CMA Alert

From akazzi@uci.edu Thu Jan 1 19:43:17 2004 From: akazzi@uci.edu (Kazzi, A. Antoine) Date: Thu, 1 Jan 2004 11:43:17 -0800 Subject: FW: Special CMA Alert: Federal Judge Blocks Medi-Cal Cuts Message-ID: <59CDD9FF884EAE4AB86132E86110D72202E0997A@wicket.ndc.mc.uci.edu> This message is in MIME format. Since your mail reader does not understand this format, some or all of this message may not be legible. ------_=_NextPart_001_01C3D09F.80E49F70 Content-Type: text/plain -----Original Message----- From: cma_alert@cmanews.org [mailto:cma_alert@cmanews.org] Sent: Wednesday, December 24, 2003 12:19 PM Federal Court Blocks Illegal Medi-Cal Cuts [Posted 12/24/03] U.S. District Judge David Levi on Tuesday granted a preliminary injunction in the lawsuit filed by CMA and other plaintiffs to stop the 5 percent Medi-Cal rate cut that was set to go into effect on January 1. In granting the preliminary injunction, Judge Levi said that the state of California failed to consider how the hundreds of millions in cuts would affect access to care for poor, disabled, elderly and children whose health care is provided by Medi-Cal. "This is excellent news," said CMA CEO Jack Lewin, M.D. "Going forward, this ruling seems to thwart the current administration's additional 10 percent proposed reductions as well. The judge's decision will prevent further erosion of access to care for our most vulnerable patients." "Because the state failed to consider the effect of a rate reduction on beneficiaries' equal access to quality medical services, in view of provider costs, the pending rate reduction is arbitrary and cannot stand," wrote Judge Levi in his 42-page ruling . "I certainly view the decision as a very substantial victory, and it's going to be a very serious obstacle to the administration's proposal to consider further rate reductions," said Craig Cannizzo, attorney with Hooper, Lundy & Bookman, Inc., of San Francisco, which filed the lawsuit on behalf of CMA and multiple other plaintiffs representing patients, dentists, pharmacists and other providers. The judge also ruled that cuts already made against Medi-Cal managed care plans would have to be addressed separately. Attorneys for CMA and its co-plaintiffs are still reviewing what the ruling means for Medi-Cal managed care plans. Medi-Cal managed care accounts for about half of all Medi-Cal recipients. In launching the legal challenge Nov. 7, CMA and other plaintiffs cited the Social Security Act, which says that a state plan for medical assistance (Medi-Cal in California) must assure that payments are "consistent with ... economy and quality of care," and are sufficient to enlist enough providers so that services are available at a level equal to those available to the general public. According to the lawsuit, the number of primary care physicians per capita for Medi-Cal patients was one-third less than for the general population using 2001 figures from the Medi-Cal Policy Institute. The figure for specialists is 50 percent less than for the general population; and for surgeons - it is two thirds less. Further cuts would have made the disparities larger. About 6.5 million people are eligible for Medi-Cal in any given month. California ranks in the bottom 10 of the 50 states for reimbursement for Medi-Cal patient care. This e-mail/fax message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail/fax and destroy all copies of the original message. ------_=_NextPart_001_01C3D09F.80E49F70 Content-Type: text/html Content-Transfer-Encoding: quoted-printable CMA Alert

-----Original Message-----
From: = cma_alert@cmanews.org [mailto:cma_alert@cmanews.org]
Sent: = Wednesday, December 24, 2003 12:19 PM

Federal Court Blocks Illegal Medi-Cal = Cuts
[Posted 12/24/03]

U.S. District Judge David Levi on Tuesday granted a preliminary injunction = in the lawsuit filed by CMA and other plaintiffs to stop the 5 percent = Medi-Cal rate cut that was set to go into effect on January 1.

In granting the preliminary injunction, Judge Levi said that the state of California failed to consider how the hundreds of millions in cuts = would affect access to care for poor, disabled, elderly and children whose health = care is provided by Medi-Cal.

"This is excellent news," said CMA CEO Jack Lewin, M.D. "Going forward, this = ruling seems to thwart the current administration's additional 10 percent = proposed reductions as well. The judge's decision will prevent further erosion = of access to care for our most vulnerable patients."

"Because the state failed to consider the effect of a rate reduction on = beneficiaries' equal access to quality medical services, in view of provider costs, = the pending rate reduction is arbitrary and cannot stand," wrote Judge Levi = in his 42-page = ruling.

"I certainly view the decision as a very substantial victory, and it's = going to be a very serious obstacle to the administration's proposal to consider = further rate reductions," said Craig Cannizzo, attorney with Hooper, Lundy = & Bookman, Inc., of San Francisco, which filed the lawsuit on behalf of CMA and = multiple other plaintiffs representing patients, dentists, pharmacists and other providers.

The judge also ruled that cuts already made against Medi-Cal managed care = plans would have to be addressed separately. Attorneys for CMA and its = co-plaintiffs are still reviewing what the ruling means for Medi-Cal managed care = plans. Medi-Cal managed care accounts for about half of all Medi-Cal recipients. =

In launching the legal challenge Nov. 7, CMA and other plaintiffs cited = the Social Security Act, which says that a state plan for medical assistance = (Medi-Cal in California) must assure that payments are "consistent with ... economy = and quality of care," and are sufficient to enlist enough providers so that services are available at a level equal to those available to the = general public. According to the lawsuit, the number of primary care physicians = per capita for Medi-Cal patients was one-third less than for the general = population using 2001 figures from the Medi-Cal Policy Institute. The figure for specialists is 50 percent less than for the general population; and for surgeons - it is two thirds less. Further cuts would have made the = disparities larger.

About 6.5 million people are eligible for Medi-Cal in any given month. = California ranks in the bottom 10 of the 50 states for reimbursement for Medi-Cal patient = care.

This e-mail/fax message, including any = attachments, is for the sole use of the intended recipient(s) and may = contain confidential and privileged information. Any unauthorized = review, use, disclosure or distribution is prohibited. If you are not = the intended recipient, please contact the sender by reply e-mail/fax = and destroy all copies of the original message.

------_=_NextPart_001_01C3D09F.80E49F70-- From pottsbri@yahoo.com Sat Jan 3 01:32:43 2004 From: pottsbri@yahoo.com (CAL/AAEM News Service) Date: Fri, 2 Jan 2004 17:32:43 -0800 (PST) Subject: IOM: CDC guidance on smallpox useful, but needs more work, -AND- HHS issues interim final rule on smallpox vaccine compensation Message-ID: <20040103013243.89950.qmail@web41311.mail.yahoo.com> --0-273772306-1073093563=:89018 Content-Type: text/plain; charset=us-ascii =================================== AHA NEWS NOW The Daily Report for Health Care Executives www.ahanews.com =================================== Monday, Dec. 22, 2003 6) IOM: CDC guidance on smallpox useful, but needs more work A new report credits HHS' Centers for Disease Control and Prevention for creating a "useful starting point" for measuring state and local readiness for smallpox attacks, but says the agency needs to collaborate better with other federal agencies, particularly HHS' Health Resources and Services Administration. The report, prepared by an Institute of Medicine panel, examines the effectiveness of a set of smallpox indicators developed by CDC earlier this year to provide guidance in the event of an attack. IOM says CDC has drafted useful guidance indicators to measure the nation's preparedness. However, it said the indicators "do not reflect the importance of communication and collaboration among the public health system, the health care system, emergency response personnel, and communities." The relationship between CDC and HRSA, in particular, "parallels the connections between public health agencies at all levels," IOM said, however, the agencies "have yet to fully coordinate their preparedness planning." A copy of the report can be found at http://www.iom.edu. ================================== =================================== Monday, Dec. 15, 2003 1) HHS issues interim final rule on smallpox vaccine compensation The Department of Health and Human Services will publish in tomorrow's Federal Register an interim final rule setting forth eligibility criteria and the process for requesting benefits and receiving payments under the federal Smallpox Vaccine Injury Compensation Program approved by Congress earlier this year. The program, funded at $42 million, provides financial and medical benefits to eligible members of an HHS-approved smallpox emergency response plan who sustained certain medical injuries caused by a smallpox vaccine. HHS began implementing the program in August when it published a table of vaccine-related injuries that are presumptively covered under the program and the timeframes within which such claims would need to be made. To receive benefits, requesters must satisfy filing deadlines described in the interim final rule, which HHS said may fall as early as Jan. 24, 2004. The agency encouraged people interested in applying for benefits to file a request form as soon as possible. For eligibility or application information, contact HHS' Health Resources and Services Administration at (888) 496-0338 or by email at smallpox@hrsa.gov. Curtis Rooney, AHA senior associate director, said today, "We're pleased that the administration has put into place this important smallpox vaccine injury compensation program." ================================== Copyright 2003 by the American Hospital Association. All rights reserved. For republication rights, contact Craig Webb. AHA News is a registered trademark of the American Hospital Association. The opinions expressed in AHA News Now are not necessarily those of the American Hospital Association. Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! Photos - Get your photo on the big screen in Times Square --0-273772306-1073093563=:89018 Content-Type: text/html; charset=us-ascii

===================================

AHA NEWS NOW

The Daily Report for Health Care Executives

www.ahanews.com

===================================

Monday, Dec. 22, 2003

6) IOM: CDC guidance on smallpox useful, but needs more work

A new report credits HHS' Centers for Disease Control and Prevention for

creating a "useful starting point" for measuring state and local readiness

for smallpox attacks, but says the agency needs to collaborate better with

other federal agencies, particularly HHS' Health Resources and Services

Administration. The report, prepared by an Institute of Medicine panel,

examines the effectiveness of a set of smallpox indicators developed by CDC

earlier this year to provide guidance in the event of an attack. IOM says

CDC has drafted useful guidance indicators to measure the nation's

preparedness. However, it said the indicators "do not reflect the importance

of communication and collaboration among the public health system, the

health care system, emergency response personnel, and communities." The

relationship between CDC and HRSA, in particular, "parallels the connections

between public health agencies at all levels," IOM said, however, the

agencies "have yet to fully coordinate their preparedness planning." A copy

of the report can be found at http://www.iom.edu.

==================================

===================================

Monday, Dec. 15, 2003

1) HHS issues interim final rule on smallpox vaccine compensation

The Department of Health and Human Services will publish in tomorrow's

Federal Register an interim final rule setting forth eligibility criteria

and the process for requesting benefits and receiving payments under the

federal Smallpox Vaccine Injury Compensation Program approved by Congress

earlier this year. The program, funded at $42 million, provides financial

and medical benefits to eligible members of an HHS-approved smallpox

emergency response plan who sustained certain medical injuries caused by a

smallpox vaccine. HHS began implementing the program in August when it

published a table of vaccine-related injuries that are presumptively covered

under the program and the timeframes within which such claims would need to

be made. To receive benefits, requesters must satisfy filing deadlines

described in the interim final rule, which HHS said may fall as early as

Jan. 24, 2004. The agency encouraged people interested in applying for

benefits to file a request form as soon as possible. For eligibility or

application information, contact HHS' Health Resources and Services

Administration at (888) 496-0338 or by email at smallpox@hrsa.gov. Curtis

Rooney, AHA senior associate director, said today, "We're pleased that the

administration has put into place this important smallpox vaccine injury

compensation program."

