January 2015

January 2015

Volume 4Issue 1

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S a n M a t e o C o u n t y

Physicianin

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Your san Mateo County Legislators

defeating Proposition 46

Federal Legislative Update

ALsO: Many stakeholders in

sale of dOCHs hospitals

Politics and legislation

70068 CMA/San Mateo LTD (1/15)Full Size: 8.5" x 11" Bleed: No Live: 7.5" x 10"Folds to: NA Perf: NAColors: 4-Color Stock: NA Postage: NA Misc: NAM

ERCER

SPONSORED BY:

70068, 70091 Copyright 2015 Mercer LLC. All rights reserved.

Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709777 South Figueroa Street, Los Angeles, CA 90017 • [email protected] • www.CountyCMAMemberInsurance.com

UNDERWRITTEN BY:

New York Life Insurance CompanyNew York, NY 10010 on Policy Form GMR

LEARN MORE ABOUT THIS VALUABLE PLAN TODAY!——————————————————

Call Mercer for free information, including features, costs, eligibility, renewability, limitations and exclusions at:

800.842.3761——————————————————

OR SCAN TO LEARN MORE!

We work to protect you.

YOU WORK TO PROTECT YOUR PATIENTS.

AS A PHYSICIAN, you probably know better than anyone else how quickly a disability can strike and not only delay your dreams, but also leave you unable to provide for your family. Whether it is a heart attack, stroke, car accident or fall off a ladder, any of these things can affect your ability to perform your medical specialty.

That’s why the SMCMA/CMA sponsors a Group Long-Term Disability program underwritten by New York Life Insurance Company:

• Benefits not tied to a practice, giving you more flexibility with potential career changes

• Benefit payments that are 100% TAX FREE — when you pay premiums yourself

• High monthly benefits up to $10,000

• Protection in your medical specialty for the first 10 years of disability

With this critical protection, you’ll have one less thing to worry about until your return.

Physician

70068 CMA/San Mateo LTD (1/15)Full Size: 8.5" x 11" Bleed: No Live: 7.5" x 10"Folds to: NA Perf: NAColors: 4-Color Stock: NA Postage: NA Misc: NAM

ERCER

SPONSORED BY:

70068, 70091 Copyright 2015 Mercer LLC. All rights reserved.

Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709777 South Figueroa Street, Los Angeles, CA 90017 • [email protected] • www.CountyCMAMemberInsurance.com

UNDERWRITTEN BY:

New York Life Insurance CompanyNew York, NY 10010 on Policy Form GMR

LEARN MORE ABOUT THIS VALUABLE PLAN TODAY!——————————————————

Call Mercer for free information, including features, costs, eligibility, renewability, limitations and exclusions at:

800.842.3761——————————————————

OR SCAN TO LEARN MORE!

We work to protect you.

YOU WORK TO PROTECT YOUR PATIENTS.

AS A PHYSICIAN, you probably know better than anyone else how quickly a disability can strike and not only delay your dreams, but also leave you unable to provide for your family. Whether it is a heart attack, stroke, car accident or fall off a ladder, any of these things can affect your ability to perform your medical specialty.

That’s why the SMCMA/CMA sponsors a Group Long-Term Disability program underwritten by New York Life Insurance Company:

• Benefits not tied to a practice, giving you more flexibility with potential career changes

• Benefit payments that are 100% TAX FREE — when you pay premiums yourself

• High monthly benefits up to $10,000

• Protection in your medical specialty for the first 10 years of disability

With this critical protection, you’ll have one less thing to worry about until your return.

Editorial CommitteeRuss Granich, Md, Chairuli Chettipally, MdSharon Clark, Md edward Morhauser, MdGurpreet Padam, Md Sue u. Malone, executive director Shannon Goecke, Managing editor

SMCMA Leadership

Vincent Mason, Md, President; Michael norris, Md, President-elect; Russ Granich, Md; Secretary- treasurer; amita Saxena, Md, Immediate Past President

alexander ding, Md; Manjul dixit, Md; toby Frescholtz, Md; edward Koo, Md; alex lakowsky, Md; Susan nguyen, Md; Michael o’Holleran, Md; Kristen Willison, Md; douglas Zuckermann, Md; david Goldschmid, Md, CMa trustee; Scott a. Morrow, Md, Health officer, County of San Mateo; dirk Baumann, Md, aMa alternate delegate

editorial/Advertising inquiries

San Mateo County Physician is published ten times per year by the San Mateo County Medical association. opinions expressed by authors are their own and not necessarily those of the SMCMa. San Mateo County Physician reserves the right to edit contributions for clarity and length, as well as to reject any material submitted.

acceptance and publication of advertising does not constitute approval or endorsement by the San Mateo County Medical association of products or services advertised.

