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Top Story: Gov. Brown, Lt. Gov. Newsom share their views on budget, health care reform with CMA physicians
Governor Jerry Brown provided more than 500 physicians and over 60 medical students at the California Medical Association's 37th Annual Legislative Leadership Conference April 5 with a quick course in how the state's $26.6 billion budget deficit was created, but concluded on the optimistic note that he would be able to solve the problem. READ MORE
Also in this issue:
- New CMA website provides suite of digital tools for effective communication
- Helping physicians respond to requests for non-beneficial treatment
- Health reform CO-OPs will be attractive to California physicians, but face many barriers, CMA tells HHS
- Understanding your contracts: CMA's resources and services
- CMA revises POLST Kit to include latest changes, new information
- Will your Blue Cross Healthy Families EPO claims be paid after March 31?
- Registration is now open for 14th Annual California Health Care Leadership Academy
- Webinar (4/20): Implementing a compliance program
- CMA schedules conferences to help physicians succeed in health reform era
Featured Member Benefit: 15% off insurance products
CMA members receive discounts on a variety of insurance products, including automobile, group health, life, long-term care, workers' compensation, and more! READ MORE
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1. Gov. Brown, Lt. Gov. Newsom share their views on budget, health care reform with CMA physicians
Governor Jerry Brown provided more than 500 physicians and over 60 medical students at the California Medical Association's 37th Annual Legislative Leadership Conference April 5 with a quick course in how the state's $26.6 billion budget deficit was created, but concluded on the optimistic note that he would be able to solve the problem.
Later, Lieutenant Governor Gavin Newsom, in the keynote address to the conference, offered his assistance to CMA's physicians in devising additional reforms that will increase access to health care for millions of Californians.
In a short question and answer session after Newsom's remarks, the lieutenant governor praised Governor Brown on his handling of California's $26.6 billion budget deficit, which the governor now pegs at $13.5 billion after the Legislature approved an initial round of budget cuts.
"I don't know what more the governor could have done…," Newsom said. "All we're asking for is the opportunity to let the people do their part," he continued, referring to Brown's continuing effort to persuade two Republicans in each house of the Legislature to vote to place a measure on the ballot that would extend temporary vehicle, sales and income taxes for an additional five years, raising enough revenue to resolve the remaining budget deficit.
Brown told reporters after his address that he plans to take trips around the state to talk to a variety of groups about the options available to balance the budget. If legislators don't provide the votes for a budget solution, the governor described the options as either an all-cuts budget or "to go to the people with some form of initiative," Brown said in response to reporters' questions.
Dustin Corcoran, CMA's Chief Executive Officer, said, "We need a sensible, balanced approach to this budget crisis. Twenty-six billion in cuts would be devastating to medical students, patients, and fundamentally, the health care system as a whole."
Brown added a note of optimism when he observed that as the state's chief executive, he has to deal with many diverse issues.
"We've got to deal with prisons, we‘ve got to deal with taxes, with water, we have a very wide range. But here's my point," Brown said. "Even though it looks pretty challenging, things in California are doing pretty well. We don't know how we're going to get that $13.5 billion (the remaining deficit after the Legislature's initial $11 billion in cuts). That's just one of the little problems I've got to deal with. But other than that I think it's clear sailing."
Newsom also spoke in positive tones when he described how he was able to initiate a universal health care plan when he was mayor of San Francisco. Instead of asking how universal health insurance should be provided, the better question was, "How should we provide universal health care? Newsom said. In answering that question, San Francisco's universal health care system was born, he explained. "We focus and orient folks around wellness and prevention."
"The feds wrote a $71.1 million check because we had a better idea," Newsom said.
Newsom said he wants to ensure that rural areas throughout the state, many of which are "underrepresented in doctors," have an adequate number of physicians to serve the needs of its citizens.