==================================

AHA News is a registered trademark of the American Hospital Association. The opinions expressed in AHA News Now are not necessarily those of the American Hospital Association.

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

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Yahoo! Photos - Get your photo on the big screen in Times Square --0-273772306-1073093563=:89018-- From pottsbri@yahoo.com Sun Jan 4 02:23:53 2004 From: pottsbri@yahoo.com (CAL/AAEM News Service) Date: Sat, 3 Jan 2004 18:23:53 -0800 (PST) Subject: CMA Summarizes New Laws that Will Affect Physicians in 04 -AND- Study: Increases in medical liability costs lead rise in U.S. tort costs Message-ID: <20040104022353.31644.qmail@web41304.mail.yahoo.com> --0-351374342-1073183033=:31541 Content-Type: text/plain; charset=us-ascii -----Original Message----- From: cma_alert@cmanews.org Subject: [CMA ALERT] December 18, 2003 4. CMA Summarizes New Laws that Will Affect Physicians in �04 Despite the recall election and an unprecedented budget crisis, the California Legislature passed many new laws this year. Below are highlights of the new laws most likely to affect physicians next year and beyond. For more details, read the feature story "New Laws 2004" online at the California Physician website. Triplicate Prescriptions: The cumbersome triplicate prescription system for Schedule II controlled substances will be phased out over the next year. Physicians will instead use forgery-proof prescription forms, printed by "security printers" that have been approved by the Board of Pharmacy. Registered Sex Offenders: A registered sex offender cannot obtain a license to practice medicine in the state of California. Similarly, the license of any physician who becomes a registered sex offender must be "promptly revoked." This law does not apply to sex-offender registrations resulting from a misdemeanor conviction for indecent exposure. A physician whose license is revoked under this law may petition a court for reinstatement a minimum of five years after the revocation and three years after successful completion of parole and/or probation. Felony Fraud: Physicians convicted of any felony involving fraud committed in conjunction with the Workers� Compensation or Medi-Cal programs will have their licenses automatically suspended. Physicians with more than one such conviction will have their licenses revoked, "unless the Medical Board finds mitigating circumstances to order some other disposition." Use of Medical Information for Marketing: California�s Confidentiality of Medical Information Act now expressly prohibits the use of medical information for marketing purposes without a signed authorization. For more details on these and other new laws of interest to physicians, http://www.cmanews.org/mailman/listinfo/cma_alert Contact: CMA�s legal information line, 415/882-5144 or legalinfo@cmanet.org. =================================== AHA NEWS NOW The Daily Report for Health Care Executives www.ahanews.com =================================== Monday, Dec. 15, 2003 Today's headlines: 2) Study: Increases in medical liability costs lead rise in U.S. tort costs The U.S. tort system experienced double-digit cost increases for the second consecutive year in 2002, while medical liability cost increases continued to outpace increases in overall tort costs, according to a new study by consultant Tillinghast-Towers Perrin. Medical liability costs have increased an average of 11.9% per year since 1975, or a factor of 21, compared to an average annual increase of 9.3% for all other tort costs, a factor of 11, the study indicates. U.S. medical liability costs totaled nearly $25 billion in 2002, or $85 per person compared to $5 per person in 1975, an escalation that has contributed to the increase in U.S. health care costs over the past 30 years, the study adds. The study can be found at http://www.tillinghast.com/tillinghast/. ================================== Copyright 2003 by the American Hospital Association. All rights reserved. For republication rights, contact Craig Webb. AHA News is a registered trademark of the American Hospital Association. The opinions expressed in AHA News Now are not necessarily those of the American Hospital Association. Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! Photos - Get your photo on the big screen in Times Square --0-351374342-1073183033=:31541 Content-Type: text/html; charset=us-ascii

-----Original Message-----

From: cma_alert@cmanews.org

Subject: [CMA ALERT] December 18, 2003

4. CMA Summarizes New Laws that Will Affect Physicians in �04

Despite the recall election and an unprecedented budget crisis, the California Legislature passed many new laws this year. Below are highlights of the new laws most likely to affect physicians next year and beyond. For more details, read the feature story "New Laws 2004" online at the California Physician website.

Triplicate Prescriptions: The cumbersome triplicate prescription system for Schedule II controlled substances will be phased out over the next year. Physicians will instead use forgery-proof prescription forms, printed by "security printers" that have been approved by the Board of Pharmacy.

Registered Sex Offenders: A registered sex offender cannot obtain a license to practice medicine in the state of California. Similarly, the license of any physician who becomes a registered sex offender must be "promptly revoked." This law does not apply to sex-offender registrations resulting from a misdemeanor conviction for indecent exposure. A physician whose license is revoked under this law may petition a court for reinstatement a minimum of five years after the revocation and three years after successful completion of parole and/or probation.

Felony Fraud: Physicians convicted of any felony involving fraud committed in conjunction with the Workers� Compensation or Medi-Cal programs will have their licenses automatically suspended. Physicians with more than one such conviction will have their licenses revoked, "unless the Medical Board finds mitigating circumstances to order some other disposition."

Use of Medical Information for Marketing: California�s Confidentiality of Medical Information Act now expressly prohibits the use of medical information for marketing purposes without a signed authorization.

For more details on these and other new laws of interest to physicians,

http://www.cmanews.org/mailman/listinfo/cma_alert

Contact: CMA�s legal information line, 415/882-5144 or legalinfo@cmanet.org.

===================================

AHA NEWS NOW

The Daily Report for Health Care Executives

www.ahanews.com

===================================

Monday, Dec. 15, 2003

Today's headlines:

2) Study: Increases in medical liability costs lead rise in U.S. tort costs

The U.S. tort system experienced double-digit cost increases for the second consecutive year in 2002, while medical liability cost increases continued to outpace increases in overall tort costs, according to a new study by consultant Tillinghast-Towers Perrin. Medical liability costs have increased an average of 11.9% per year since 1975, or a factor of 21, compared to an average annual increase of 9.3% for all other tort costs, a factor of 11, the study indicates. U.S. medical liability costs totaled nearly $25 billion in 2002, or $85 per person compared to $5 per person in 1975, an escalation that has contributed to the increase in U.S. health care costs over the past 30 years, the study adds. The study can be found at http://www.tillinghast.com/tillinghast/.

==================================

AHA News is a registered trademark of the American Hospital Association. The opinions expressed in AHA News Now are not necessarily those of the American Hospital Association.

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

Do you Yahoo!?
Yahoo! Photos - Get your photo on the big screen in Times Square --0-351374342-1073183033=:31541-- From pottsbri@yahoo.com Mon Jan 5 04:13:47 2004 From: pottsbri@yahoo.com (CAL/AAEM News Service) Date: Sun, 4 Jan 2004 20:13:47 -0800 (PST) Subject: CMS ANNOUNCES PAYMENT INCREASES FOR PHYSICIANS IN 2004 IN ACCORD WITH HISTORIC MEDICARE REFORM LAW Message-ID: <20040105041347.31433.qmail@web41310.mail.yahoo.com> --0-956564043-1073276027=:29530 Content-Type: text/plain; charset=us-ascii -----Original Message----- From: Christina Battisti [mailto:CBattisti@CMS.HHS.GOV] Sent: Wednesday, December 31, 2003 6:33 AM Subject: FOR IMMEDIATE RELEASE Contact: CMS Press Office (202) 690-6145 December 31, 2003 CMS ANNOUNCES PAYMENT INCREASES FOR PHYSICIANS IN 2004 IN ACCORD WITH HISTORIC MEDICARE REFORM LAW The Centers for Medicare & Medicaid Services today issued a final rule that will increase payments to more than 875,000 physicians and other health care professionals for services under the Medicare Physician Fee Schedule by an average of more than 1.5 percent for calendar year 2004. These increases were part of the Medicare Prescription Drug, Improvement, and Modernization Act (DIMA) and replace payment rates published in November that would have reduced payment rates by an average of about 4.5 percent. The earlier rates were based on formula required by Medicare law, but President Bush signed the DIMA law on December 8 that included provisions to raise physician payment rates. The new, higher rates become effective January 1. Physicians in some rural and other areas will see an additional increase in payments as a result of the DIMA provision requiring CMS to change how it adjusts payments to recognize area cost differences. This provision will increase Medicare payment to physicians in some areas of the country by as much as 4.8 percent. A separate provision, affecting physicians in Alaska, will result in more than a 52 percent increase in average physician fee schedule payments for 2004. "We've moved quickly to implement these changes and provide physicians with the higher payments on time with the New Year," Health and Human Services Secretary Tommy G. Thompson said. "By raising payment rates instead of reducing them, we create incentives for physicians to continue to treat Medicare beneficiaries." Because of the late timing of the change in payment rates under this rule, CMS is extending until February 17 the deadline for physicians to decide whether or not they want to participate in Medicare in 2004. Nearly 90 percent of physicians enrolled to treat Medicare beneficiaries chose participating status in 2003, and nearly 95 percent of Medicare claims are submitted by participating physicians. Participating physicians are paid using a higher fee schedule than that used for nonparticipating physicians, but agree to accept assignment and to bill beneficiaries only for the 20 percent co-payment. The new rule will establish more accurate Medicare payment for drugs and their administration. The rule reduces payment for injectible and certain other drugs covered by Medicare to more closely reflect the prices actually charged to physicians by their suppliers. Currently, Medicare pays for these drugs at the lesser of the physician's actual charge to Medicare or 95 percent of the average wholesale price (AWP). Under the new rule, Medicare will pay for most of these drugs at the lesser of the actual charge or 85 percent of the April 1, 2003 AWP. In addition, Medicare will increase payment for the administration of drugs. As required by the statute, certain drugs will continue to be paid at 95 percent of the AWP. These include blood clotting factors; drugs or biologicals that are new in 2004; pneumonia, influenza and hepatitis B vaccines; certain drugs or biologicals furnished in connection with renal dialysis services; and certain infusion drugs that are furnished through certain items of durable medical equipment, such as a nebulizer. Still other drugs, specifically identified as overpaid in studies by the General Accounting Office or the Health and Human Services Office of Inspector General, may be paid as low as 80 percent of the AWP. However, the rule also permits the manufacturer to submit data and other information to CMS to support a request for higher reimbursement for any drug paid under Part B. The final rule with comment period will be published in the January 6, 2004 Federal Register, and will become effective January 1, 2004. Comments will be accepted until March 8, 2004. CMS will review and respond to public comments through additional rulemaking later in 2004. ### Christina Battisti Public Affairs Specialist CMS Office of Public Affairs 202.690.6145 (main line) 202.260.4448 (direct) 202.690.7159 (fax) Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! Photos - Get your photo on the big screen in Times Square --0-956564043-1073276027=:29530 Content-Type: text/html; charset=us-ascii

-----Original Message-----

From: Christina Battisti [mailto:CBattisti@CMS.HHS.GOV]

Sent: Wednesday, December 31, 2003 6:33 AM

Subject: FOR IMMEDIATE RELEASE

Contact: CMS Press Office (202) 690-6145

December 31, 2003

CMS ANNOUNCES PAYMENT INCREASES FOR PHYSICIANS IN 2004 IN ACCORD WITH HISTORIC MEDICARE REFORM LAW

The Centers for Medicare & Medicaid Services today issued a final rule that will increase payments to more than 875,000 physicians and other health care professionals for services under the Medicare Physician Fee Schedule by an average of more than 1.5 percent for calendar year 2004.

