AB 933 (FONG) which would require doctors doing utilization review for California's injured workers will be taken up again starting in January of 2010. The bill was scheduled for hearing on 6/24/09 by the Senate Labor and Industrial Relations Committee; however, the bill's author, Assemblyman Paul Fong requested cancellation of the hearing.
This writer first sought review of the policy allowing non-California licensed doctors to overrule California-licensed treating physicians in a letter to the Office of Administrative Law in August of 2005. The effort to secure reform legislation countermanding the interests of insurance companies and the Schwarzenegger administration is now on its way to a fifth year.
The Schwarzenegger administration remains firmly committed to the wishes of the insurance companies who are supported by the Chambers of Commerce, the California Manufacturing Association, and the California State Association of Counties, all known for their positions against the interests of workers, in this case, injured workers in particular.
As the law stands now, medical directors who supposedly supervise utilization review are required to be licensed in California -- the striking exemption is that the doctors who actually do the reviews do not need to be licensed in California. By contrast, doctors who do the same job in Texas must be licensed in Texas. The upshot is that Texas-licensed doctors may do utilization review in California without California licensure whereas California-licensed doctors may not do utilization review in Texas unless they're also licensed in Texas.
The power point of politics in this case is that the only successful program the Schwarzenegger administration has implemented since 2004 is Workers' Compensation Reduction. The program has reduced employers' costs somewhat (including in my private office) and in so doing has boosted insurance company profits by leaps and bounds. The program also grinds a massive boot into the necks of injured workers whose benefits have been slashed and whose access to care has been cut.
The political lesson is this: one doesn't score easily when one asks an administration to alter the only successful program it has managed to implement in four years. Putting labor down while elevating the profits of insurance companies has been a goal of the Schwarzenegger administration. Both goals have been reached.
Even for labor the stake is modest: injured workers often are forced out of the workplace, cease to be union members, no longer pay union dues, and become of limited interest even to their former unions.
Doctors treating injured workers often see their treatment protocols tossed into the ash heap. Meanwhile, the same doctors remain responsible for the treatment that the insurance companies and their compliant utilization review companies have delayed or denied.
Requiring state-licensure doesn't solve the entire problem: there are still compliant doctors with state licenses who'll deny or delay care that their paymasters want denied or delayed. All the same, AB 933 would at least make non-California licensed doctors responsible to state standards, standards for which they're not currently responsible, for instance, California-licensure requires a 12-hour course in pain management. Non-California licensed doctors don't currently have to comply with this requirement.
The long and the short of it is this: last year Gov. Schwarzenegger vetoed a similar bill, AB 2969 (Lieber), and this year was poised to veto AB 933 (Fong). The idea now is to outwait the Governor. The time he has left to grind injured workers into the dirt is limited. Supporters of reform can wait until the tide turns.
Wednesday, June 17, 2009
Thursday, June 11, 2009
UNION OF AMERICAN PHYSICIANS AND DENTISTS PROTESTS PHYSICAN LAYOFFS AND PLANNED UNIT CLOSURE AT YOUNTVILLE VETERANS' HOME
by Robert L. Weinmann, MD
In a masterpiece of timing just before Memorial Day, staff and residents of the Yountville Veterans' Home were told that the California Department of Veterans' Affairs is closing the acute care unit of the home's Holderman Hospital. Layoff notices have been sent.
1,100 veterans who reside at the home are being ignored as though they didn't exist, like battle-worn boots that saw their best days at Bastogne, or maybe somewhere in Korea or Vietnam. Eight layoff notices were received by doctors represented by the Union of American Physicians and Dentists (UAPD). Yountville's Home Administration office explained that the state needs to save money. Evidently, slicing medical care from veterans is California's preferred choice.
Stuart A. Bussey, MD, JD, president of the UAPD, declared that the California Veterans Affairs Department (CVDA) "is using the budget cuts as an excuse to close down this acute care unit and cut other medical servces, which it has wanted to do for a long time."
Bussey stated that the Yountville facility "is one of the largest groups of veterans in the country, and they need the care that this unit and these physicians provide." Bussey pointed out that providing equivalent care off-site will increase costs and that the premature layoffs are a thinly disguised method of unit closure before the actual closure.
This action by the state reportedly will save California about $4,000,000 in staff time. No mention was made about the $11,000,000 annual lost reimbursement to the state. No mention was made about the shoddy treatment shoved down the throats of America's veterans. No mention was made of the shame this move bestows on California.