For more information, contact the managing editor at (650) 312-1663 or [email protected].

Visit our website at smcma.org, like us at facebook.com/smcma, and follow us at twitter.com/sMCMedAssoc.

© 2015 San Mateo County Medical association

november/december 2015 - Volume 4, issue 1

Columns

S a n M a t e o C o u n t y

Physician

President’s Message: Waiting to exhale ................................................. 4Vincent Mason, Md

Feature Articles

new health laws for 2015 ..................................................................8

Your san Mateo County legislators .................................................10

defeating Proposition 46 .................................................................12

Federal legislative update ...............................................................13

Member updates, index of advertisers ......................................... 14

Of interest

executive Report: Many stakeholders in sale of dOCHs hospitals .......... 5Sue u. Malone

4 sAn MAteO COUntY PHYsiCiAn | JAnUARY 2015

In 1995, a movie directed by Forest Whittaker and staring four African American women (Whitney Houston, Loretta Divine, Angela Bassett and Lela Rochon) told the story of the search for the “perfect moment in all our lives” when we get to EXHALE. For these four characters it was about the “right” relationship (one of trust, mutual respect and support).

For those of use in medicine, it is about the right moment when we as health care providers get to practice medicine without the worries of MICRA, the uncertainty of the ACA, the insanity of negotiating with big insurance companies like Blue Shield, navigating through yet another layer of EHR, or dealing with the potential sell of Seton to Prime Health, Inc. These all constitute moments when we would like to just exhale.

In 1995 there was no formal EHR—paper charts ruled the day. There was

President’s Message by Vincent Mason, Md

Waiting to exhale

no discussion of transitioning to ICD-10, and Evidence-Based Medicine was a fairly new terms. Medicare Severity DRGs had not yet been implemented, and the notion of consumer-driven medicine was a foreign concept. And the likelihood of anything close to the ACA was probably laughable.

I would not have been able to understand the political challenges to medicine just in 2014 alone (MICRA, EHR, SGR CURES, and so on), were it not for the tremendous help and support of the California Medical Association. They lobby tirelessly on the front lines for physicians every day. Their ability to support physicians, and help us frame our stories so that politicians can understand what medicine means to us, is amazing.

I’ve had the good fortune to attend the annual House of Delegates for the CMA as a delegate for District VII over the past two years. Physicians are passionate and committed to maintaining the core values of medicine in California. I realize that not all physicians have the time to participate in the arduous political process of the CMA/HOD or even the SMCMA. What I am hopeful for is for those

of us who cannot volunteer our time will volunteer our monies or donate (basically, pay your membership dues) to help continue having advocates on the political forefront fight for physicians’ needs and concerns.

In October 2014 I wrote a letter asking members for financial support on the campaign against Proposition 46. Even though we defeated this in November with 67% of the votes, it is important that we remain vigilant. Our “waiting to exhale” moment in medicine may never happen, but the tireless efforts of our advocates at the CMA, coupled with your support, means we can all breathe a little bit easier in the years to come.

For those of you who would still like to contribute to the ongoing battle for No on Prop 46, please visit www.smcma.org/NoonProp46 to contribute online, or mail your check to SMCMA, 777 Mariners Island Blvd. #100, San Mateo, CA 94404.

Happy New Year! ■

“

“our “waiting to exhale” moment in medicine may never happen, but the tireless efforts of our advocates at the CMa, coupled with your support, means we can all breathe a little bit easier in the years to come.