These increases were part of the Medicare Prescription Drug, Improvement, and Modernization Act (DIMA) and replace payment rates published in November that would have reduced payment rates by an average of about 4.5 percent. The earlier rates were based on formula required by Medicare law, but President Bush signed the DIMA law on December 8 that included provisions to raise physician payment rates. The new, higher rates become effective January 1.

Physicians in some rural and other areas will see an additional increase in payments as a result of the DIMA provision requiring CMS to change how it adjusts payments to recognize area cost differences. This provision will increase Medicare payment to physicians in some areas of the country by as much as 4.8 percent. A separate provision, affecting physicians in Alaska, will result in more than a 52 percent increase in average physician fee schedule payments for 2004.

"We've moved quickly to implement these changes and provide physicians with the higher payments on time with the New Year," Health and Human Services Secretary Tommy G. Thompson said. "By raising payment rates instead of reducing them, we create incentives for physicians to continue to treat Medicare beneficiaries."

Because of the late timing of the change in payment rates under this rule, CMS is extending until February 17 the deadline for physicians to decide whether or not they want to participate in Medicare in 2004. Nearly 90 percent of physicians enrolled to treat Medicare beneficiaries chose participating status in 2003, and nearly 95 percent of Medicare claims are submitted by participating physicians. Participating physicians are paid using a higher fee schedule than that used for nonparticipating physicians, but agree to accept assignment and to bill beneficiaries only for the 20 percent co-payment.

The new rule will establish more accurate Medicare payment for drugs and their administration. The rule reduces payment for injectible and certain other drugs covered by Medicare to more closely reflect the prices actually charged to physicians by their suppliers. Currently, Medicare pays for these drugs at the lesser of the physician's actual charge to Medicare or 95 percent of the average wholesale price (AWP). Under the new rule, Medicare will pay for most of these drugs at the lesser of the actual charge or 85 percent of the April 1, 2003 AWP. In addition, Medicare will increase payment for the administration of drugs.

As required by the statute, certain drugs will continue to be paid at 95 percent of the AWP. These include blood clotting factors; drugs or biologicals that are new in 2004; pneumonia, influenza and hepatitis B vaccines; certain drugs or biologicals furnished in connection with renal dialysis services; and certain infusion drugs that are furnished through certain items of durable medical equipment, such as a nebulizer.

Still other drugs, specifically identified as overpaid in studies by the General Accounting Office or the Health and Human Services Office of Inspector General, may be paid as low as 80 percent of the AWP. However, the rule also permits the manufacturer to submit data and other information to CMS to support a request for higher reimbursement for any drug paid under Part B.

The final rule with comment period will be published in the January 6, 2004 Federal Register, and will become effective January 1, 2004. Comments will be accepted until March 8, 2004. CMS will review and respond to public comments through additional rulemaking later in 2004.

###

Christina Battisti

Public Affairs Specialist

CMS Office of Public Affairs

202.690.6145 (main line)

202.260.4448 (direct)

202.690.7159 (fax)

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

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Yahoo! Photos - Get your photo on the big screen in Times Square --0-956564043-1073276027=:29530-- From pottsbri@yahoo.com Thu Jan 8 07:09:00 2004 From: pottsbri@yahoo.com (CAL/AAEM News Service) Date: Wed, 7 Jan 2004 23:09:00 -0800 (PST) Subject: CA association sues state agency over interpretation of nurse staffing regs, -AND- Delays in Los Angeles Emergency Rooms Increase Response Times of Paramedics Message-ID: <20040108070900.48668.qmail@web41309.mail.yahoo.com> --0-1019847686-1073545740=:47054 Content-Type: text/plain; charset=us-ascii =================================== AHA NEWS NOW The Daily Report for Health Care Executives www.ahanews.com =================================== Monday, Jan. 5, 2004 1) CA association sues state agency over interpretation of nurse staffing regs The California Healthcare Association has filed suit against the state Department of Health Services over the state's interpretation of nurse staffing regulations that took effect Jan. 1. The civil suit was filed on Dec. 30 and assigned to Sacramento County Superior Court Judge Trena Burger-Plavin. CHA has requested an expedited hearing; as of News Now's deadline, no decision on a hearing date had been announced. At issue is a departmental interpretation of the law holding that a hospital still is subject to the reg's staffing ratios when a nurse is temporarily away from patients. CHA says this means that a nurse cannot even take a break or get a meal unless there's another qualified nurse available to fill in. "This requirement will result in virtually all nursing units in the state failing to comply; and cannot be met by California's hospitals without effectuating draconian reductions in emergency and other services as there is an acute, statewide shortage of licensed nurs! es," the suit said. CHA stressed that it's not opposing the ratios, but rather challenging how they were interpreted. ================================== Copyright 2004 by the American Hospital Association. All rights reserved. For republication rights, contact Craig Webb. AHA News is a registered trademark of the American Hospital Association. The opinions expressed in AHA News Now are not necessarily those of the American Hospital Association. ==================================== -----Original Message----- From: California Healthline To: CALIFORNIAHEALTHLINEHTML@MAILINGS.ADVISORY.COM Sent: 12/19/2003 10:34 AM Delays in Los Angeles Emergency Rooms Increase Response Times of Paramedics, Study Finds 12/19/2003 Paramedics in Los Angeles often are not available to provide emergency services because of "inordinate delays in dropping off patients" at emergency rooms, according to a study released Friday that will appear in the January issue of the Annals of Emergency Medicine, the Los Angeles Times reports. In the study, Dr. Marc Eckstein, medical director of the Los Angeles Fire Department and an emergency physician at the Keck School of Medicine at the University of Southern California, and colleagues analyzed data from department dispatchers. The study found that between April 2001 and March 2002, in one in every eight trips to ERs paramedics could not "return to duty rapidly" because they had to wait for ERs to admit patients, the Times reports. According to the study, paramedics often had to wait more than 27 minutes -- 12 minutes longer than recommended -- for ERs to admit patients. The study found that Martin Luther King Jr./Drew Medical Center, Good Samaritan Hospital and Cali! fornia Hospital Medical Center were responsible for many of the delays. "It is not clear precisely how much" the delays at ERs, which are caused by a "crush of patients," affect the response times of paramedics, the Times reports. However, Carol Gunter, acting director of the Los Angeles County Emergency Medical Services Agency, said, "We'd get to patients faster" without the delays (Hymon, Los Angeles Times, 12/19). ===================================== Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes --0-1019847686-1073545740=:47054 Content-Type: text/html; charset=us-ascii

===================================

AHA NEWS NOW

The Daily Report for Health Care Executives

www.ahanews.com

===================================

Monday, Jan. 5, 2004

1) CA association sues state agency over interpretation of nurse staffing regs

The California Healthcare Association has filed suit against the state Department of Health Services over the state's interpretation of nurse staffing regulations that took effect Jan. 1. The civil suit was filed on Dec. 30 and assigned to Sacramento County Superior Court Judge Trena Burger-Plavin. CHA has requested an expedited hearing; as of News Now's deadline, no decision on a hearing date had been announced. At issue is a departmental interpretation of the law holding that a hospital still is subject to the reg's staffing ratios when a nurse is temporarily away from patients. CHA says this means that a nurse cannot even take a break or get a meal unless there's another qualified nurse available to fill in. "This requirement will result in virtually all nursing units in the state failing to comply; and cannot be met by California's hospitals without effectuating draconian reductions in emergency and other services as there is an acute, statewide shortage of licensed n! urses," the suit said. CHA stressed that it's not opposing the ratios, but rather challenging how they were interpreted. ==================================

AHA News is a registered trademark of the American Hospital Association. The opinions expressed in AHA News Now are not necessarily those of the American Hospital Association.

====================================

-----Original Message-----

From: California Healthline

To: CALIFORNIAHEALTHLINEHTML@MAILINGS.ADVISORY.COM

Sent: 12/19/2003 10:34 AM

Delays in Los Angeles Emergency Rooms Increase Response Times of Paramedics, Study Finds

12/19/2003

Paramedics in Los Angeles often are not available to provide emergency services because of "inordinate delays in dropping off patients" at emergency rooms, according to a study released Friday that will appear in the January issue of the Annals of Emergency Medicine, the Los Angeles Times reports. In the study, Dr. Marc Eckstein, medical director of the Los Angeles Fire Department and an emergency physician at the Keck School of Medicine at the University of Southern California, and colleagues analyzed data from department dispatchers. The study found that between April 2001 and March 2002, in one in every eight trips to ERs paramedics could not "return to duty rapidly" because they had to wait for ERs to admit patients, the Times reports. According to the study, paramedics often had to wait more than 27 minutes -- 12 minutes longer than recommended -- for ERs to admit patients. The study found that Martin Luther King Jr./Drew Medical Center, Good Samaritan Hospital and C! alifornia Hospital Medical Center were responsible for many of the delays. "It is not clear precisely how much" the delays at ERs, which are caused by a "crush of patients," affect the response times of paramedics, the Times reports. However, Carol Gunter, acting director of the Los Angeles County Emergency Medical Services Agency, said, "We'd get to patients faster" without the delays (Hymon, Los Angeles Times, 12/19).