The UAPD states that the CDVA is not following proper procedures such as allowing community involvement and advises concerned citizens to register protests with state legislators.
Politicsofhealthcare.blogspot.com points out that the State of California, simultaneously with this cutback to veterans, panders to the insurance industry and willingly foregoes fees that could be paid by out-of-state utilization review doctors (see stories about AB 933, Fong) to the benefit of California's coffer.
source: UAPD press release, 5/28/09, swilson@uapd.com
by Robert L. Weinmann, MD
In a masterpiece of timing just before Memorial Day, staff and residents of the Yountville Veterans' Home were told that the California Department of Veterans' Affairs is closing the acute care unit of the home's Holderman Hospital. Layoff notices have been sent.
1,100 veterans who reside at the home are being ignored as though they didn't exist, like battle-worn boots that saw their best days at Bastogne, or maybe somewhere in Korea or Vietnam. Eight layoff notices were received by doctors represented by the Union of American Physicians and Dentists (UAPD). Yountville's Home Administration office explained that the state needs to save money. Evidently, slicing medical care from veterans is California's preferred choice.
Stuart A. Bussey, MD, JD, president of the UAPD, declared that the California Veterans Affairs Department (CVDA) "is using the budget cuts as an excuse to close down this acute care unit and cut other medical servces, which it has wanted to do for a long time."
Bussey stated that the Yountville facility "is one of the largest groups of veterans in the country, and they need the care that this unit and these physicians provide." Bussey pointed out that providing equivalent care off-site will increase costs and that the premature layoffs are a thinly disguised method of unit closure before the actual closure.
This action by the state reportedly will save California about $4,000,000 in staff time. No mention was made about the $11,000,000 annual lost reimbursement to the state. No mention was made about the shoddy treatment shoved down the throats of America's veterans. No mention was made of the shame this move bestows on California.
The UAPD states that the CDVA is not following proper procedures such as allowing community involvement and advises concerned citizens to register protests with state legislators.
Politicsofhealthcare.blogspot.com points out that the State of California, simultaneously with this cutback to veterans, panders to the insurance industry and willingly foregoes fees that could be paid by out-of-state utilization review doctors (see stories about AB 933, Fong) to the benefit of California's coffer.
source: UAPD press release, 5/28/09, swilson@uapd.com
Friday, May 22, 2009
AB 933 (Fong) Wins Assembly Vote: Will Governor Arnie Schwarzenegger Continue his Gift Program to Insurance Companies? by Robert L. Weinmann, MD
AB 933 (Fong) won a resounding victory in the Assembly on Wednesday, 20 May 2009, on a 49 to 30 vote. The bill now goes to the Senate.
If AB 933 (Fong) becomes law it'll put a stop to the perfidious practice of some insurance companies that use non-California licensed physicians to do utilizatiion review in Workers' Compensation cases. These doctors who are not licensed to practice medicine in California are not responsible to the Medical Board of California for harmful decisions even though the Medical Board of California says that Utilization Review is part of medical practice and that doctors doing Utilization Review for California's injured workers should be licensed in California.
These exempt doctors are also not responsible to their own state boards since their own state boards don't have jurisdiction in California. In the meanwhile, cash-strapped California takes another body blow. Since these doctors aren't required to be licensed in California, they don't pay fees to the Medical Board of California. They get a free ride. Their share is paid by properly licensed doctors in California whose legal medical decisions are often blocked, delayed, and denied by the non-paying free-ride non-California licensed doctors. How d'ya like them apples, reader!?
Here's the rub: the propositions just got wiped out in the May 19th Special Election. Governor Schwarzenegger said that the people have spoken and now he'll have to teach them a lesson by cutting services right and left. Meanwhile, the Governor continues to give insurance companies a free ride by allowing them to employ Utilization Review doctors who don't pay license fees to the State of California. If only 1,000 non-California licensed doctors enjoy this benefit, the Medical Board of California is deprived of $808,000 (the real number has never been disclosed).
Governor Schwarzenegger is about to punish the public for not trusting political hypocrisy and for voting down his propositions. Meanwhile, he continues to reward insurance companies that hire non-California licensed doctors whose decisions often deprive injured workers and sick patients from the medical care they deserve.
Readers who have strong enough feelings on this issue need to make contact with their State Senators. So far the issue has been largely partisan, Democrats voting for the bill, Republicans, against. It is hard to believe that we're giving gifts to insurance companies while the public unnecessarily pays the piper
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If AB 933 (Fong) becomes law it'll put a stop to the perfidious practice of some insurance companies that use non-California licensed physicians to do utilizatiion review in Workers' Compensation cases. These doctors who are not licensed to practice medicine in California are not responsible to the Medical Board of California for harmful decisions even though the Medical Board of California says that Utilization Review is part of medical practice and that doctors doing Utilization Review for California's injured workers should be licensed in California.