JAnUARY 2015 | sAn MAteO COUntY PHYsiCiAn 5

The decision by Daughters of Charity Health System (DOCHS)to sell its hospitals has generated considerable angst on the part of physicians, employees, patients, and the community at large. As many of you are aware, the Daughters has been losing money for some period of time and are now facing

the danger of closing or filing for bankruptcy. I thought I would give some background regarding the decision-making that went into the Daughers’ Board action behind its decision to sell its five hospitals, including St. Vincent Medical Center in Los Angeles (366 licensed beds), St. Francis Medical Center in Lynwood (384 licensed beds), O’Connor Hospital in San Jose (358 licensed beds), Saint Louise Regional Hospital in Gilroy (93 licensed beds), and Seton Medical Center (357 licensed beds), all general acute-care hospitals. Note: Seton also operates a 116-licensed bed SNF, with five licensed beds, in Moss Beach). The Daughters is a nonprofit religious corporation, and is the sole corporate

executive Report by Sue u. Malone

Many stakeholders in sale of dOCHs hospitals

member of its five California nonprofit religious corporations.

The Ministry and Daughters have requested the California Attorney General’s consent to allow it to enter into a Definitive Agreement with Prime Healthcare Services, Inc., a Delaware corporation, and Primate Healthcare Foundation, a Delaware nonprofit non-stock corporation, whereby control and governance of Daughters and its affiliated entities would be transferred to Prime, Inc., and Prime Foundation.

I will focus on Seton Medical Center and Seton Coastside for this discussion, as the sale of this facility will directly impact our community.

In 2012 the Daughters entered into an affiliation agreement with Ascension Health Alliance to share in certain consulting and strategic services provided by Ascension. It was also to serve as a platform to continue the Daughters’ strategic dialogue regarding formation of an official partnership. After considerable discussion, the parties ultimately could not reach a mutual agreement that would ensure the long-term viability of the Daughters and its health facilities.

By 2013-14, the Daughters’ Board decided that the current structure and sponsorship of Daughters was not feasible to continue as a result of the dire financial conditions and cash projections.

The Daughters originally decided to solicit offers for only its Seton, Seton-Coastside, O’Connor, and Saint Louise facilities; however, last winter it widened the process to include soliciting offers for St. Francis and St. Vincent Medical facilities, as well as the entire health system. The Board specified guiding principles for a change in control, such as protecting the pensions of current and former employees, repaying major business partners, honoring its employee collective bargaining agreements, and obtaining commitments to the continued provision of acute care services and indigent care, including its participation in the Medi-Cal and Medicare programs for the communities served by its health facilities.

Initially 133 parties were contacted as potential bidders. After initial conversations there were 72 parties expressing interest in the health

“

“By 2013-14, the daughters’ Board decided that the current structure and sponsorship of daughters was not feasible to continue as a result of the dire financial conditions and cash projections.

facilities. During several rounds in the bidding process, that number dwindled to 29 bids (11 bids for the full system and 14 bids for individual or groups of hospitals). Two months later, another round of talks took the number to 15 bids (eight bids for the full system and seven bids for individual or groups of hospitals). At that point it was the decision of the Daughters’ Board to focus efforts on buyers interested in a full-system transaction as they felt that there was not a combination of proposals to form a comprehensive solution.

The Daughters did access a short-term financing bridge loan in the amount of $125 million to mitigate immediate cash needs for an period long enough to allow it to find a buyer and close sale transaction. That loan must be repaid by July 10, 2015. The lender holds liens on substantially all of Daughters’ assets.

When the Daughters went to the Attorney General with its Definition Agreement to sell its hospitals to Prime, the AG was informed that none of the other bidders interested in individual hospitals or groups of facilities were prepared to assume the Daughters’ pension obligations, and attempting to execute multiple transactions could expose the Daughters to the risk of transaction failure if all the agreements were not executed simultaneously. There was also concern that if there was any transaction failure, there would be a withdrawal liability on the multi-employer pension plans of approximately $200 million. Also the individual hospital bids did not satisfy all of the Daughters’ obligations.

In the end there were four final proposals offered for the full health system: two for-profit hospital offers; and two offers for management of the facilities by private equity firms. The Daughters’ Board established eleven criteria to evaluate the offers. In October, the Board selected the offer proposed by Prime, as its offer not only satisfied the selection criteria but materially exceeded the others offers. No other proposals demonstrated similar strength.