=====================================

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

Do you Yahoo!?
Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes --0-1019847686-1073545740=:47054-- From akazzi@uci.edu Fri Jan 9 06:31:50 2004 From: akazzi@uci.edu (Kazzi, A. Antoine) Date: Thu, 8 Jan 2004 22:31:50 -0800 Subject: 2. Court Rules in Favor of Noncontracting Physicians (CMA Alert) Message-ID: <59CDD9FF884EAE4AB86132E86110D72202E09A67@wicket.ndc.mc.uci.edu> This message is in MIME format. Since your mail reader does not understand this format, some or all of this message may not be legible. ------_=_NextPart_001_01C3D67A.43904B70 Content-Type: text/plain Indeed, this is a MAJOR victory which was most dangerous and one that will be likely be followed by an HMO-DHS counter-attack. We must be ready, more ready for this challenge and predict it will come stronger ahead of us... So, join the CMA... Yes, Join the CMA... Join the CMA... And of course, please make sure that, irrespective of who you belong to in EM, whether you are a member of AAEM, ACEP, SAEM, all or none, please most of all make sure that you contribute to the EMPAC, the one (unified/united) California fund for political action committee... Email me for details on how to contribute to EMPAC> My two cents... Antoine Kazzi A. Antoine Kazzi, MD, FAAEM Vice-President, the American Academy of Emergency Medicine Vice-Chair, Department of Emergency Medicine University of California, Irvine -----Original Message----- From: cma_alert@cmanews.org [mailto:cma_alert@cmanews.org] Sent: Thursday, January 08, 2004 2:50 PM 2. Court Rules in Favor of Non-Contracting Physicians In a significant victory for physicians, a Los Angeles trial court ruled that non-contracting physicians who provide emergency services to health plan enrollees are not prohibited from balance billing those patients if an HMO fails to reimburse them for the entire amount billed. In this case, Prospect Health Service Medical Group v. St. Johns Emergency Medical Group, the plaintiff (a capitated IPA) argued that when a physician bills and is paid by an HMO or its contracting intermediary, an "implied contract" has been created whereby the physician is prohibited from balance billing the patient under the Knox-Keene Act. In her decision, Judge Linda Lefkowitz ruled that non-contracting physicians are not precluded from balance billing patients and that an opinion published by the Department of Managed Health Care to that effect wrongly relied on unpublished, distinguishable cases, which have no precedential value. Judge Lefkowitz also rejected the plaintiff's request to set Medicare rates as the defined "reasonable" rate for emergency medical services. Click here to download a copy of the court's opinion in this case. For more information, see CMA ON-CALL document #0130, "Non-contracting Physicians/Implied Contracts." ON-CALL documents are available free to CMA members at CMA's members-only website . Nonmembers can purchase ON-CALL documents for $2 per page at the CMA Bookstore . Contact: CMA's legal information line, 415/882-5144 or legalinfo@cmanet.org This e-mail/fax message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail/fax and destroy all copies of the original message. ------_=_NextPart_001_01C3D67A.43904B70 Content-Type: text/html CMA Alert

Indeed, this is a MAJOR victory which was most dangerous and one that will be likely be followed by an HMO-DHS counter-attack. We must be ready, more ready for this challenge and predict it will come stronger ahead of us...

So, join the CMA...

Yes, Join the CMA...

Join the CMA...

And of course, please make sure that, irrespective of who you belong to in EM, whether you are a member of AAEM, ACEP, SAEM, all or none, please most of all make sure that you contribute to the EMPAC, the one (unified/united) California fund for political action committee... Email me for details on how to contribute to EMPAC>

My two cents...

Antoine Kazzi

A. Antoine Kazzi, MD, FAAEM

Vice-President, the American Academy of Emergency Medicine

Vice-Chair, Department of Emergency Medicine

University of California, Irvine

-----Original Message-----
From: cma_alert@cmanews.org [mailto:cma_alert@cmanews.org]
Sent: Thursday, January 08, 2004 2:50 PM

2. Court Rules in Favor of Non-Contracting Physicians

In a significant victory for physicians, a Los Angeles trial court ruled that non-contracting physicians who provide emergency services to health plan enrollees are not prohibited from balance billing those patients if an HMO fails to reimburse them for the entire amount billed.

In this case, Prospect Health Service Medical Group v. St. Johns Emergency Medical Group, the plaintiff (a capitated IPA) argued that when a physician bills and is paid by an HMO or its contracting intermediary, an "implied contract" has been created whereby the physician is prohibited from balance billing the patient under the Knox-Keene Act.

In her decision, Judge Linda Lefkowitz ruled that non-contracting physicians are not precluded from balance billing patients and that an opinion published by the Department of Managed Health Care to that effect wrongly relied on unpublished, distinguishable cases, which have no precedential value.

Judge Lefkowitz also rejected the plaintiff's request to set Medicare rates as the defined "reasonable" rate for emergency medical services.

Click here to download a copy of the court's opinion in this case. For more information, see CMA ON-CALL document #0130, "Non-contracting Physicians/Implied Contracts." ON-CALL documents are available free to CMA members at CMA's members-only website. Nonmembers can purchase ON-CALL documents for $2 per page at the CMA Bookstore.

Contact: CMA's legal information line, 415/882-5144 or legalinfo@cmanet.org

This e-mail/fax message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail/fax and destroy all copies of the original message.

------_=_NextPart_001_01C3D67A.43904B70-- From pottsbri@yahoo.com Mon Jan 12 01:36:14 2004 From: pottsbri@yahoo.com (CAL/AAEM News Service) Date: Sun, 11 Jan 2004 17:36:14 -0800 (PST) Subject: Federal Appeals Court Panel Upholds State Rules on Physician Advertisements Message-ID: <20040112013615.37191.qmail@web41309.mail.yahoo.com> --0-1414384946-1073871374=:36910 Content-Type: text/plain; charset=us-ascii -----Original Message----- From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] Sent: Monday, January 05, 2004 10:51 AM Federal Appeals Court Panel Upholds State Rules on Physician Advertisements 01/05/2004 A three-judge panel of the U.S. 9th Circuit Court of Appeals on Friday upheld state rules that limit the content that physicians can include in their advertisements, the http://www.sfgate.com/cgi-bin/article.cgi?file=/news/archive/2004/01/03/state0324EST0007.DTL AP/San Francisco Chronicle reports. The regulations, enacted in 1994, mandate that physicians cannot advertise that they are "board certified" from medical institutions in the event that those institutions do not meet standards established by the Medical Board of California . In the case, the Sonora-based American Academy of Pain Management filed a lawsuit against the state over allegations that the rules violated the First Amendment after the medical board said that physicians could not advertise that they are board certified by the group. Judge Procter Hug ruled that the rules did not the violate First Amendment rights of physicians because the regulations did not prevent them from "advertising that they limit their practice to certain fields or that they are members of, or have had special education from, non-qualified boards or associations." Hug wrote, "Such consistent usage informs the medical community and the general public that the physicians and surgeons advertising that they are 'board certified' have met a certain standard of postgraduate education and experience" (Kravets, AP/San Francisco Chronicle, 1/3). Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes --0-1414384946-1073871374=:36910 Content-Type: text/html; charset=us-ascii

-----Original Message-----

From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM]

Sent: Monday, January 05, 2004 10:51 AM

Federal Appeals Court Panel Upholds State Rules on Physician Advertisements

01/05/2004

A three-judge panel of the U.S. 9th Circuit Court of Appeals on Friday upheld state rules that limit the content that physicians can include in their advertisements, the http://www.sfgate.com/cgi-bin/article.cgi?file=/news/archive/2004/01/03/state0324EST0007.DTL AP/San Francisco Chronicle reports. The regulations, enacted in 1994, mandate that physicians cannot advertise that they are "board certified" from medical institutions in the event that those institutions do not meet standards established by the Medical Board of California <http://www.medbd.ca.gov/> . In the case, the Sonora-based American Academy of Pain Mana! gement <http://www.aapainmanage.org/> filed a lawsuit against the state over allegations that the rules violated the First Amendment after the medical board said that physicians could not advertise that they are board certified by the group.

Judge Procter Hug ruled that the rules did not the violate First Amendment rights of physicians because the regulations did not prevent them from "advertising that they limit their practice to certain fields or that they are members of, or have had special education from, non-qualified boards or associations." Hug wrote, "Such consistent usage informs the medical community and the general public that the physicians and surgeons advertising that they are 'board certified' have met a certain standard of postgraduate education and experience" (Kravets, AP/San Francisco Chronicle, 1/3).

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

Do you Yahoo!?
Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes --0-1414384946-1073871374=:36910-- From pottsbri@yahoo.com Tue Jan 13 07:17:28 2004 From: pottsbri@yahoo.com (CAL/AAEM News Service) Date: Mon, 12 Jan 2004 23:17:28 -0800 (PST) Subject: Bush Administration To Announce New Policy on Excessive Medicare Payments Message-ID: <20040113071728.42502.qmail@web41314.mail.yahoo.com> --0-1956235946-1073978248=:42348 Content-Type: text/plain; charset=us-ascii IMPORTANT NOTE: The rule would apply to prescription drugs administered by physicians, pharmacy services, ambulance services, medical equipment and supplies, laboratory tests and diagnostic imaging, but it would NOT apply to physician services provided under the Medicare fee schedule. -----Original Message----- From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] Bush Administration To Announce New Policy on Excessive Medicare Payments 01/05/2004 The Bush administration is expected to issue a final rule soon on a proposal designed to prevent health care providers from submitting Medicare and Medicaid claims that are "substantially in excess" of what they typically charge private payers for items or services, the New York Times reports. Violation of the policy could result in the exclusion of hospitals, drugstores and other providers from any federal health care program if their government prices are more than 20% higher than their "usual charges," which would be calculated as either the average or median amount charged to private patients and insurers for items or services during the past year, according to the Times. The rule would apply to prescription drugs administered by physicians, pharmacy services, ambulance services, medical equipment and supplies, laboratory tests and diagnostic imaging, but it would not apply to physician services provided under the Medicare fee schedule. Providers that offer charity care to the uninsured would be allowed to exclude such cases when calculating their usual charges. The administration said the new policy is necessary as "the Medicare program pays considerably more for some items and services than other payers" because some providers are "simply overcharging" the program. Lewis Morris, chief counsel to the HHS inspector general, said the policy would not require providers to offer the federal government their "best price," but it would address "the narrow situation in which providers are charging Medicare or Medicaid substantially more than they regularly charge a majority of their customers." Reaction Health care providers maintain that medical payments are "so complex and convoluted" that calculating usual charges and making "meaningful comparisons" between Medicare and other insurers would be "impossible," the Times reports. Richard Pollack, executive vice president of the American Hospital Association, said, "Compliance with the proposed rule would be unworkable, extremely burdensome and exceedingly expensive" because "[m]ost hospitals have 10,000 or more items or services" on their fee schedules and have ever-changing contracts with 25 to 100 or more insurers. Pollack estimated compliance with such a rule would cost $1 billion annually. Meanwhile, some insurers said the rule might encourage providers to increase their charges to private insurers rather than reducing charges to the government, which would increase insurance premiums (Pear, New York Times, 12/28/03). Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes --0-1956235946-1073978248=:42348 Content-Type: text/html; charset=us-ascii

IMPORTANT NOTE:

The rule would apply to prescription drugs administered by physicians, pharmacy services, ambulance services, medical equipment and supplies, laboratory tests and diagnostic imaging, but it would NOT apply to physician services provided under the Medicare fee schedule.

-----Original Message-----

From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM]

Bush Administration To Announce New Policy on Excessive Medicare Payments

01/05/2004

The Bush administration is expected to issue a final rule soon on a proposal designed to prevent health care providers from submitting Medicare and Medicaid claims that are "substantially in excess" of what they typically charge private payers for items or services, the New York Times reports. Violation of the policy could result in the exclusion of hospitals, drugstores and other providers from any federal health care program if their government prices are more than 20% higher than their "usual charges," which would be calculated as either the average or median amount charged to private patients and insurers for items or services during the past year, according to the Times.

The rule would apply to prescription drugs administered by physicians, pharmacy services, ambulance services, medical equipment and supplies, laboratory tests and diagnostic imaging, but it would not apply to physician services provided under the Medicare fee schedule.

