Monday, October 29, 2012
Saturday, October 20, 2012
OBAMACARE: "DOCTORS ET CETERA" IN THE ACA AND IPAB
DO IT OUR WAY OR DIE
October 29th Update to Politico comment of October 22nd. The above comment is in reference to "Presidential debate: 5 things to watch Monday" by MAGGIE HABERMAN and GLENN THRUSH | 10/22/12 4:23 AM EDT.
Read more: http://www.politico.com/news/
The highwater mark of Obamacare is carried in the bowels of the Independent Payment Advisory Board (IPAB), a level that hasn't yet been reached because the Affordable Care Act (ACA) is still in its infancy. It is the IPAB that will have the authority to declare entire diagnostic and treatment protocols too extravagant not only for Medicare but also for the general public and therefore not covered or payable by the ACA -- that's when Obamacare will become known for its bite.
But that bite won't chomp on President Obama or Congress because both of them are exempt from the ACA. Did you know that? Congress has its own health care plan. The Congressional plan does not include an IPAB to water down care by restricting access to diagnostic testing and treatment. The current ACA does just that. The IPAB portion of the ACA should be repealed even if we continue to debate the rest of it.
Keep in mind that Congress keeps special healthcare benefits handy for itself including access to treatment at military hospitals.
In the autumn of 2009 President Obama stated "I will ensure that no government bureaucrat gets between you and the care you need." It's probably safe to say he wasn't thinking of the IPAB at the time. President Obama has now promised a minimum of 15 brand new bureaucrats.
In the first debate, President Obama said the IPAB would consist of "doctors et cetera." The fact is that there'll be plenty of "et cetera" but there's no obligation under the ACA that any of the 15 appointees to the IPAB must be a physician.
Governor Romney did no better than the president because he didn't seem to realize that President Obama was winging it when he said "doctors et cetera." What else does Governor Romney not know about the ACA except that he prefers his pals in the insurance industry, the blokes who rescind health care contracts once the subscriber has the temerity to get sick?
For a guy known for his financial expertise, we're surprised that the Governor failed to mention that each one of the 15 appointees to the IPAB will be paid $165,000 annually for a total annual budget of $2,475,000 just for the 15 appointees -- staff and resource time will get counted later, right?
The IPAB can be repealed without repealing the entire bill. The mechanism would be to rescind Sections 3403 and 10320. The current stand-off means that one side won't improve what's wrong with the ACA and the other side would repeal all of it to bring back the greed-soaked insurance companies.
See also our October 4th blog; use the glossary to find more articles about the IPAB, the ACA, and related topics.
October 29th Update to Politico comment of October 22nd. The above comment is in reference to "Presidential debate: 5 things to watch Monday" by MAGGIE HABERMAN and GLENN THRUSH | 10/22/12 4:23 AM EDT.
Read more: http://www.politico.com/news/
The highwater mark of Obamacare is carried in the bowels of the Independent Payment Advisory Board (IPAB), a level that hasn't yet been reached because the Affordable Care Act (ACA) is still in its infancy. It is the IPAB that will have the authority to declare entire diagnostic and treatment protocols too extravagant not only for Medicare but also for the general public and therefore not covered or payable by the ACA -- that's when Obamacare will become known for its bite.
But that bite won't chomp on President Obama or Congress because both of them are exempt from the ACA. Did you know that? Congress has its own health care plan. The Congressional plan does not include an IPAB to water down care by restricting access to diagnostic testing and treatment. The current ACA does just that. The IPAB portion of the ACA should be repealed even if we continue to debate the rest of it.
Keep in mind that Congress keeps special healthcare benefits handy for itself including access to treatment at military hospitals.
In the autumn of 2009 President Obama stated "I will ensure that no government bureaucrat gets between you and the care you need." It's probably safe to say he wasn't thinking of the IPAB at the time. President Obama has now promised a minimum of 15 brand new bureaucrats.
In the first debate, President Obama said the IPAB would consist of "doctors et cetera." The fact is that there'll be plenty of "et cetera" but there's no obligation under the ACA that any of the 15 appointees to the IPAB must be a physician.
