CMA Accomplishments

The world is increasingly complicated and fraught with risk for physicians. Everywhere you turn, there is some interest group or corporation seeking to usurp the sacred authority of physicians, usually in the name of making an extra buck.  The multi-faceted and integrated advocacy that the changing world requires can come only from organized medicine.

As you read the below about CMA’s accomplishments over the past year, we hope that you do so with a mixture of pride and even hope – pride that as a member of organized medicine you are fighting to protect what is important, and hope that our strength, vigilance, and dedication will continue to protect the ability of doctors to practice your noble profession.

Protecting Access to Doctors

At the heart of much of CMA advocacy is our efforts to ensure patients have access to doctors. This takes on many forms, including working to improve reimbursement, fighting against onerous regulations, protecting patients from unlawful rescissions of their insurance, and health reform. In the last year, CMA:

• successfully defended its injunction against Medi-Cal provider cuts, saving doctors more than $100 million and helping Medi-Cal patients keep their doctors;
• won enhanced physician network adequacy requirements for insurers and reduced administrative burdens for physicians in the Department of Managed Health Care’s “timely access” regulations;
• filed an amicus brief defending the ability and flexibility of state and local governments to pursue health reform without federal pre-emption;
• for the second year, put a bill on Governor Schwarzenegger’s desk that would protect patients from unlawful rescissions of their

• health insurance;

• when physician licensing faced months-long delays due to furloughs of Medical Board employees, filed a lawsuit to exempt the Medical Board from any state furloughs; and

• with LACMA jointly submitted an amicus brief in support of a lawsuit filed against Blue Cross for illegally cancelling patients’ health insurance policies.

Health Information Technology

The federal stimulus package passed earlier this year included billions of dollars for physicians to help them purchase and transition to electronic health records (EHRs). For the first time, there was recognition of the need to provide resources to help physicians transition to EHRs. EHRs may not be for all physicians and all practices, but for those for whom it makes sense, CMA is providing them with the information and assistance they need to make the transition successfully.

To help physicians navigate their way through the decision whether to adopt EHRs and how to obtain federal funding, CMA created an HIT Resource Center on our website. We are also leading a coalition that recently made the shortlist to be named one or both HIT Regional Extension Centers (REC) for California. Being named a REC would put us in the perfect position to give physicians the information and assistance they need to transition successfully to EHRs. And finally, CMA is in the process of vetting EHR vendors, so that physicians have a credible source of information to help them select which vendor and which EHR works best for their practice.

No other organization in California has been able to provide physicians with the resources that CMA has to help physicians adopt new health information technology.

Practice Management Tools

Particularly for physicians who practice in solo or small group settings, the challenges of managing a practice are greater with every passing year. Public and private payors alike squeeze your bottom line, interfere with your ability to treat your patients, and require ungodly amounts of paperwork. And these are on top of the everyday issues of running a business.

To help physicians meet these challenges over the last year, CMA:

• published the Best Practices manual, providing physicians with information and tools to improve the efficiency and quality of their practices;
• produced the Red Flags Rule Toolkit and webinars, helping physicians understand and comply with new identity theft regulations promulgated by the Federal Trade Commission; and
• updated, as we do every year, CMA ON-CALL, an online library available free to members that contains over 4,500 pages of legal, regulatory, and reimbursement information for physicians.

Protecting the Profession of Medicine

Government bureaucrats, insurance companies, hospitals, optometrists, psychologists, nurses, physical therapists, and others all want to practice medicine or tell physicians how to do so. These incursions threaten the profession and risk undermining the quality of care provided to patients.

This year, CMA:

• successfully waged an extensive lobbying and grassroots advocacy campaign to defeat three separate legislative attempts by hospitals and labor unions to erode California’s bar on the corporate practice of medicine;
• counseled the Attorney General on the corporate bar, ultimately obtaining an AG opinion reinforcing the ban and preventing corporate interests from unduly influencing physicians’ professional judgment; and
• defeated a number of legislative attempts to expand the scope of practice of allied health professionals, including:

• a bill allowing pharmacists to independently initiate and provide immunizations to children and adults;
• a bill allowing physical therapists to evaluate and treat patients without a previous diagnosis or referral from a licensed physician; and
• efforts by nurse practitioners to gain admitting privileges

CMA is also working with the American Academy of Ophthalmologists to prevent the Board of Optometry from promulgating unsafe regulations that would lower the standards for the training required to treat glaucoma, and is fighting an effort by the Schwarzenegger Administration to expand the scope of practice of nurse anesthetists.

The efforts by other professions to practice medicine will continue next year, as nurses, optometrists, and others are planning further attacks on medicine.