These exempt doctors are also not responsible to their own state boards since their own state boards don't have jurisdiction in California. In the meanwhile, cash-strapped California takes another body blow. Since these doctors aren't required to be licensed in California, they don't pay fees to the Medical Board of California. They get a free ride. Their share is paid by properly licensed doctors in California whose legal medical decisions are often blocked, delayed, and denied by the non-paying free-ride non-California licensed doctors. How d'ya like them apples, reader!?
Here's the rub: the propositions just got wiped out in the May 19th Special Election. Governor Schwarzenegger said that the people have spoken and now he'll have to teach them a lesson by cutting services right and left. Meanwhile, the Governor continues to give insurance companies a free ride by allowing them to employ Utilization Review doctors who don't pay license fees to the State of California. If only 1,000 non-California licensed doctors enjoy this benefit, the Medical Board of California is deprived of $808,000 (the real number has never been disclosed).
Governor Schwarzenegger is about to punish the public for not trusting political hypocrisy and for voting down his propositions. Meanwhile, he continues to reward insurance companies that hire non-California licensed doctors whose decisions often deprive injured workers and sick patients from the medical care they deserve.
Readers who have strong enough feelings on this issue need to make contact with their State Senators. So far the issue has been largely partisan, Democrats voting for the bill, Republicans, against. It is hard to believe that we're giving gifts to insurance companies while the public unnecessarily pays the piper
###
Thursday, May 7, 2009
INJURED WORKERS WIN ASSEMBLY INSURANCE COMMITTEE VOTE by Robert L. Weinmann, MD
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.
###
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.
###
Saturday, April 18, 2009
AB 933 (Fong) requires licensure in California: it does not require doctors to live or reside in California
AB 933 (Fong) deals with licensure for psychologists and physicians -- it will oblige physicians who do utilization review for injured workers in California and who are not licensed in California to get licensed in California. It will not require that they live or reside in California. Watch out for a workers' comp lobbying group alleging that it represents management and that has been going from office to office telling legislators and staff that the bill would require the doctors to live or reside in California. This assertion is false. One wonders in astonishment at a lobbying tactic of such dubious merit.
Sunday, March 29, 2009
Monday, March 23, 2009
SCHWARZENEGGER'S GIFT TO INSURANCE COMPANIES COULD HARM PATIENTS (HEALTHCARE JOURNAL OF NORTHERN CALIFORNIA, Jan/Feb, 2009), sequel to HOW TO PRACTICE MEDICINE WITHOUT A LICENSE (SAN FRANCISCO CHRONICLE, 8/29/08)
On 26 February 2009 The Hon. Paul Fong introduced AB 933 which will require any doctor who does utilization review in California to be licensed for medical practice in California. Last year the Hon. Sally Lieber introduced AB 2969 to accomplish this objective. The bill passed the legislature and was vetoed by the Governor. This year we'll give our Governor another chance to see the light and sign the legislation.