Governor Romney did no better than the president because he didn't seem to realize that President Obama was winging it when he said "doctors et cetera." What else does Governor Romney not know about the ACA except that he prefers his pals in the insurance industry, the blokes who rescind health care contracts once the subscriber has the temerity to get sick?
For a guy known for his financial expertise, we're surprised that the Governor failed to mention that each one of the 15 appointees to the IPAB will be paid $165,000 annually for a total annual budget of $2,475,000 just for the 15 appointees -- staff and resource time will get counted later, right?
The IPAB can be repealed without repealing the entire bill. The mechanism would be to rescind Sections 3403 and 10320. The current stand-off means that one side won't improve what's wrong with the ACA and the other side would repeal all of it to bring back the greed-soaked insurance companies.
See also our October 4th blog; use the glossary to find more articles about the IPAB, the ACA, and related topics.
Thursday, October 4, 2012
AFFORDABLE CARE ACT LOSES DEBATE
OBAMA and ROMNEY Debate each other but the loser is The Affordable Care Act.
It appears as though President Obama likes the name, Obamacare, for the Affordable Care Act (ACA). It wouldn't hurt if he understood his own legislation better. On other hand, why should he? He and Congress are exempt from it. Romney simply doesn't need it.
Romney said during the debate of 3 October 2012 that Obamacare "puts in place an unelected board that's going to tell people ultimately what kind of treatments they can have." Romney doesn't like that idea. Except he has incorrectly, some would say on purpose, misconstrued the unelected board, named the Independent Payment Advisory Board (IPAB). It will consist of political appointees none of whom need be a physician. Its purpose will be to oversee Medicare costs. The IPAB will have the power to shut down certain costs incurred by Medicare if costs soar out of control and Congress fails to intervene. The IPAB will not be enabled to tell individual physicians what tests to order or what treatment should be used. It will not be allowed to ration care on a patient-by-patient basis. It will not be empowered to raise the Medicare eligibility age or shift costs to retireds. What the IPAB will have will be the power to determine which diagnostic and treatment protocols aren't worth funding anymore and will in that way ration care for the entire Medicare population, the same as when private insurance companies tell hapless patients that they're seeking what they determined in cloaked boardrooms were actually "non-covered benefits," i.e., you pay for it yourself because this or that benefit is not included in your private health care plan. The IPAB method constitutes a form of sophisticated rationing, but it's not on an individual patient-by-patient basis.
Obama said that the IPAB would be composed of "doctors et cetera." Not necessarily. There's no provision in the ACA that requires doctors to be appointed to the IPAB. Obama himself evidently didn't know that when he made his comment, either that or he sought to hoodwink the audience. The 15 or so appointees to the IPAB will be political appointees who will not need to report directly to Congress. They will not be elected so they won't represent the public or an electorate. Their job will be to make economic judgments when they decide which diagnostic and treatment protocols will be covered by Medicare and which won't be covered. In short, your doctor can prescribe whatever he wants. But your doctor can't make Medicare pay for it. And neither can you.
The IPAB is empowered by Sections 3403 and 10320 of the ACA. These sections of the ACA should be repealed. We'll have more to say in due course. So should Obama and Romney. The October 3rd debate showed that both candidates have lots more to learn about the ACA. For instance, they can tell us if it's correct that the members of this board are to be paid $165,000 per year at a total public cost of $2,475,000. Repealing these two sections of the ACA will save taxpayers nearly $2.5 million.
It appears as though President Obama likes the name, Obamacare, for the Affordable Care Act (ACA). It wouldn't hurt if he understood his own legislation better. On other hand, why should he? He and Congress are exempt from it. Romney simply doesn't need it.
