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.

SB 492 (HERNANDEZ) re optometry vs. ophthalmology

SB 492 (Hernandez) is in the process of being prepared for committee hearing. This bill intends to water down ophthalmology in order to facilitate optometry (the lacrimation of ophthalmology). In general it's part of Senator Hernandez's overall effort to reduce the scientific and scholarly requirements of medical practice that currently requires a medical degree. In a recent previous post our report revealed why a California hospital's Board of Directors recently voted to allow a nurse practitioner to join the medical staff and have admitting and discharge privileges despite a negative vote by the hospital's Medical Executive Committee. In effect, this hospital passed a mini-version of SB 491 (Hernandez) which was intended to equate MDs and Nurse Practitioners (SB 491 failed in the legislature but has had new life breathed into it by the hospital in question, see our editorial, June 15).


SB 492 opposition still includes the California Medical Association, California Neurology Society,  and the California Society of Physical Medicine and Rehabilitation, and numerous others. What it does not include is a faction of ophthalmologists whose practices are intertwined in terms of referrals with optometrists. Many of these ophthalmologists are opposed but won't speak out -- it's their  way of straddling the issue and walking down the middle of the road.