Under the agreement, Prime would acquire substantially all of the assets (excluding intellectual property, religious artifacts, historical records, and certain land and properties). Prime would assume the liabilities relating to pensions, collective bargaining agreements, accrued but

unpaid time off, vacation, sick leave, etc.; taxes, including transfer taxes and unpaid real estate taxes; the government payment programs (including any overpayments), accounts payable, accrued liabilities, and so on. Daughters would be assured of $11.5 million in cash and Prime would pay $843 million, of which $394 million would be cash and $449 million would be the assumption of liabilities.

When the SMCMA members who are members of the Seton professional staff asked us to look into the merits of the proposed sale to Prime, we agreed to do so. We were well aware that there was considerable dissension on the part of the SEIU, some members of the community that Seton serves, and political leaders who were urged to oppose the sale. Ultimately, when we attempted to figure out which elected members of the state legislature and Congress

actually opposed the sale, we found that what was reported in the media was not necessarily accurate, as in some cases an elected leader changed his or her mind, or decided not to take a public position at all.

Working with former president, David Goldschmid, (former head of the Seton ER Department) started to review the information available on the due diligence performed by the Daughters’ Board.

Also, as a long time supporter of the Health Plan of San Mateo (HPSM), SMCMA was persuaded by a letter the HPSM Executive Director, Maya Altman, wrote to the Attorney General. In this letter the HPSM proposed very specific conditional criteria to protect the critical hospital-based services and ensure continuity of care for Medi-Cal beneficiaries in San Mateo County. As you may be aware,

executive Report by Sue u. Malone

Seton Medical Center and Seton Coastside provide essential hospital based services such as emergency services, subacute care, and long term care to many HPSM members, who are all Medi-Cal beneficiaries in San Mateo County. Maya’s “ask” on behalf of the Health Plan was a very thoughtful, detailed 11-point request of the Attorney General to require that Prime, or any other potential buyer, if the transaction between DCHS and Prime Health Care Services is approved, adhere to their eight recommended conditions in order to preserve and protect the critical hospital-based services and ensure continuity of care for Medi-Cal beneficiaries in San Mateo County.

On Friday, January 11, David Goldschmid presented SMCMA’s remarks during the Attorney General’s public hearing held in Daly City, This hearing was one of many public hearings scheduled throughout the state on the subject of the sale.. Below is SMCMA’s statement.

These conditions primarily relate to the continuation of the existing types and levels of services to HPSM members, along with mutually agreeable new contracts and terms.

The Attorney General has until February 6, 2015, to make her decision. ■

Comments by

San Mateo County Medical Association

Proposed Sale of Seton Medical Center and Seton Coastside

by Daughters of Charity Health System

The San Mateo County Medical Association (SMCMA) wishes to state its support of the sale of Seton Medical Center and Seton Coastside by the Daughters of Charity Health System to Prime Healthcare Services.

SMCMA supports the conditional requirements proposed by the Health Plan of San Mateo (HPSM) in its letter to the Attorney General dated December 5, 2014 if the transaction between DCHS and Prime Healthcare Services if approved.

SMCMA also supports continued operation of the Seton Medical Center as a general acute care hospital for at least ten years from the closing date of the transaction.

Seton provides essential hospital-based services such as emergency services, subacute care, and long term care to the community at large and in particular HPSM members, who are all Medi-Cal beneficiaries in San Mateo County. With passage of the Affordable Care Act, HPSM is experiencing significant growth; therefore, it is vital that Seton continue to provide the critical functions it has contributed to this community over many years.

We ask that the Attorney General approve the sale and take into consideration the conditions sought by the Health Plan of San Mateo, which is fully supported by the SMCMA.

The San Mateo County Medical Association, representing over 1,500 physicians practicing in San Mateo County.

Submitted by:

David Goldschmid, MD Sue U MaloneFormer President Executive DirectorSan Mateo County Medical Association San Mateo County Association

dRUG PResCRiBinG And disPensinG

AB 467 (Stone) - Prescription Drugs: Collection and Distribution Program

Establishes a license and regulatory framework for a “surplus medication collection and distribution intermediary” to facilitate the donation of surplus medications in California. Requires the Board of Pharmacy to license a surplus medication collection and distribution intermediary, established for the purpose of facilitating the donation or transfer of medications between entities under a specified unused medication repository and distribution program. Authorizes the intermediary to charge specified fees. Relates to license renewal. Requires the keeping and maintaining of complete records. Provides that fees collected would be deposited in the Pharmacy Board Contingent Fund.

