Wednesday, January 16, 2019

Legislative Alert: Urge Legislators to Oppose Bill that would Require Medical Board Investigations for Prescription Drug Deaths

On June 26, the Assembly Business and Professions Committee will be considering a bill that would require a coroner to file a report with the medical board when a controlled substance is found to be a contributing factor in a death.

While well-intentioned, SB 62 simplifies a very complicated issue to the potential detriment of patients. CMA is urging physicians to contact their assembly members today and ask them to oppose this flawed bill.

Click "take action" below to quickly and easily contact your legislator via CMA's grassroots action center.

 Call (877) 362-8455 to be connected with your legislator

Take Action

I Made the Call!

Description

SB 62 (Price) would expand provisions to require a coroner to file a report with the Medical Board of California when he or she determines that a Schedule II, III, or IV drug was a contributing factor in a death.

Senator Price's stated assumption that a coroner’s report connects the dots between overdose deaths and so-called physician over-prescribing is fundamentally flawed.

This bill is a response to growing concern about prescription drug abuse, an issue that is of great concern to CMA and physicians across the state. However, the statistics show that the vast majority of people who abuse prescription drugs acquire them from friends and family (often without their knowledge) or from sources other than the prescriber. There are also many circumstances in which individuals with legitimate prescriptions for controlled substances might die, including non-compliance with prescriber's orders or mixing the drugs with other substances like illicit drugs or alcohol.

As currently written, this bill would make it increasingly more difficult for patients being treated for pain to get appropriate treatment, as physicians will become less likely to prescribe controlled substances for fear of a medical board investigation.
CMA has requested an amendment to the bill that would require the medical board to notify a physician when a report with his/her name is received. This amendment would help provide some balance by providing physicians the opportunity to seek ongoing education on opioid prescribing or identify fraudulent activity being done in their name, but the author has refused to accept it.

We ask that you and your colleagues
call, fax or email your legislators
TODAY and ask for a NO vote on this bill

The bill is expected to be heard in the Assembly Business and Professions Committee this week.

Phone calls and office visits are most effective, but faxes and emails are important too. If you choose to fax or email your legislators, we strongly encourage that you personalize the letter (provided below), which will greatly increase its impact.

If you are logged into the CMA website, your legislators should automatically be displayed. If not, you can click here to locate your legislators by zip code.

Talking points, a sample email, and background information are below.

Talking Points

  • As a physician, I am very concerned about the growth in prescription drug abuse and want to be a partner in addressing it, but SB 62 is an approach that will have significant unintended consequences.
  •  The reports being required under SB 62 will make physicians less likely to prescribe drugs on Schedule II, III, and IV for fear of investigation even in instances when the care is appropriate. Doing so will impact patient’s ability to get appropriate pain management.
  • There are many circumstances in which a person with a legitimate prescription for a controlled substance may die, including the patient being non-compliant with the prescriber’s orders or mixing the drugs with other substances like illicit drugs or alcohol.
  • Patients being treated for pain may also have comorbities that could result in death. None of these instances reflect inappropriate practice by a physician and yet all of them could be reported to the Medical Board for investigation under SB 62.
  • Further, the vast majority of people (70%) who use drugs for non-medical purposes did not get it from a prescriber, but from other sources.
  •  The risk of negatively impacting patient care must be balanced with the potential benefit. Given all the extenuating factors that exist in assessing overdoses related to controlled substances, SB 62 is not balanced.
  • CMA has requested an amendment to the bill that would require the medical board to notify a physician when a report with his/her name is received. This amendment would help provide some balance by providing physicians an opportunity to seek ongoing education on opioid prescribing or identify fraudulent activity being done in their name, but the author has refused to accept it.
  •  I urge Assembly-member ____________ to vote no on SB 62 unless the requested amendment is taken.

 



Noridian EDI: Early On-Boarding

In preparation for the cutover from Palmetto GBA, Noridian is offering “early boarding” to ensure physician offices are transitioned without any interruption in your business.

For more information about early boarding please go to www.edissweb.com.