Providers that offer charity care to the uninsured would be allowed to exclude such cases when calculating their usual charges. The administration said the new policy is necessary as "the Medicare program pays considerably more for some items and services than other payers" because some providers are "simply overcharging" the program. Lewis Morris, chief counsel to the HHS <http://www.hhs.gov/> inspector general, said the policy would not require providers to offer the federal government their "best price," but it would address "the narrow situation in which providers are charging Medicare or Medicaid substantially more than they regularly charge a majority of their customers."

Reaction

Health care providers maintain that medical payments are "so complex and convoluted" that calculating usual charges and making "meaningful comparisons" between Medicare and other insurers would be "impossible," the Times reports. Richard Pollack, executive vice president of the American <http://www.hospitalconnect.com/login/aha> Hospital Association, said, "Compliance with the proposed rule would be unworkable, extremely burdensome and exceedingly expensive" because "[m]ost hospitals have 10,000 or more items or services" on their fee schedules and have ever-changing contracts with 25 to 100 or more insurers. Pollack estimated compliance with such a rule would cost $1 billion annually. Meanwhile, some insurers said the rule might encourage providers to increase their charges to private insurers rather than reducing charges to the government, which would increase insurance premiums (Pear, New York Times, 12/28/03).

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

Do you Yahoo!?
Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes --0-1956235946-1073978248=:42348-- From pottsbri@yahoo.com Wed Jan 14 13:41:15 2004 From: pottsbri@yahoo.com (CAL/AAEM News Service) Date: Wed, 14 Jan 2004 05:41:15 -0800 (PST) Subject: Federal Judge Issues Preliminary Injunction To Block Medi-Cal Reimbursement Rate Cuts Message-ID: <20040114134115.95659.qmail@web41312.mail.yahoo.com> --0-730341637-1074087675=:94098 Content-Type: text/plain; charset=us-ascii The 11 plaintiffs that joined the CMA in suing the Department of Health Services included CAL/ACEP who contributed 5000$ to the cost of this lawsuit. Following a ruling like this, it is very unlikely for the Governor or DHS to move forward with the additional 10% reduction they were planning to force on us next year in addition to the 5% which was stopped. A few words of appreciation are due here to our colleagues on the CAL/ACEP Board and in the CMA leadership for their proactive vision and action here. Antoine Kazzi, MD, FAAEM AAEM Vice President -----Original Message----- From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] Sent: Monday, January 05, 2004 10:51 AM Federal Judge Issues Preliminary Injunction To Block Medi-Cal Reimbursement Rate Cuts 01/05/2004 Chief U.S. District Judge David Levi on Dec. 23 issued a preliminary injunction that will prevent the implementation of 5% cuts to Medi-Cal reimbursement rates for providers who serve traditional fee-for-service beneficiaries, who make up about half of the program's beneficiaries, the http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/12/24/BUG6L3TEKE1.DTL San Francisco Chronicle reports (Colliver, San Francisco Chronicle, 12/24/03). The California Medical Association and 11 other plaintiffs representing Medi-Cal providers in November filed the lawsuit to halt the implementation of the rate cut, which was approved by the Legislature as part of the fiscal year 2003-2004 budget to save the state $115 million and help eliminate a $38 billion budget deficit. The lawsuit claims that the reduction violates the federal Social Security Act, which requires that Medicaid reimbursement rates attract enough docto! rs to serve the program's beneficiaries, and alleges that the state did not hold a properly noticed public hearing on the rate reductions ( http://www.californiahealthline.org/members/basecontent.asp?contentid=50539&collectionid=3&program=1 California Healthline, 12/17/03). Levi ruled that the rate reductions, which were scheduled to take effect Jan. 1, would violate federal law because a previous ruling by the U.S. 9th Circuit Court of Appeals, which includes California, established that Medi-Cal beneficiaries are entitled to a rate-setting process that is not arbitrary and considers provider costs, quality of services and equal access to medical services (Rabin, Los Angeles Times, 12/24/03). The preliminary injunction does not apply to Medi-Cal's managed care plans, whose members account for 51.6% of the program's beneficiaries. Levi ruled that "it is the responsibility of the health plans, not the provide! rs, to challenge the cuts affecting those patients," the Chronicle reports. Lynn Carman, an attorney for the independent pharmacists who were represented in the suit, said they are considering whether to file an appeal or a new lawsuit to halt reimbursement cuts for providers who serve managed care beneficiaries (San Francisco Chronicle, 12/24/03). Ruling Details "As long as the state wishes to be a part of the Medicaid program, it must meet the requirements of the Medicaid Act," Levi wrote in a 42-page order. He wrote, "In this case, there is no record of considered decision-making," adding that there is no evidence that lawmakers sought a recommendation from the Department of Health Services "or that any responsible official in state government made a determination" of reimbursement rates that took into account the provisions of the Medicaid Act. Levi said he has seen evidence that there are "serious access problems even under the current rates" and that providers are likely to stop accepting new Medi-Cal beneficiaries or stop serving their existing patients if the rates are reduced. While attorneys for DHS Director Diana Bonta, the defendant in the lawsuit, argued that the state made the cuts because it was "faced with very difficult choices and made the best decision that it could," Levi said that bu! dget constraints "are not alone a valid justification for rate setting." Levi said Bonta's attorneys could not demonstrate that the Legislature made the cuts based on data that showed the reductions "could be sustained by providers, in light of their costs, without a loss of quality or equal access for Medi-Cal recipients" (Walsh/Brown, http://www.sacbee.com/content/politics/ca/budget/story/8001980p-8938494c.html Sacramento Bee, 12/24/03). Reaction The decision is "a victory" for patient advocates and professional organizations representing physicians, dentists and pharmacists, the Times reports. Dr. Jack Lewin, chief executive of the California Medical Association , said the decision will "prevent further erosion of access to care for our most vulnerable patients" (Los Angeles Times, 12/24/03). Although the plaintiffs had sought an injunction that would prevent cuts for all Medi-Cal beneficiaries, Craig Cannizzo, an attorney for the physicians in the suit, said, "I view [the decision] as a complete victory because it's going to be a very serious obstacle to the administration's proposal to consider further rate reductions." Former Gov. Gray Davis (D) initiated the 5% reductions, but Gov. Arnold Schwarzenegger (R) has proposed http://www.californiahealthline.org/members/basecontent.asp?contentid=50507&collectionid=3&program=1 an additional 10% reduction to Medi-Cal reimbursement rates. DHS spok! esperson Robert Miller said it was "much too early to say" what the ruling's implications are and what actions the department can take in response (San Francisco Chronicle, 12/24/03). Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes --0-730341637-1074087675=:94098 Content-Type: text/html; charset=us-ascii

The 11 plaintiffs that joined the CMA in suing the Department of Health Services <http://www.dhs.cahwnet.gov/> included CAL/ACEP who contributed 5000$ to the cost of this lawsuit.

Following a ruling like this, it is very unlikely for the Governor or DHS to move forward with the additional 10% reduction they were planning to force on us next year in addition to the 5% which was stopped.

A few words of appreciation are due here to our colleagues on the CAL/ACEP Board and in the CMA leadership for their proactive vision and action here.

Antoine Kazzi, MD, FAAEM

AAEM Vice President

-----Original Message-----

From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM]

Sent: Monday, January 05, 2004 10:51 AM

Federal Judge Issues Preliminary Injunction To Block Medi-Cal Reimbursement Rate Cuts

01/05/2004

Chief U.S. District Judge David Levi on Dec. 23 issued a preliminary injunction that will prevent the implementation of 5% cuts to Medi-Cal <http://www.medi-cal.ca.gov/> reimbursement rates for providers who serve traditional fee-for-service beneficiaries, who make up about half of the program's beneficiaries, the http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/12/24/BUG6L3TEKE1.DTL San Francisco Chronicle reports (Colliver, San Francisco Chronicle, 12/24/03). The California <http://www.cmanet.org/> Medical Association and 11 other plaintiffs representing Medi-Cal providers in November filed the lawsuit to halt the implementation of the rate cut, which was approved by the Legislature as part of the fiscal year 2003-2004 budget to save the state $115 million and help eliminate a $38 billion budget deficit. The lawsuit claims that the reduction violates the federal Social Security Act, which requires that Medicaid reimbursement rates attract enough doctors to serve the program's beneficiaries, and alleges that the state did not hold a properly noticed public hearing on the rate reductions ( http://www.californiahealthline.org/members/basecontent.asp?contentid=50539&collectionid=3&program=1 Californ! ia Healthline, 12/17/03). Levi ruled that the rate reductions, which were scheduled to take effect Jan. 1, would violate federal law because a previous ruling by the U.S. 9th Circuit Court of Appeals, which includes California, established that Medi-Cal beneficiaries are entitled to a rate-setting process that is not arbitrary and considers provider costs, quality of services and equal access to medical services (Rabin, <http://www.latimes.com/news/local/la-me-doctors24dec24,1,3473454.story> Los Angeles Times, 12/24/03). The preliminary injunction does not apply to Medi-Cal's managed care plans, whose members account for 51.6% of the program's beneficiaries. Levi ruled that "it is the responsibility of the health plans, not the providers, to challenge the cuts affecting those patients," the Chronicle reports. Lynn Carman, an at! torney for the independent pharmacists who were represented in the suit, said they are considering whether to file an appeal or a new lawsuit to halt reimbursement cuts for providers who serve managed care beneficiaries (San Francisco Chronicle, 12/24/03).

Ruling Details

"As long as the state wishes to be a part of the Medicaid program, it must meet the requirements of the Medicaid Act," Levi wrote in a 42-page order. He wrote, "In this case, there is no record of considered decision-making," adding that there is no evidence that lawmakers sought a recommendation from the Department <http://www.dhs.cahwnet.gov/> of Health Services "or that any responsible official in state government made a determination" of reimbursement rates that took into account the provisions of the Medicaid Act. Levi said he has seen evidence that there are "serious access problems even under the current rates" and that providers are likely to stop accepting new Medi-Cal beneficiaries or stop serving their existing patients if the rates are reduced. While attorneys for DHS Director Diana Bonta, the defendant in the lawsuit, argued that the state made the cut! s because it was "faced with very difficult choices and made the best decision that it could," Levi said that budget constraints "are not alone a valid justification for rate setting." Levi said Bonta's attorneys could not demonstrate that the Legislature made the cuts based on data that showed the reductions "could be sustained by providers, in light of their costs, without a loss of quality or equal access for Medi-Cal recipients" (Walsh/Brown, http://www.sacbee.com/content/politics/ca/budget/story/8001980p-8938494c.html Sacramento Bee, 12/24/03).

