LEGISLATIVE FLAME-OUTS RE MEDI-CAL, OPHTHALMOLOGY, AND FAIRNESS IN CONTRACTING

AB 1805 (Skinner & Pan), which would restore the 10% cut in Medi-Cal reimbursement for Medicaid patients in California, is bogged down, mired in the mud of the Assembly Appropriations Committee where it is being held hostage. The 10% cut was imposed by the state budget in 2011 and recently was denied restoration by Governor Brown's recently revealed budget for 2014. It is clear that the Governor isn't going to do much to help Medi-Cal recipients or their treating doctors. Even if the bill passes, it'll have to survive his Gubernatorial veto. Readers interested in the survival of this bill will be obliged to rely on the democratic process, i.e., they'll need to call their elected state reps.


AB 2400 (Ridley-Thomas), sponsored by the California Medical Association, which would have allowed providers the ability to negotiate changes unilaterally made by health plans and their insurance companies, or to terminate the contract if agreement could not be reached, has bitten the dust. The tilt of the current administration, like the one that preceded it, is towards big business and against hapless patients and their beleaguered providers. This bill was residing uncomfortably in Senate Health Committee. Now it rests in not so peaceful repose. Readers interested in this bill will need to try to restore interest and build a wider coalition in 2015 than they had this year.


SB 492 (Hernandez) which would allow optometrists to practice aspects of ophthalmology that they are not currently licensed for has had better success. This bill passed Assembly Business and Professions Committee. It is opposed  by the California Medical Association, the Union of American Physicians and Dentists, the California Neurology Society, and a host of professional organizations whose weight in this case is negligible since their combined opposition is regarded as turf protection. 


One success is the failure of SB 1215 (Hernandez) to clear the Senate Business and Professions Committee. This bill would have eliminated the in-office exception for specific procedures such as physical therapy and advanced imaging including CAT and MRI scanning, ultrasound, and other procedures, thereby sending patients on a perpetual run-around. Readers can learn  more about this bill on the Advocacy and Legislation sections of the California Neurology Society website. The CMA, UAPD, CNS, et al were opposed and were part of a wide coalition in opposition.


An aulde lesson in these bills is the importance of coalitions not all of whose members need necessarily have a stake in the outcome. Protection of public welfare still plays a role albeit not as much as many of us would like.

ALERT: The trial lawyers' malpractice initiative has now been officially designated as Proposition 46 while the campaign against it, which we support, will be known as the No on 46 Campaign. The idea is to add Proposition 46 to our list of flame-outs lest its carelessness and callousness burn irreparable damage into California's health care.

Interim Bill Review: AB 1340, 2400, 1805, 1886, and the thinly disguised malpractice initiative

This post includes late additions to the original posting


Assembly Bill 1340 (Achadjian) that would establish Enhanced Treatment Programs is a life-and-death issue for nurses, technicians, and doctors who take care of the sickest and the meanest among us. For this privilege the trial lawyers would like to force the doctors, but not themselves, to pee in a cup. That's the program the trial lawyers are hiding behind in their shameless effort to get higher malpractice awards for themselves under the guise of the Troy and Alana Pack Safety Act which has as its most likely main benefit for a family of four the opportunity to pay $1,000 more annually for health insurance.


Assembly Bill 2400 (Ridley-Thomas) would level the playing field so that Big Biz insurance companies would not be as able as they are now to drive down access to care for patients with chronic and expensive illnesses. For this privilege the trial lawyers want the doctors to pee in a cup. The trial lawyers who have even gone so far as to concoct bogus statistics actually are the ones who should pee in cups. Their campaign cited a report from March of 2000 by the California Medical Board which said "many believe" that 15% of the general population has problems with substance abuse and that among health care professionals the lifetime level might even be 18%. This rough estimate was a supposition, not a researched statistic. Moreover, this lifetime risk translates to no more than 2% at any one time. The trial lawyers' addled research team that thought this one up should pee in as many cups as can be distributed as quickly as possible.


As for the convicted drunken driver who fled the scene  after running down 10 year old Troy and 7 year old Alana Pack,  it is known that she had three drunken-driver convictions before the accident.  Because she fled the scene and evaded the authorities for two days, a timely blood alcohol test was not obtained. While she was on the run, her apartment was searched. Cocaine was found. She eventually told police she'd taken vicodin prescribed by her treating doctor. Her legal defense at trial was that it was her doctors' fault because they prescribed the medicine for pain relief. She did not assert that they also told her to drive under the influence. Her sentence: 30 years in prison.


