Governor Walker of Wisconsin is fighting hard to be recalled. His wish to follow former Gov. Gray Davis of California into political exile deserves to be honored.
Govenor Kasich of Ohio also evidently wants to be recalled although he doesn't know it yet. He should be obliged. Both Governors Walker and Kasich, once they recognized urgent fiscal situations, immediately sought to destroy collective bargaining.
The citizens of Wisconsin and Ohio deserve better than they're getting and should increase efforts to recall their respective governors. Since one of the issues is pensions, we need to ask this question: were either Gov. Walker or Gov. Kasich to retire today, what would their pensions be? Once we know that, we can decide whether we think their pensions need trimming.
While we're at it, we should ask if it's correct that in Ohio corporations have been released from over $100,000,000 in taxes. If that assessment is correct, then that situation needs to be addressed not only in Ohio and Wisconsin but in every other state where earmarks have been a staple of business life.
These issues impinge upon healthcare delivery. In California when Arnold Schwarzenegger followed Davis into office, his first step was to set aside as much of collective bargaining as he could and to ruin workers' compensation for injured workers. Schwarzenegger enabled insurance companies to use doctors without California licenses to overrule and deny care prescribed to injured workers by duly licensed California doctors. The assertion was that this step would save money for the state. In reality, businesses saved some money but the huge beneficiaries were the insurance companies who used and continue to use one slick trick after another to deny care to injured workers.
Injured workers in California have wrongfully been denied care that was won in collective bargaining. Thanks to collective bargaining, however, California's injured workers are not without power and the ability to fight back. Walker of Wisconsin and Kasich of Ohio want to go further. They want to strip the workers, injured and uninjured alike, of any power to fight back. Such a move would be a boon to insurance companies that will be enabled to deny care as though there were no tomorrow. For some injured workers, tomorrow vanished yesterday.
It is fair game for the governors to seek reforms in pensions and to advocate for cost-sharing in healthcare. The unions have already agreed to that. But that's not enough for Gov. Walker or Gov. Kasich. Their purpose is not to establish equity but to ruin the unions and to destroy collective bargaining. That is why they deserve to be recalled and, if possible, sent into retirement without pensions.
AFSCME, AFL-CIO, and the Union of American Physicians and Dentists have repeatedly picked up the gauntlet that Governor Schwarzenegger threw into the faces of honorably employed public servants. In 2006, AFSCME, AFL-CIO, passed a resolution stating that Utilization Review doctors should be licensed in the states where they practice. But even Gov. Schwarzenegger wasn't autocratic enough to try to rescind the right to bargain collectively. Walker and Kasich display an arrogance that even Terminator Arnie couldn't quite muster. The solution in California was for Schwarzenegger to run out his string and then to vote down his retainers. The solution in Wisconsin and Ohio is for citizens to agree that pension and healthcare adjustments are indicated. They should then recall Governors Walker and Kasich. There is a moral to the story: protection of our rights requires eternal vigilance.
Monday, February 21, 2011
Tuesday, January 18, 2011
First Step: Repeal Section 10320 of the Affordable Care Act
In response to Politico writer Jennifer Haberkorn's article, "Tom Daschle, Bill Frist join forces on health care reform," here is my comment as to why Section 10320 of the ACA should be repealed.
Tuesday, January 4, 2011
PEER REVIEW: ON A COLLISION COURSE WITH FINANCE, USED TO SILENCE PHYSICIANS, DOCTOR RAO STANDS FIRM AGAINST THE ODDS.
by Robert L. Weinmann, MD
In the Superior Court of California, County of Alameda, a
peer review drama is unfolding. Petitioner R.V. Rao has taken on Washington Township Health Care District, Respondent, re its judicial review committee.
In a nutshell, a conflict is now in about its 8th year. The conflict arose after Dr. Rao questioned administrative proceedings in the hospital and indicated that conflicts of interest may exist between optimal medical care and profitability. Doctor Rao reported his findings to appropriate official agencies. The agencies found fault with the hospital and reportedly told the hospital that Rao had complained. Rao's confidential cover as a whistleblower was blown. This scenario set the stage for on-going conflict. At a judicial review hearing called "JRC1" or "Rao I" Doctor Rao was involuntarily terminated from the Washington Hospital medical staff. Eventually, there was a second peer review proceeding called "JRC2" or "Rao II."
The court document, # HG10540985, refers to the hearing as "JRC2" and "Rao II." Respondent Washington Hospital wanted "to strike portions of the Petition pertaining to the second peer review proceeding." The court document states that "the motion is DENIED."