Reaction

The decision is "a victory" for patient advocates and professional organizations representing physicians, dentists and pharmacists, the Times reports. Dr. Jack Lewin, chief executive of the California Medical Association <http://www.cmanet.org/> , said the decision will "prevent further erosion of access to care for our most vulnerable patients" (Los Angeles Times, 12/24/03). Although the plaintiffs had sought an injunction that would prevent cuts for all Medi-Cal beneficiaries, Craig Cannizzo, an attorney for the physicians in the suit, said, "I view [the decision] as a complete victory because it's going to be a very serious obstacle to the administration's proposal to consider further rate reductions." Former Gov. Gray Davis (D) initiated the 5% reductions, but Gov. Arnold Schwarzenegger (R) has proposed http://www.californiahealthline.org/members/basecontent.asp?contentid=50507&collectionid=3&program=1 an additional 10% reduction to Medi-Cal reimbursement rates. DHS spokesperson Robert Miller said it was "much too early to say" what the ruling's implications are and what actions the department can take in response (San Francisco Chronicle, 12/24/03).

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

Do you Yahoo!?
Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes --0-730341637-1074087675=:94098-- From pottsbri@yahoo.com Thu Jan 15 18:27:39 2004 From: pottsbri@yahoo.com (CAL/AAEM News Service) Date: Thu, 15 Jan 2004 10:27:39 -0800 (PST) Subject: Medi-Cal Reimbursement Rate Cut Included in Budget Proposal May Be Illegal, Legislative Analyst Says Message-ID: <20040115182739.51297.qmail@web41303.mail.yahoo.com> --0-1784842744-1074191259=:50387 Content-Type: text/plain; charset=us-ascii -----Original Message----- From: cma_alert@cmanews.org [mailto:cma_alert@cmanews.org] Sent: Tuesday, January 13, 2004 9:29 AM Proposed Budget Would Cut Medi-Cal Reimbursement by 10% The new administration on Friday released its proposed 2004-2005 budget-which includes a 10 percent cut to Medi-Cal provider rates and caps enrollment for Healthy Families and other health and welfare programs. Californians United for Quality Health-the CMA-led coalition of physicians, patients, and consumer and health care advocates-continues to work hard to make the administration understand that the proposed cuts will actually end up costing the state more than they save. Not only will the state forfeit hundreds of millions in federal matching dollars, but the cuts will also drive up costs in overwrought emergency rooms. The 10 percent in Medi-Cal cuts mimics those proposed by Governor Gray Davis last year. Gov. Davis' cuts were reduced by the legislature to 5 percent and would have gone into effect on January 1, had CMA not sought and won an injunction in federal court. In granting the preliminary injunction, U.S. District Judge David Levy said that the state of California failed to consider how the cuts would affect access to care for the more than 6 million poor, disabled, elderly and children whose health care is provided by Medi-Cal. -----Original Message----- From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] Sent: Wednesday, January 14, 2004 10:29 AM Medi-Cal Reimbursement Rate Cut Included in Budget Proposal May Be Illegal, Legislative Analyst Says 01/14/2004 In her nonpartisan analysis of the state budget proposal put forth by Gov. Arnold Schwarzenegger (R), Legislative Analyst Elizabeth Hill on Tuesday said that the proposal is a "solid starting point" but noted that a provision to reduce Medi-Cal provider reimbursements might be illegal, the http://www.sacbee.com/content/politics/ca/budget/story/8096801p-9029196c.html Sacramento Bee reports (Hill, Sacramento Bee, 1/14). The $99.1 billion budget proposal does not include a tax increase but would reduce state funding for health care programs by more than $900 million, with about $880 million in spending cuts to Medi-Cal, including a provider reimbursement rate cut of 10% ( http://www.californiahealthline.org/members/basecontent.asp?contentid=50671&collectionid=3&contentarea=39984 California Healthline, 1/13). In her report, Hill noted that the budget depends on savings from the 10% rate reduction in addition to a previous 5% reimbursement cut that c! urrently is being challenged in court (Mendel, http://www.signonsandiego.com/news/uniontrib/wed/news/news_1n14budget.html San Diego Union-Tribune, 1/14). The California Medical Association and 11 other plaintiffs representing Medi-Cal providers in November filed a lawsuit to halt the implementation of the 5% reimbursement rate cut, which was approved by the Legislature as part of the fiscal year 2003-2004 budget. Chief U.S. District Judge David Levi last month issued a preliminary injunction preventing the implementation of the cuts scheduled to take effect Jan. 1 ( http://www.californiahealthline.org/members/basecontent.asp?contentid=50659&collectionid=3&contentarea=39888 California Healthline, 1/12). Other Programs Hill stated that proposed reductions in spending for state programs "would have far-reaching consequences for the scope of state services" and urged lawmakers to consider tax increases or removing tax exemptions to increase state revenue (Halper, http://www.latimes.com/news/local/la-me-lao14jan14,1,1693445.story?coll=la-headlines-california Los Angeles Times, 1/14). The budget proposal also would limit enrollment in Healthy Families and other health programs, increase fees for enrollees of some programs and eliminate some domestic services for people with disabilities and elderly residents (California Healthline, 1/13). Hill noted that about 55% of the proposed budget reductions come from program cuts and that 45% come from borrowing, reappropriating local government funds and other sources. She said that about 67% of the savings would be sustainable in future years (Gledhill, http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2004/01/14/MNGS649LVD1.DTL San Francisco Chronicle, 1/14). Hill concluded, "Even if every solution proposed by the governor were adopted and the savings scored by the administration were realized, we estimate there would be at least a $6 billion structural budget problem remaining" by 2005 (Los Angeles Times, 1/14). Reaction Finance Director Donna Arduin disputed the $6 billion figure, saying that the amount "will come down" to about $3 billion when the administration releases details about cuts to health care and prison programs (Marimow, San Jose Mercury News, 1/14). The http://www.contracostatimes.com/mld/cctimes/content_syndication/local_news/7706449.htm Contra Costa Times reports that both Republicans and Democrats "applauded the report, with both claiming it bolstered their positions" (LaMar, Contra Costa Times, 1/14). Assembly Budget Committee Chair Jenny Oropeza (D-Long Beach) said that the remaining budget shortfall predicted by Hill shows that "[w]e have to do more than cut programs for the poor" to balance the budget (Los Angeles Times, 1/14). However, Senate Budget Committee Vice Chair Dick Ackerman (R-Irvine) said that the budget is designed to reduce the deficit over several years, adding, "It's going to be a two- to thr! ee-year fix to get out of the hole" (San Francisco Chronicle, 1/14). Schwarzenegger's budget proposal, including a summary and highlights of the budget for health and human services, is available online . Note: You will need Adobe Acrobat Reader to access the proposal. The Legislative Analyst's report also is available online Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes --0-1784842744-1074191259=:50387 Content-Type: text/html; charset=us-ascii

-----Original Message-----

From: cma_alert@cmanews.org [mailto:cma_alert@cmanews.org]

Sent: Tuesday, January 13, 2004 9:29 AM

Proposed Budget Would Cut Medi-Cal Reimbursement by 10%

The new administration on Friday released its proposed 2004-2005 budget-which includes a 10 percent cut to Medi-Cal provider rates and caps enrollment for Healthy Families and other health and welfare programs.

Californians United for Quality Health-the CMA-led coalition of physicians, patients, and consumer and health care advocates-continues to work hard to make the administration understand that the proposed cuts will actually end up costing the state more than they save. Not only will the state forfeit hundreds of millions in federal matching dollars, but the cuts will also drive up costs in overwrought emergency rooms.

The 10 percent in Medi-Cal cuts mimics those proposed by Governor Gray Davis last year. Gov. Davis' cuts were reduced by the legislature to 5 percent and would have gone into effect on January 1, had CMA not sought and won an injunction in federal court. In granting the preliminary injunction, U.S. District Judge David Levy said that the state of California failed to consider how the cuts would affect access to care for the more than 6 million poor, disabled, elderly and children whose health care is provided by Medi-Cal.

-----Original Message-----

From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM]

Sent: Wednesday, January 14, 2004 10:29 AM

Medi-Cal Reimbursement Rate Cut Included in Budget Proposal May Be Illegal, Legislative Analyst Says

01/14/2004

In her nonpartisan analysis of the state budget proposal put forth by Gov. Arnold Schwarzenegger (R), Legislative Analyst Elizabeth Hill on Tuesday said that the proposal is a "solid starting point" but noted that a provision to reduce Medi-Cal <http://www.medi-cal.ca.gov/> provider reimbursements might be illegal, the http://www.sacbee.com/content/politics/ca/budget/story/8096801p-9029196c.html Sacramento Bee reports (Hill, Sacramento Bee, 1/14). The $99.1 billion budget proposal does not include a tax increase but would reduce state funding for health care programs by more than $900 million, with about $880 million in spending c! uts to Medi-Cal, including a provider reimbursement rate cut of 10% ( http://www.californiahealthline.org/members/basecontent.asp?contentid=50671&collectionid=3&contentarea=39984 California Healthline, 1/13). In her report, Hill noted that the budget depends on savings from the 10% rate reduction in addition to a previous 5% reimbursement cut that currently is being challenged in court (Mendel, http://www.signonsandiego.com/news/uniontrib/wed/news/news_1n14budget.html ! San Diego Union-Tribune, 1/14). The California Medical Association and 11 other plaintiffs representing Medi-Cal providers in November filed a lawsuit to halt the implementation of the 5% reimbursement rate cut, which was approved by the Legislature as part of the fiscal year 2003-2004 budget. Chief U.S. District Judge David Levi last month issued a preliminary injunction preventing the implementation of the cuts scheduled to take effect Jan. 1 ( http://www.californiahealthline.org/members/basecontent.asp?contentid=50659&collectionid=3&contentarea=39888 California Healthline, 1/12).

Other Programs

Hill stated that proposed reductions in spending for state programs "would have far-reaching consequences for the scope of state services" and urged lawmakers to consider tax increases or removing tax exemptions to increase state revenue (Halper, http://www.latimes.com/news/local/la-me-lao14jan14,1,1693445.story?coll=la-headlines-california Los Angeles Times, 1/14). The budget proposal also would limit enrollment in Healthy <http://www.healthyfamilies.ca.gov/hf/hfhome.jsp> Families and other health programs, increase fees for enrollees of some programs and eliminate some domestic services for ! people with disabilities and elderly residents (California Healthline, 1/13). Hill noted that about 55% of the proposed budget reductions come from program cuts and that 45% come from borrowing, reappropriating local government funds and other sources. She said that about 67% of the savings would be sustainable in future years (Gledhill, http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2004/01/14/MNGS649LVD1.DTL San Francisco Chronicle, 1/14). Hill concluded, "Even if every solution proposed by the governor were adopted and the savings scored by the administration were realized, we estimate there would be at least a $6 billion structural budget problem remaining" by 2005 (Los Angeles Times, 1/14).

Reaction

Finance Director Donna Arduin disputed the $6 billion figure, saying that the amount "will come down" to about $3 billion when the administration releases details about cuts to health care and prison programs (Marimow, <http://www.mercurynews.com/mld/mercurynews/news/7707440.htm> San Jose Mercury News, 1/14). The http://www.contracostatimes.com/mld/cctimes/content_syndication/local_news/7706449.htm Contra Costa Times reports that both Republicans and Democrats "applauded the report, with both claiming it bolstered their positions" (LaMar, Contra Costa Times, 1/14). Assembly Budget Committee! Chair Jenny Oropeza (D-Long Beach) said that the remaining budget shortfall predicted by Hill shows that "[w]e have to do more than cut programs for the poor" to balance the budget (Los Angeles Times, 1/14). However, Senate Budget Committee Vice Chair Dick Ackerman (R-Irvine) said that the budget is designed to reduce the deficit over several years, adding, "It's going to be a two- to three-year fix to get out of the hole" (San Francisco Chronicle, 1/14).