Legislation Jeopardizes Patient Safety


As health care delivery becomes more complex, expanding the team of health care professionals that serves patients makes sense. However, it is not in the best interest of patients to abandon the current physician-led team approach to health care. California’s SB 491, SB 492, and SB 493 would allow nurses, optometrists, and pharmacists to take on the duties of a medical doctor without a doctor’s training. RCMA/CMA and the Coalition for Patient Access and Quality Care are working together to make sure lawmakers realize that providing allied health practitioners with independent and/or expanded practice will not provide newly insured patients, who are more likely to have complex medical conditions, with access to the health care they deserve

Find out how you can help by visiting www.qualitycareaccess.org



Legislation To Repeal SGR Unveiled


The Energy and Commerce Committee Republicans unveiled draft legislation that would repeal the sustainable growth rate (SGR) formula and replace it with a new system for determining Medicare physician payments. Building off a framework released this spring; the legislation would eliminate the SGR and replace it with a modified fee-for-service system with an emphasis on improving quality and outcomes through performance measures, while also providing means for physicians to participate in alternative payment models.


Medi-Cal Cuts Challenged


This week 8,000 physicians, administrators and healthcare workers joined together at the State Capitol to voice their opposition to the Medi-Cal cuts that are scheduled to be implemented next month. A large bipartisan group of legislators support the effort to reverse the Medi-Cal cuts and restore a health care safety net to California. We Care for California, which mobilized the rally, is one of the largest coalitions in state history.  However, the fight to restore funding is not over and RCMA/CMA will continue its multi-pronged efforts aimed at stopping the harmful Medi-Cal cuts, pursuing every path available including advocacy, legal and legislative.


Covered California Update

Covered California, the state agency implementing the Affordable Care Act (ACA), has announced participating health insurers and proposed premiums for the state's exchange.  13 commercial health plans were selected to offer products on the exchange, including California's three largest insurance providers, Kaiser Permanente, Anthem Blue Cross and Blue Shield of California. One major concern for contracting physicians is a loophole in the ACA that could see physicians left to foot the bill for services provided to patients who haven't paid their insurance premiums. The law allows for a three month "grace period" for non-payment of premiums, but only requires insurers to pay the claims through the first month of non-payment. The final version of the exchange model contract included a provision that requires 15 days advance notice to physicians when a patient has entered the second month of the grace period, but still leaves the burden of 60 days worth of unpaid claims on the physician and the patient.

For more information about Covered California, please contact your RCMA Physician Advocate Mitzi Young at myoung@cmanet.org or (888) 236-0267.


Funding UCR School of Medicine

California’s Senate and Assembly have unanimously approved identical bills appropriating $15,000,000 annually from the General Fund to the Regents of the University of California for allocation to the School of Medicine at UC Riverside. The Inland Empire has the lowest ratio of primary care physicians and specialists of any region in the state. The Council on Graduate Medical Education, a federally funded and authorized group that assesses the physician workforce and reports to federal policymakers, recommends a minimum of 60 to 80 primary care physicians and 85 to 105 specialists per 100,00 people. Sadly, the physician and specialist ratio in the Inland Empire is barely half of that recommended number. The UC Riverside School of Medicine is a critical factor in addressing this need, and consistent state funding is needed for the school to maintain its accreditation.

Gary Honts Named Chief Executive Officer for JFK Memorial Hospital

Gary Honts, who has been leading JFK Memorial Hospital in an interim role since September 2012, has been named permanent chief executive officer.  As CEO, Honts will oversee strategic, operational and clinical activities for the 156-bed facility and related outpatient clinics.

“Gary is a highly qualified CEO with more than 30 years of healthcare industry experience during which he has led a wide variety of healthcare organizations including community hospitals, large trauma centers and an academic medical center,” said Jeffrey Koury, senior vice president for Tenet’s California region. “During his tenure at JFK Memorial, Gary has demonstrated exceptional leadership capabilities.  His extensive experience in hospital operations coupled with his knowledge of the hospital, its staff and the community will continue to make him an outstanding leader of the executive team.”  

Since joining JFK Memorial, Honts has developed and executed strategies to provide high-quality, integrated care in the Coachella Valley community. Prior to his leadership post at JFK, Honts served as CEO at Creighton University Medical Center (CUMC) and Community Hospital of Los Gatos.  He also held leadership positions at Atlanta Medical Center, St. Joseph Hospital (now a part of CUMC) and Hilton Head Hospital.  Honts earned an undergraduate degree from the University of Nebraska and a master’s degree in health administration from the University of St. Francis in Joliet, Ill.