Romney said during the debate of 3 October 2012 that Obamacare "puts in place an unelected board that's going to tell people ultimately what kind of treatments they can have." Romney doesn't like that idea. Except he has incorrectly, some would say on purpose, misconstrued the unelected board, named the Independent Payment Advisory Board (IPAB). It will consist of political appointees none of whom need be a physician. Its purpose will be to oversee Medicare costs. The IPAB will have the power to shut down certain costs incurred by Medicare if costs soar out of control and Congress fails to intervene. The IPAB will not be enabled to tell individual physicians what tests to order or what treatment should be used. It will not be allowed to ration care on a patient-by-patient basis. It will not be empowered to raise the Medicare eligibility age or shift costs to retireds. What the IPAB will have will be the power to determine which diagnostic and treatment protocols aren't worth funding anymore and will in that way ration care for the entire Medicare population, the same as when private insurance companies tell hapless patients that they're seeking what they determined in cloaked boardrooms were actually "non-covered benefits," i.e., you pay for it yourself because this or that benefit is not included in your private health care plan. The IPAB method constitutes a form of sophisticated rationing, but it's not on an individual patient-by-patient basis.
Obama said that the IPAB would be composed of "doctors et cetera." Not necessarily. There's no provision in the ACA that requires doctors to be appointed to the IPAB. Obama himself evidently didn't know that when he made his comment, either that or he sought to hoodwink the audience. The 15 or so appointees to the IPAB will be political appointees who will not need to report directly to Congress. They will not be elected so they won't represent the public or an electorate. Their job will be to make economic judgments when they decide which diagnostic and treatment protocols will be covered by Medicare and which won't be covered. In short, your doctor can prescribe whatever he wants. But your doctor can't make Medicare pay for it. And neither can you.
The IPAB is empowered by Sections 3403 and 10320 of the ACA. These sections of the ACA should be repealed. We'll have more to say in due course. So should Obama and Romney. The October 3rd debate showed that both candidates have lots more to learn about the ACA. For instance, they can tell us if it's correct that the members of this board are to be paid $165,000 per year at a total public cost of $2,475,000. Repealing these two sections of the ACA will save taxpayers nearly $2.5 million.
Tuesday, October 2, 2012
AB 369 (HUFFMAN) RE "STEP THERAPY" VETOED
ASSEMBLYMAN JARED HUFFMAN found out too late that his vote in favor of SB 863 helped seal the doom of his own bill, AB 369, which was intended to put an end to the merciless use of "step therapy," the method favored by insurance companies to restrict access of patients to medications prescribed by their personal physicians.
When Governor Brown signed SB 863 into law, the light went out not only for AB 1687 (Fong) but also for AB 369 (Huffman). Governor Brown's veto message of AB 1687 said that the bill wasn't necessary because SB 863 was now the law. Both bills passed the legislature on a bipartisan basis, but both bills were vetoed by Gov. Brown. In this piece, we'll discuss AB 369 which this writer supported (see June 2011 issue of www.politicsofhealthcare.com).
"Step therapy" is the process by which patients are required by insurance companies, HMOs, PPOs, or others to try specified generic medications before they're allowed to try better, newer, or more expensive medications that may have actually been prescribed by their treating doctors. The purpose is cost control even if patients are harmed in the process.
In his veto message for AB 369 Brown acknowledged that "this bill would prohibit a health plan or insurer from requiring a patient to try and 'fail' more than two medications before allowing a patient to have the pain medication prescribed by his or her doctor." In fact, the part about "two medications" was already a compromise, but that wasn't enough for the insurance companies, health plans, or Governor Brown who is seeking their support for other issues.
In the veto message, the Governor used one of the worst aspects of SB 863 to justify his veto decision against AB 369. Here's what he said: "Independent medical reviews are available to resolve differences in clinical judgment when they occur, even on an expedited basis."
Keep in mind that in workers comp the names of the independent medical reviewers are supposed to be kept secret. Keep in mind that in the private plans the decision means that patients will be obliged to rely on medications that their personal physicians had purposefully not prescribed.
Brown said that "any limitations on the practice of 'step-therapy' should better reflect a health plan or insurer's legitimate role in determining the allowable steps." In other words, we're told that the health plan's cost-control panel has a "legitimate role" in overruling the strictly medical decisions of our personal physicians. That's the law that Governor Brown favors. Moreover, had AB 369 become law, it would have run counter to the aims and objectives of SB 863 which puts anonymous and often non-California licensed doctors who have not interviewed or examined the patients in control of properly licensed treating physicians who've actually interviewed and examined the patients.
