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News

Monday Rx: Pre Authorization, Roe V. Wade, State Budget, 151st Installation, LACMA Solutions Portal and Upcoming Events

July 11 Monday Rx.png

Pre Authorization Update

Aetna recently announced it will no longer require pre-approval for most cataract surgeries. This decision came a year after Aetna implemented a policy requiring all cataract surgeries to be “pre-certified,” claiming that it would “help members avoid unnecessary surgery.”

CMA and others in organized medicine strongly objected to this policy, which created unnecessary delays and obstacles for patients and physicians, reducing the availability of health care services and increasing insurance company profits at the expense of patient care.

Learn more here.

I am pleased to announce that LACMA has a team of physician leaders led by Dr. Robert Bitonte, representing solo and small medical practices, who are looking at specific, meaningful and tangible ways to deliver good policy and reduce and even eliminate prior authorization requirements. As LACMA leader Dr. Sam Fink says, “Patients have plenty of advocacy groups that can fight on their behalf, and usually patients eventually get approved for whatever treatment, test, or procedure they are seeking. But, I and my staff are overwhelmed with meaningless paperwork and phone calls, even for simple medications and tests.”

Dr. Fink stresses that the amount of paperwork levied on physicians takes him and his staff away from patient care. “Neither my staff or I have time for this nonsense. It limits the number of patients that I can see in a day, limits the amount of time I spend with them, and burns out my staff to no end. I'm sure that there have been times when I have not ordered a test or prescribed a certain medication simply because I didn't want to commit my practice's resources to fighting a stupid battle,” Fink said.

We must and will do more. In the weeks ahead, not months or years, members will see more than effort, but a sustained fight with legislative teeth, and have our elected leaders “walk in the shoes” of a physician in private practice” to truly understand how administrative burdens lead to burnout and missed opportunities with patients.

Roe V. Wade Update

Members are no doubt aware of the historic decision handed down by the Supreme Court recently.  What tools and resources are available for physicians? 

Read more about the executive order here

The Emergency Medical Treatment and Active Labor Act (EMTALA) provides more information here.

State Update At-A-Glance

Last week the State Legislature sent Governor Gavin Newsom AB 178, a Budget Bill, Jr. that finalizes the budget agreement between the Governor and the State Legislature. SB 154, the main budget bill, was sent to the Governor earlier in the month to meet the state’s constitutional deadline to pass a budget. AB 178 and SB 154 together constitute the budget for the fiscal year 2022-2023. I think it's important for members to be aware of CMA negotiated components that are finalized in this package.

  • General Fund backfill of Proposition 56 programs, in order to provide full funding for provider supplemental payments and GME programs;
  • $1.3 billion for health care worker retention pay which will provide a financial stipend for every individual working in eligible hospital settings, including physicians who will be eligible for $1000 if they provide patient care in a hospital during the eligibility period, which will take place later in 2022;
  • $700 million in equity and practice transformation payments in order to better meet the needs of the Medi-Cal population. $200 million of this funding is meant to assist practices to shift to alternative payment models as envisioned in the Office of Health Affordability legislation;
  • $200 million for reproductive health and reproductive justice issues, including $40 million for uncompensated care reimbursement to providers of reproductive health services;
  • Expansion of full scope Medi-Cal to all eligible individuals regardless of age or documentation status, eliminating the existing age limitations;
  • Elimination of many, but not all of the remaining AB 97 10% provider rate reductions from the recession-era budget;
  • Permanently extends key telehealth flexibilities implemented during the pandemic in the Medi-Cal program, ensuring payment parity for providers utilizing audio/visual, audio-only, and asynchronous store-and-forward technologies, as well as other key provisions;
  • Extends the Medi-Cal managed care time and distance standards requirements to 2026, and provides additional guidance referencing the need for plans to fully complete corrective action plans associated with the time and distance standards, in order to provide appropriate access to care for Medi-Cal beneficiaries;
  • $351.6 million in health care workforce funding in addition to funding provided in the May Revision proposal;
  • Continuous Medi-Cal coverage for all income eligible children 0-5 years old to prevent coverage churn of this population during these critical developmental years;
  • Eliminates co-pays in Medi-Cal, reducing administrative burdens on doctors to collect these minimal charges which created barriers to care for Medi-Cal beneficiaries when they were collected at all; and
  • Retains funding for the Child Health and Disability Program (CHDP), slated for discontinuation by the Administration.

Historic President and Officers Installation Will Be Held on Thursday, July 14th!

