Legislation
Legislators, CMA Negotiating Hospitals' Rights to Hire MDs PDF  | Print |  Email

June 3, 2010

A state Senate bill that would allow hospitals in medically underserved areas of California to hire physicians is being negotiated with the California Medical Association (CMA).

“We’re working with CMA to reach a compromise. Hopefully we can do so over the next one to two weeks, said Andrew LaFlamme, Capital Director for Senator Roy Ashburn (R-Bakersfield). On Feb. 27, 2009 Ashburn introduced SB 726 which would expand a pilot project ending on Jan. 1, 2011 allowing qualified district hospitals to employ a physician and surgeon under certain conditions. Two assembly bills are proposing similar legislation.

California is one of about five states that still prohibit corporations or other legal entities from hiring physicians and surgeons. But there’s a long list of proponents for hospital districts hiring physicians, including the Medical Board of California, the California Association of Rural Clinics, the American Association of Retired Persons, the California State Association of Counties and many more. Those opposing the bill include CMA, the Central Valley Health District and the Santa Clara County Medical Association Alliance.

Proponents of the three bills say that rural or impoverished areas are not getting the medical care they need because there is not enough potential revenue in those areas to cover physicians’ costs.  But if doctors could share certain expenses for things like facilities, insurance premiums, billing and other necessities, it would make it more realistic for doctors to locate in those areas.

Opponents, such as the California Medical Association (CMA), say there’s an inherent conflict of interest when doctors become employees of hospitals.

“It’s not a good idea, it sounds attractive because it helps to get more doctors in rural areas. It sounds like apple pie and motherhood,” said Luther Cobb, a thoracic surgeon in Eureka and the Vice Speaker of the House of Delegates for CMA. “But you end up having two masters and the interest of the patient isn’t necessarily in the interest of the hospital,” he said.

Rural healthcare districts have lobbied hard for this bill, LaMar said. And while there is definitely a shortage of physicians in rural areas, this is not the answer, he contends. He said CMA has pushed through legislation to provide money to forgive loans for medical students and for loans to medical students who agree to practice in underserved areas.

Last year CMA actually supported a version of SB 726 which allowed for less physicians to be hired and more monitoring. But that bill got amended in the assembly. Now CMA and legislators are back to negotiations.

LaFlamme of Ashburn’s office countered Cobb’s argument that being employed by a hospital would change physicians’ medical care. “They’re saying there’s some undue influence, we say that already exists, probably more so if it’s your own practice.  I think the reality is they’re worried about their piece of the pie, they get paid a large amount of money to be on call [for the hospital,” LaFlamme said. Furthermore, he said, doctors already take the Hippocratic Oath. “We trust in that, and that’s what protects patients as it is.”

Two other bills, which also would allow for hospitals hiring doctors in medically underserved areas, are awaiting action in the Assembly. AB 648 is sponsored by Assemblymember Wesley Chesbro (D-North Coast) and supported by the California Hospital Association. Discussions about AB 648 are on going, said Jan Emerson spokeswoman for the California Hospital Association, but she declined to comment on those.

AB 646 by Assemblymember Sandre Swanson (D-Alameda) is a two-year bill and is in the Senate Business and Professions Committee.

Both Chesbro and Swanson are principal co-authors of Ashburn’s SB 726. That bill would expand the pilot project which currently allows each qualified district hospital to employ up to two physicians and surgeons with contracts that last no more than four years. The total number of physicians and surgeons that can be hired is 20 and the program expires January 1, 2011.

SB 726 sponsors contend that this existing pilot project is too narrow and does not provide enough data. SB 726 would expand that pilot allowing qualified hospitals to hire up to two physicians and surgeons and three additional ones if the district can demonstrate clear need following a public hearing. The expanded pilot project would last until Jan. 1, 2018 and would require the California Medical Board to report to the legislature on the project in 2013 and 2016. Hospitals would qualify for hiring if they are located in a medically underserved area and can show proof that they have had a vacancy for more than 12 months.


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Last Updated on Friday, 04 June 2010 14:14
 
House Passes Bill to Delay SGR Cut PDF  | Print |  Email

May 28, 2010

On Friday the House of Representatives passed a scaled back version of H.R. 4213 which contains a provision that would prevent a looming 21 percent cut to Medicare physician reimbursements on June 1. Now the bill goes back to the Senate but Congress does not reconvene until June 7.