California's health care network faces serious challenges, Newsom said. This year's $1.7 billion in state budget cuts to Medi-Cal were as devastating to the state's health care as the provider cuts of three years ago would have been if the courts had not blocked them, he observed. As mayor of San Francisco, Newsom joined CMA in its lawsuit against the cuts.
- To listen to a podcast of the governor's remarks, go to:
http://cal.md/legday_gov - To listen to a podcast of the lieutenant governor's remarks, go to:
http://cal.md/legday_ltgov
Contact: CMA member help center, (916) 786-4262 (4CMA) or memberservice@cmanet.org.
2. New CMA website provides suite of digital tools for effective communication
The California Medical Association (CMA) is delighted to announce the launch of a new website designed for easier, more intuitive navigation and loaded with a suite of digital tools that will help you get the most from your membership.
The new CMA website provides members with a personalized web experience accessible across platforms, including mobile devices, so that no matter how you access the website, you will get what you want, how you want it.
The website also provides members with the ability to customize their content, frequency and delivery method of the information they receive from CMA, making the site more relevant for each individual.
Some other new features include:
- Online applications and membership renewals
- A searchable policy compendium
- A searchable issues database
- A physician finder
- Online event registration
- And more!
We encourage you to take a look around and activate your web account to update your profile. Let us know what you think!
Contact: Katherine Boroski, (916) 551-2074 or kboroski@cmanet.org.
3. Helping physicians respond to requests for non-beneficial treatment
An important part of a physician's daily practice is exercising professional judgment to determine the medical treatments that are most likely to be effective for attaining a patient's goals of care. Often, a patient or the patient's health care decision-maker will consent to the treatment or treatments recommended by the physician as most likely to be medically effective.
Occasionally, however, a patient or his or her health care decision-maker will request one or more medical treatments that the physician determines to be medically ineffective for the patient's particular medical condition and goals of care.
To help physicians and medical institutions deal with this difficult issue, CMA has created medical-legal document #0403, "Responding to Requests for Non-Beneficial Treatment Decisions."
The document discusses the legal immunities, principles of medical ethics and CMA policy that supports physician and medical institution decisions to decline non-beneficial treatment requests from patients or their health care decision-makers.
The document also offers guidance on how to handle conflicts that arise after a determination that a requested treatment would be medically ineffective or non-beneficial. To assist in fair and satisfactory decision-making about what constitutes medically ineffective or non-beneficial treatment, CMA recommends that health care institutions adopt policy that follows a "due process approach" to resolving conflicts and outlines several steps that should be considered.
Medical-legal document #0403, "Responding to Requests for Non-Beneficial Treatment Decisions," as well as the rest of the CMA medical-legal library (formerly CMA On-Call), is available free to members at CMA's online resource library. Nonmembers can purchase medical-legal documents for $2 per page.
Contact: Samantha Pellon, (916) 551-2872 or spellon@cmanet.org.
4. Health reform CO-OPs will be attractive to California physicians, but face many barriers, CMA tells HHS
The federal health reform law - the Patient Protection and Affordable Care Act (ACA) - calls for creation of non-profit health insurance plans, called CO-OPs (Consumer Operated and Oriented Plans), which can be operated by its community beneficiaries (consumers, providers and employers), but cannot be run by the government or an insurance company.
"CMA believes that the not-for-profit, local governance CO-OP model will be attractive to California physicians and patients," said a March 4 letter to the U.S. Department of Health and Human Services (HHS) signed by California Medical Association (CMA) President James Hinsdale, M.D.
CMA urged HHS to promote physician involvement in CO-OPs – on their governing boards and in their management and provider networks, noting that several rural and suburban-rural communities in California are interested in forming CO-OPs.
"CO-OPs may be the only entities truly interested in insuring and serving their local rural residents. Therefore, if the ACA's goal is to expand access to affordable coverage options for the uninsured, particularly in rural areas, HHS should help to foster the CO-OP model," the CMA letter said.
