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.