“I have thoroughly enjoyed getting to know the Coachella Valley since joining JFK Memorial and I’m eager to continue our plans for growth and service to the community,” Honts said. “With the continued growth in the region, our hospital and its outpatient clinics, such as the JFK Bone and Joint Institute, provide critical services to the area. We’re committed to meeting the evolving health care needs of our patients and the community.”

JFK Memorial Hospital has been providing medical care to residents in the Central/Eastern Coachella Valley since 1966. The hospital offers a 24-hour emergency room, comprehensive orthopedic services, general surgical services, cardiac and vascular care, urology services, women’s and maternity/obstetrical services, pediatric services, acute care for the elderly unit, ambulatory surgery center and other inpatient and outpatient services. JFK Memorial Hospital is fully accredited by The Joint Commission, the nation’s foremost hospital accreditation agency.

Legislative Alert: Urge Your Assembly Member to Support Bill to Close ACA Loophole

Please contact your legislators today and urge them to support this important bill, which would increase funding for Medi-Cal providers and incentivize large companies to provide adequate employer-sponsored coverage.
Additional information, including talking points, is available below.

Call (877) 362-8455 to be connected with your legislator

Click Here to Take Action!

 Click Here if you Made the Call!

AB 880 (Gomez) would address a loophole in the Affordable Care Act (ACA) by requiring large employers (500 or more employees) to pay a penalty for each employee enrolled in Medi-Cal. The funding generated would be used to expand access to care by increasing Medi-Cal provider rates and to pay for the nonfederal share of Medi-Cal costs.

The ACA requires individuals, employers and government to share responsibility for health coverage.  Individuals must have health coverage or pay a penalty. The government, through the “optional” Medicaid expansion and other efforts, will increase eligibility to millions of uninsured. Employers with an average of at least 50 full time employees will either provide affordable health coverage or pay a penalty for each employee who accesses subsidized coverage in the state exchange. However, nothing in the ACA or current law discourages large employers from reducing the hours or wages of their employees in order to make them Medi-Cal eligible.

Given that Medi-Cal pays some of the lowest provider rates in the country, coupled with the increased demands on the system as the state expands eligibility to 138 percent of the federal poverty level, the system simply cannot survive if large businesses begin shifting the costs of their employees' health care onto taxpayers. California already pays its Medi-Cal providers the lowest rates of all Medicaid programs in the nation. Although California has taken major steps to make health care coverage a reality for many people in our state by reducing the number of uninsured, the true test of our commitment will be improving Medi-Cal provider rates to ensure access to care.

We ask that you and your colleagues call, fax or email your legislators TODAY and urge them to protect access to care.   

Phone calls and office visits are most effective, but faxes and emails are important too. If you choose to fax or email your legislators, we strongly encourage that you personalize the letter (provided below), which will greatly increase its impact.

If you are logged into the CMA website, your legislators should automatically be displayed. If not, you can click here to locate your legislators by zip code.

You can also call CMA's legislator connect hotline at (877) 362-8455 to be easily connected to your legislator.  You will be asked to enter your zip code and select your legislator.

Give your name, specialty and let them know that you are their constituent.

Talking Points

  • The Affordable Care Act is built on a foundation of individual, employer and government responsibility. Individuals must have health insurance or pay a penalty. The federal government provides subsidies and an expansion of Medi-Cal. Employers are required to provide affordable coverage or pay a penalty to offset the cost of public subsidies for their full-time employees who go into the exchange.
  • The ACA, however, does not extend the employer responsibility penalty to employers that have workers enrolled in Medi-Cal. As a result, there have been widespread reports of employers dropping coverage for their low-wage employees as a cost-saving measure, anticipating that taxpayers through Medi-Cal will pick up the tab.
  •  Although Medi-Cal is intended to provide essential health care services to many of the poorest and most vulnerable Californians, it has unfortunately become a broken promise for access to health care.
  • Largely due to low reimbursement (ranking 50th out of 50 states), physician participation in Medi-Cal is lower than it should be as we prepare to fully implement the ACA.
  •  As a result, more than half of Medi-Cal patients report difficulty finding a provider. When they are unable to find a provider, many Medi-Cal patients seek preventive and other non-urgent care in the hospital emergency department, the most expensive kind of care.
  • The funds generated by AB 880 will be used to support the Medi-Cal program by paying the non-federal state share of the program costs for workers, increasing the reimbursement rate for providers and shoring up the safety net for all Californians who need care.