One of the greatest barriers to starting a medical insurance CO-OP will be the amassing of the financial reserves necessary to cover unexpected catastrophic claims and losses, the CMA letter noted. "Thus, CO-OPs will either have to carry large financial reserves or be forced to purchase reinsurance to mitigate unexpected catastrophic losses.
The ACA provides $6 billion in loans and grants to help CO-OPs get started and to fund the necessary reserves. The loans must be repaid within five years of operation and can only be used for start-up costs. They cannot be used for lobbying or marketing. Grants for reserves will be more substantial and must be repaid over a 15-year period.
However, CMA warned that "there will be many barriers to entering the complex California insurance market," and urged HHS to allow flexibility in the ACA's loan and grant provisions to help CO-OPs develop in local communities.
CMA urged HHS to explore ways the federal government could sponsor reinsurance to CO-OPs. "We believe a national reinsurance pool could foster the entry of CO-OPs into the California insurance market which would promote competition that would in-turn drive down premiums, improve physician participation and increase access to care."
The CMA letter emphasized that in order for CO-OPs to provide access to comprehensive, quality patient services, they must have "robust provider networks of primary care and specialist physicians, who must be paid fairly and adequately.
"First and foremost, HHS must ensure that the rates paid to insurers, including CO-OPs, participating in the State Health Insurance Exchanges be risk-adjusted to account for California's higher practice expenses (rent, non-physician wages) and the socioeconomic and health status of our population," the CMA letter said.
CMA emphasized that CO-OPs must be able to pay physicians actuarially sound rates, which are essential to attracting and maintaining physician participation in a start-up CO-OP.
For more information on CO-OPs, see CMA's Federal Health Reform Issue Brief, "Consumer Operated and Oriented Plans."
Contact: David Ford, (916) 551-2554 or dford@cmanet.org.
5. Understanding your contracts: CMA's resources and services
Assessing and reviewing your contracts is essential to getting the most out of any contract proposal, whether it involves employment agreements, managed care contracts, shareholder agreements or hospital-based contracts.
Because the "devil is in the details," ambiguously worded contracts may not contain the provisions meant to protect you and your medical practice from detrimental deals.
CMA offers a number of resources and services to assist CMA members in simplifying the at-times-daunting contract review.
One such resource is CMA's contract analysis service through which CMA members can receive written reviews of specific physician contracts. CMA members get 20 percent off attorney's fees of the law firm that has contracted to do these reviews. The analysis fee depends upon the type of contract to be reviewed. Included in the price are an initial appointment (either by phone or in person) prior to the analysis and an additional appointment after the physician has received the analysis, if the physician so desires.
Through this CMA service, attorneys under contract with CMA will review a contract for compliance with California and federal law and determine whether, from a business and practical perspective, the provisions of the contract are beneficial for the physician or medical group. Vague provisions are noted and alternative language physicians may wish to consider is suggested.
The service covers many different types of physician contracts, such as employment contracts, expense sharing arrangements, management service organization or administration contracts, hospital recruitment and hospital-based contracts, managed care and IPA contracts, shareholder agreements, and foundational model contracts, among others.
In addition, CMA annually updates several documents from its online medical-legal library that may assist members in the contracting process.
Employment contracts and physician employers or employees are discussed in CMA medical-legal document #0213, "Model Employment Contract." This document highlights the concerns of both parties in a contract format and discusses common issues presented by employment arrangements. Another useful document is #0224, "Ethical Guidelines for Employer and Employee Relationships," which presents guidelines and tips on how best to arrange an employment agreement that is ethically and legally sound.
The medical-legal library also has an entire chapter devoted to the managed care contracting process. One relevant document from that chapter is #1070, "Managed Care Contractual Protections," which includes information on certain clauses in physician contracts with health plans and insurers.