AB 1535 (Bloom) - Pharmacists: Naloxone Hydrochloride

Authorizes a pharmacist to furnish naloxone hydrochloride (“Narcan”) in accordance with standardized procedures or protocols developed and approved by both the Board of Pharmacy and the Medical Board. Requires the development of protocols on the education of the person to whom the drug is furnished and notification of the patient’s primary care provider. Requires the pharmacists to complete related training. Prohibits furnishing the medication to the patient without consultation. Authorizes related regulations.

HeALtH BeneFit eXCHAnGe

AB 617 (Nazarian) - Health Benefit Exchange: Appeals

Establishes an appeals process for eligibility determinations for insurance affordability programs (including Medi-Cal and tax credits available through the California Health Benefit Exchange (Covered California) and requires Covered California to contract with the Department of Social Services to serve as the designated entity to hear appeals.

HeALtH CARe COVeRAGe

SB 964 (Hernandez, E.) - Health Care Coverage

Increases oversight of health care service plans with respect to compliance with timely access and provider network adequacy standards. Authorizes a health plan to include in its contracts with providers provisions requiring compliance with timely access and network adequacy data reporting requirements. Requires DMHC to annually review health plan compliance with timely access standards and to post its final findings from the review, and any waivers or alternative standards approved by DMHC, on its website. Authorizes DMHC to develop, and requires health plans to use, standardized methodologies for timely access reporting, and exempts the development and adoption of the standardized reporting methodologies from the Administrative Procedures Act, the body of law governing state regulations, until January 1, 2020.

SB 1053 (Mitchell) - Health Care Coverage: Contraceptives

Requires, effective January 1, 2016, most health plans and insurers to cover a variety of Food and Drug Administration-approved contraceptive drugs, devices, and products for

The California Legislature had an active year, passing many new laws affecting health care. Below are highlights of the new laws likely to impact physicians in 2015 and beyond.

New He altH l aws for 2015


women, as well as related counseling and follow-up services and voluntary sterilization procedures. Prohibits cost-sharing, restrictions, or delays in the provision of covered services, but allows cost-sharing and utilization management procedures if a therapeutic equivalent drug or device is offered by the plan with no cost-sharing.

HEALTH CARE FACILITIES AND FINANCING

AB 1570 (Chesbro) - Residential Care Facilities for the Elderly

Increases training requirements for licensees and staff of Residential Care Facilities for the Elderly (RCFE). Deletes the existing requirement of 40 hours of classroom instruction for RCFE licensee certification training programs and replaces it with 80 hours of required coursework, which shall include at least 60 hours of coursework that shall be attended in person. Adds personal rights, management of antipsychotic medication, managing Alzheimer’s disease and related dementias, and managing the physical environment, including maintenance and housekeeping to the list of items covered in the RCFE licensee certification training program.

SB 1004 (Hernandez, E.) - Health Care: Palliative Care

Requires the Department of Health Care Services (DHCS) to assist Medi-Cal managed care plans in delivering palliative care services, and requires DHCS to consult with stakeholders and directs DHCS to ensure the delivery of palliative care services in a manner that is cost-neutral to the General Fund, to the extent practicable. Authorizes implementation through all plan letters and similar instructions.

SB 1299 (Padilla) - Workplace Violence Prevention Plans: Hospitals

Requires the Occupational Safety and Health Administration Standards Board, no later than July 1, 2016, to adopt standards that require specified hospitals to adopt a workplace violence prevention plan as part of their injury and illness prevention plan to protect health care workers and other facility personnel from aggressive and violent behavior. Requires the Division of Occupational Safety and Health to post a report on violent incidents at hospitals on its website. Exempts certain hospitals.

MEDICAL PRACTICE AND ETHICS

AB 1577 (Atkins) - Certificates of Death: Gender Identity

Requires a person completing a certificate of death to record the decedent’s sex to reflect the decedent’s gender identity. Requires identity to be reported by the informant, unless the person completing the certificate is presented with a specified document, in which case the person would be required to record the decedent’s sex as that which corresponds with the gender identity as indicated in document. Provides the procedure in the absence of such document.