Check out the following stories:
"Schwarzenegger's gift to insurance companies could harm patients," Healthcare Journal of Northern California, Jan/Feb 2009, www.hcjnc.com, click on "breaking news,"
"Review Adds Insult to Injury," TRADE WINDS, The Newsletter of the International Association of Machininists and Aerospace Workers," V. 56, #1, Winter 2008, www.local1781.org or google www.Local1781.org/TRADEWINDSJan08.pdf
"Insurance Industry Sabotages Injured Workers in California," www.californiaprogressreport.com/2008/10/insurance_indus.html, 5 October 2008
"How to practice medicine without a license," San Francisco Chronicle, 8/29/08 (just google the title as per above)
UTILIZATION REVIEW IS A TOOL INSURANCE COMPANIES MAY USE TO RESTRICT INJURED WORKERS FROM ACCESS TO CARE including diagnostic testing and actual treatment. In this way corporate profits and executive compensation are enhanced. Because the Hon. Paul Fong introduced AB 933 the issue is heating up in Sacramento, but it's not yet as hot as it's going to get. Here's what Russell Wyllie, Mountain View, wrote in the letters section of the San Jose Mercury News on 3/28/09:
"The Mercury News (Editorial, March 23) describes how the 2004 workers' compensation reform has 'worked wonders,' but it hasn't been so wonderful for injured workers ... the lower costs of workers' compensation insurance has come at the expense of employees injured on the job ... "
See www.mercurynews.com for Wyllie's complete letter-to-the-editor
WHILE THE ISSUE HEATS UP, INJURED WORKERS CONTINUE TO GET THE PROVERBIAL SHAFT. HERE'S A CURRENT EXAMPLE OF HOW IT'S DONE:
One year ago an injured worker was prescribed care. When the doctor who made the recommendation was asked to see the patient for follow-up one year later, he found that the recommended treatment had not been done because the insurance company and its utilization company had not authorized it. In the meantime, the injured worker hired an attorney. We then discovered that the insurance company did not authorize the treatment because a utilization review doctor rejected it. Next we learned that the utilization review doctor was licensed in Florida, but not in California. This point is important because it means that negligence by the Florida doctor re utilization review of an injured worker in California is not subject to discipline by the Medical Board of California. Neither is the Florida-licensed doctor subject to discipline by the Medical Board of Florida since that medical board doesn't have jurisdiction in California. It appears that the Florida doctor has a pass-go for malpractice since his utilization review decisions aren't under the jurisdiction of any state medical board. Meanwhile, the patient has gone without treatment.
Some say this system is made in heaven for the insurance companies and their bought-and-paid-for utilization review companies. Others would say that by mentioning heaven this writer is pointing in the wrong direction.
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On 26 February 2009 The Hon. Paul Fong introduced AB 933 which will require any doctor who does utilization review in California to be licensed for medical practice in California. Last year the Hon. Sally Lieber introduced AB 2969 to accomplish this objective. The bill passed the legislature and was vetoed by the Governor. This year we'll give our Governor another chance to see the light and sign the legislation.
Check out the following stories:
"Schwarzenegger's gift to insurance companies could harm patients," Healthcare Journal of Northern California, Jan/Feb 2009, www.hcjnc.com, click on "breaking news,"
"Review Adds Insult to Injury," TRADE WINDS, The Newsletter of the International Association of Machininists and Aerospace Workers," V. 56, #1, Winter 2008, www.local1781.org or google www.Local1781.org/TRADEWINDSJan08.pdf
"Insurance Industry Sabotages Injured Workers in California," www.californiaprogressreport.com/2008/10/insurance_indus.html, 5 October 2008
"How to practice medicine without a license," San Francisco Chronicle, 8/29/08 (just google the title as per above)
UTILIZATION REVIEW IS A TOOL INSURANCE COMPANIES MAY USE TO RESTRICT INJURED WORKERS FROM ACCESS TO CARE including diagnostic testing and actual treatment. In this way corporate profits and executive compensation are enhanced. Because the Hon. Paul Fong introduced AB 933 the issue is heating up in Sacramento, but it's not yet as hot as it's going to get. Here's what Russell Wyllie, Mountain View, wrote in the letters section of the San Jose Mercury News on 3/28/09:
"The Mercury News (Editorial, March 23) describes how the 2004 workers' compensation reform has 'worked wonders,' but it hasn't been so wonderful for injured workers ... the lower costs of workers' compensation insurance has come at the expense of employees injured on the job ... "
See www.mercurynews.com for Wyllie's complete letter-to-the-editor
WHILE THE ISSUE HEATS UP, INJURED WORKERS CONTINUE TO GET THE PROVERBIAL SHAFT. HERE'S A CURRENT EXAMPLE OF HOW IT'S DONE:
One year ago an injured worker was prescribed care. When the doctor who made the recommendation was asked to see the patient for follow-up one year later, he found that the recommended treatment had not been done because the insurance company and its utilization company had not authorized it. In the meantime, the injured worker hired an attorney. We then discovered that the insurance company did not authorize the treatment because a utilization review doctor rejected it. Next we learned that the utilization review doctor was licensed in Florida, but not in California. This point is important because it means that negligence by the Florida doctor re utilization review of an injured worker in California is not subject to discipline by the Medical Board of California. Neither is the Florida-licensed doctor subject to discipline by the Medical Board of Florida since that medical board doesn't have jurisdiction in California. It appears that the Florida doctor has a pass-go for malpractice since his utilization review decisions aren't under the jurisdiction of any state medical board. Meanwhile, the patient has gone without treatment.
Some say this system is made in heaven for the insurance companies and their bought-and-paid-for utilization review companies. Others would say that by mentioning heaven this writer is pointing in the wrong direction.
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