H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010 would postpone that cut until 2012. In the meantime the bill proposes providing a 2.2 percent increase in Medicare payment rates for the rest of 2010 and a 1 percent increase for 2011, reported the House Committee on Ways and Means. In 2012 the payment rates would go back to the current law levels, meaning physicians would be facing significant cuts again. This provision is estimated to cost $22.9 billion over 10 years. 

The skyrocketing national debt made it extremely difficult to secure the votes needed to pass the bill in the House. H.R. 4213 has been ping ponging between the House and Senate. The House passed it on Dec. 9 and sent it to the Senate on Dec. 10. It came out of the Finance Committee on Mar. 1 and the Senate passed it with amendments on Mar. 10 and it went back to the House on Mar. 18.

This latest proposal to delay Medicare reimbursement cuts is a compromise from a provision being discussed a week ago which would have provided a five-year fix to the physician payment formula for Medicare called the sustainable growth rate (SGR). Congress established the SGR formula in 1997. Based on that formula whenever a physician’s costs grow faster than the economy, Medicare reimbursements would be reduced. But legislators have continually delayed the cuts.


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Last Updated on Friday, 28 May 2010 13:26
 
Congress to Vote on Medicare Cut Reprieve PDF  | Print |  Email

 May 21, 2010

Early next week the U.S. House of Representatives is expected to vote on an extension of the current rate of Medicare payments to doctors and the Senate would get the bill later in the week.

Without the extension Medicare payments are due to be cut by 21 percent as of June 1 this year. H.R. 4213, would avoid those rate cuts for three and a half years. The proposed legislation would allow for a 1.3 percent increase in Medicare payments on June 1, 2010; a 1 percent increase on Jan. 1, 2011 and from 2012 to 2013 annual rates could not be cut. After 2013 determination of the payments would go back to the Sustainable Growth Rate (SGR) formula. Congress implemented SGR in 1997 to reduce the growth of healthcare costs by reducing Medicare payments whenever doctors’ costs grew faster than the economy. Despite this formula, Congress has continually stepped in to delay cuts in Medicare.

The California Medical Association (CMA) is supportive of the deal, said CMA spokesman Andrew LaMar. “We’d like to have this resolved once and for all, but a reprieve for three years is better than having a 21 percent cut in June,” he said.

While the American Medical Association (AMA) acknowledged the temporary relief of Congress’ proposal, the organization is still unsatisfied with the latest deal.

“The AMA is deeply disappointed that Congress will once again fail to permanently correct the Medicare physician payment formula that Republican and Democrat members of Congress, President Obama and policy experts have said should be repealed," stated J. James Rohack, MD and President of the AMA, in a press release.

The AMA contends that Congress could have solved the dilemma five years ago at a cost of $49 billion and now it says the short-term solution being considered by Congress will add up to more than that.

Medicare cuts of 21 percent would put some physicians out of business, LaMar said. A Humboldt Co. practice that treats Medicare patients almost exclusively said it would not be able to make payroll 30 days after such a cut.

And with both Medicare and Medi-Cal facing huge increases in the future due to more seniors as the result of the baby boomer generation and more people able to get medical care under healthcare reform, the medical profession not only needs to hold the line, it needs to expand, LaMar said.


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Last Updated on Friday, 21 May 2010 10:04
 
Bill Moves to Increase Authority of Physician Assistants PDF  | Print |  Email

May 19, 2010

A bill to increase the authority of physician assistants in California recently got approval on the Senate floor and is making its way to the State Assembly.

With as many as 44 million additional U.S. residents becoming eligible for healthcare coverage as a result of healthcare reform, there are strong concerns about the capacity of the medical profession to serve them. Senator Fran Pavley (D-Agoura Hills) has introduced Senate Bill 1069 to increase the authority of physician assistants (PAs) to perform routine medical duties leaving physicians with more time to attend to patients.

The bill would give PAs the authority to order medical equipment such as crutches and wheel chairs.  They would also be able to sign off on disabilities for unemployment insurance, order home health care, sign off on employee medical exams and sports physicals for minors. California has 7,000 licensed PAs, but more will be needed.

“There is a shortage of care providers in the entire country,” said Don Robinson, Chief Administrative Officer for Hill Physicians Medical Group Inc. of San Ramon. Hill represents 3,000 physicians.

PAs free doctors up to spend more time with patients.

“Which is what all doctors ask for,” Robinson said. Hill has not yet reviewed SB 1069, but Robinson said, “We would expect to see the entire country move in this direction.”