The document stated that "the motion of Respondent Washington Township Health Care District to strike portions of the Petition of Petitioner R.V. Rao for Writ of Mandamus is DENIED in part and GRANTED in part."
The petition then indicates that a "second judicial review committee ... completed proceedings into charges made June 4, 2007 on June 5, 2010." The court document refers to "the first judicial review committee ... to terminate Petitioner's medical staff membership."
In reference to the 2nd hearing, Washington Hospital sought to "strike portions of the Petition pertaining to the second peer review proceeding." This motion was denied. What is the material that the hospital wanted to strike?
We know that Dr. Rao appeared as a discussant in the movie, Life For Sale, available on DVD and on-line as www.lifeforsalemovie.com.
I am personally on record about this movie, having stated that it "explores dangerous nooks and crannies of healthcare that until now have remained hidden from public view."
Rao appears in the movie as a discussant about peer review. Although he does not mention any hospital by name or present himself as any hospital's spokesperson, his comments have been taken as critical of Washington Hospital. The movie has had public viewing including 13 minutes of the movie shown at a Continuing Medical Education seminar on Sham Peer Review sponsored by the Union of American Physicians and Dentists and the University of California at Irvine.
In general the movie suggests that conflicts of interest may exist between optimal medical care and optimal financial gain. Some critics feel that Rao's participation in this movie solidified opposition against him.
In the meantime, Washington Hospital has made spectacular financial progress despite miserable economic times. The San Jose Mercury News' report by Matthew Artz, 12/27/10, states that the hospital's CEO, Nancy Farber, would get a salary increase from $614,000 per year to $632,000 with total compensation set at about $857,000 ($245,502 in performance bonuses). Washington Township health care district board member Bernard Stewart was quoted as saying "in my opinion it is hard to describe our CEO's performance this year as anything other than outstanding."
Meanwhile, in the Supreme Court of the State of New York, Appellate Division, Second Judicial Department, Anthony Colantonio, respondent, versus Mercy Medical Center, we have language stating that "the defendants were not entitled to immunity under 42 USC 11112 (a)..."
Doctor Colantonio was asked why his hospital was taking him on. Colantonio replied "I spent seven months writing letters about patient care issues that needed to be corrected. This was after two years of complaining verbally. I could no longer look the other way while patients were dying. They found my conduct 'disruptive.' "
Peer Review privacy, for which I personally have testified in the California legislature, is now under the gun and, regrettably, perhaps with good reason if it can be shown that the process is being subverted. The doctors in the Colantonio case are now subject to civil lawsuits since providing false testimony is not protected under the Health Care Quality Improvement Act.
At the same time, doctors who take on hospital administrations or who are felt to be too vigorous in their protests run the risk of being called "disruptive," which in turn can lead to hospital discipline and adverse reports to state medical boards (these reports are known as 805s in California).
In Rao's case, the court is being asked to undertake judicial review in order to overturn the termination order from the Washington Township Health Care District Board of Directors.
My opinion was stated at one of the hearings where I testified at Washington Hospital on behalf of Dr. Rao. I pointed out that had the doctors in Redding spoken out and questioned the administration as well as their own colleagues, the catastophic conduct reported to have occurred there -- including unnecessary operations -- would have been nipped in the bud.
Doctor Rao acted honorably. He should be exonerated and restored to full privileges at Washington Hospital.
by Robert L. Weinmann, MD
In the Superior Court of California, County of Alameda, a
peer review drama is unfolding. Petitioner R.V. Rao has taken on Washington Township Health Care District, Respondent, re its judicial review committee.
In a nutshell, a conflict is now in about its 8th year. The conflict arose after Dr. Rao questioned administrative proceedings in the hospital and indicated that conflicts of interest may exist between optimal medical care and profitability. Doctor Rao reported his findings to appropriate official agencies. The agencies found fault with the hospital and reportedly told the hospital that Rao had complained. Rao's confidential cover as a whistleblower was blown. This scenario set the stage for on-going conflict. At a judicial review hearing called "JRC1" or "Rao I" Doctor Rao was involuntarily terminated from the Washington Hospital medical staff. Eventually, there was a second peer review proceeding called "JRC2" or "Rao II."
The court document, # HG10540985, refers to the hearing as "JRC2" and "Rao II." Respondent Washington Hospital wanted "to strike portions of the Petition pertaining to the second peer review proceeding." The court document states that "the motion is DENIED."