Starting 1 January 2013, an Independent Medical Review system will replace the current Utilization Review (UR) system. The chief differences are that the IMR doctors will have their names protected and will only be able to be challenged for bias, fraud, or conflict of interest, a challenge that may be difficult to undertake if the the doctors' names are protected. The current system of UR is subject to challenge in court.
Governor Brown's veto of AB 369 is harmful to patients and is favorable to the financial interests of the insurance companies and health plans. IMR doctors and their employers should be subject to challenge in court. Governor Brown's veto prevents lawyers from using AB 369 to litigate against the restrictive treatment provisions incorporated into SB 863.
Huffman joins Fong in that both legislators cast incompatible votes and helped in the downfall of their own respective bills. The master legislator in this case turns out to be Brown. Wie Schade (too bad).
When Governor Brown signed SB 863 into law, the light went out not only for AB 1687 (Fong) but also for AB 369 (Huffman). Governor Brown's veto message of AB 1687 said that the bill wasn't necessary because SB 863 was now the law. Both bills passed the legislature on a bipartisan basis, but both bills were vetoed by Gov. Brown. In this piece, we'll discuss AB 369 which this writer supported (see June 2011 issue of www.politicsofhealthcare.com).
"Step therapy" is the process by which patients are required by insurance companies, HMOs, PPOs, or others to try specified generic medications before they're allowed to try better, newer, or more expensive medications that may have actually been prescribed by their treating doctors. The purpose is cost control even if patients are harmed in the process.
In his veto message for AB 369 Brown acknowledged that "this bill would prohibit a health plan or insurer from requiring a patient to try and 'fail' more than two medications before allowing a patient to have the pain medication prescribed by his or her doctor." In fact, the part about "two medications" was already a compromise, but that wasn't enough for the insurance companies, health plans, or Governor Brown who is seeking their support for other issues.
In the veto message, the Governor used one of the worst aspects of SB 863 to justify his veto decision against AB 369. Here's what he said: "Independent medical reviews are available to resolve differences in clinical judgment when they occur, even on an expedited basis."
Keep in mind that in workers comp the names of the independent medical reviewers are supposed to be kept secret. Keep in mind that in the private plans the decision means that patients will be obliged to rely on medications that their personal physicians had purposefully not prescribed.
Brown said that "any limitations on the practice of 'step-therapy' should better reflect a health plan or insurer's legitimate role in determining the allowable steps." In other words, we're told that the health plan's cost-control panel has a "legitimate role" in overruling the strictly medical decisions of our personal physicians. That's the law that Governor Brown favors. Moreover, had AB 369 become law, it would have run counter to the aims and objectives of SB 863 which puts anonymous and often non-California licensed doctors who have not interviewed or examined the patients in control of properly licensed treating physicians who've actually interviewed and examined the patients.
Starting 1 January 2013, an Independent Medical Review system will replace the current Utilization Review (UR) system. The chief differences are that the IMR doctors will have their names protected and will only be able to be challenged for bias, fraud, or conflict of interest, a challenge that may be difficult to undertake if the the doctors' names are protected. The current system of UR is subject to challenge in court.
Governor Brown's veto of AB 369 is harmful to patients and is favorable to the financial interests of the insurance companies and health plans. IMR doctors and their employers should be subject to challenge in court. Governor Brown's veto prevents lawyers from using AB 369 to litigate against the restrictive treatment provisions incorporated into SB 863.
Huffman joins Fong in that both legislators cast incompatible votes and helped in the downfall of their own respective bills. The master legislator in this case turns out to be Brown. Wie Schade (too bad).
Saturday, September 29, 2012
AB 1687 (FONG) IS VETOED BY GOV. BROWN
In a master stroke of double-edged legislative slight of hand, Governor Brown vetoed a bill that would've given injured workers a fighting chance when faced with wrongful denial of treatment.
In his veto message, the Governor said "The recently enacted landmark comprehensive workers' compensation reform legislation makes this measure unnecessary. These reforms -- backed by both Democrats and Republicans -- reduce costs to businesses and protect workers. Further, they will help to avert an imminent crisis of skyrocketing rates that would have hurt both injured workers and businesses."