PROFESSIONAL LICENSING AND DISCIPLINE

SB 1159 (Lara) - License Applicants: Individual Tax Identification

Prohibits licensing boards under the Department of Consumer Affairs from denying licensure to an applicant based on his or her citizenship or immigration status, and requires a licensing board and the State Bar to require, by January 1, 2016, that an applicant for licensure provide his or her individual taxpayer identification number or a social security number for an initial or renewal license.

PUBLIC HEALTH

AB 1559 (Pan) - Newborn Screening Program

Requires the Department of Public Health to expand statewide screening of newborns to include screening for adrenoleukodystrophy (ALD), several different inherited conditions that affect the nervous system and adrenal glands, as soon as the disease is adopted by the federal Recommended Uniform Screening Panel.

AB 1819 (Hall) - Family Day Care Home: Smoking Prohibition

Prohibits the smoking of tobacco in a private residence that is licensed as a family day care home without regard to whether the act occurs during the hours of operation of the home. Makes a conforming change.

AB 1898 (Brown) - Public Health Records: Reporting HIV/AIDS

Adds hepatitis B, hepatitis C, and meningococcal infection to the list of diseases that local health officer reports to the Department of Public Health (for the purpose of the investigation, control, or surveillance of human immunodeficiency virus/acquired immune deficiency syndrome and co-infection).

REPRODUCTIVE ISSUES

SB 1135 (Jackson) - Inmates Sterilization

Prohibits sterilization for the purpose of birth control of an individual under the control of the Department of Corrections and Rehabilitation or a county correctional facility. Prohibits any means of sterilization of an inmate, except when required for the immediate preservation of life in an emergency medical situation and when medically necessary to treat a diagnosed condition and certain requirements are satisfied. Requires reports of procedures. Relates to notification regarding sterilization. ■


Your saN Mateo CouNtY legislators selected 2014 healthcare legislation

c aliFoRnia state senate

Rich goRdon - distRic t 24

San Mateo County (17.5%): Atherton, East Palo Alto, Half Moon Bay, Menlo Park, Portola Valley, Woodside

Santa Clara County (19%): Cupertino (7.7%), Los Altos, Los Altos Hills, Mountain View, Palo Alto, Sunnyvale

Assemblymember Gordon authored AB 496, Medicine: continuing medical education: sexual orientation, gender identity, and gender expression, which was signed by Governor Brown on September 26, 2014.

Existing law requires all continuing medical education courses on or after July 1, 2006, to contain curriculum that includes cultural and linguistic competency, as defined, in the practice of medicine. Cultural competency is defined as a set of integrated attitudes, knowledge, and skills that enables a health care professional or organization to care effectively for patients from diverse cultures, groups, and communities. AB 496 expands this recommendation to include, as appropriate, information pertinent to the appropriate treatment of, and provision of care to,

jeRRy hill - distRic t 13San Mateo County (82.5%): Atherton, Belmont, Brisbane, Burlingame, East Palo Alto, Foster City, Half Moon Bay, Hillsborough, Menlo Park, Millbrae, Pacifica, Portola Valley, Redwood City, San Bruno, San Carlos, San Mateo, S. San Francisco (72.6%), Woodside

Santa Clara County (18.8%): Los Altos, Los Altos Hills, Palo Alto, Mountain View, Sunnyvale

Senator Hill authored SB 1311, Hospitals: antimicrobial stewardship, which was signed by Governor Brown on September 29, 2014.

This legislation requires that all general acute care hospitals adopt and implement an antimicrobial stewardship policy that includes a process to evaluate the judicious use of antibiotics. It also requires a general acute care hospital to develop a physician-supervised antimicrobial workgroup and to appoint to that group at least one physician or pharmacist who is knowledgeable about microbial stewardship through previous training.

Hill introduced the legislation because widespread use of antibiotics has increased resistance to infections. More than two million Americans each year, including 23,000 people who die, are infected with antibiotic resistant infections, according to the Centers for Disease Control and Prevention (CDC). “The CDC has sounded the alarm and California is responding,” said Hill,

maRk leno - distRic t 11

All of San Francisco County

San Mateo County (17.5%): Colma, Daly City, S. San Francisco (27.4%)

Senator Leno co-authored, with Senator Ed Hernandez, (D-West Covina), SB 18, Medi-Cal renewal, which was signed by Governor Brown on September 25, 2014.

