Monday, December 5, 2016

The R & R Ride for SB 1160 (Mendoza)

Now that Governor Brown signed SB 1160 (Mendoza) into law, it's time for the bill to enter the "rulemaking" phase. That's when legislation either gets its teeth or gets its teeth kicked in. The Rules and Regulations (R&R) Ride for SB 1160 (Mendoza) starts at the Hiram Johnson State Office Building at 455 Golden Gate Avenue, San Francisco, 10 AM, 4 January 2017. Public testimony is supposedly limited to 10 minutes per speaker. The subject will be Title 8, CCRs, Section 10770 (amended) and 10770.7 (newly adopted).

Here is our opinion: implementation of SB 1160 (Mendoza) needs to be far more friendly to injured workers than it currently is. The Rules and Regulations (R & Rs) as proposed will implement a lien process that may be expanded in the sense that it will apply not only to doctors who accept liens but also to any physician or other provider who runs into snags with payment so that the only way remaining to proceed with an unpaid claim is through the lien process. That means if the lien process becomes the only viable option for a delayed or denied payment for medical or other service it will be necessary to file a lien under new R & Rs. That means increased crunch and grind especially for small offices. In turn that means progressive reduction in access to care for injured workers.  

We also believe that a hint of hypocrisy persists in the process. Here's how: supposedly, treating doctors will get the first 30 days of treatment unimpeded by Utilization Review. Not quite. Not all procedures will be removed from the UR Cauldron of Dismissal: MRI scanning will remain off limits. So will non-formulary medications and durable medical equipment costing over $250. Psychological treatment will remain on the proscribed list (remember in 2015 that Neuropsych QME was unilaterally and arbitrarily canceled by the Director). 

Surgery will still require prior authorization by UR. 

For these reasons, we urge participants with a stake in this process to file statements:

By mail, Workers Comp Appeals Board, Annette Gabrielli, Regional Coordinator, P.O. Box 429459, San Francisco, CA. 94142-9459

By delivery service or personal delivery, WCAB, Annette Gabrielli, Regional Coordinator, 455 Golden Gate Avenue, 9th floor, San Francisco.

By Fax, 1-415-703-4549.

Have fun over the New Year's Holiday but keep your fingers crossed. We give you two references, see below.


"Weinmann: Now Comes SB 1160: Unreasonable Denials,", 2016-08-23;

"SB 1160 (Mendoza): anti-fraud legislation aimed at physicians permits MPN fraud,", 2016-08-06.

Monday, October 17, 2016


In a historic development for professional unions, Stuart Bussey, MD, JD, president of the Union of American Physicians and Dentists (UAPD), stated on 15 October 2016 that the private practice physicians at Auburn Medical Center (AMC) in Tacoma, Washington, voted to join the UAPD -- the occasion is historic because it is the first time that the UAPD has formally organized a hospital medical staff outside of California. Although the UAPD has had non-California membership throughout its history, this effort marks the first successful organizational campaign outside of California. This step means that the UAPD and its AMC members can now negotiate legally with MultiCare which had opposed the formation of a doctors' union but which also indicated its intent to work with the physicians' elected union representative.

Local leadership was provided by Virginia Stowell, MD, general surgeon, whose concerns included winning more autonomy for physicians in the disposition of patient care, developing more clout in the negotiation of compensation and working conditions, and preventing the arbitrary outsourcing of professional work by hospital administration. Stowell's history includes having worked at MultiCare since 2012. Before that she was in private practice for 16 years. At the present time, MultiCare reviews physician compensation and makes its own decisions. From now on the UAPD will be enabled to participate in these decisions. In leading up to this historic vote, Stowell won two cases with NLRB that prevented MultiCare from foisting its will upon their physicians. In a nutshell, NLRB ruled that efforts by MultiCare  to prevent its doctors from discussing wages and working conditions violated the National Labor Relations Act which protects this activity.

It was pointed out during the voting process that hospitals have many committees staffed by physicians but that in the final analysis such committees have minimal ability to oppose administrative decisions decided upon by management. Stowell and others, including Neil Partain, a hospitalist at AMC, agreed that it would be better for the physicians and their patients if the doctors had a union to represent their views before the hospital and MultiCare.

Representing the UAPD in this effort was Theodore Gashaw, Lead Organizer, 916-796-3124,  Gashaw said that members of other systems have also called him although at this time MultiCare is where the UAPD has received the most interest.

Meanwhile in California, expanded interest in private practice organization is anticipated especially since Governor Brown signed AB 72 (Bonta) into law. This bill slashes "surprise billing" (see our previous editorial about "surprise billing" and AB 72, 6 October 2016) but leaves "network contraction" intact. Critics point out to what extent this legislation, under the guise of patient protection, actually promotes corporate compensation at the expense of patient care.

Thursday, October 6, 2016

SB 1160 (Mendoza): anti-fraud legislation aimed at physicians permits MPN fraud

Governor Brown signed SB 1160 (Mendoza) supposedly to combat fraud in the form of abusive lien practices by physicians. The trouble is that injured workers in disputed claims often rely on physicians to risk non-payment by accepting liens, hopefully eventually to be paid. SB 1160 shoots an arrow into the heart of this largess because its language is such that it discourages physicians from getting involved in any liens at all. The net result is that many injured workers will no longer have access to medical care.

In exchange for this slap-in-the-face the bill supposedly eases up on Utilization Review for the first 30 days following injury. The idea, or so said the press releases, was to facilitate treatment. The trouble in this part of the bill is that it actually specifically prevents physicians even in this 30 day period from getting certain crucial but specific diagnostic studies because they're deemed too expensive. Access to profit trumps patient care in SB 1160. 