CMA members have online access to analyses of several health plan provider contracts. CMA also offers a toolkit for payor contracting, "Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations," that provides physicians and their office staff with a checklist to assist in the review process. Each step listed in the checklist is highlighted in detail, with sample forms and letters that may be customized for each medical practice.
Contact: CMA's member help center, (800) 786-4262 or legalinfo@cmanet.org.
6. CMA revises POLST Kit to include latest changes, new information
The California Medical Association (CMA) has revised its Physician Orders for Life Sustaining Treatment (POLST) Kit to incorporate a new official California POLST form and additional information approved by the California POLST Task Force.
The POLST form, used for patients with a serious illness or whose life expectancy is a year or less, outlines a plan of care in actionable physician orders that reflect the patient's wishes concerning medical treatment and interventions at life's end.
The POLST form was revised after reviews by the California POLST Task Force, which analyzes the California form every two years and recommends changes in response to feedback from health care providers, consumer advocates and others, based on usage of the form in the field. The revisions were also approved by the California Emergency Medical Services Authority Commission. CMA participates on the POLST Task Force.
CMA's POLST Kit includes legal forms and wallet identification cards, and answers frequently asked questions about end-of-life issues. Physicians are encouraged to keep a supply of forms in their offices for use when having end-of-life discussions with patients.
Revised POLST Kits can be purchased from CMA's resource library. Single copies are $5 for members and $6 for nonmembers. Significant discounts are available on bulk purchases.
Contact: CMA Publications, (800) 882-1262.
7. Will your Blue Cross Healthy Families EPO claims be paid after March 31?
Effective April 1, in order to be paid for services provided to Blue Cross Healthy Families EPO patients, physicians must be in the Blue Cross Healthy Families network.
As previously reported in CMA Alert, the Department of Managed Health Care approved the physician networks in the remaining Blue Cross Healthy Families EPO counties in January. With this approval, Blue Cross was no longer required to offer continuity of care plans, and they were phased out on March 31.
Blue Cross announced in March 2009 that it would require physicians to sign a separate contract and accept reduced rates if they wanted to continue treating Blue Cross-insured patients through the Healthy Families and Access for Infants and Mothers programs. The new lower payments vary but hover just above Medi-Cal rates.
Physicians who have patients currently undergoing a course of treatment and believe that transition of care to another provider could adversely impact the patient's care can contact Blue Cross Utilization Management at 888/831-2246 to request authorization for continued care as a non-participating physician.
Patients can locate in-network physicians by visiting the Blue Cross website (click Find a Doctor) or by calling the number on the back of their insurance cards.
Download a copy of the notice that was sent to physicians in February.
Contact: CMA's reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org.
8. Registration is now open for the 14th Annual California Health Care Leadership Academy
Registrations are now being accepted for the 14th Annual California Health Care Leadership Academy, June 3-5, 2011, at the Renaissance Esmeralda Resort & Spa in Indian Wells.
This year's conference, "The Next Step: Successfully Negotiating Health Reform," will focus on the implementation of federal health reform. Among the issues that will be discussed are Accountable Care Organizations, new quality measurement and reporting initiatives, and the role of health information technology.
Breakout sessions will cover a variety of practice management topics.
Register by May 6 and save up to $100 on a single registration. Groups of three or more will save an additional $75-$100 per registration.
For more information and to register, visit the Leadership Academy website or call 800/795-2262. The CMA-organized Leadership Academy is co-sponsored by the California Medical Group Management Association and the CMA Foundation.
Contact: Leadership Academy hotline, (800) 795-2262 or leadership@cmanet.org.
9. Webinar (4/20): Implementing a compliance program
Health care reform legislation requires providers of medical services to persons enrolled in Medicare, Medicaid (Medi-Cal in California) or the Children's Health Insurance Program (CHIP) to establish a compliance program to detect illegal activities or civil and administrative violations.