This legislation provides renewal assistance to California families who receive Medi-Cal by ensuring that California receives up to $12 million in funding to help families renew their Medi-Cal assistance next year. The bill requires the state to accept a $6 million grant offered by the California Endowment and seek $6 million in matching federal dollars.

“We want to ensure that eligible Californians do not have a gap in coverage, which might force them to forego important medical care,” said Leno.

c aliFoRnia state assembly


Your saN Mateo CouNtY legislators selected 2014 healthcare legislation

c aliFoRnia state assembly

Assemblymember Mullin authored AB 1841, Medical assistants, which was signed by Governor Brown on September 15, 2014.

This legislation expands the “technical supportive services” a medical assistant can provide, as outlined in the Pharmacy Law, to include handing to a patient a properly labeled and prepackaged prescription drug, other than a controlled substance, ordered by a licensed physician and surgeon, a licensed podiatrist, a physician assistant, a nurse practitioner, or a certified nurse-midwife, as specified.

“Given the millions of patients who are newly eligible for health care coverage,” stated Mullin’s office, “providing medical assistants with this authority will help reduce waiting times, expand access and improve patient care and satisfaction in community clinics.”

kevin mullin - distRic t 22

San Mateo County (64.4%): Belmont, Brisbane, Burlingame, Foster City, Hillsborough, Millbrae, Pacifica, Redwood City, San Bruno, San Carlos, San Mateo, S. San Francisco (65.7%)

Phil ting - distRic t 19

San Francisco County (41.9%)

San Mateo County (18.1%): Broadmoor, Colma, Daly City, S. San Francisco (34.3%)

Assemblymember Ting authored AB 1743, Hypodermic needles and syringes, which was signed by Governor Brown on September 15, 2014.

This legislation permanently gives pharmacists the choice to sell syringes to an adult without a prescription if the pharmacist meets uniform requirements for the provision of information and materials about safe syringe disposal, drug treatment access, and options for testing and treating HIV and hepatitis. Sharing used syringes is the most common way hepatitis C virus (HCV) is spread and the second most common way of spreading HIV and hepatitis B.

“The facts are clear and undisputed,” said Ting. “Allowing adults to purchase syringes from pharmacists saves lives by preventing the spread of deadly diseases. Doctors, nurses, and pharmacists support this policy, which is why it is the law of the land in nearly every state..”

Ting also authored AB 2102: Licensees: data collection, which was signed by Governor Brown on September 18, 2014. This legislation requires that the Board of Registered Nursing, the Physician Assistant Board, the Respiratory Care Board of California, and the Board of Vocational Nursing and Psychiatric Technicians of the State of California collect and report specific demographic data relating to its licensees, subject to a licensee’s discretion to report his or her race or ethnicity, to the Office of Statewide Health Planning and Development. The bill would require these boards to collect this data at least biennially, at the times of both issuing an initial license and issuing a renewal license.

“More Californians than ever before have health insurance, said Ting, “but this growth in coverage through Covered California may not lead to better health while communication barriers persist. We have an obligation to act to ensure good health outcomes for limited English speaking Californians.” ■

the lesbian, gay, bisexual, transgender, and intersex communities.

“Unfortunately, LGBT patients disproportionately experience inequities in medical treatment due to a lack of provider understanding, said Gordon’s’ office. “The first of its kind in the nation, AB 496 will help ensure LGBT communities have access to quality healthcare.”

Assemblymember Gordon also authored AB 1821, Medical foster homes, which was signed by Governor Brown on September 27, 2014. This legislation gives the U.S. Department of Veterans Affairs authority to create a three-year Medical Foster Home Pilot Program in California. An alternative to institutionalization for often elderly and medically frail veterans giving veterans, medical foster homes give patients the option to live and receive care in a private home. Said Gordon, “Providing this alternative for our veterans is one way that we can show our respect and gratitude for their service to our country.”


DEFEATING PROPOSITION 46:VICTORY AT THE BALLOT BOX

on november 4, 2015, 68% of californians voted no on Proposition 46 because the smcma and cma...

Raised a massive War chest

CMa’s initial $5 million pledge

convinced coalition partners—hospitals,

dentists, medical malpractice carriers, and others—to join

and contribute.