So much for easing up on Utilization Review. It appears that once again injured workers get the short end of the stick if in fact they get any part of it at all. 


Governor Brown vetoed AB 2086 (Cooley), by and large for the same wobbly reasons that he vetoed AB 1542 last year, namely, that the bill "would create a unique lower standard" even though this specialty had already served the state and its injured workers well for 22 years before it was dissolved for undisclosed political reasons. The bill had no significant opposition in the legislature. This bill would have required the Division of Workers Comp to appoint qualified clinical neuropsychologists as QMEs (Qualified Medical Evaluators) to evaluate injured workers who sustained cerebral concussion and/or traumatic brain injury (TBI) for return to work placement. Impartial non-medical organizations supported the bill, for instance, organizations not representing either physicians or psychologists such as the California Alliance of Retired Americans (CARA) which told the governor in written communication that "TBI patients need all the help they can get." What is clear from the veto is that none of this help is going to be provided by Governor Brown. 

AB 72 (Bonta) targets physicians but leaves insurance companies and MPNs unscathed

Governor Brown signed AB 72 (Bonta) to put a stop to "surprise billing" but he left intact the ability of Medical Provider Networks (MPNs) and insurance companies to skimp on medical coverage, for instance, by not retaining enough specialists. When the MPN's patients then need the specialist that the MPN can't provide, "out-of-network" specialists are summoned. The "out-of-network" physicians, since they're not in-network, may bill at higher rates than the MPNs -- this practice has resulted in unpleasant surprises to patients when they learn that the medical bills they're getting are higher than expected because the specialist called in at the last minute was "out-of-network." This practice ends with Bonta's legislation which targets doctors but spares MPNs. Here's the scoop: the MPN purposefully retains too few doctors, especially specialists, in order to avoid paying "in-network" specialists. This desultory practice is known as "network contraction" or "in-network sharing." It allows more of subscribers' premium payments to be used for increased executive compensation instead of for patient care. Bonta's bill could have fixed this aspect of the problem along with the smack-down on "surprise billing." Only Bonta didn't want to ruffle the feathers of the insurers and MPNs. This writer recommends for legislative year 2017 that CMA, CSIMS, CNS, and UAPD seek legislation requiring MPNs to field fully staffed networks so that "out-of-network" doctors are no longer needed. The legislation needed would require that MPNs be fully  staffed or else -- the or else would be dissolution of the MPN for non-compliance.

Friday, September 16, 2016


This memo was sent as a personal message to Governor Brown re AB 72 (Bonta) earlier this month just after the bill was enrolled and sent to his desk. Now we make it public:

"Because AB 72 leaves 'network contraction' as a viable business method, eliminating only the 'surprise billing' element,  if you let AB 72 slip into law, you might want to add a memo of your own that there should be follow-up legislation to make sure that the medical networks are fully staffed. 'Fully staffed' means that they include a complete range of medical and surgical specialists. 

Meantime, we recommend a veto."

Robert L. Weinmann, MD, Editor

Robert L. Weinmann, MD, Editor, The Weinmann Report ( 

Reference for our readers:

Our original piece was posted on-line at on 12 August 2016.  The title was "Assembly Bill 72 (Bonta): Oppose Unless Amended, a pending bait and switch bill," in other words, a bill to disallow "surprise billing" while leaving the underlying mechanism enabling appointment of out-of-network doctors intact. The mechanism is called "network contraction" and is also  known as "in-network cost sharing." It allows networks to understaff by purposefully not carrying enough network doctors to cover all medical and surgical specialties. It's a profitable network move at the expense of services to network subscribers or customers who don't know their insurance plan is not required by law to retain a full network of physicians and surgeons. So here is the amendment we recommended as of 8/12/16:

Health-care plans should be required to maintain full provider lists covering all specialties. The plans should provide these lists to their in-network providers and to all of their subscribers and customers. Networks that fail in this requirement should be penalized by fines and disciplinary action against their managers and officers.

9/23/2016 -- flash! Governor Brown signed AB 72 into law. There are no provisions in the bill to prevent corporate greed, e.g., "network contraction." The bill is aimed squarely between the eyes of "out-of-network" providers.

Thursday, September 1, 2016


The undersigned recently participated in two investigative stories, one on television, NBC Bay Area, the other on radio, KPFA, 94.1 Wednesday, 8/31/16.

The NBC Bay Area story was a three-part investigation of workers comp. The focus was bureaucratic delay and denial of care to injured workers in California. Here are the links: Dozens of Injured San Jose Firefighters Denied Workers' Comp Treatment; Workers' Comp Drags Out Medical Care, Injured Workers and their Doctors Say; and Injured Workers Face Stacked Deck During Workers' Comp Appeals Process, Critics Say.

The KPFA 94.1 story was broadcast on WorkWeek Radio. This program addressed "the growing crisis for injured workers" in California and revealed that Maximus, which does so-called "independent medical review," was paid $40 million in a "no bid contract to make determinations of whether workers were entitled to medical care." The story is a production of Work Week Radio,

The undersigned commented on SB 1160 (Mendoza) and on the continuing travesty that allows Utilization Review (UR) and Independent Medical Review (IMR) doctors to determine California-based cases even though these doctors may not be licensed in California and aren't subject to the state medical board. While SB 1160 may actually improve UR somewhat, its lien provisions harm access to care for injured workers.