The document stated that "the motion of Respondent Washington Township Health Care District to strike portions of the Petition of Petitioner R.V. Rao for Writ of Mandamus is DENIED in part and GRANTED in part."
The petition then indicates that a "second judicial review committee ... completed proceedings into charges made June 4, 2007 on June 5, 2010." The court document refers to "the first judicial review committee ... to terminate Petitioner's medical staff membership."
In reference to the 2nd hearing, Washington Hospital sought to "strike portions of the Petition pertaining to the second peer review proceeding." This motion was denied. What is the material that the hospital wanted to strike?
We know that Dr. Rao appeared as a discussant in the movie, Life For Sale, available on DVD and on-line as www.lifeforsalemovie.com.
I am personally on record about this movie, having stated that it "explores dangerous nooks and crannies of healthcare that until now have remained hidden from public view."
Rao appears in the movie as a discussant about peer review. Although he does not mention any hospital by name or present himself as any hospital's spokesperson, his comments have been taken as critical of Washington Hospital. The movie has had public viewing including 13 minutes of the movie shown at a Continuing Medical Education seminar on Sham Peer Review sponsored by the Union of American Physicians and Dentists and the University of California at Irvine.
In general the movie suggests that conflicts of interest may exist between optimal medical care and optimal financial gain. Some critics feel that Rao's participation in this movie solidified opposition against him.
In the meantime, Washington Hospital has made spectacular financial progress despite miserable economic times. The San Jose Mercury News' report by Matthew Artz, 12/27/10, states that the hospital's CEO, Nancy Farber, would get a salary increase from $614,000 per year to $632,000 with total compensation set at about $857,000 ($245,502 in performance bonuses). Washington Township health care district board member Bernard Stewart was quoted as saying "in my opinion it is hard to describe our CEO's performance this year as anything other than outstanding."
Meanwhile, in the Supreme Court of the State of New York, Appellate Division, Second Judicial Department, Anthony Colantonio, respondent, versus Mercy Medical Center, we have language stating that "the defendants were not entitled to immunity under 42 USC 11112 (a)..."
Doctor Colantonio was asked why his hospital was taking him on. Colantonio replied "I spent seven months writing letters about patient care issues that needed to be corrected. This was after two years of complaining verbally. I could no longer look the other way while patients were dying. They found my conduct 'disruptive.' "
Peer Review privacy, for which I personally have testified in the California legislature, is now under the gun and, regrettably, perhaps with good reason if it can be shown that the process is being subverted. The doctors in the Colantonio case are now subject to civil lawsuits since providing false testimony is not protected under the Health Care Quality Improvement Act.
At the same time, doctors who take on hospital administrations or who are felt to be too vigorous in their protests run the risk of being called "disruptive," which in turn can lead to hospital discipline and adverse reports to state medical boards (these reports are known as 805s in California).
In Rao's case, the court is being asked to undertake judicial review in order to overturn the termination order from the Washington Township Health Care District Board of Directors.
My opinion was stated at one of the hearings where I testified at Washington Hospital on behalf of Dr. Rao. I pointed out that had the doctors in Redding spoken out and questioned the administration as well as their own colleagues, the catastophic conduct reported to have occurred there -- including unnecessary operations -- would have been nipped in the bud.
Doctor Rao acted honorably. He should be exonerated and restored to full privileges at Washington Hospital.
Thursday, November 4, 2010
OBAMACARE NEEDS INSTANT REVISION by Robert L. Weinmann, MD
"I WILL ENSURE THAT NO GOVERNMENT BUREAUCRAT GETS BETWEEN YOU AND THE CARE YOU NEED"
Inadvertently, some would say, Obamacare contains provisions that effectively ration care. With all due intent, others assert, it's no accident that the present version of Obamacare contains language creating pre-authorization restrictions. Here's how it works.
In the autumn of 2009 President Obama said "I will ensure that no government bureaucrat gets between you and the care you need." At the same time, however, Congress was considering HR 3200 which contained a provision to establish "a private-public advisory committee" to "recommend" treatment options. The public reaction was tepid, but House Minority Leader John Boehner (R-Ohio) and Speaker Nancy Pelosi (D-CA) noticed problems. The difference was that Boehner wanted to expose these discrepancies but didn't at the time have enough information to do so. The bill was only in its formative stages even though it was being rushed through the legislative process (see The Hill's Blog Briefing Room, story by Michael O'Brien with comment by the undersigned, 3/04/10). Pelosi didn't worry about internal problems in the bill --her agenda and that of President Obama was to get the bill passed no matter what flaws might be in it.