It took $60 million to defeat Prop. 46.

assembled an exceptional

team

Highly influential external consultants

from both sides of the aisle

Brilliant campaign managers

a coherent and effective CMa team

built a broad and deep coalition

Business, labor, local government, community clinics,

Planned Parenthood, aClu, naaCP,

taxpayers, teachers, firefighters—nearly 800 organizations in

total across California

natural alliance between lawyers and the democratic party

neutralized

conducted a Flawless air game

Consistent and unified messaging, trained physician

spokespeople. extreme message

discipline. no mistakes

“no on 46” message communicated daily

on social media platforms.

Myriad “no on 46” traditional media

campaign ads, recordings, visuals, and news releases

“no on 46” endorsements by

every major editorial board in California

and a Flawless

ground game

energized San Mateo County physicians

Countless “no on Prop. 46” buttons,

lab coat cards, brochures, posters,

yard signs, and bumper stickers

distributed

Hundreds of individual San Mateo

County physicians talked to voters

about the deception and trickery of

Prop.. 46.

SMCMa representatives

spoke at medical staff meetings to

inform and motivate a county-wide

response.

1 2 3 4 5


2014 FEDER AL LEGISLATION

Medicare payment reformA Medicare Geographic Payment Locality update for California was included in the Medicare SGR Patch legislation last spring. It will update the outdated Medicare payment localities across California, so that San Diego and Sacramento, for instance, will no longer be considered rural under the Medicare geographic payment formula. The legislation sets a floor so that rural physicians will never be cut below current geographic formula payment levels. If local practice costs increase, payments will increase—but they will never go below the 2014 floor.

Medicare sGR reformIn 2014, Congress came close to passing comprehensive, bipartisan, bicameral legislation that repeals the Sustainable Growth Rate (SGR) formula and establishes a new physician payment system. It was approved by three committees of jurisdiction with the support of 600 national and state physician organizations. This was an unprecedented achievement. Unfortunately, Congress ran out of time and the political will to finish the bill, so it adopted a short-term patch for the 17th time. The patches now cost more than the SGR reform legislation.

The Medicare payment system must be fixed to meet the growing health care needs of California’s seniors. Fixing the Medicare payment system will provide stability, allow more physicians to remain in practice, and attract new physicians to our high-cost state. Because Medicare impacts all private payers in the state, SGR reform will improve access to care for all Californians.

Medicaid rate increasesMedicaid primary care physician reimbursement rates were increased to Medicare levels for two years starting in 2012. The increase applies to family physicians, internists, pediatricians, related internal medicine and pediatric subspecialties, and immunizations. Proposed legislation would extend the payment parity for two more years and add ob-gyn primary care services.

ISSuES TO wATCH IN 2015the administrative load and competing regulatory programsStudies show that one of the greatest frustrations to physicians is the time and expense they must devote to administrative and regulatory requirements, pulling time away from patient care without a direct benefit to care delivery or health outcomes.

• Electronic health records (EHR) and meaningful use. At the top of many physicians’ lists of things that need to change are unhelpful EHR systems and unachievable meaningful use requirements. According to data the Centers for Medicare & Medicaid Services (CMS) released in mid-December, more than 50 percent of eligible professionals will face payment penalties next year because they could not fulfill meaningful use requirements.

• ICD-10 implementation. End-to-end testing, which will take place between January and March, should provide insight on potential disruptions from ICD-10 implementation, scheduled for October 1, 2015.

• Federal fraud and abuse programs. While preventing unscrupulous activities in the Medicare system is an appropriate goal, many physicians are being unduly taxed by the “bounty-hunter” efforts of the Medicare recovery audit contractors (RAC). In fact, more than 60 percent of RAC determinations are overturned when appealed. Meanwhile, CMS has a two-year backlog of appeals to sort through.

the Medicare physician payment systemCongress will need to act early this year to avoid a 21 percent pay cut scheduled to take effect April 1 under theSGR formula.

Adequate provider networksThe current trend toward very limited provider networks has necessitated physician action to ensure patients have access to the care they need.

Prescription drug abuse and overdoseMost stakeholders now agree that the nation’s prescription drug overdose epidemic should be addressed primarily through treatment, prevention and education rather than law enforcement. But much work remains to execute solutions in local communities. ■

FEDER AL LEGISL ATIVE uPDATE


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Documents

January 2015