- Ensuring access to quality medical care
- Strengthening public health
- Promoting health education and advancing careers in health
- Protecting the physician-patient relationship
- Working to protect patients
- Preserving economic stability
- Advancing new technologies
Ensuring access to quality medical care
The California Medical Association (CMA) is dedicated to ensuring all Californians have access to medical care and can see a doctor when they need one. As physicians, we know that it is most effective to treat patients as soon as health issues arise. Access is essential to boosting prevention, protecting the public health and tackling widespread afflictions, such as obesity early.
At the heart of CMA advocacy are our efforts to ensure patients have access to doctors, which takes many forms, including:
- Championing universal health care coverage;
- Advocating for adequate, accurate and transparent provider networks;
- Stopping insurers from canceling coverage for patients after they become seriously ill, a practice known as rescissions;
- Defending our injunction against Medi-Cal provider cuts, saving doctors more than $100 million and helping Medi-Cal patients keep their doctors;
- Streamlining and improving the physician licensing process at the Medical Board of California and filing a lawsuit to exempt the Medical Board from any state furloughs to avoid additional licensing backlogs;
- Partnering with AARP to aggressively advocate against Medicare cuts that harm seniors' access to doctors; and
- Defending the constitutionality of the Medical Injury Compensation Reform Act (MICRA) in court, filing an amicus brief and testifying before the appellate court in the case, which ultimately upheld the constitutionality of MICRA.
For patients, access means knowing that their personal physician is in the network of doctors that their plan or policy will pay for. By establishing and maintaining a relationship with both a primary care and specialist physician, patients can count on quality care that is tailored to their needs.
Access also means making sure a doctor can keep his or her practice economically viable. CMA works to ensure that payments for physician services by all payors cover a doctor's cost of doing business.
Fostering an environment that allows physicians to operate cost-effective medical practices will help draw doctors to California and keep them here. Physicians want to spend their time treating and maintaining the health of their patients, but every hour a doctor spends jumping through regulatory hoops, is an hour less they can spend providing care.
Strengthening public health
CMA physicians strongly believe in keeping people healthy by ensuring access to preventive services, including immunizations and cancer screenings, while providing them with information to make healthy choices relating to nutrition, exercise and the environment.
CMA was founded in response to the need to professionalize the practice of medicine and protect the public health in the midst of a devastating cholera outbreak in Sacramento, more than 150 years ago. The public health was so important to these groundbreaking physicians that they highlighted it in the mission of their new organization: "to promote the science and art of medicine, the care and well-being of patients, the protection of the public health and the betterment of the medical profession. "
Advancing public health remains a core objective of the organization. CMA has:
- Lead the fight against smoking and tobacco use;
- Championed the creation of a separate Department of Public Health;
- Encouraged routine HIV screening in health care settings by streamlining the consent process;
- Supported legislation to ensure that children are fully immunized against devastating but preventable diseases, such as pertussis;
- Promoted childhood obesity prevention strategies, such as restaurant menu labeling, banning soda in school, supporting safe routes for children to walk and bike to school, and maintaining rigorous P.E. standards in school;
- Supported strict limits on diesel emissions to help prevent disease caused by poor air quality; and
- Joined manufacturers and state and local public health officials to advocate for timely and equitable distribution of seasonal influenza vaccine, so doctors have an adequate supply on hand to meet the needs of their patients.
In addition, the CMA Foundation, which is the philanthropic arm of CMA, has become a national force in the public health arena. The foundation has spearheaded a number of public health initiatives, outreach programs and physician educational conferences, which demonstrate a deep commitment to improving the health of all Californians.
Promoting health education and advancing careers in health
With Baby Boomers beginning to retire and health care reform expanding coverage to millions of previously uninsured citizens, California will need an ample supply of doctors. Meeting this burgeoning patient need is a paramount concern for CMA.
As California's population grows rapidly and ages, the demand for physicians' increases as well. Our state is becoming more culturally and ethnically diverse, and many areas that have traditionally been medically underserved are expected to see the greatest population growth.
At the same time, many of California's physicians are approaching retirement age, and the pipeline designed to replace them is experiencing bottlenecks at both the medical school and residency training levels. Medical school debt is growing faster than physician income, and it is one of the primary reasons that the supply of primary care physicians is lagging, even further behind that of specialists.
CMA has been active on a number of fronts to address the challenges of physician supply and maldistribution, including:
- Creating the Steve Thompson Loan Repayment Program that provides grants to pay off medical loans for doctors working in underserved areas. Each participating physician receives up to $105,000 in exchange for a three-year service commitment in a medically underserved area of the state;
- Supporting new medical schools, UC Merced and UC Riverside, and pushing an expedited timeline
- to build them;
- Supporting efforts to increase the diversity of the physician workforce through CMA's Ethnic Medical Organization Section; and
- Promoting increased incentives for pursuing primary care and supporting primary care physicians to keep their practices viable.
In the coming years, CMA will step-up efforts to encourage the education and training of more physicians in California, in hopes they will stay to practice in and serve California patients as well.
Protecting the physician-patient relationship
Physicians view the doctor-patient relationship as sacrosanct, the very foundation of health care. This relationship stems from a physician's primary ethical obligation – to place a patient's welfare above their own self-interest and above obligations to other groups, and to advocate for their patient's welfare. CMA passionately fights to protect this precious doctrine on multiple fronts.
CMA fiercely defends California's bar on the corporate practice of medicine, which prevents corporate interests from unduly influencing physicians' professional judgments in the name of profit and to the detriment of patients. Hospitals and other corporate interests do not have the same ethical and moral obligation to the patient as a physician does; therefore, it is essential to maintain the firewall between medical decisions and the corporate bottom line.