Legislative Alert: Urge your Legislator to OPPOSE Bills to Expand Scope of Nonphysician Practitioners

Urge your assembly members to OPPOSE SB 491, SB 492 and SB 493 today!

These bills would provide nurse practitioners with independent practice, allow optometrists to perform surgical and nonsurgical primary care beyond their scope of practice, and create a new advanced practice pharmacist who can prescribe medication and administer immunizations. Ultimately, these bills will put patients at risk and lower the quality of care provided in our state.

Additional information, including talking points, are provided below.

(Click here to) Take Action!

(Click here if you called) I Made the Call!

Call (877) 362-8455 to be connected with your legislator.

CMA is urging you to call your legislators and ask for NO votes on SB 491, SB 492 and SB 493. These three bills will expand scope of practice and remove necessary supervision by a physician and surgeon, ultimate harming patients while decreasing quality of care.

 SB 491 (Hernandez) – This bill would allow nurse practitioners to open practices without any oversight from a trained medical doctor and prescribe dangerous, addictive drugs without supervision. While an important part of the health care delivery system, nurse practitioners simply do not have adequate training or years of education that physicians do in order to be qualified to practice medicine without physician involvement.

SB 492 (Hernandez) – This bill would allow optometrists to provide primary care service including diagnosing diabetes, high cholesterol and hypertension. Under this bill, optometrists would be able to examine, prevent, diagnose and treat any disease, condition or disorder of the visual system, the human eye and adjacent related structures.

SB 493 (Hernandez) – This bill would allow advanced practice pharmacists to evaluate and manage diseases and health conditions without physician consultation. Additionally, any pharmacist would be able to furnish prescription smoking cessation drugs and devices with known harmful side effects including depression and in some cases, suicide.

All three of these bills will be heard in the Assembly Business, Professions and Consumer Protection Committee soon.

Legislators need to know the true impact these bills would have in their districts.

Your calls are imperative to help us stop these bills and protect patients. We ask that you and your colleagues call, fax or email your legislators TODAY and urge them to vote NO on SB 491, SB 492 and SB 493!

Phone calls and office visits are most effective, but faxes and emails are important too. If you choose to fax or email your legislators, we strongly encourage that you personalize the letter (provided below), which will greatly increase its impact.

If you are logged into the CMA website, your legislators should automatically be displayed. If not, you can click here to locate your legislators by zip code.

Talking Points

  • SB 491, SB 492, and SB 493 harm patient safety plain and simple.
  •  Other health professionals, while hugely important to the health care delivery system and an integral part of medicine, are not trained to diagnose and treat diseases like physicians are.
  •  Rather than further fragment the health care delivery system, we need to be looking at integrated care models that utilize everyone to the best of their abilities.
  •  SB 491, SB 492 and SB 493 will allow NPs, optometrists and pharmacists to practice medicine without being subject to the controls and oversight of the Medical Practice Act. The end result would be that these specific health practitioners would be held to a lower standard of care than physicians providing the same service.
  • If passed, these bills will allow individuals the ability to prescribe dangerous medications such as opioids. The Registered Board of Nursing is simply not equipped to oversee such prescribing and does not have an investigatory arm, as the Medical Board of California does.  
  • In my own experience, under-trained professionals order more tests and imaging studies as well as send patients for more referrals than do physicians.
  • To ensure patient safety, medical care must be administered in coordinated teams led by experienced, fully trained, qualified physicians.  
  • Proponents of this bill are using the guise of health care reform to say that independent practice will expand access to care. That is just not the case.
  • The same economic factors that I face as a physician will impact NPs, optometrists and pharmacists. (Expand on the economic considerations you face each day).
  • The number of physicians in California is unevenly distributed with regards to the general population, but these bills do not solve the problem. The majority of allied health professionals are practicing in the same regions as physicians now. There is no proof that indicates NPs, optometrists and pharmacists will indeed move to rural or under-served areas.
We believe patients are best served when they are provided with meaningful access to safe medical care provided by medical teams led by highly trained and qualified physicians.


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