Currently in California PAs can take health histories, do physical examinations for making assessments and diagnoses and for reviewing treatments and revising them. They can certify that a person is disabled for the purpose of getting a handicapped placard; they can perform medical exams and sign off on certificates for people applying for licenses to drive commercial vehicles or school buses.

Those entities that have formally endorsed the bill include the California Academy of Physician Assistants, the California Medical Association, the California Assisted Living Association, the California Radiology society, The American College of Obstetricians and Gynecologists, District IX, the United Nurses Associations of California, the California Academy of Family Physicians and the Medical Board of California, among others.

“California is right in line with other states in terms of improving inclusion of PAs in relevant laws,” said Ann Davis, Director of State Government Advocacy and Outreach for the American Academy of Physician Assistants. “Many states are involved in similar updates. In general, California has a very favorable regulatory climate for physician-PA teams,” she said.


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Last Updated on Wednesday, 19 May 2010 13:32
 
$2.5B Retrieved in Medicare Fraud Crackdown; Feds Bring on the Heat PDF  | Print |  Email

May 14, 2010

A recent report from the federal government showed that $2.5 billion was recovered in 2009 in cases involving healthcare fraud. That’s a 29 percent increase over fiscal year 2008.

The U.S. Department of Health and Human Services (HHS) and the U.S. Department of Justice (DOJ) jointly filed The Annual Health Care Fraud and Abuse Control Program Report. It contains a litany of added tools and funding for preventing, detecting and taking enforcement action against fraud in Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and private insurance.

These new approaches are part of the Affordable Care Act, signed into law on Mar. 23. The Act adds $350 million over the next decade for fighting fraud and hiring additional agents and officials to police all realms of the healthcare industry including physicians, pharmacies, hospitals, clinics, pharmaceutical companies, nursing homes, and mental health facilities.

“The Affordable Health Care Act gives us new tools to fight fraud, protect consumers, and safeguard taxpayer dollars,” said Secretary of Health and Human Services Kathleen Sebelius in a press release. “It strengthens our ability to stop fraud before it starts by making it harder to submit false claims and easier to catch those who try to cheat out consumers. And the new law will guarantee that those who try to game the system face severe consequences, ” she said.

Some of the new measures include increasing federal sentences for healthcare fraud by 20% to 50% in cases that cause more than $1 million in losses. To combat healthcare fraud on the front end the Act allows for fingerprinting, site visits and criminal background checks of providers before they start billing Medicare, Medicaid or CHIP. And if a credible fraud allegation has been made and an investigation is pending, HHS can hold Medicare and Medicaid payments of providers who have been accused of fraud.

One way the Affordable Care Act will enhance existing fraud fighting systems is to expand Project HEAT (Health Care Fraud Prevention & Enforcement Action Team). HEAT was born on May 20 last year to increase collaboration between the Departments of Justice and Health and Human Services and the Centers for Medicare and Medicaid Services. Project HEAT consists of key enforcement agents, prosecutors and staff in each of those agencies.

The HEAT will grow some existing partnerships between DOJ and HHS such as their Medicare Fraud Strike Forces. Those have been set up in health care fraud hot spots like South Florida, New York, Texas, California Louisiana and Michigan.

One of the most egregious crimes exposed by these strike forces was a case in Florida where a physician and a nurse administered hundreds of unnecessary HIV infusion treatments to patients. The patients were paid $150 per visit to accept the treatments. The physician was sentenced to 30 years in prison and the nurse got seven years. They were part of a large HIV infusion fraud operation in South Florida that included at least 11 clinics in scams generating more than $100 million in false Medicare claims.

Pharmaceutical companies have also been targeted. Pfizer Inc. agreed to pay $2.3 billion, the largest settlement for health care fraud in the history of the DOJ and HHS Office of Inspector General. Pfizer’s subsidiary Pharmacia and Upjohn Co. Inc. promoted the sale of the anti-inflammatory drug, Bextra, for uses not indicated on its label.  And Pfizer promoted three other drugs for off-label uses, an anti-psychotic, an antibiotic and an anti-epileptic drug.

Other pharmaceutical companies that got hit with fines were Eli Lilly and Co., which settled for $1.4 billion; Bayer HealthCare LLC, which agreed to pay $97.5 million and Abbott Laboratories Inc., which agreed to pay $28 million for false pricing on intravenous drugs and blood products.


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Last Updated on Thursday, 03 June 2010 13:37
 
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