On a strictly party line vote, AB 933 (Fong) cleared the Assembly Insurance Committee by a 7 to 3 vote: the aye votes were Joe Coto, chair; Charles Calderon, Wilmer Carter, Mike Feuer, Mary Hayashi, Jerry Hill, and Norma Torres. The nay votes were Martin Garrick, Sam Blakeslee, and Roger Niello.
AB 933 (Fong) will require doctors who do utilization review for injured workers in California to be licensed in California and pay fees to the Medical Board of California. The idea is to make sure that doctors who can delay, deny, approve, or modify treatment have the same licensure and are subject to the same discipline as are the injured workers' treating physicians.
Opponents argue that all physicians have the same training and education so licensure in any state should suffice. This assertion ignores the fact that California has specific rules, regulations, and educational requirements about pain management that are not required of non-California licensed doctors. Insurance companies use these doctors in part because under current law non-California licensed doctors may deny care, cause increased pain and suffering to injured workers, and suffer no recriminations for wrong or harmful decisions. Fong's utilization review bill will change all that -- treating, consulting, and utilization review doctors will all become responsible to the same state authority. It will put an end to the get-out-of-jail free cards that non-California licensed doctors now enjoy.
Opponents also incorrectly argue that there are not enough California doctors willing to do utilization review. By now the oppostion knows that this argument is false; nevertheless, they continue to hope this specious argument will convince someone. The fact is that there are so many more California-licensed doctors willing and able to do utilization review that they cannot all be hired. That is why one utilization review company has a waiting list of applicants for physicians who have applied for utilization review positions.
This question then arises: if there are enough California licensed doctors to do the job, why hire non-California licensed doctors? One answer is that the non-California licensed doctors aren't responsible to the Medical Board of California and are also not responsible to their own state medical board since an out-of-state medical board doesn't have jurisdiction in California. If the non-California doctor wrongfully denies care and harms an injured worker, that doctor is not subject to discipline by any state board at all. Such doctors are only responsible to their employers, the utilization review companies owned or retained by insurance companies, many known for spurious denials of indicated medical care. The not-so-silent accusation is that insurance companies seek to avoid medical costs by asserting that prescribed care isn't needed -- non-California licensed doctors are felt more likely to comply with this perversion of utilization review than doctors who are subject to medical discipline by specific state medical boards. Utilization review by non-California doctors is the latest health-care epidemic. It needs to be stopped.
Since AB 933 (Fong) is now ready for a floor vote in the Assembly, one can expect that the insurance companies will lay down the law to their Assembly allies, to their friends in the state senate, and to Governor Schwarzenegger (last year Gov. Schwarzenegger vetoed a similar bill thereby saving the necks of the insurance companies). The question this year is who will listen to arguments that have been shown to be bereft of truth.
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i think the bill has merits based on one simple fact that the art of practse of medicine is differmnt in each state based on the licensure regs and the evaluation of injured workers is art of practise of medicine
ReplyDeletethe other alternative would be to let the main licensuire body know about that action and let that state whyere the health caqre provider has license bring action because he is practising the art of medicine out of stste without license
what ever
there is room for national licensure!!
deineswh patel
boston
NTIONAL LICENSURE RUNS INTO STATES RIGHTS ISSUES BUT IS A VIABLE ISSUE ALL THE SAME. FOR EXAMPLE, THE USA HAS NATIONAL BOARDS THAT ARE REQUIRED FOR STATE LICENSURE BUT LICENSURE ITSELF IS A STATE-BY-STATE MATTER. THANK YOU FOR YOUR COMMENT. -- RW
ReplyDeleteRE: AB933
ReplyDeleteThis is a critical piece of legislation that must be passed. Althouhg it is only part of our case situation and did not impact us too much to this point, our experience is as follows:
My wife was injured at work. Although we have managed to work with the system to generally get to the proper doctors and care facilities, it has been 11 months of unbelievable stress culminated with a denial of a treatment that was clearly needed. After several direct calls to the manager at the workers comp company and a simple phone call by our Doctor, the denial was reversed. It is our belief that without our aggressive personal efforts, the process would not have gone the way we wanted and needed and definately not as quickly as we managed. There is absolutely no question that the vast majority of individuals do not have the expertise, communication skills, time and energy to do what we have been able to do. We have been persistent with case workers and several doctors offices to the point of frustrating them due to our persistent attitude, but much of what we needed to get done would not have happened without our strong effort. We were able request and confirm that the review members were indeed California licensed doctors, but it required us to quote Federal Law to advise the case worker that he had authority to approve the treatment we needed. We did not feel we should wait for additional delays for others to review when he had the authority to GET IT DONE. When advised that we knew and understood the law, the case worker was clearly caught off guard by our knowledge and - what a surprise - the treatment was approved immediately. Bottom line to us - if you don't have the ability to work the system, represent your needs, express them intelligently based on knowledge and then follow up with conviction, you will not get what you need timely and or even correctly. Until AB933 passes, everyone MUST request that review boards consist of California licensed Doctors. You may not be able to dictate anything, but you will then know where you stand in those situations. You must then document EVERY conversation you have. This is the most critical issue whether to get certain procedures approved or just to have necessary support info throughout the process. Then when it comes time to discuss settlement issues and to adddress accountability of the decision makers, you have details. If you do not have the capability to get involved at this level, we believe this process would never have gotten to where we needed and would probably have had to hire legal assistance. In regards to AB933, if patients knew from the start that all their decisions were being made by licensed California doctors, it would eliminate many concerns and accelerate the process by avoiding questionable decision making and delays. Although we have been fortunate in our situation in getting California licensed decision makers, we clearly see how this is a problem for many others and adversely impacts a critical issue of timeliness and accuracy of treatment approvals.
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