Protecting the Quality of Care

Physicians are not just on the front lines of providing health care; they are on the front lines of ensuring that the quality of health care meets the incredibly high standards of care where they practice. While nearly all peer review done in California is done efficiently, timely, and in a manner that protects patients from quality of care deficiencies, the current peer review system can be enhanced. CMA sponsored a bill to prevent the use of improper or biased review to remove physicians for non-quality of care concerns and to correct those rare circumstances where peer review is delayed to the point that patients are placed in danger by the inability to promptly remove a physician who is providing substandard care.

CMA also filed an amicus brief in a case defending physicians’ right to a hearing before their peers.

Protecting MICRA

CMA has continued its staunch defense against attacks by personal injury lawyers on MICRA, California’s landmark medical malpractice reform law that keeps doctors medical liability premiums and thus health care costs in check, helping ensure patients have access to their doctors. This year, CMA defended the constitutionality of MICRA in court, filing an amicus brief and testifying before the appellate court in the case, which ultimately upheld the constitutionality of MICRA. CMA is also working to ensure that federal health reform efforts do not undermine MICRA.

Personal injury lawyers ramped up their attacks on MICRA in the press this year, very likely in an attempt to set the stage for an assault on MICRA in the next 1-2 years. CMA is engaged on all levels in preparation for the expected attack, working with our coalition and county partners to educate physicians, lawmakers, and the public about the importance of preserving this law.

Membership

A growing and active membership is the foundation for the success of organized medicine. This year, we are working on new ways to educate non-member physicians about the value of CMA and to connect member physicians to the services and benefits that CMA offers. These initiatives include:

• the Membership Ambassador program, designed to give physicians the tools they need to more easily recruit their colleagues;
• a Member Help Center to address any questions physicians have, or to steer them to the right CMA resource to get the help or information they need;
• a revamped package of services and benefits to give physicians a greater monetary return on their investment in CMA membership; and
• providing physicians with HIT support, as discussed earlier.

These initiatives and efforts by our county partners have helped CMA maintain relatively stable membership levels during the economic downturn of the last year, as other member-based organizations have suffered large setbacks.

CALPAC

CALPAC continues to play a vital role in our advocacy efforts, helping to identify and elect candidates that share CMA’s vision for medicine and health care. This election cycle is particularly exciting for physicians, as two physicians are viable candidates for open Assembly seats. CALPAC’s continued investment in Independent Expenditures is meeting the demands of a changing political landscape and helping to make sure that true physician champions get elected to the state legislature.

CALPAC is also playing a major role in raising the visibility of our grassroots advocacy, to ensure that the physician voice is heard on important issues impacting health care in the legislature and
in Congress.

Payor Advocacy

Physicians and their practices are frequently plagued by payor issues, particularly with insurers and government. Whether caused by greed, bureaucratic incompetence, or both, payment issues pose a very real threat to the viability of many physician practices.

CMA’s Economic Services team is your advocate with payors in three critical ways:

• They work with public and private payors to prevent onerous provisions from getting into contracts;
• They give physicians the tools to figure out whether to get into contracts in the first place; and
• They help physicians with payment issues with private and public payors.

These services paid off for CMA member physicians big-time in the last year, when the Medicare transition to Palmetto created numerous payment delays. CMA’s Economic Services team helped recover more than $100 million in delayed payments for California physicians.

Another big concern with payors are increasing efforts by insurers and government alike to use massive databases to pay physicians less, usually dressed up as efforts to improve quality or lower costs. The California Physician Performance Initiative (CPPI), a collaborative of insurance companies and other payors, is seeking to use physician performance “grades” to economically profile physicians. CMA fought to get physicians the right to review the data used to grade their performance, which helped to uncover serious flaws in the CPPI methodology.

CMA also filed a lawsuit against health insurance giant WellPoint, alleging that they colluded with Ingenix, a unit of United Health Group, on a price-fixing scheme to set artificially low reimbursement rates for out-of-network care.

Health Reform

And last, but certainly not least, health reform. Physician passions run high on health care reform, and they should. Doctors care deeply about their profession and their patients, and want to make sure that any reform helps to address the problems they face, not create new ones. While many physicians have differing views on how to do so, nearly all physicians agree on the need to expand the access that people have to their doctors. This belief is at the core of CMA’s long-time tradition and policy of fighting to expand access to care.

This year, we carried the spirit of that tradition into the federal health reform debate. Even though it sometimes appeared that the folks in Washington weren’t listening to health care providers, Congressional leadership was listening to CMA.
CMA has long fought to expand access to quality health care at the federal and state level, and is committed to pursuing health system reform that:

• sets the doctor-patient relationship as the foundation for our health care system,
• expands access to care for the underinsured and uninsured,
• provides help to low income families to make coverage more affordable,
• funds Medicare, Medicaid, and other health programs at levels to ensure access to care, and
• includes market reforms of the for-profit insurance industry.

CMA physician leaders and staff and our partner county medical societies have been working on these goals with California’s congressional delegation, other key members of Congress, and the Obama Administration.