Yeah, right! There's a line about this kind of reasoning in The King and I when the beleagured king says he doesn't know whether or not to make an alliance with a stronger country. The weaker countries, he says, can't really help him. By contrast the larger and stronger countries may protect him out of everything he has. That's the situation injured workers will face when SB 863 becomes effective on 1 Jan 2013. They'll be "protected" out of some benefits they currently have in return for some benefits many will never get.
The recently enacted reform legislation to which the Governor refers is SB 863 which creates a secret panel of Independent Medical Review (IMR) doctors who will replace the current Utilization Review system (UR). Currently, utilization review doctors can be challenged in court for incorrect decisions. Under the new system the IMR doctors can only be challenged for bias, fraud, or conflict of interest. Trouble is that SB 863 also contains a provision which protects and conceals the names of the IMR doctors.
SB 863 increases permanent disability (PD) in one section of the legislation while another part of the bill disqualifies conditions that currently qualify for PD such as dyssomnia from chronic pain and sexual dysfunction from spinal injuries.
On the other hand, Paul Fong's legislation, AB 1687, would have required denials of care to be made in plain language so that obfuscations and wrongful denials of treatment dished out to injured workers could be stopped dead in their perfidious tracks. Now that that bill has been vetoed, injured workers have lost their last chance at fair play.
We have witnessed a sleek lesson in political maneuvering. First, the Governor personally worked for passage of SB 863 with its provision for Alternative Dispute Resolution (ADR) and keeping secret the names of Independent Medical Review (IMR) doctors. One would think the unions would have opposed the bill because of the ADR provision alone. One might even have expected principled opposition from the California Medical Association (CMA) because of the secrecy provisions that would be bestowed on an entire cadre of doctor-judges including doctors unlicensed to practice in California. In fact, the International Longshore and Warehouse Union, Southern California District Council, California Teamsters Public Affairs Council, SEIU 121, and the United Firefighters of Los Angeles did oppose SB 863. But the California Labor Federation which helped create the bill with the assistance of big business including Grimmway Farms got support from other unions including the American Federation of State, County and Municipal Employees (AFSCME) and from the California Medical Association (CMA).
One of the same unions that supported AB 1687, the California Labor Federation, was simultaneously involved in writing SB 863 with provisions that would eventually doom AB 1687, e.g., the secrecy provisions protecting the non-California licensed doctors. It's logical that if the Governor supported SB 863 he would veto AB 1687 since enforcement of AB 1687 would put a legal crimp into the secrecy provisions of SB 863. The California Labor Federation's support for AB 1687 came before SB 863 was completely written. In short, CLF was engaged in the composition of SB 863 even while CLF was ostensibly supporting AB 1687. AB 1687 passed the legislature before SB 863 was finalized. Fong's bill turned out to be an inconvenience to Gov. Brown and to the California Labor Federation and was doomed for failure once SB 863 passed. When SB 863 got signed by the Governor, the fate of AB 1687 was sealed.
The Open Government website reports that Assemblyman Fong voted for SB 863 which turns out to have been equivalent to voting against his own bill. The irony is that Paul Fong was obliged to stand by while SB 863 got signed into law and his own bill got vetoed.
Score: Governor Brown goes 2 for 2, Fong is 1 for 2, while the injured worker community goes scoreless, again.
In his veto message, the Governor said "The recently enacted landmark comprehensive workers' compensation reform legislation makes this measure unnecessary. These reforms -- backed by both Democrats and Republicans -- reduce costs to businesses and protect workers. Further, they will help to avert an imminent crisis of skyrocketing rates that would have hurt both injured workers and businesses."
Yeah, right! There's a line about this kind of reasoning in The King and I when the beleagured king says he doesn't know whether or not to make an alliance with a stronger country. The weaker countries, he says, can't really help him. By contrast the larger and stronger countries may protect him out of everything he has. That's the situation injured workers will face when SB 863 becomes effective on 1 Jan 2013. They'll be "protected" out of some benefits they currently have in return for some benefits many will never get.