Schwarzenegger's budget proposal, including a summary and highlights of the budget for health and human services, is available online <http://www.dof.ca.gov/HTML/BUD_DOCS/Bud_link.htm> . Note: You will need Adobe Acrobat Reader to access the proposal. The Legislative Analyst's report also is available online <http://www.lao.ca.gov/2004/budget_overview/130104_budget_overview.htm>

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

Do you Yahoo!?
Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes --0-1784842744-1074191259=:50387-- From akazzi@uci.edu Fri Jan 16 18:42:40 2004 From: akazzi@uci.edu (Kazzi, A. Antoine) Date: Fri, 16 Jan 2004 10:42:40 -0800 Subject: Emergency Physicians: CMA, CAL/ACEP and CAL/AAEM Need Your Help t o Qualify 911 Initiative for Ballot Message-ID: <59CDD9FF884EAE4AB86132E86110D72202E09B11@wicket.ndc.mc.uci.edu> This message is in MIME format. Since your mail reader does not understand this format, some or all of this message may not be legible. ------_=_NextPart_000_01C3DC60.8523C170 Content-Type: multipart/alternative; boundary="----_=_NextPart_001_01C3DC60.8523C170" ------_=_NextPart_001_01C3DC60.8523C170 Content-Type: text/plain Anyone planning to practice in California needs to pay attention to this initiative, and donate what you can. This initiative, if it passes, would alter the landscape for EM in CA dramatically, and permanently. It will foster fair wages, help dramatically to pay for now-uncompensated care, and generally enhance professional satisfaction for all of us. The specialists will, once again, have some promise of reimbursement if they take ED call. Donate directly to EMPAC. This can be done online on the AAEM website and will be forwarded to the California PAC. Your contribution is critical for the success of this initiative. Antoine Kazzi A. Antoine Kazzi, MD, FAAEM Vice-President, the American Academy of Emergency Medicine =========================== Physicians: CMA Needs Your Help to Qualify 911 Initiative for Ballot CMA and its partners in the Coalition to Preserve Emergency Care (CPEC) in November began fund-raising efforts to support the 2004 Trauma and Emergency Care Initiative. The initiative would increase the 911 surcharge to 3.7 percent on telephone calls made within California to fund 911 emergency dispatch, hospital emergency rooms, trauma centers, emergency doctors, and on-call physician specialists. CMA still needs to raise $600,000 to meet its fund-raising goal of $900,000. While this is a lot of money, the return on the investment for physicians will be great. The initiative, if successful, is expected to raise $500 to $800 million annually for trauma and emergency services, $200 million of which go to reimburse emergency and on-call physicians for care provided to uninsured and underinsured patients. CMA needs your help to reach its goal. Many CMA members received donation forms with their 2004 CMA/county medical society dues statements but have yet to make a donation. If you have not received a donation form, or need a new one, click here to download a copy. CMA leaders express their gratitude to those who have already donated to this important effort. Special thanks go out to the Orange County Medical Association and Martin Fishman, M.D., past president of the Santa Clara County Medical Association, who have donated $17,000 and $6,000 respectively. CMA is also asking physicians to help qualify the initiative for the November 2004 ballot by gathering petition signatures from their patients, colleagues, and others. To qualify, CMA and the other members of CPEC must gather 600,000 valid signatures by the April 12 deadline. Physicians interested in helping with either of these endeavors should contact CMA's Bret Sotkiewicz at 916/551-2558 or bsotkiewicz@cmanet.org . This e-mail/fax message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail/fax and destroy all copies of the original message. ------_=_NextPart_001_01C3DC60.8523C170 Content-Type: text/html CMA Alert

Anyone planning to practice in California needs to pay attention to this initiative, and donate what you can. This initiative, if it passes, would alter the landscape for EM in CA dramatically, and permanently. It will foster fair wages, help dramatically to pay for now-uncompensated care, and generally enhance professional satisfaction for all of us. The specialists will, once again, have some promise of reimbursement if they take ED call.

Donate directly to EMPAC. This can be done online on the AAEM website and will be forwarded to the California PAC. Your contribution is critical for the success of this initiative.

Antoine Kazzi

A. Antoine Kazzi, MD, FAAEM

Vice-President, the American Academy of Emergency Medicine

===========================

Physicians: CMA Needs Your Help to Qualify 911 Initiative for Ballot

CMA and its partners in the Coalition to Preserve Emergency Care (CPEC) in November began fund-raising efforts to support the 2004 Trauma and Emergency Care Initiative. The initiative would increase the 911 surcharge to 3.7 percent on telephone calls made within California to fund 911 emergency dispatch, hospital emergency rooms, trauma centers, emergency doctors, and on-call physician specialists.

CMA still needs to raise $600,000
to meet its fund-raising goal of $900,000. While this is a lot of money, the return on the
investment for physicians will be great. The initiative, if successful,
is expected to raise $500 to $800 million annually for trauma and emergency services, $200 million of which go to reimburse emergency and on-call physicians for care provided to uninsured and underinsured patients.

CMA needs your help to reach its goal. Many CMA members received
donation forms with their 2004 CMA/county medical society dues statements but have yet to make a donation. If you have not received a donation form, or need a new one, click here to download a copy.

CMA leaders express their gratitude to those who have already donated to this important effort. Special thanks go out to the Orange County Medical Association and Martin Fishman, M.D., past president of the Santa Clara County Medical Association, who have donated $17,000 and $6,000 respectively.

CMA is also asking physicians to help qualify the initiative for the November 2004 ballot by gathering petition signatures from their patients, colleagues, and others. To qualify, CMA and the other members of CPEC must gather 600,000 valid signatures by the April 12 deadline.

Physicians interested in helping with either of these endeavors should contact CMA's Bret Sotkiewicz at 916/551-2558 or bsotkiewicz@cmanet.org.

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$1.6 TRILLION IN 2002 Message-ID: <20040119051002.95899.qmail@web41306.mail.yahoo.com> --0-1667443369-1074489002=:93439 Content-Type: text/plain; charset=us-ascii -----Original Message----- From: cma_alert@cmanews.org [mailto:cma_alert@cmanews.org] Sent: Thursday, January 08, 2004 2:50 PM 3. CMA Supports Physicians' Rights to Fair Peer Review CMA filed an amicus brief this week with the California Court of Appeal in San Diego, supporting physicians' fundamental rights to fair peer review hearings and procedures. In this case, Penny Pancoast, M.D., v. Medical Staff of Sharp Memorial Hospital, Dr. Pancoast was summarily suspended from a hospital medical staff despite the fact she was on a voluntary leave of absence and was not admitting or treating patients at the hospital. Dr. Pancoast successfully obtained a trial court order that her privileges be restored. The hospital has petitioned the state court of appeal to reverse the trial court's ruling. According to state law (Business & Professions Code �809.5), summary suspension-the abrupt suspension of a physician's hospital privileges without first providing a fair hearing-should only be imposed when a physician poses an "imminent danger" to patients' health and safety. In the brief, CMA argued that hospitals must not be allowed to deny physicians their legal right to due process by ignoring the legal standard and summarily suspending physicians whose conduct does not pose an "imminent danger" to patients. Instead, the hospital and medical staff should be required to provide a notice of charges and opportunity for a hearing as required by the law, and the physician's privileges and membership should be unaffected during that process. "Such a suspension and the subsequent reporting [to the Medical Board of California and the National Practitioner Data Bank] impose a severe professional stigma that stays with a doctor the rest of her professional career. Every application and biannual reapplication for hospital privileges, every application for malpractice insurance, every application for membership in a professional society and-most importantly-every application for economic participation as a provider in health plans, large medical groups and IPAs asks whether the doctor's privileges have been suspended," the brief stated. "Because of the irreversible consequences...the summary suspension mechanism cannot and should not be used except in cases where the medical staff can affirmatively demonstrate real imminent harm to identifiable patients." The court is not expected to make a ruling on the case for several months. Click here for more information, including a copy of CMA's brief ======================================== -----Original Message----- From: Ulric Wair [mailto:UWair@CMS.HHS.GOV] Sent: Thursday, January 08, 2004 6:22 AM CMS NEWS - FOR IMMEDIATE RELEASE CMS Public Affairs Office Thursday, January 8, 2004 HEALTH CARE SPENDING REACHES $1.6 TRILLION IN 2002 Health care spending in the United States rose to $1.6 trillion in 2002, up from $1.4 trillion in 2001 and $1.3 trillion in 2000, according to a report issued today by the Centers for Medicare & Medicaid Services (CMS). The growth rate of 9.3 percent for 2002, the latest year for which actual spending figures are available, compared to 8.5 percent in 2001 and marked the 6th consecutive year in which health spending grew at an accelerated rate. Health expenditures per person averaged $5,440 in 2002, up $419 from $5,021 in 2001. Per person spending in 2000 was $4,670. In 2002, health spending grew 5.7 percentage points faster than the overall economy as measured by growth of the gross domestic product (GDP) - the total value of goods and services produced in the United States. The health care share of GDP increased to 14.1 percent in 2001 and 14.9 in 2002, after nearly a decade in the 13.1 to 13.4 percent-of-GDP range, said an article by economists in CMS' Office of the Actuary that appeared today in the journal Health Affairs. Prescription drugs continued to lead the rise in personal health care expenditures, with a 15.3 percent jump in 2002. However, this was down slightly from the 15.9 percent increase measured in 2001. Total spending for prescription drugs for the year was $162.4 billlion, compared with $140.8 billion in 2001. While the growth in private health insurance spending for prescription drugs at 16.1 percent slowed in 2002, out-of-pocket spending for prescription drugs sped up to 14.4 percent as the effect of tiered drug formulaires shifted more of the cost to consumers. Hospital spending increased by 9.5 percent in 2002 to $486.5 billion, marking the fourth consecutive year of accelerated growth and the first time the rate of hospital spending outpaced overall spending rate of growth since 1991. The resurgence in hospital spending growth since 2000 followed a period of managed care expansion that dampened growth in inpatient hospital utilization. Recent spending trends reflect growing demands for services, rising compensation and other input costs as well as the increased ability of hospitals to negotiate higher prices from private payers. Spending for physician services reached $340 billion in 2002, an increase of 7.7 percent that was slightly slower than the growth rate of 8.6 percent in 2001. Expenditures for free-standing home health agencies grew by 7.2 percent in 2002, the second consecutive year of expansion driven primarily by a rebound in Medicare spending. A change in the statutory definition of "homebound" expanded the number of beneficiaries eligible for Medicare services. Private payers funded more than half of national health expenditures in 2002, with private health insurance contributing $549.6 billion, 35 percent of the total. Out of pocket payments of $212.5 billion accounted for 14 percent of expenditures and continued to decline as a share of total spending. More than half the increase in out-of-pocket spending for all health services came from increases in out-of-pocket spending for prescription drugs. The public sector accounted for the remaining 46 percent of health payments, with the Medicaid program, funding 16 percent of aggregate spending, or $249 billion, nearly equaling the 17 percent, $267 billion, spent by Medicare. Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes --0-1667443369-1074489002=:93439 Content-Type: text/html; charset=us-ascii

-----Original Message-----

From: cma_alert@cmanews.org [mailto:cma_alert@cmanews.org]

Sent: Thursday, January 08, 2004 2:50 PM

3. CMA Supports Physicians' Rights to Fair Peer Review

CMA filed an amicus brief this week with the California Court of Appeal in San Diego, supporting physicians' fundamental rights to fair peer review hearings and procedures.

