2007 Accomplishments

On the next few pages you will read about CMA’s most noteworthy accomplishments of the past year, none of which would have been possible without your involvement and the support of your dues dollars.

Health Care Reform

Governor Schwarzenegger declared 2007 the “year of health care reform in California.” In April, he keynoted CMA’s Legislative Leadership Conference, and told the more than 500 physicians, medical students, and medical executives in attendance that he is committed to securing, not weakening, the patient-physician relationship and that he will continue to work with CMA to that end.

CMA spent much of the past year at center of the discussion on how to fix California’s broken health care system. CMA has been in constant negotiations with all of the major players, making sure that the interests of physicians and their patients are well represented. CMA has steadfastly supported three core principles critical to achieving comprehensive reform: universal coverage, shared responsibility, and stable long-term funding.

One of the more onerous ideas to emerge this year was the governor’s proposal to pay for health reform by imposing a 2 percent tax on physicians. Defeating this has been the centerpiece of CMA’s legislative agenda this year. Due in large-part to CMA advocacy, none of the reform proposals that have emerged thus far has contained such a tax.

Blue Cross

This year CMA declared war on Blue Cross of California, a perennial “bad actor” in the health insurance industry. Most notably, CMA asked state insurance regulators to take action against Blue Cross for jeopardizing the physician-patient relationship and engaging in unlawful business practices that have reduced patient access to care.

CMA in April joined a class action consumer lawsuit seeking to stop Blue Cross from illegally cancelling individual health insurance policies after patients got sick, without any indication that policyholders intentionally lied on their applications to cover up preexisting medical conditions – a standard required by state law.

CMA also rallied hundreds of physicians to call the Department of Managed Health Care and express outrage over Blue Cross’s failure to provide them with timely access to its new fee schedule, which left many physicians unable to assess the financial impact that the rate changes would have on their practices.

State Department of Public Health

CMA has long championed a proactive public health policy. Over the past two years, CMA has played an integral role in the resurrection of the California Department of Public Health, which was disbanded in the 1970s under then-Governor Ronald Reagan.

Made possible by a CMA-sponsored bill, the new California Department of Public Health (DPH) opened for business on July 1, 2007. CMA has and will continue to participate in the reorganization process and help build DPH into an agency that can effectively address California’s pressing public health concerns, such as bioterrorism, emergency response, and the prevention and detection of communicable diseases.

Medicare Payment Reform

CMA this year became the first medical association in the country to present a proactive, long-term plan to Congress for overhauling the broken Medicare payment system. The proposal would, among other things, eliminate the flawed sustainable growth rate (SGR) formula, provide payment updates based on practice cost increases, and update the geographic payment localities. The proposal also presents credible alternatives to the SGR “spending target” approach to containing costs.

While lawmakers were unable to come to an agreement on a long-term fix to the Medicare payment problem this year, CMA once again mobilized physicians to educate their members of Congress about the serious access-to-care problems created by inadequate Medicare funding.

CMA also this year sponsored a bill to fix the inequitable and outdated Medicare geographic payment formula. The bill, which has bipartisan support from key members of the California congressional delegation, would allow currently underpaid counties to be reimbursed based on more accurate geographic practice costs. Perhaps most important, the legislation would protect physicians in other counties from payment cuts by establishing a geographic payment floor at current levels.

Scope of Practice

CMA successfully averted a number of legislative attempts to expand the scope of practice of allied health professionals, including a bill that would allow psychologists to prescribe psychotropic drugs; one that would allow acupuncturists to use low-level lasers for medical purposes; and another that would eliminate many physician supervision requirements for nurse practitioners. All of these bills stalled in committee and were tabled until next year.

While CMA does not oppose all expansions of scope of practice, CMA believes that patients are put at risk when nonphysician practitioners provide care for which they are inadequately trained. CMA believes that any such proposal must be carefully studied to ensure that patient care is not jeopardized.

CMA Foundation

It has been a whirlwind couple of years for the CMA Foundation. Having more than doubled in staff size and revenue in the past two years, the foundation has been busy developing innovative new programs to engage the health care community and address pressing public health issues, including obesity, type-2 diabetes, antibiotic awareness, cervical cancer, and ethnic disparities in health care.

Practice Management Seminars

CMA and county medical societies cohosted a series of practice management workshops throughout the state to help improve the efficiency—and the bottom line— of physician practices. These events were very well received by physicians and practice managers alike and the program will be expanded next year.

Enforcing the RICO Settlement

In a historic action six years ago, CMA filed a civil racketeering (RICO) lawsuit against for-profit HMOs in California, alleging that HMOs were using fraud and other illegal activities to interfere in the physician-patient relationship. Of the 10 defendants named in the lawsuit, six settled (including the merged Anthem/WellPoint/Blue Cross), and three had their cases dismissed by the court.

In addition to $384 million in cash payments to physicians, the settlements will provide at least four years of prospective relief valued at $1 billion over four years. The settling health plans have made binding commitments to change the way they do business with physicians and to put a stop to business practices that were used to deny or delay payment to physicians for legitimate claims. These changes are expected to result in increased predictability and speed of claims payment, creating significant value for physicians by reducing time-consuming and costly administrative burdens.

While the HMOs have made great strides, issues continue to rise – and CMA continues monitor their compliance with the settlement terms and has filed and won a number of compliance disputes.

We Must Stand Together

Now more than ever, we must stand together. A unified front among physicians in all specialties, modes of practice, and geographies is what makes CMA, as you just read, so unique and influential on a local, state, and federal level.

As Abraham Lincoln famously said in his 1858 race for the United States Senate: “A house divided against itself cannot stand.” The only way we can continue to improve health care in California is to work out our differences internally and then have a strong unified front for the profession.