Inaccurate information and faulty rating programs can undermine the doctor-patient relationship. CMA has challenged Blue Shield's Blue Ribbon recognition program that aims to identify doctors who meet certain care standards, but the data the health plan uses has inherent flaws and ratings are inaccurate and unreliable. CMA has worked with physicians to correct misinformation and asked Blue Shield to address the program's fundamental shortcomings.
CMA also leads efforts in multiple arenas to leave the determination of what is medically necessary treatment where it belongs – in the hands of doctors. Health insurance gatekeepers and finance officers continually find new ways to delay and deny care, and erect barriers to medically necessary care for patients. Doctors are often a patient's only ally in this David vs. Goliath battle that frequently entails mountains of paperwork and endless phone calls. Doctors believe it is a fundamental element of the physician-patient relationship to fight for their patients' needed care to be delivered in a timely manner.
Working to protect patients
CMA has worked for over 150 years, to advance medicine and improve patient care. Central to this mission is an unflinching dedication to delivering the highest quality care and by demanding rigorous training and education standards for health professionals.
California law fosters a team approach to medicine in which doctors collaborate with physician assistants, nurses and others. However, this longstanding and highly successful model of providing physician-led, patient-centric care is in jeopardy. Some health care providers are seeking to expand their scope of practice – to treat patients for medical conditions that were not part of their training. They argue for taking on this greater role by saying it will enhance patient access to care and reduce health care costs.
Mid-level practitioners and other allied health professionals play a significant role in health care, but patients must not substitute them for physicians. A patient's care should begin with a primary care physician, who can most ably advise a patient on what care he or she needs. Simply expanding the scope of practice of practitioners, without expanded training or education, can mean lowering the standard of care for patients. It is imperative that the drive for "access" does not translate into a second tier of health care, one that offers convenience and lower cost in exchange for poorer quality and reduced patient safety. All Californians deserve a health care system that protects their safety and standard of care.
In addition to ensuring patients see the appropriate providers for what they need, physicians work hard to hold themselves to the highest standards. CMA has worked in recent years to bolster the peer review system, a mechanism to directly and accurately assess the care delivered by a physician and whether it could be improved.
Peer reviews are intended to identify incompetent or unprofessional physicians early and terminate, suspend, or limit their practice, if necessary. The chief objective is to protect patient safety and ensure the highest quality medical care.
CMA has also helped put more information in the hands of patients so they can better decide who they should see. CMA pushed legislation requiring health care practitioners to disclose to patients their license status and highest level of degree earned. Patients are often unaware of the differences in the qualifications, training and education of their health care providers. This "truth in advertising" concept helps patients make safe and educated choices, and it protects the public.
Preserving economic stability
Physicians and their practices are frequently plagued by payment issues with insurers and the government. Underpayment or lack of payment jeopardizes the economic viability of physicians and their practices, and in so doing, threatens patients' access to care.
CMA helped pass a law designed to protect patients by ensuring physicians are financially capable of providing service for patients. Physicians must be protected from HMO abuse in order to protect the public interest in a viable health care delivery system. CMA staff work to ensure physician economic stability in several critical ways:
- Preventing onerous provisions from getting into physician contracts;
- Providing physicians the tools to assess whether to sign contracts in the first place; and
- Helping physicians overcome barriers to receiving prompt and fair reimbursement.
- CMA has long advocated for comprehensive health insurance market reform, to rein in profit-driven health plans that inappropriately delay or deny care, including:
- Advocating for fair and timely payment of provider claims by alerting legislative and regulatory bodies about HMO payment abuses;
- Ensuring that a reasonable portion of every health care premium dollar goes to direct patient care, and not to health plan profits or wasteful administrative expenses. Congress included a minimum medical loss ratio (MLR) requirement in federal health care reform at CMA's urging and;
- Battling for years to prohibit health plans from unfairly rescinding health coverage after costly claims arise, leaving sick patients with no insurance and nowhere to turn for desperately needed care. This provision was eventually included in the landmark federal health care reform law.
CMA has led successful efforts in the legislative and legal arenas to prevent draconian cuts in the already unconscionably low Medi-Cal provider reimbursements, which helps doctors keep their practices open to serve Medi-Cal enrollees as well as the uninsured.
CMA continues to staunchly defend against attacks by personal injury lawyers on the Medical Injury Compensation Reform Act (MICRA), California's landmark medical malpractice reform law that keeps doctors' medical liability premiums – and thus health care costs – in check. MICRA helps ensure patients have access to their doctors.
Advancing new technologies
Under the provisions of the American Recovery and Reinvestment Act (ARRA, or the "Stimulus Act"), physicians are eligible for incentives for making the transition to electronic health records (EHRs).
Given California's size, this incentive program could bring hundreds of millions of new federal dollars to the state, and generate thousands of new high-paying jobs in the health information technology (HIT) sector.
CMA has been at the vanguard in helping California physicians to understand this opportunity and to retool their practices to access these federal funds. Some of the services provided by CMA include:
- Education about federal rules and regulations;
- Discounts on vetted and approved EHR systems; and
- Webinars and educational seminars for physicians.
In addition, CMA has joined with the California Primary Care Association (CPCA) and the California Association of Public Hospitals and Health Systems (CAPH) to form the California Health Information Partnership and Services Organization (CalHIPSO). CalHIPSO is a stand-alone 501(c)(3) organization that has received a $30 million federal grant to help providers in small practices, community health centers and public hospitals to make the transition to EHR.
In addition to bringing federal resources into the state, implementation of HIT will also improve the quality and efficiency of health care. It will allow all providers to have necessary clinical information available at the point of care, allowing them to reduce duplication and medical errors. This will have the added benefit of reducing the cost of care.
CMA will continue to be a trusted resource for physicians who are accessing this unprecedented opportunity.