not covered for life-saving treatments,” says CMA President Theodore M. Mazer, M.D. “We should not force the newly insured to seek care in emergency departments when their conditions have worsened and become more expensive. We stand with AG Becerra and the other states to protect affordable health care coverage and access to physicians for our most vulnerable patients.”

The Texas lawsuit seeks to stop the ACA Medicaid expansion; end tax credits that help people afford insurance; allow insurance companies to deny coverage to people with pre-existing conditions; take away seniors’ prescription drug discounts; strip funding from our nation’s public health system, including work to combat the opioid epidemic; and much more. If the ACA were terminated, the state of California would stand to lose $160.2 billion in health care funding.

Texas, joined by 19 other states, filed the lawsuit in the United States District Court for the Northern District of Texas, Fort Worth Division, on February 28, 2018. The suit alleges that the ACA is no longer constitutional due to the passage of the Republican tax break bill, passed in December 2017, which eliminated the ACA individual mandate penalty payment. Although Congress recently repealed the individual mandate penalties for 2019, the ACA framework remains the law of the land. In the motion to intervene, Attorney General Becerra argues that the ACA has not been repealed by the passage of the Republican tax break bill, and its constitutionality has been upheld by the Supreme Court.

CMA supports the ACA and the expansion of health insurance coverage that it brought to more than 5.5 million Californians. The ACA’s Medi-Cal expansion now covers nearly 4 million Californians, with 1.5 million more insured under Covered California. The ACA reduced California’s uninsured from 17 percent of the population to less than 7 percent.

“Dismantling the ACA would be devastating to California’s working families,” said Dr. Mazer. “CMA encourages lawmakers to engage with physicians and other experts to improve on the gains of the ACA in order to increase patient access to care, particularly for our most vulnerable populations.”

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4. Commission studying continuing board certification is seeking physician input

A new commission has been formed—Continuing Board Certification: Vision for the Future—to bring together multiple stakeholders to re-envision the future of continuing board certification. The commission members represent a broad cross-section of physicians from a wide variety of specialties and practice settings and a diverse group of stakeholder communities, including national specialty and state medical societies, hospitals and health systems, health care organizations, and the general public.

Throughout the process, the commission will seek feedback from a diverse group of stakeholders using a variety of methods including an open survey launched in February. The survey is an important opportunity to participate in the process, and physicians are encouraged to complete the survey and share it with your colleagues and organizations.

Click here to take the survey, which is open until April 30.

For more information about the commission, visit www.visioninitiative.org. 

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5. Last chance: Register for CMA’s April 18 Legislative Advocacy Day!

Your voice is key to our success in the Capitol. Critical issues affecting physicians are being decided in the legislative arena at a fast and furious pace, including the newly introduced AB 3087. The California Medical Association (CMA) has some of the best lobbyists, lawyers and advocates in the Capitol, but the most powerful weapon in advancing the cause of physicians and their patients is you.

Hearing from a physician with experience from the frontlines of medicine can make all the difference for a legislator facing a complicated health care issue. That’s where you come in.

Join more than 400 physicians, residents and medical students in Sacramento on April 18, 2018, for CMA’s 44th annual Legislative Advocacy Day to lobby your legislative leaders as champions for medicine and your patients. You will also have the opportunity go to the Capitol throughout the day to meet with legislators on health care issues.

“It’s just so much fun to go there with hundreds of doctors and medical students in our white coats and to let Californians know that we’re there to advocate for them, for the health system, for access to care and for the issues that matter to them,” says Los Angeles family physician Jerry Abraham, M.D., MPH, who has attended CMA’s Legislative Advocacy Day for the past two years.

This is a unique event for California physicians and is free of charge to all CMA members.

Register today for this free event and join us in Sacramento on April 18.

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6. Saturday, April 28, is National Prescription Drug Take Back Day

Saturday, April 28, 2018, is National Prescription Drug Take Back Day. On this day, hundreds of locations throughout California will be accepting and properly disposing of unused prescription drugs, including controlled substances. Proper disposal of unused prescription drugs helps prevent diversion and misuse associated with these medications.

This one-day event will provide patients with free, anonymous collection of unwanted and expired medicines. The last National Take Back event collected 456 tons of unwanted prescription drugs at almost 5,500 collection sites nationwide.

In addition to providing a safe, convenient and responsible means of disposal, the event also aims to educate the general public about the potential for abuse of these medications. A significant component of the prescription drug abuse and diversion problem stems from misuse of unused drugs.

According to the Substance Abuse and Mental Health Administration, over 71 percent of prescription pain medications are obtained from family and friends, and 5 percent took the medication from a friend or relative without asking.

Physicians can take action by encouraging their patients to participate in Take Back Day. To find a collection site near your practice, click here.

This and other resources are available on CMA's safe prescribing webpage at www.cmanet.org/safe-prescribing. 

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7. Molina Medical Group is now Golden Shore Medical Group

On January 1, 2018, Molina Medical Group changed its name to Golden Shore Medical Group. Additionally, Golden Shore has hired Network Medical Management (NMM) as its new medical service organization. NMM will administer specific managed care operations for Golden Shore, including claims, contracting and provider network support. 

Golden Shore has confirmed that it is working with Molina Medical Group-contracted primary care physicians to secure new contracts under Golden Shore Medical Group. Until then, the existing contracts remain in place. Specialists are not required to enter into new contracts unless they are requesting a change to the existing contractual terms.

Authorization requests should be directed to NMM at (626) 282-0288 (press option #5, then press #2). If submitting claims electronically, use payor ID NMM03. For paper claims, mail to:

Golden Shore Medical Group
c/o: Network Medical Management
1680 S. Garfield Ave. # 200
Alhambra, CA 91801

To stay up to date with NMM news, visit the NMM website.

For more information on transition protocols, click here. 

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8. Featured member benefit

PrivaPlan Associates: PrivaPlan Associates provides HIPAA solutions to California Medical Association (CMA) members. The nationally acclaimed CMA/PrivaPlan online compliance toolkit provides an easy-to-follow do-it-yourself program for HIPAA privacy, security, and breach compliance.

Additionally, PrivaPlan provides security risk analyses and privacy reviews to assist CMA members in meaningful use attestation and compliance in general. PrivaPlan can also assist CMA members in completion of HIPAA policies and procedures as well as provide HIPAA breach notification investigation and follow-up services. For more information, go to www.privaplan.com.

Contact: CMA member help center, (800) 786-4262 or memberservice@cmanet.org. 

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