The recently enacted reform legislation to which the Governor refers is SB 863 which creates a secret panel of Independent Medical Review (IMR) doctors who will replace the current Utilization Review system (UR). Currently, utilization review doctors can be challenged in court for incorrect decisions. Under the new system the IMR doctors can only be challenged for bias, fraud, or conflict of interest. Trouble is that SB 863 also contains a provision which protects and conceals the names of the IMR doctors.
SB 863 increases permanent disability (PD) in one section of the legislation while another part of the bill disqualifies conditions that currently qualify for PD such as dyssomnia from chronic pain and sexual dysfunction from spinal injuries.
On the other hand, Paul Fong's legislation, AB 1687, would have required denials of care to be made in plain language so that obfuscations and wrongful denials of treatment dished out to injured workers could be stopped dead in their perfidious tracks. Now that that bill has been vetoed, injured workers have lost their last chance at fair play.
We have witnessed a sleek lesson in political maneuvering. First, the Governor personally worked for passage of SB 863 with its provision for Alternative Dispute Resolution (ADR) and keeping secret the names of Independent Medical Review (IMR) doctors. One would think the unions would have opposed the bill because of the ADR provision alone. One might even have expected principled opposition from the California Medical Association (CMA) because of the secrecy provisions that would be bestowed on an entire cadre of doctor-judges including doctors unlicensed to practice in California. In fact, the International Longshore and Warehouse Union, Southern California District Council, California Teamsters Public Affairs Council, SEIU 121, and the United Firefighters of Los Angeles did oppose SB 863. But the California Labor Federation which helped create the bill with the assistance of big business including Grimmway Farms got support from other unions including the American Federation of State, County and Municipal Employees (AFSCME) and from the California Medical Association (CMA).
One of the same unions that supported AB 1687, the California Labor Federation, was simultaneously involved in writing SB 863 with provisions that would eventually doom AB 1687, e.g., the secrecy provisions protecting the non-California licensed doctors. It's logical that if the Governor supported SB 863 he would veto AB 1687 since enforcement of AB 1687 would put a legal crimp into the secrecy provisions of SB 863. The California Labor Federation's support for AB 1687 came before SB 863 was completely written. In short, CLF was engaged in the composition of SB 863 even while CLF was ostensibly supporting AB 1687. AB 1687 passed the legislature before SB 863 was finalized. Fong's bill turned out to be an inconvenience to Gov. Brown and to the California Labor Federation and was doomed for failure once SB 863 passed. When SB 863 got signed by the Governor, the fate of AB 1687 was sealed.
The Open Government website reports that Assemblyman Fong voted for SB 863 which turns out to have been equivalent to voting against his own bill. The irony is that Paul Fong was obliged to stand by while SB 863 got signed into law and his own bill got vetoed.
Score: Governor Brown goes 2 for 2, Fong is 1 for 2, while the injured worker community goes scoreless, again.
Tuesday, September 25, 2012
SB 863 is the medical-legal equivalent of last night's officiating blunder at the Seahawks-Packers fiasco
Once in a while we get to review medical-legal blunders with the same gusto ordinarily reserved for football blunders like the Packers-Seahawks officiating error of Monday night, 9/24/12
We'll spare readers the details of the officiating blunder that led to the Seahawks 14-12 declared win last night. We're confident that it'll be subject to review for years to come. We're also confident that SB 863 will be reviewed as the fiasco that it is, i.e., a method that conceals the names of Independent Medical Review (IMR) doctors while at the same time rendering them practically immune from legal appeals from even the most egregiously wrong decisions, much akin to the NFL standing by the blunders of its replacement referees.
As matters stand now, the IMR doctors who'll replace the current Utilization Review system can only be challenged based on bias, fraud, or conflict of interest. That's the genius of the California Labor Federation, Grimmway, and Governor Brown, all of whom must have skimmed this part of the bill with about as much insight as the NFL replacement referees used last night. They seem to have overlooked how difficult it is to accuse someone of bias, fraud, or conflict of interest without knowing the name of the alleged perpetrator.
If a spirited appeal is to be mounted against SB 863, it should start with repeal of the IMR section of SB 863 or with a restraining order against it.