HR 3200 then gave way to HR 3962 which included a provision to set up a Health Benefits Advisory Committee which was further described as "a private-public advisory committee which will be a panel of medical and other experts to be known as the the Health Benefits Advisory Committee to recommend covered benefits." In other words, Medicare patients were on the verge of being "recommended" out of the care they needed. Patients generally were on the verge of being "protected" out of the care they might need by a new bureacracy for health care regulation that was actually contained in legislation that was being hurried past Congress.
HR 3962 would include an Independent Medicare Advisory Board (IMAB) that would be empowered to regulate care before-the-fact by utilizing techniques known as "pre-authorization" and "utilization review." At this point, chills should have radiated down President Obama's back. His allies in Congress had undercut his promise. Did he understand that? Nancy Pelosi should have been alerted that the IMAB would be a bureaucratic adjustment that would toss Presidents Obama's promise onto the scrapheap of political rhetoric.
Still there was no hue and cry about specifics in the bill which went unread by many Congressional representatives who didn't notice that key words such as "provider" or "other medical experts" were often used to hide the fact that non-doctors would be making medical decisions pertaining to access to care. Red flags were flying but a divided Congress wasn't arguing technical issues that should have been openly discussed. After all, it is not too difficult for most of us to recognize when we're being "protected" out of our rights and property.
That's when the next metamorphosis occurred, namely, changing the name of the IMAB to the Independent Payment Advisory Board (IPAB). Now the cat was out of the bag -- the bill, as critics had opined all along, wasn't about medical care after all. It was about cost-containment. President Obama's promise was now consigned to the proverbial scrapheap -- without a word in protest from the President.
The IPAB language, now inserted into the Affordable Health Choices Act of 2009, was fleshed out by Section 10320 of the legislation. The IPAB removes Congress from the ability to make decisions. In the opinion of this writer, it is a danger to patients, doctors, and hospitals. Organizations purportedly interested in affordable healthcare should seek repeal of Section 10320 -- repeal of this section does not spell the demise of the entire bill. Repeal of Section 10320 should be a priority of the hospital associations, the medical associations, and the unions -- in fact, everybody. It is just as harmful to a corporate CEO as it is to the lowest paid worker -- that is why the unions should also seek repeal of Sec. 10320.
The IPAB is a sneaky attempt to restore rationing by enabling denials of care in advance. It is a utilization review mechanism designed to reduce costs by reducing access to care. It should be repealed.
Inadvertently, some would say, Obamacare contains provisions that effectively ration care. With all due intent, others assert, it's no accident that the present version of Obamacare contains language creating pre-authorization restrictions. Here's how it works.
In the autumn of 2009 President Obama said "I will ensure that no government bureaucrat gets between you and the care you need." At the same time, however, Congress was considering HR 3200 which contained a provision to establish "a private-public advisory committee" to "recommend" treatment options. The public reaction was tepid, but House Minority Leader John Boehner (R-Ohio) and Speaker Nancy Pelosi (D-CA) noticed problems. The difference was that Boehner wanted to expose these discrepancies but didn't at the time have enough information to do so. The bill was only in its formative stages even though it was being rushed through the legislative process (see The Hill's Blog Briefing Room, story by Michael O'Brien with comment by the undersigned, 3/04/10). Pelosi didn't worry about internal problems in the bill --her agenda and that of President Obama was to get the bill passed no matter what flaws might be in it.
HR 3200 then gave way to HR 3962 which included a provision to set up a Health Benefits Advisory Committee which was further described as "a private-public advisory committee which will be a panel of medical and other experts to be known as the the Health Benefits Advisory Committee to recommend covered benefits." In other words, Medicare patients were on the verge of being "recommended" out of the care they needed. Patients generally were on the verge of being "protected" out of the care they might need by a new bureacracy for health care regulation that was actually contained in legislation that was being hurried past Congress.
HR 3962 would include an Independent Medicare Advisory Board (IMAB) that would be empowered to regulate care before-the-fact by utilizing techniques known as "pre-authorization" and "utilization review." At this point, chills should have radiated down President Obama's back. His allies in Congress had undercut his promise. Did he understand that? Nancy Pelosi should have been alerted that the IMAB would be a bureaucratic adjustment that would toss Presidents Obama's promise onto the scrapheap of political rhetoric.