We look forward to seeing everyone this Thursday for the 151st Installation of President and Officers in-person event! Thank you to everyone who RSVP'd and the entire LACMA team for putting this event together.

See you soon!

New LACMA Solutions Portal Is Almost Here

I’ve been sharing an exciting upgrade to our solutions portfolio (see screenshots below) which will include over 40+ partners to help physicians in any mode of practice. Easy to navigate, concierge and call center support will be part of a new platform for members only. The launch date will be late July to early August to ensure it exceeds member expectations. 

How to Respond to Requests for Patient Records

It is essential that you protect yourself from the inappropriate release of patient medical records to avoid potential violations of federal or state patient privacy laws. Guidance to help you properly respond to the most common types of requests for patient records, which can originate from subpoenas, attorney’s letters, law enforcement, regulatory agencies, and patients themselves, is provided in a recent article published by the Cooperative of American Physicians (CAP).

Read Article

As a leading provider of superior medical malpractice coverage in California for more than 40 years, CAP remains committed to providing physicians with secure and affordable protection and relevant practice and risk management resources, such as this article, to help you run a safe and successful practice.

To learn more about becoming a CAP member, please call 800-356-5672 or email MD@CAPphysicians.comRequest an Instant Quote today to see how much you can save on medical malpractice coverage through CAP.

Professional liability coverage for CAP Members is provided by Mutual Protection Trust pursuant to Ins. Code section 1280.7

Virtual Grand Rounds: Updates in COVID-19 and Monkeypox

Join the California Medical Association Virtual Grand Rounds: Updates on COVID-19 and Monkeypox; on Tuesday, July 12, 2022, from 12:00 p.m. PT to 1:00 p.m. PT

Even as the COVID-19 pandemic continues, we are now confronted by a new virus: monkeypox. Join us to hear from California State Epidemiologist Erica Pan, M.D., and Peter Chin-Hong, M.D., an infectious disease expert, from UC San Francisco. Dr. Pan will share the latest information about the state of COVID-19 and Dr. Chin-Hong will discuss the emergence of monkeypox as a global phenomenon, and as well as the epidemiology, signs and symptoms of this disease.

Date: July 12, 2022

Time: 12:00 pm - 1:00 pm PST

RSVP Here

The Health Equity Imperative

We look forward to you joining and participating in this engaging virtual conversation. LACMA will host Elaine Batchlor, MD. MPH on July 18, 2022, at 6:00 pm.

This town hall will cover the following objectives:

  • List the essential elements of the Health Equity movement and how MLK Community Hospital sets its course for Health Equity.
  • Describe the state of the art in developing metrics and defining desired outcomes for Health Equity to promote quality, culturally competent services, and patient engagement.
  • Delineate a Health Equity vision for vulnerable populations and the providers who serve them.

This activity has been planned and implemented in accordance with the California Medical Association (CMA) CME Accreditation Standards through joint-providership of Garfield Medical Center and Los Angeles County Medical Association.

Garfield Medical Center is accredited by the California Medical Association (CMA) to provide continuing medical education for physicians. Garfield Medical Center takes responsibility for the content, quality and scientific integrity of this CME activity.

Garfield Medical Center designates this educational activity for a maximum of ONE (1.0) AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity. This credit may also be applied to the CMA Certification in Continuing Medical Education. All faculties including presenters, planners and moderators have no financial disclosure.

Date: July 18, 2022

Time: 6:00 pm

RSVP Here

Join Us for LACMA Family & Friends at LA Dodgers

Healthcare Appreciation Night!

The Los Angeles County Medical Association is excited to spend an evening together with all members at the Dodger Stadium for Dodger Healthcare Appreciation Night! 

Tickets:

  • $20 for LACMA members & first guest
  • $34 for each additional guest up to 3 guests per member. 

Limited tickets available, RSVP by August 24, 2022.

This special event ticket package includes your ticket to the game and an exclusive Healthcare Appreciation Night lightweight hoodie.*

Be sure to stick around after the game for Friday Night Fireworks

***Tickets will be distributed by LACMA prior to the game through MLB Ballpark App once payment has been completed. Attendees will need to download MLB Ballpark App***

Date: September 30, 2022

Time: 7:10 pm PST

RSVP Here

#MondayMotivation

"We are not just products of our past; people in our present also influence us and help mold our character."

Gustavo Friederichsen

Chief Executive Officer

Los Angeles County Medical Association

“If it matters to our LACMA members, it matters to me.”

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