Our reward, as doctors whose duty includes the relief of pain, is now supposed to be to pee in cups while prosecutors who get wrongful convictions because they withheld exculpatory evidence from the defense booze it up when what they deserve is to pee in cups and then serve out the time they foisted upon defendants who've since been released because of wrongful convictions. It's a logical next step to have every lawyer,  as he passes through security to enter the courthouse, pee in a cup.

Late flash: the trial lawyers' initiative has been officially designated Proposition 46. The campaign against it will be known as the No on 46 campaign. We support the No on 46 Campaign.


Medi-Cal: we support AB 1805 (Skinner and Pan) which would restore the 10% cut in Medi-Cal remuneration that was installed by the State Budget Act of 2011.  It isn't lost on us that devoted  doctors who take care of the sickest and poorest among us would also be obliged to pee in the trial lawyers' cups. Of course, some might say that Gov. Brown already did that for them when he sent through his recent budget bill which managed once again to give the short end of the stick to the doctors who care for Medi-Cal patients. His having done so raises the ugly spectre of  a possible veto of the Skinner-Pan bill even if it passes handily.


AB 1886 (Eggman): Its original aim, while modified pursuant to amendments obtained by the CMA, remains unchanged, e.g., indefinite posting of disciplinary actions, civil judgments, and arbitration awards against doctors, just enough to make sure that good doctors who  run afoul of one or another disciplinary board become persona non grata to whatever managed care, HMO, or PPO organizations that want to use even minor misdemeanor convictions to ruin careers. It's all about the control and humbling of what used to be an honored profession. Doctors need to learn to say "no" to their would be overseers.
 
So here are our recommendations: yes on AB 1340, yes on AB 2400, yes on AB 1805, and no on AB 1886 and no, no, no on the Troy and Alana Pack Patient Safety Act, now officially designated as Proposition 46. Accordingly, we urge support for the No on 46 Campaign.


References


www.politicsofhealthcare.com, 4/29/14, Oppose AB 1886 (Eggman) Unless Amended, and California Medical Association Legislative Hot List, 6/02/14 (author accepted CMA's amendments , CMA now neutral);
www.politicsofhealthcare.com, 6/24/14, AB 2400 (Ridley-Thomas), Deserves Support plus an amendment;
www.politicsofhealthcare.com, 6/23/14, AB 1340 (Achadjian), Deserves Safe Passage;
www.politicsofhealthcare.com, 6/18/14, AB 1805 (Skinner & Pan), Supporting Medi-Cal and 6/16/14, Medi-Cal Patients Snubbed by State Budget;
www.politicsofhealthcare.com, 4/24/14, Random Drug Testing for Lawyers and 5/28/14, Drug Testing for Lawyers and Pharmaceutical Executives

AB 1805 (Skinner & Pan): supporting Medi-Cal; SB 1215 (Hernandez): this one bites the dust.

Now that the State Budget has in effect told Medi-Cal patients to wander off and die quietly someplace, the next step is to push for passage of AB 1805 (Skinner and Pan). This bill aims to restore the 10% cut that was put into effect with the State Budget Act of 2011. It is this 10% cut that the State Budget that just passed this past Sunday could have restored. If AB 1805 passes it still risks veto by the Governor. In fact, AB 1805 isn't going anywhere very fast since it is as of this writing being held, some would say smothered, in Assembly Appropriations.


On the other hand, we're glad to report that SB 1215 (Hernandez) took its final dive for this year when it failed to clear the Senate Business and Professions Committee. One of the principal purposes of this bill was to eliminate the exception for in-office referrals for selected specific services such as advanced imaging, radiation therapy, and even physical therapy, in other words, as mean spirited a bill as one could envision.


The Skinner-Pan bill needs help because it is on a collision course with the newly accepted State Budget which went out of its way do kick the Medi-Cal patient in the butt by denying access to services. In support of this bill is the California Medical Association, the California Neurology Society, the Union of American Physicians and Dentists, and most organized professional medical groups.


Individual letters to your Assembly representatives and State Senators are needed to assist in the passage of AB 1805 and to try to turn aside the anticipated gubernatorial veto.