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SDCMS-CMA Top Issues
Table of Contents:
California’s landmark 1975 Medical Injury Compensation Reform Act (MICRA) is a law that ensures injured patients receive fair compensation while preserving every Californian’s access to healthcare. MICRA has kept the doors of medicine open for nearly 40 years, protecting California’s healthcare safety net by keeping medical malpractice insurance available and affordable.
Prior to MICRA, out-of-control medical liability costs were forcing clinics, doctors, and other healthcare providers to leave the practice of medicine altogether. MICRA has helped stabilize medical liability costs, keeping more providers and clinics open and treating patients — and more stability means healthcare providers of all types have been less likely to close their doors because of skyrocketing liability premiums.
Weakening MICRA’s intent or protections will result in higher healthcare costs overall, no improvement in quality, and reduced access to services. Even with MICRA, many specialty services today like obstetricians, nurse midwives, community clinics, emergency providers, and rural providers remain particularly vulnerable to any liability increases or weakening of MICRA’s reforms.
We only need to look at other states to see how important it is to preserve MICRA. States with medical liability reform are able to attract more doctors, and are less likely to suffer from shortages of specialty providers leading to the closing of hospitals, clinics, and trauma centers.
According to the Texas Alliance for Patient Access, Texas enacted medical liability reforms in 2003 and has since added more than 14,000 in-state, active physicians. Additionally, 35 rural Texas counties have added at least one obstetrician, including 16 counties that previously had none; 46 counties that did not have an emergency medicine physician now do; and 15 counties that did not have a cardiologist now do.
In New York, a state without reforms, 19 counties are without obstetricians, 22 are without internal medicine specialists, and 15 do not have surgical specialty doctors, according to a 2010 study by The Center for Health Workforce Studies. According to a July 2012 story in The New York Times, several hospitals in New York City are partially or completely without liability insurance due to the high cost of liability premiums.
Background: Enacted in 1965 through amendments to the Social Security Act, Medicaid is a health and long-term care coverage program that is jointly financed by states and the federal government. Each state establishes and administers its own Medicaid program and determines the type, amount, duration, and scope of services covered within broad federal guidelines. States must cover certain mandatory benefits and may choose to provide other optional benefits.
Federal law also requires states to cover certain mandatory eligibility groups, including qualified parents, children, and pregnant women with low income, as well as older adults and people with disabilities with low income. States have the flexibility to cover other optional eligibility groups and set eligibility criteria within the federal standards. The Affordable Care Act of 2010 creates a new national Medicaid minimum eligibility level that covers most Americans with household income up to 133% of the federal poverty level. This new eligibility requirement is effective January 1, 2014, but states may choose to expand coverage before this date.
The Children’s Health Insurance Program (CHIP) was created in 1997 through an amendment to the Social Security Act to provide healthcare coverage to low-income children not already eligible for Medicaid. Like Medicaid, CHIP is jointly financed by states and the federal government. States have the option of using CHIP funds to expand their existing Medicaid program, create a separate stand-alone CHIP, or do a combination of both.
In October 2011, the Centers for Medicare and Medicaid Services (CMS) approved California’s plan to reduce rates for Medi-Cal (Medicaid in California) providers by 10% (adopted to deal with the state deficit), retroactive to June 1, 2011. In December 2012, a three-judge panel of the 9th U.S. Circuit Court of Appeals overturned a district court ruling to stop the retroactive 10% cut. Healthcare providers then asked the full 9th Circuit court to review the case. In May 2013, the full 9th Circuit Court upheld the cut, and, as a result, the 10% rate reduction must now be implemented unless plaintiffs appeal the case to the U.S. Supreme Court and the high court blocks the cut while the case is heard and decided.
California lawmakers could also block the cut by approving legislation that draws enough support to sustain a possible veto by the governor. Meanwhile, the governor included the rate reduction in his revised fiscal year 2013–2014 budget proposal. The cuts, which are based on funding levels from fiscal year 2008–2009, could result in a 25% reduction to Medi-Cal services.
Physicians, who work to protect patients, believe the state’s action flies in the face of the intent of federal laws intended to assure that Medicaid patients have access to medical care, and undermines the goals of healthcare reform. California is below the national average with respect to Medicaid reimbursement rates: Medi-Cal reimburses 51% of Medicare’s reimbursement rates for the same services compared to 66% of Medicare’s rates nationally. In San Diego, 42% of healthcare providers accept Medicaid.
Scope of Practice
Background: CMA both supports utilizing allied health professionals — physical therapists, optometrists, nurse anesthetists, pharmacists, nurse practitioners, psychologists, audiologists, chiropractors, podiatrists, dentists, clinical social workers, naturopaths, etc. — to the top of their training and recognizes the important role they play in the healthcare delivery team. Allied health professional scope of practice expansions must be examined carefully to ensure that patient care is not jeopardized, i.e., that allied health professionals have the proper experience, training, and education to treat patients safely, and that the physician is the final decision maker.
Background: California law prohibits any person from practicing medicine in this state without a valid certificate of licensure (Bus. & Prof. Code section 2052). This prohibition not only applies to lay individuals but, with limited exceptions, also to corporations and other artificial entities that have “no professional rights, privileges, or powers” under California’s Medical Practice Act (Bus. & Prof. Code section 2400).
The bar to the corporate practice of medicine — corporate bar — is designed to protect the public from possible abuses stemming from the commercial exploitation of the practice of medicine. It ensures that those persons who make decisions affecting the provision of medical care understand the quality of care implications of those decisions, possess the professional ethical obligation to place the patient’s interests foremost, and are subject to the full panoply of enforcement powers of the Medical Board of California, which is charged with the administration of the Medical Practice Act.
The corporate practice of medicine prohibition has been interpreted broadly to encompass not only direct medical decisions, but “business” and “administrative” decisions that have medical implications as well. For example, the prospective purchase of a piece of radiological equipment could be impacted by business considerations, medical considerations, or by an amalgam of factors emanating from both business and medical areas.