How Well Do You Know the Issues Critical to Physicians?
WHAT DOES “SGR” STAND FOR, AND WHY SHOULD I CARE?
The flawed and (un)Sustainable Growth Rate formula has since 1997 determined how much Medicare pays you for the services you provide. In 2002, SGR cut your reimbursement rate by 4.8%:
- 2002: -4.8%
- 2003: 1.4%
- 2004: 1.8%
- 2005: 1.5%
- 2006: 0.2%
- 2007: 0.0%
- 2008: 0.5%
- 2009: 1.1%
- 2010: 1.3%
- 2011: 0.9%
- 2012: 0.0%
And on January 1, 2013, SGR will cut your rate again by 27% — plus a 2% sequestration budget cut! SDCMS and CMA continue to lobby intensely to stop the approaching draconian Medicare cuts, and continue to work with congressional leadership to permanently repeal the SGR. We are promoting long-term payment reform starting with a period of transition to test alternative payment methods and will eventually implement physician-led, patient-centered payment models and delivery systems.
WHAT DOES “GPCI” STAND FOR, AND WHY SHOULD I CARE
The U.S. Department of Health and Human Services has knowingly used an outdated system — the Geographic Practice Cost Index — to pay physicians for more than 10 years, assigning to San Diego — America’s eighth largest city — a RURAL cost-of-living multiplier. GPCI results in the underpayment of 14 California counties, including San Diego, up to 14% per year. Three physicians (including an SDCMS physician) and seven California counties sued the DHHS for $3.2 billion in 2007. As recommended by the IOM, CMA urges Congress to update the localities to Metropolitan Statistical Areas consistent with the way Medicare organizes and pays hospitals. Support the Farr-Bilbray budget-neutral solution!
WHAT IS CMA’S POSITION ON NONPHYSICIAN SCOPE-OF-PRACTICE EXPANSIONS?
While CMA does not oppose all expansions of scope of practice for nonphysician providers (physical therapists, optometrists, nurse anesthetists, pharmacists, nurse practitioners, psychologists, audiologists, chiropractors, podiatrists, dentists, clinical social workers, naturopaths, etc.), these proposals must be examined carefully to ensure that patient care is not jeopardized, i.e., that nonphysician providers have the proper experience, training, and education to treat patients safely, and that the physician is the final decision maker.
WHAT DOES “MICRA” STAND FOR, AND WHY SHOULD I CARE?
The 1975 Medical Insurance Compensation Reform Act has kept the doors of medicine open and has protected the healthcare safety net in California by keeping medical malpractice insurance available and affordable. CMA supports continuation of MICRA and keeping the cap on non-economic damages (one of its many provisions) at $250,000. CMA defended MICRA in 2012 before the 5th Appellate District Count, which upheld the constitutionality of MICRA’s $250,000 cap.
WHAT IS THE BAR TO THE COR PORATE PRACTICE OF MEDICINE, AND WHY SHOUL D I CARE?
Unlike many states, California outlawed the practice of medicine by businesses and nonphysicians. This “corporate bar” protects patients and preserves physician autonomy by keeping hospitals and other commercial entities from directly hiring physicians and from dictating clinical decisions based on profit. With tightening economic pressures, hospitals and others are constantly seeking to erode the corporate bar. They would like to directly hire doctors and control physician freedom and patient access to care. Compromising physicians’ professional judgment would result in higher healthcare costs and diminished quality of care for our patients.
HOW DID CMA DEFEND MEDI-CAL IN 2011–12, FOLLOWING YEARS OF HARD WORK?
CMA led a coalition that spent more than $1 million in legal fees to successfully block a 10% Medi-Cal reimbursement rate reduction, to stop $5 doctor copays, to protect access to care for Medi-Cal patients, and to stop $137 million in Medi-Cal physician payment cuts for services provided to children! In addition, CMA was party to a lawsuit that reached the U.S. Supreme Court that now ensures physicians can sue in order to block Medi-Cal cuts.
HOW HAVE SDCMS AND CMA FOUGHT TO PROTECT SAN DIEGO COUNTY’S EMERGENCY SERVICES?
CMA prevented any diversion of the $55 million in Maddy Fund monies, which provide critical resources to reimburse physicians for uncompensated care provided in the ER. CMA also protected funding for the Emergency Services Commission, which oversees planning for emergency services.
HOW DOES SDCMS ENSURE I HAVE A VOICE AT THE TABLE IN LOCAL HEALTHCARE DISCUSSIONS?
SDCMS physician leaders and staff are active participants in healthcare stakeholder meetings throughout the county:
- Adult Obesity
- Childhood Obesity
- Countywide Health Information Exchange
- Regional Chamber of Commerce
- County Health Services Advisory Board
- Healthy San Diego
- San Diegans for Healthcare Coverage
- Mental Health America
- San Diego Beacon Community Health Information Exchange
- San Diego / Imperial Counties Chapter of the American Red Cross
As well, SDCMS physician leaders and staff are asked regularly to speak at hospital general staff meetings, hospital medical executive committee meetings, resident physician meetings, medical student meetings, and retired physician meetings.
HOW DOES SDCMS HELP ENSURE SAN DIEGO COUNTY HAS A REQUISITE PHYSICIAN WORKFORCE?
In 2002, SDCMS conducted San Diego County’s first Physician Workforce and Compensation Survey. The results provided SDCMS and local healthcare policymakers with their first insights into physicians’ attitudes toward their work, as well as San Diego County’s physician compensation environment. Subsequent Physician Workforce and Compensation surveys conducted by SDCMS in 2005, 2007, 2009, and again in 2011, continue to yield valuable data and insights for our San Diego County physician community, and local and state legislators.
HOW DOES SDCMS SUPPORT ACCESS TO CARE FOR OUR REGION’S UNINSURED POPULATIONS?
The SDCMS Foundation’s outreach and commitment to serve the medical needs of those less fortunate in San Diego County have created a healthy network of medical professionals determined to make a difference. More than 620 physicians volunteer with the Foundation’s flagship program, Project Access San Diego, which has assisted more than 1,600 uninsured adults in the community in receiving specialty health services. The Foundation’s programs help physicians, patients, and our community at large by offering efficient and meaningful access to specialty care, preventive health education, and by serving as a resource of information and support for medical students. Project Access San Diego has coordinated $5.5 million in donated care by San Diego County doctors, hospitals, and ancillary providers. The Foundation as well continues to support our future physicians, having awarded 13 UC San Diego medical students $31,000 in scholarships since 2007, and has increased the professional capacity of primary care physicians and improved patient care through its eConsultSD.
HOW HAS CMA BEEN INVOLVED IN FEDERAL HEALTHCARE REFORM?
With the U.S. Supreme Court ruling to uphold the Affordable Care Act (ACA) and the State of California moving swiftly to implement health reform, CMA continues to focus on implementation of the Health Benefits Exchange and improvements to the ACA. CMA supports the ACA’s expansion of affordable healthcare coverage to California’s uninsured, expanding access to primary care, investments in public health, and stopping the for-profit insurance industry abuses. While the ACA expanded coverage, it fails to ensure that such coverage will result in real access to a doctor. CMA advocates the following improvements to the ACA to ensure access to care: Repeal the Medicare SGR; eliminate the Independent Medicare Payment Advisory Board (IPAB); and increase the Medi-Cal payment rates to Medicare levels. Healthcare reform will not work unless Medi-Cal is fixed.