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A Productive 2005 House of Delegates
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Sue U. Malone When
the 2005 CMA House of Delegates convened in Anaheim in mid-March, there
were several very fractious issues to be debated on the floor that
appeared destined to divide the body. By the end of the session,
however, the House had resolved the issues through compromise, and the
House was largely unified. The GPCI fix to deal
with geographic payment inequities in California, proposed by the GPCI
Task Force and adopted by the CMA Board of Trustees, that has been
discussed in prior issues of the Bulletin, was on the agenda for
the House. What resulted, however, was a compromise agreement that
California would seek a change in Medicare’s budget neutrality law
(federal law requires changes in the Medicare program to be budget
neutral) to apply to the state of California as a whole. It is hoped
that such an approach would relieve the geographic disparities, without
adversely affecting any county in a way that reduces current or
projected payment. If enacted, such legislation would allow the Centers
for Medicare and Medicaid (CMS) to implement a CMA proposal through the
normal rule-making process. The House also directed the CMA to make
fixing the Medicare sustainable growth rate (SGR) formula the
association’s highest federal legislative priority. Subsequent to the
House meeting, the CMS decided not to go ahead with CMA’s originally
proposed GPCI fix, which had been submitted to CMS six months earlier.
The agency was concerned that the demonstration project, because it
required mandatory participation of all California physicians and had
not gone through the normal rule-making process for public comment,
would expose the CMS to lawsuits. Another contentious
issue was the so-called “silent PPOs,” the practice of third-party
payers using a physician’s discounted rate without that physician’s
knowledge and consent. The issue was not that going after silent PPOs
was bad, but rather that the resolution particularly attacked the 18
county medical society foundations that operate under the umbrella
organization of California Foundations for Medical Care (CFMC). Many
felt the thrust of the resolution attacked them unfairly since they do
not operate as silent PPOs. The resolution was sponsored by the Solo and
Small Group Practice Forum. The House recommended that CMA consider
litigation to combat unfair discounting and other egregious business
practices engaged in by health plans, PPOs, and other organizations and
to prevent proliferation of silent PPOs in California while legal
actions are being designed and implemented. Another proposal
offered by CALPAC, the political action arm of the CMA, asked the House
to support a $50.00 a year increase in CMA membership dues in 2006 to be
directed to the CALPAC fund to increase the effectiveness of CALPAC and
give CMA much greater political clout to protect physician practices and
access to care in the future. Many county executives, including me, were
concerned that such a dues increase, on the heals of a CMA $20 dues
increase in 2005, will be just one more excuse for some physicians not
to support the CMA and the county societies. The House felt otherwise
and endorsed the resolution. I should mention that there is a provision
that those group practices and individuals who choose not to pay for
PACs may allocate their $50 additional dues to a CMA MICRA protection
fund. The House also asked
the CMA to support legislation requiring pharmacies to transfer current
valid prescriptions to another pharmacy on a patient’s request without
requiring a new prescription from the prescribing physician and without
conveying prescribing authority to pharmacies. The House also called
on the CMA to support legislation to eliminate the security prescription
requirement for Schedule II, III, IV, and V controlled substances. The delegates
criticized Congress for interfering in the Schiavo case and also called
on the CMA to educate physicians about the appropriate use of hospice
care and to support increased coverage by public and private payers for
palliative and hospice care. The House affirmed
CMA’s existing policy in opposing physician-assisted suicide. (You may
be aware that there is currently pending in the state legislature a
physician-assisted suicide bill, AB 654, which just passed out of the
Assembly Judiciary Committee.) The House also asked the Board of
Trustees to consider options for enhancing the availability of donated
organs for the long waiting list of patients who are not recipients of
life savings organs in time to save their lives. Other actions
included recommending a ban on direct-to-consumer advertising of
prescription drugs and FDA-regulated medical devices; exploring the
feasibility of establishing a panel of independent physicians to make
final medical determinations on a patient’s ability to hold a
California driver’s license when the patient has been denied a license
through the DMV screening/examination process; requesting the Department
of Health Services, the MBC, and/or other appropriate state agencies to
investigate whether cosmetic centers that perform laser procedures,
inject Botox, or provide other medical services in the absence of
continuous physician supervision, violate the scope of practice laws and
Health and Safety Code requirements for medical facilities; endorsing
the preservation of the MBC diversion program; and urging that the CMA
continue to study the advisability of creating a specialized health care
court system. Of course, there were many, many more issues brought
before the House, but this should give you an idea of the diversity of
the subjects covered. Marin County Kaiser
emergency room physician, Michael Sexton, was elected as CMA’s new
president. Anmol Mahal, a gastroenterologist from Fremont was elected
president-elect.
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