Then we can test other sections of SB 863, for instance, to what extent were the new lien processes or the Medicare RBRVS improperly composed as intentional encumbrances to the legitimate rights of injured workers.
We'll spare readers the details of the officiating blunder that led to the Seahawks 14-12 declared win last night. We're confident that it'll be subject to review for years to come. We're also confident that SB 863 will be reviewed as the fiasco that it is, i.e., a method that conceals the names of Independent Medical Review (IMR) doctors while at the same time rendering them practically immune from legal appeals from even the most egregiously wrong decisions, much akin to the NFL standing by the blunders of its replacement referees.
As matters stand now, the IMR doctors who'll replace the current Utilization Review system can only be challenged based on bias, fraud, or conflict of interest. That's the genius of the California Labor Federation, Grimmway, and Governor Brown, all of whom must have skimmed this part of the bill with about as much insight as the NFL replacement referees used last night. They seem to have overlooked how difficult it is to accuse someone of bias, fraud, or conflict of interest without knowing the name of the alleged perpetrator.
If a spirited appeal is to be mounted against SB 863, it should start with repeal of the IMR section of SB 863 or with a restraining order against it.
Then we can test other sections of SB 863, for instance, to what extent were the new lien processes or the Medicare RBRVS improperly composed as intentional encumbrances to the legitimate rights of injured workers.
Thursday, September 20, 2012
NO MORE TIME FOR CREDITS AND KUDOS!
SB 863 provides for an Independent Medical Review system to replace the current Utilization Review (UR) system. Under the current system, wrong and harmful decisions can be appealed in court. Under the new system, the IMR doctors will have their names protected so that attorneys won't know the names of the doctors who will now enjoy even more power than their UR predecessors. The IMR doctors will only be able to be challenged based on allegations of bias, fraud, or conflict of interest. Trouble is that it's nearly impossible to assert bias, fraud, or conflict of interest without a name. It appears that the new law will enable IMR doctors to participate in bias, fraud, and conflict of interest. Was this legislative slight-of-hand an accident of sloppy bill-writing or something worse?
In France, prior to the Revolution in 1789, the nobility had the power to issue "lettres de cachet" which enabled accused persons to be tossed into The Bastille without a trial and without knowing the names of their accusers. We should not accept a system in California that relies on ghost-doctors whose names are kept secret from applicant and defense attorneys.
Keep in mind that UR doctors are not required to be licensed in California. Neither will IMR doctors be required to be licensed in California. Non-California licensed doctors who render IMR decisions that control the treating doctors will not be responsible to the Medical Board of California whereas the actual treating doctors will be. Is that equitable?
Although the UR and IMR doctors are responsible to their own state boards, those boards don't have jurisdiction in California. A similar issue arose in Texas and was cured when Texas passed legislation to require Texas medical licensure of doctors doing utilization review in Texas. As matters stand now, Texas doctors without California licenses can practice utilization review in California even though the Medical Board of California has stated that doing utilization review constitutes the practice of medicine. But if California doctors want to do utilization review in Texas they're obliged to be licensed in Texas.
If SB 863 looks like a stacked deck, that may be because it is.
In France, prior to the Revolution in 1789, the nobility had the power to issue "lettres de cachet" which enabled accused persons to be tossed into The Bastille without a trial and without knowing the names of their accusers. We should not accept a system in California that relies on ghost-doctors whose names are kept secret from applicant and defense attorneys.
Keep in mind that UR doctors are not required to be licensed in California. Neither will IMR doctors be required to be licensed in California. Non-California licensed doctors who render IMR decisions that control the treating doctors will not be responsible to the Medical Board of California whereas the actual treating doctors will be. Is that equitable?
Although the UR and IMR doctors are responsible to their own state boards, those boards don't have jurisdiction in California. A similar issue arose in Texas and was cured when Texas passed legislation to require Texas medical licensure of doctors doing utilization review in Texas. As matters stand now, Texas doctors without California licenses can practice utilization review in California even though the Medical Board of California has stated that doing utilization review constitutes the practice of medicine. But if California doctors want to do utilization review in Texas they're obliged to be licensed in Texas.
If SB 863 looks like a stacked deck, that may be because it is.
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