It’s a New Day

It’s a beautiful new day for San Diego Physician magazine, and it’s a new day at CMA as well. On November 1, 2006, former State Senator Joe Dunn assumed the reins as CEO/EVP after a tremendous 12-year tenure by Dr. Jack Lewin, who has moved on to a similar role at the American Academy of Cardiology. In a speech to CMA’s Council on Legislation here in San Diego in November 2006, Mr. Dunn revealed what the future at CMA will feel like: “We’re mad as hell, and we’re not going to take it any more.” He said that advocating for our patients and for our profession will win every time … as long as we speak with one voice.

Speaking With One Voice

When Cigna used software to systematically “downcode” physician payments, CMA’s board of trustees voted unanimously to file the RICO lawsuits that led to settlements with almost all the for-profit health plans. Just one of those, Blue Cross, netted $39.6 million for California’s physicians and a payment of $1,155,961.24 to San Diego’s physicians. More importantly, the settlements changed how insurers behave in their definition of medical necessity — the process they use to approve certain services — and in many other important ways going forward.

When the California Department of Managed Health Care (DMHC) issued regulations to bar physicians from billing patients for emergency services they had rendered in good faith, CMA filed a “Public Records Act” request for the documents and communications that lead DMHC to that action. The author of the regulations, Kevin Donohue, subsequently resigned from his post at DMHC when the search revealed that he had a conflict of interest due to financial ties to insurance companies that DMHC regulated.

When the CEO and administration at San Buenaventura Hospital attempted to take control of its medical staff, seized the medical staff funds, and attempted to institute a new set of bylaws, CMA’s legal department supported the medical staff’s legal challenge right up until the CEO resigned and medical staff “self-governance” was restored. CMA then sponsored SB 1325, successfully battled the California Hospital Association, and passed into law the principles and requirements for hospital medical staff self-governance.

When the rest of organized medicine was pondering the embarrassment of the uninsured, San Diego’s favorite son, then-CMA President Bob Hertzka, created — and CMA adopted — a plan to fund catastrophic and preventive healthcare coverage for nearly everyone, with the goal of ensuring that no one should ever again declare bankruptcy due to healthcare costs.

And while the rest of the nation covets our MICRA legislation, CMA has successfully defended every challenge to every part of it now for over 30 years.

So, What About 2007?

Governor Schwarzenegger has said that 2007 will be the “Year of Healthcare” in California. CMA is actively participating in the discussions with the governor’s office and with the legislative leaders around the proposals being debated. Senator Perata and Assembly Speaker Nuñez have presented proposals that have in them many questions yet to be answered. The governor has outlined his ideas as well. Whether real healthcare reform is passed this year or next remains to be seen, but the preservation of the primacy of the physician-patient relationship will be CMA’s number-one criterion by which such proposals are judged.

CMA will continue to fight those who would enslave physicians by banning their right to bill for services rendered in good faith and those who would sell our contracts to others without our consent. We will succeed in outlawing “silent PPOs.”

Wayne Iverson, San Diego delegate to CMA, recognized that organized medicine needed to do more at the national level than just eliminate Medicare’s sustainable growth rate formula (SGR) and correct the unfair reimbursement under current geographic practice cost index (GPCI) rules. He introduced a resolution at the CMA House of Delegates to create a CMA task force to propose broader reforms to Medicare. That task force has now been appointed, and CMA will look at the whole of Medicare and its ills. Just as we did with the healthcare financing proposals to cover the uninsured, CMA has a chance to lead the way for our AMA and for other states. We will do away with the SGR formula and correct the geographic disparities caused by the GPCIs, but we will also listen to physicians and their patients, and, together, propose reforms that will make Medicare more responsive to both.

The current administration in Washington, DC, has successfully reformed Medicare in several major ways already, most significantly with the introduction of a pharmacy benefit included in the Medicare Modernization Act of 2004. However, several other reforms have received less attention, including the beginnings of “means testing” (a differential cost for enrollees based on income) and of privatization, especially with the drug benefit and with Medicare Advantage (Managed Care). CMA has become aware of at least one major flaw in Medicare Advantage — in the new FFS plans — that can lock physicians into de-facto contracts for enrolled patients, possibly at rates never negotiated or accepted by the physician. CMA will work with our AMA and with other state medical societies to see that this absolutely unfair practice is stopped.

Every year, CMA also works on a host of other issues of public health and patient safety. As an active member of Cal RHIO — the state body developed to facilitate electronic integration of providers and other health systems — CMA will see to it that physicians’ and patients’ interests are served as these proposals for personal health records, electronic health records, and systems of integration are designed and implemented.

It is becoming clearer every year that the idea proposed a decade ago that there would soon be too many physicians was one seen through a glass very darkly. Quite the opposite now, shortages of physicians in many specialties already exist. CMA has created a task force to look at one of these: the grave concern about the ultimate survival of primary care.

Finally, it is more important than ever that organized medicine’s leadership be in touch with those they lead. CMA has hired a new director of information technology, and, with her help, we will create a means to canvass key local leaders from the counties and specialties, CMA’s House of Delegates itself, and medical society and specialty society executives so that CMA’s policy and actions will be informed by the opinions of the broader membership.

It’s a Big Year Ahead

This may be one of the most important years for healthcare policy in California, and CMA will be at every table where that policy is discussed. We recognize that we won’t win every battle, but we will never leave the field. The profession of medicine will not only survive, but will thrive because 35,000 physicians have banded together and, with one voice — the voice of the physicians of the California Medical Association — will demand that our practices and our patients be what every policy maker considers as they propose their reforms.

We will not tolerate regulatory bodies illegally attempting to take away our rights.

We will not allow health plans and hospitals — or any other group — to dominate the finances of healthcare.

Physicians won’t take it any more. CMA knows that.