Still there was no hue and cry about specifics in the bill which went unread by many Congressional representatives who didn't notice that key words such as "provider" or "other medical experts" were often used to hide the fact that non-doctors would be making medical decisions pertaining to access to care. Red flags were flying but a divided Congress wasn't arguing technical issues that should have been openly discussed. After all, it is not too difficult for most of us to recognize when we're being "protected" out of our rights and property.
That's when the next metamorphosis occurred, namely, changing the name of the IMAB to the Independent Payment Advisory Board (IPAB). Now the cat was out of the bag -- the bill, as critics had opined all along, wasn't about medical care after all. It was about cost-containment. President Obama's promise was now consigned to the proverbial scrapheap -- without a word in protest from the President.
The IPAB language, now inserted into the Affordable Health Choices Act of 2009, was fleshed out by Section 10320 of the legislation. The IPAB removes Congress from the ability to make decisions. In the opinion of this writer, it is a danger to patients, doctors, and hospitals. Organizations purportedly interested in affordable healthcare should seek repeal of Section 10320 -- repeal of this section does not spell the demise of the entire bill. Repeal of Section 10320 should be a priority of the hospital associations, the medical associations, and the unions -- in fact, everybody. It is just as harmful to a corporate CEO as it is to the lowest paid worker -- that is why the unions should also seek repeal of Sec. 10320.
The IPAB is a sneaky attempt to restore rationing by enabling denials of care in advance. It is a utilization review mechanism designed to reduce costs by reducing access to care. It should be repealed.
Tuesday, July 27, 2010
Utilization Review in Workers Comp by Non-licensed Doctors
Utilization Review by doctors without California licenses continues to bedevil California physicians and rob injured workers of indicated care.
Here's what happened recently to an orthopedist in San Jose and his patient. The orthopedist found that his patient had evidence of an osteoid osteoma or similar lesion. The orthopedist stated in his report that "there is clear-cut pathology ... with a dye leak from the mid-carpal joint to the radiocarpal joint through the scapholunate and triquetro-hamate intervals."
The treating orthopedic surgeon sought authorization for left wrist arthroscopy and excision of the lesion in the distal radius. The insurance company handed over this request for authorization to a doctor without a California license. The proposed medical treatment was then deemed "not certified" and denied.
In a formal affirmation of the denied authorization, the Utilization Review doctor asserted he'd had "peer-to-peer discussion" with the treating orthopedist. This description stretches the truth. The out-of-state doctor may call himself a peer but, truth is, the California-licensed orthopedist completed a 12 hour course in pain management as required by the Medical Board of California whereas the out-of-state doctors isn't required to meet this requirement. He is exempt. But he is useful to insurance companies that want surgery delayed or denied.
When the treating orthopedist reviewed the non-California licensed doctor's negative report, he found that the non-California licensed doctor had not reviewed the X-rays. Nonetheless, the non-California licensed doctor turned a patient away from needed and indicated arthroscopy.
The treating orthopedist, duly licensed to practice medicine in California, stated in his own rebuttal, that "it is reasonable to proceed with a surgical arthroscopy " and, "prior to a final decision regarding surgery, to proceed with a limited bone scan to evaluate the bone lesion seen on CT."
This effort was initially thwarted by the Schwarzenegger administration's application of law. A non-California licensed doctor was allowed to overrule a licensed California doctor. In this case, harm was done because necessary and needed surgical intervention was delayed and initially denied. The treating doctor had to take on an insurance company and their non-California licensed doctor. Readers will be glad to know the arthroscopy was eventually done thanks to the fighting spirit of the treating doctor. The lesion was excised and the patient is a happy camper (no thanks to the Schwarzenegger administration and its distortion of Utilization Review).
The fault lies with the Office of Administrative Law and the Schwarzenegger administration. Both have cow-towed to insurance company interests. Both have made it possible for carpetbaggers to practice medicine in California. AB 933 (Fong) would put a stop to this nonsense. AB 933 (Fong) will require that doctors who do Utilization Review for injured workers in California be licensed in California.
The latest amendments to AB 933 (Fong) include provisions to govern how Medical Provider Networks function so that the perception that MPNs drop physicians from their rosters on an arbitrary basis can be corrected.
AB 933 (Fong) is up for hearing in Senate Appropriations on Monday, August 2nd. E-mail your concerns to committee staff, bob.franzoia@sen.ca.gov, and copy to assemblymember.fong@asm.ca.gov
Here's what happened recently to an orthopedist in San Jose and his patient. The orthopedist found that his patient had evidence of an osteoid osteoma or similar lesion. The orthopedist stated in his report that "there is clear-cut pathology ... with a dye leak from the mid-carpal joint to the radiocarpal joint through the scapholunate and triquetro-hamate intervals."