Implementing a compliance program in a physician's office does not have to be a daunting task. Please join us on April 20, 2010, for an informative webinar, presented by Mary Jean Sage from Sage Associates. The one-hour webinar will be presented twice, at 12:15 p.m. and again at 6:15 p.m. For more information, or to register, visit http://www.cmanet.org/events.
Contact: CMA Member Help Center (800) 786-4262 or memberservice@cmanet.org.
10. CMA schedules conferences to help physicians succeed in health reform era
Physicians face dramatically different market and economic forces created by passage of the Patient Protection and Affordable Care Act (ACA). The sweeping health reform law mandates a host of payment reforms and calls for creation of new physician networks organized to improve quality of care and reduce cost.
To assist independent physicians in navigating these uncharted reform waters, the California Medical Association (CMA) is working with county medical societies and associations to schedule a series of conferences called "Strategies for Independent Physicians to Collaborate and Succeed in the Era of Reform."
The conferences, the first of which is in San Francisco on April 30, 2011, will provide information on the various business models that can help physicians pool their talents to effectively compete in the new health care marketplace. Topics also will include ways to provide improved quality of care through clinical integration, and whether it is feasible to form physician-led networks, including new Accountable Care Organizations (ACOs).
At each conference, a comprehensive resource manual will be provided. Items included will be:
- A checklist enabling physicians to analyze their local market conditions to see what opportunities/organizational structures are most practical;
- An identification of various business models to consider, as well as an analysis of the economic efficiencies that can be achieved by forming an organization;
- A discussion of the tools needed to improve quality, maximize reimbursement, and clinically integrate for the purposes of joint contracting under the antitrust laws
- Health information technology (HIT) as a fundamental practice tool, HIT readiness and financing opportunities;
- Legal issues to consider when partnering with hospitals.
Conference Schedule
San Mateo: The first conference, hosted by the San Mateo County Medical Association, 777 Mariners Island Blvd., Ste. 100, San Mateo, CA, will be held Saturday, April 30, 2011, from 9 a.m. to 2 p.m.
Other sponsors include the San Francisco Medical Association, the Santa Clara County Medical Association, the Santa Cruz County Medical Association and the Monterey County Medical Association. The conference is free to association members.
Contact: Astrid Meghrigian, (415) 350-3966 or ameghrigian@cmanet.org.
Oakland: Conference number two, hosted by the Alameda-Contra Costa Medical Association, 6230 Claremont Avenue, Oakland, CA, will be held Saturday, May 7, 2011, from 10 a.m. to 2 p.m. Other sponsors include the Solano County Medical Society, the Napa County Medical Society, Sonoma County Medical Society and Marin Medical Society. The conference is free and open to members only.
Contact: Ashleigh Strasheim, (415) 924-3891 or ashleigh@marinmedicalsociety.org.
Fresno: Conference number three, hosted by the Fresno/Madera Medical Society, 1382 East Alluvial Ave., Suite 106, Fresno, CA, will be held Wednesday, May 11, 2011, from 6 p.m. to 9 p.m. The Kern County Medical Society also is sponsoring the conference, which is free to society members. There is a $20 charge for each guest.
Contact: Sandy Palumbo, (559) 224-4224.
French Camp: Conference number four, hosted by the San Joaquin Medical Society, will be in the Community Room for the Health Plan of San Joaquin at 7751 South Manthey Road, French Camp, CA, on Saturday, May 14, 2011, from 8:30 a.m. to 2 p.m. Other sponsors include the Stanislaus County Medical Society, Sierra-Sacramento Medical Society, Tuolumne County Medical Society, and the Merced-Mariposa Medical Society.
Contact: (209) 952-5299.
11. Featured Member Benefit: 15% off insurance products
CMA members receive discounts on a variety of insurance products, including automobile, group health, life, long-term care, workers' compensation, and more!
To find out how you can save up to 15 percent visit the member benefits page.
For more information on these and other member benefits, click here or contact CMA at memberservice@cmanet.org or (800) 786-4262 (4CMA).