The treating orthopedic surgeon sought authorization for left wrist arthroscopy and excision of the lesion in the distal radius. The insurance company handed over this request for authorization to a doctor without a California license. The proposed medical treatment was then deemed "not certified" and denied.
In a formal affirmation of the denied authorization, the Utilization Review doctor asserted he'd had "peer-to-peer discussion" with the treating orthopedist. This description stretches the truth. The out-of-state doctor may call himself a peer but, truth is, the California-licensed orthopedist completed a 12 hour course in pain management as required by the Medical Board of California whereas the out-of-state doctors isn't required to meet this requirement. He is exempt. But he is useful to insurance companies that want surgery delayed or denied.
When the treating orthopedist reviewed the non-California licensed doctor's negative report, he found that the non-California licensed doctor had not reviewed the X-rays. Nonetheless, the non-California licensed doctor turned a patient away from needed and indicated arthroscopy.
The treating orthopedist, duly licensed to practice medicine in California, stated in his own rebuttal, that "it is reasonable to proceed with a surgical arthroscopy " and, "prior to a final decision regarding surgery, to proceed with a limited bone scan to evaluate the bone lesion seen on CT."
This effort was initially thwarted by the Schwarzenegger administration's application of law. A non-California licensed doctor was allowed to overrule a licensed California doctor. In this case, harm was done because necessary and needed surgical intervention was delayed and initially denied. The treating doctor had to take on an insurance company and their non-California licensed doctor. Readers will be glad to know the arthroscopy was eventually done thanks to the fighting spirit of the treating doctor. The lesion was excised and the patient is a happy camper (no thanks to the Schwarzenegger administration and its distortion of Utilization Review).
The fault lies with the Office of Administrative Law and the Schwarzenegger administration. Both have cow-towed to insurance company interests. Both have made it possible for carpetbaggers to practice medicine in California. AB 933 (Fong) would put a stop to this nonsense. AB 933 (Fong) will require that doctors who do Utilization Review for injured workers in California be licensed in California.
The latest amendments to AB 933 (Fong) include provisions to govern how Medical Provider Networks function so that the perception that MPNs drop physicians from their rosters on an arbitrary basis can be corrected.
AB 933 (Fong) is up for hearing in Senate Appropriations on Monday, August 2nd. E-mail your concerns to committee staff, bob.franzoia@sen.ca.gov, and copy to assemblymember.fong@asm.ca.gov
Wednesday, October 28, 2009
KENTUCKY MEDICAL BOARD JOINS TEXAS IN REQUIRING UTILIZATION REVIEW DOCTORS TO BE LICENSED IN THE STATE WHERE THEY DO UTILIZATION REVIEW FOR INJURED WORKERS
by Robert L. Weinmann, MD
In 2005 the Office of Administrative Law in California allowed the Schwarzenegger administration to implement an interpretation of the law to permit doctors without California licenses to do utilization review for (I would say "against") injured workers in California.
This change in how the law is used and implemented has been beneficial to insurance companies and utilization review companies that have used this controversial legislative interpretation to delay and deny payments for diagnostic testing and treatment to California's injured workers. The California Society of Industrial Medicine and Surgery (CSIMS), the California Physical Medicine and Rehabiliation Society (CPMRS) and the Union of American Physicians and Dentists (UAPD) are sponsoring legislation to correct this abuse.
The California Medical Association, the Medical Board of California, and the California Labor Federation are among the several organizations that have previously determined that utilization review doctors ruling on injured workers in California should be licensed in California.
The Schwarzenegger administration is beleagured by its convenient cooperation with the interests of insurance companies -- the American Federation of State, County, and Municipal Employees (AFSCME) and the UAPD have repeatedly pointed out this connivance. The Schwarzenegger administration is also encumbered by its support of environmental changes considered too liberal by his party's right wing. As a result, the Schwarzenegger administration tries to be as close to right-wing business and management interests as possible. The idea is to be in position to help the Republican party in the next election. Insurance company interests persuaded the Govenor to veto previous legislation to level the playing field for injured workers.
In 2007 there was a mini-repudiation of Governor Schwarzenegger's policy when Texas made it a matter of law that utilization review doctors had to be licensed in Texas. The Schwarzenegger administration considered the change in Texas law to be aberrant and said that its own policy in California reflected "best practices."
Wrong. Further repudiation of the Schwarzenegger administration now comes from Kentucky. Preston F. Nunnelley, MD, President, Kentucky Board of Medical Licensure, disclosed on 27 October 2009 that "the Board determined that anyone performing or submitting peer reviews on Kentucky residents must be licensed to practice medicine or osteopathy within the Commonwealth."
Last year Governor Schwarzenegger vetoed AB 2969 (Lieber) which would have corrected the administration's current policy (see "How to practice medicine without a license," San Francisco Chronicle, 8/29/08) by requiring doctors who do utilization review re injured workers in California to be licensed in California.
This year AB 933 (Fong) passed the Assembly and awaits hearing in the State Senate in January, 2010. The Governor previously indicated he was prepared to veto this bill. AB 933 by Paul Fong is similar to Sally Lieber's bill. It would also require doctors doing utilization review in California to be licensed in California.
We don't know if the events in Kentucky will cause the Governor to revisit his concept of "best practices" or if he'll continue to bow down to insurance company interests. We don't advise holding one's breath awaiting the outcome.
by Robert L. Weinmann, MD
In 2005 the Office of Administrative Law in California allowed the Schwarzenegger administration to implement an interpretation of the law to permit doctors without California licenses to do utilization review for (I would say "against") injured workers in California.
This change in how the law is used and implemented has been beneficial to insurance companies and utilization review companies that have used this controversial legislative interpretation to delay and deny payments for diagnostic testing and treatment to California's injured workers. The California Society of Industrial Medicine and Surgery (CSIMS), the California Physical Medicine and Rehabiliation Society (CPMRS) and the Union of American Physicians and Dentists (UAPD) are sponsoring legislation to correct this abuse.
The California Medical Association, the Medical Board of California, and the California Labor Federation are among the several organizations that have previously determined that utilization review doctors ruling on injured workers in California should be licensed in California.
The Schwarzenegger administration is beleagured by its convenient cooperation with the interests of insurance companies -- the American Federation of State, County, and Municipal Employees (AFSCME) and the UAPD have repeatedly pointed out this connivance. The Schwarzenegger administration is also encumbered by its support of environmental changes considered too liberal by his party's right wing. As a result, the Schwarzenegger administration tries to be as close to right-wing business and management interests as possible. The idea is to be in position to help the Republican party in the next election. Insurance company interests persuaded the Govenor to veto previous legislation to level the playing field for injured workers.
In 2007 there was a mini-repudiation of Governor Schwarzenegger's policy when Texas made it a matter of law that utilization review doctors had to be licensed in Texas. The Schwarzenegger administration considered the change in Texas law to be aberrant and said that its own policy in California reflected "best practices."
Wrong. Further repudiation of the Schwarzenegger administration now comes from Kentucky. Preston F. Nunnelley, MD, President, Kentucky Board of Medical Licensure, disclosed on 27 October 2009 that "the Board determined that anyone performing or submitting peer reviews on Kentucky residents must be licensed to practice medicine or osteopathy within the Commonwealth."
Last year Governor Schwarzenegger vetoed AB 2969 (Lieber) which would have corrected the administration's current policy (see "How to practice medicine without a license," San Francisco Chronicle, 8/29/08) by requiring doctors who do utilization review re injured workers in California to be licensed in California.
This year AB 933 (Fong) passed the Assembly and awaits hearing in the State Senate in January, 2010. The Governor previously indicated he was prepared to veto this bill. AB 933 by Paul Fong is similar to Sally Lieber's bill. It would also require doctors doing utilization review in California to be licensed in California.
We don't know if the events in Kentucky will cause the Governor to revisit his concept of "best practices" or if he'll continue to bow down to insurance company interests. We don't advise holding one's breath awaiting the outcome.
Monday, August 31, 2009
SECRET NEGOTIATIONS EXPOSED: MANAGEMENT COLLUDES WITH LABOR
by Robert L. Weinmann, MD
In an effort to put more money into Permanent Disability (PD), certain key lobbyists from powerful interests in organized labor have colluded with Big Business to draft secret proposals that will inevitably harm injured workers and their doctors while providing minimal palliation to the lingering PD crisis brought about by Gov. Schwarzenegger and his administration. The background for the current maneuvering is SB 899, the refusal of the current administration to reform utilization review, the refusal to let injured workers pre-designate their own Primary Treating Physician (PTP), and the recent Almaraz-Guzman decision that Big Biz and the insurance industry abhor.
An amendment to be heard in the Assembly this week may be offered to SB 186 (DeSaulnier). Here's the scoop:
Under current law the PTP may prescribe diagnostic testing and treatment. But the PTP's decision may be delayed or denied by Utilization Review (UR). If the PTP and UR disagree, one method of resolution is to get a Qualified Medical Evaluation (QME). The QME reviews the reports filed by both the PTP and UR, interviews and examines the injured worker, and makes a definitive conclusion. The amendment about to be offered would delete the QME step and would substitute a paper-review-process known as an Independent Medical Review (IMR). The IMR process does not include interview and examination of the patient. It is a less expensive process that is also more likely to result in denial of care. The money saved would ostensibly go into the PD pot. The IMR and the UR approaches are similar in that neither requires re-interview or further examination of the injured worker. Both are paper decisions. This process is favored by the private insurance industry because it reduces costs and adds to corporate profit.
The IMR process is laden with potential mischief because it takes away the injured worker's best chance to be heard and examined again. The IMR process carries with it a large dose of potential medical mischief not only for wrongful denials of injured workers but also for liability to the PTP for an accusation of malpractice for treatment recognized as needed but not provided.
The amendment also envisions lien changes. Under current law many doctors who know that treatment is indicated and will eventually be recognized as such simply provide it in timely fashion even though it has been denied by UR -- they seek reimbursement afterwards by lien. The amendment or amendments to be offered to SB 186 (DeSaulnier) would discourage liens and further reduce access to care for injured workers.
The recommendation of The Weinmann Report is to ask your state senator or assembly representative to oppose these proposed amendments. If you are not sure who that is, try http://www.leginfo.ca.gov/yourleg/html. You may want to copy Sen. DeSaulnier (senator.desaulnier@sen.ca.gov), the Senate Labor and Industrial Relations Committee (gideon.baum@sen.ca.gov) and The Assembly Insurance Committee (markrakich@asm.ca.gov).
Faxed copy has the advantage of being signed.
by Robert L. Weinmann, MD
In an effort to put more money into Permanent Disability (PD), certain key lobbyists from powerful interests in organized labor have colluded with Big Business to draft secret proposals that will inevitably harm injured workers and their doctors while providing minimal palliation to the lingering PD crisis brought about by Gov. Schwarzenegger and his administration. The background for the current maneuvering is SB 899, the refusal of the current administration to reform utilization review, the refusal to let injured workers pre-designate their own Primary Treating Physician (PTP), and the recent Almaraz-Guzman decision that Big Biz and the insurance industry abhor.
An amendment to be heard in the Assembly this week may be offered to SB 186 (DeSaulnier). Here's the scoop:
Under current law the PTP may prescribe diagnostic testing and treatment. But the PTP's decision may be delayed or denied by Utilization Review (UR). If the PTP and UR disagree, one method of resolution is to get a Qualified Medical Evaluation (QME). The QME reviews the reports filed by both the PTP and UR, interviews and examines the injured worker, and makes a definitive conclusion. The amendment about to be offered would delete the QME step and would substitute a paper-review-process known as an Independent Medical Review (IMR). The IMR process does not include interview and examination of the patient. It is a less expensive process that is also more likely to result in denial of care. The money saved would ostensibly go into the PD pot. The IMR and the UR approaches are similar in that neither requires re-interview or further examination of the injured worker. Both are paper decisions. This process is favored by the private insurance industry because it reduces costs and adds to corporate profit.
The IMR process is laden with potential mischief because it takes away the injured worker's best chance to be heard and examined again. The IMR process carries with it a large dose of potential medical mischief not only for wrongful denials of injured workers but also for liability to the PTP for an accusation of malpractice for treatment recognized as needed but not provided.
The amendment also envisions lien changes. Under current law many doctors who know that treatment is indicated and will eventually be recognized as such simply provide it in timely fashion even though it has been denied by UR -- they seek reimbursement afterwards by lien. The amendment or amendments to be offered to SB 186 (DeSaulnier) would discourage liens and further reduce access to care for injured workers.
The recommendation of The Weinmann Report is to ask your state senator or assembly representative to oppose these proposed amendments. If you are not sure who that is, try http://www.leginfo.ca.gov/yourleg/html. You may want to copy Sen. DeSaulnier (senator.desaulnier@sen.ca.gov), the Senate Labor and Industrial Relations Committee (gideon.baum@sen.ca.gov) and The Assembly Insurance Committee (markrakich@asm.ca.gov).
Faxed copy has the advantage of being signed.
Subscribe to:
Posts (Atom)
Posts