In this case, Penny Pancoast, M.D., v. Medical Staff of Sharp Memorial Hospital, Dr. Pancoast was summarily suspended from a hospital medical staff despite the fact she was on a voluntary leave of absence and was not admitting or treating patients at the hospital. Dr. Pancoast successfully obtained a trial court order that her privileges be restored. The hospital has petitioned the state court of appeal to reverse the trial court's ruling.

According to state law (Business & Professions Code �809.5), summary suspension-the abrupt suspension of a physician's hospital privileges without first providing a fair hearing-should only be imposed when a physician poses an "imminent danger" to patients' health and safety. In the brief, CMA argued that hospitals must not be allowed to deny physicians their legal right to due process by ignoring the legal standard and summarily suspending physicians whose conduct does not pose an "imminent danger" to patients. Instead, the hospital and medical staff should be required to provide a notice of charges and opportunity for a hearing as required by the law, and the physician's privileges and membership should be unaffected during that process.

"Such a suspension and the subsequent reporting [to the Medical Board of California and the National Practitioner Data Bank] impose a severe professional stigma that stays with a doctor the rest of her professional career. Every application and biannual reapplication for hospital privileges, every application for malpractice insurance, every application for membership in a professional society and-most importantly-every application for economic participation as a provider in health plans, large medical groups and IPAs asks whether the doctor's privileges have been suspended," the brief stated. "Because of the irreversible consequences...the summary suspension mechanism cannot and should not be used except in cases where the medical staff can affirmatively demonstrate real imminent harm to identifiable patients." The court is not expected to make a ruling on the case for several months.

Click here <http://www.calphys.org/html/bb469.asp> for more information, including a copy of CMA's brief

========================================

-----Original Message-----

From: Ulric Wair [mailto:UWair@CMS.HHS.GOV]

Sent: Thursday, January 08, 2004 6:22 AM

CMS NEWS - FOR IMMEDIATE RELEASE

CMS Public Affairs Office

Thursday, January 8, 2004

HEALTH CARE SPENDING REACHES $1.6 TRILLION IN 2002

Health care spending in the United States rose to $1.6 trillion in 2002, up from $1.4 trillion in 2001 and $1.3 trillion in 2000, according to a report issued today by the Centers for Medicare & Medicaid Services (CMS).

The growth rate of 9.3 percent for 2002, the latest year for which actual spending figures are available, compared to 8.5 percent in 2001 and marked the 6th consecutive year in which health spending grew at an accelerated rate.

Health expenditures per person averaged $5,440 in 2002, up $419 from $5,021 in 2001. Per person spending in 2000 was $4,670.

In 2002, health spending grew 5.7 percentage points faster than the overall economy as measured by growth of the gross domestic product

(GDP) - the total value of goods and services produced in the United States.

The health care share of GDP increased to 14.1 percent in 2001 and 14.9 in 2002, after nearly a decade in the 13.1 to 13.4 percent-of-GDP range, said an article by economists in CMS' Office of the Actuary that appeared today in the journal Health Affairs.

Prescription drugs continued to lead the rise in personal health care expenditures, with a 15.3 percent jump in 2002. However, this was down slightly from the 15.9 percent increase measured in 2001. Total spending for prescription drugs for the year was $162.4 billlion, compared with $140.8 billion in 2001.

While the growth in private health insurance spending for prescription drugs at 16.1 percent slowed in 2002, out-of-pocket spending for prescription drugs sped up to 14.4 percent as the effect of tiered drug formulaires shifted more of the cost to consumers.

Hospital spending increased by 9.5 percent in 2002 to $486.5 billion, marking the fourth consecutive year of accelerated growth and the first time the rate of hospital spending outpaced overall spending rate of growth since 1991.

The resurgence in hospital spending growth since 2000 followed a period of managed care expansion that dampened growth in inpatient hospital utilization. Recent spending trends reflect growing demands for services, rising compensation and other input costs as well as the increased ability of hospitals to negotiate higher prices from private payers.

Spending for physician services reached $340 billion in 2002, an increase of 7.7 percent that was slightly slower than the growth rate of 8.6 percent in 2001.

Expenditures for free-standing home health agencies grew by 7.2 percent in 2002, the second consecutive year of expansion driven primarily by a rebound in Medicare spending. A change in the statutory definition of "homebound" expanded the number of beneficiaries eligible for Medicare services.

Private payers funded more than half of national health expenditures in 2002, with private health insurance contributing $549.6 billion, 35 percent of the total. Out of pocket payments of $212.5 billion accounted for 14 percent of expenditures and continued to decline as a share of total spending. More than half the increase in out-of-pocket spending for all health services came from increases in out-of-pocket spending for prescription drugs.

The public sector accounted for the remaining 46 percent of health payments, with the Medicaid program, funding 16 percent of aggregate spending, or $249 billion, nearly equaling the 17 percent, $267 billion, spent by Medicare.

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

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Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes --0-1667443369-1074489002=:93439-- From pottsbri@yahoo.com Tue Jan 20 02:45:04 2004 From: pottsbri@yahoo.com (CAL/AAEM News Service) Date: Mon, 19 Jan 2004 18:45:04 -0800 (PST) Subject: AAEM Scientific Assembly Message-ID: <20040120024504.6652.qmail@web41304.mail.yahoo.com> --0-1757252174-1074566704=:5857 Content-Type: text/plain; charset=us-ascii -----Original Message----- From: AAEM [mailto:info@aaem.org] Sent: Monday, January 19, 2004 2:28 PM To: akazzi@attglobal.net Subject: AAEM Scientific Assembly AAEM Scientific Assembly - Registration Deadline Extended, Hotel Information, Pre-Conference Information It's not too late to attend AAEM's 10th Annual Scientific Assembly in Miami, February 20-22, 2004. The early registration deadline of January 21 has been extended to February 4, 2004. Remember, registration is free to members! You can register on-line at www.aaem.org. Hotel reservations can still be made by calling the Marriott Biscayne Bay at 800-228-9290 or 305-374-3900 and asking for the AAEM room block. The Marriott is the closest downtown hotel to South Beach (2.5 miles) and just a 1/2 mile from Bayside Marketplace. While in Miami, attend one (or two) of AAEM's pre-conference courses All courses except for Ultrasound will be offered on Thursday, February 19, 2004. ABEM's Continuous Certification: What You Need to Pass Advanced EKG Assessment Course Noninvasive Ventilatory Management Preparing for In-Service: What to Expect on Your Test Presentation Skills and PowerPoint Simulation in the Clinical Teaching Setting The Business of Emergency Medicine Made Simple Ultrasound Course (two days February 18-19, 2004) Finally, think about attending the Cruise on Friday evening, February 20, 2004. Spaces are now available and we've had to get a bigger yacht! For a full preliminary program, including course costs, CME hours and descriptions, go to www.aaem.org. American Academy of Emergency Medicine 611 E. Wells Street Milwaukee, WI 53202 800-884-2236 Fax: 414-276-3349 E-mail: info@aaem.org Website: www.aaem.org You have received this message because you have had previous contact with the American Academy of Emergency Medicine. If you do not wish to be included in our mailing list, please forward this message to info@aaem.org. Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes --0-1757252174-1074566704=:5857 Content-Type: text/html; charset=us-ascii

-----Original Message-----

From: AAEM [mailto:info@aaem.org]

Sent: Monday, January 19, 2004 2:28 PM

To: akazzi@attglobal.net

Subject: AAEM Scientific Assembly

AAEM Scientific Assembly - Registration Deadline Extended, Hotel Information, Pre-Conference Information

It's not too late to attend AAEM's 10th Annual Scientific Assembly in Miami, February 20-22, 2004. The early registration deadline of January 21 has been extended to February 4, 2004. Remember, registration is free to members! You can register on-line at www.aaem.org.

Hotel reservations can still be made by calling the Marriott Biscayne Bay at 800-228-9290 or 305-374-3900 and asking for the AAEM room block. The Marriott is the closest downtown hotel to South Beach (2.5 miles) and just a 1/2 mile from Bayside Marketplace.

While in Miami, attend one (or two) of AAEM's pre-conference courses

All courses except for Ultrasound will be offered on Thursday, February 19, 2004.

ABEM's Continuous Certification: What You Need to Pass

Advanced EKG Assessment Course

Noninvasive Ventilatory Management

Preparing for In-Service: What to Expect on Your Test Presentation Skills and PowerPoint Simulation in the Clinical Teaching Setting The Business of Emergency Medicine Made Simple Ultrasound Course (two days February 18-19, 2004)

Finally, think about attending the Cruise on Friday evening, February 20, 2004. Spaces are now available and we've had to get a bigger yacht!

For a full preliminary program, including course costs, CME hours and descriptions, go to www.aaem.org.

American Academy of Emergency Medicine

611 E. Wells Street

Milwaukee, WI 53202

800-884-2236

Fax: 414-276-3349

E-mail: info@aaem.org

Website: www.aaem.org

You have received this message because you have had previous contact with the American Academy of Emergency Medicine. If you do not wish to be included in our mailing list, please forward this message to info@aaem.org.

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

Do you Yahoo!?
Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes --0-1757252174-1074566704=:5857-- From pottsbri@yahoo.com Wed Jan 21 05:31:04 2004 From: pottsbri@yahoo.com (CAL/AAEM News Service) Date: Tue, 20 Jan 2004 21:31:04 -0800 (PST) Subject: Peds EM conference, Feb 25-29 in Park City; -AND- New York Symposium on International Emergency Medicine, Mar 19 Message-ID: <20040121053104.68264.qmail@web41312.mail.yahoo.com> --0-1705972205-1074663064=:66830 Content-Type: text/plain; charset=us-ascii -----Original Message----- From: AAEM [mailto:info@aaem.org] Sent: Monday, January 19, 2004 9:20 AM Subject: Pediatric EM Conference Set for February 25-29 The Primary Children's Medical Center and the Department of Pediatrics at the University of Utah School of Medicine are jointly sponsoring Pediatric Emergency Medicine 2004, February 25-29, in Park City, UT. This conference is designed for all physicians who provide acute care to children. The five-day course emphasizes the proper diagnosis and management of the acutely ill or injured child. For more information or to register for the conference, please go to: http://www.uuhsc.utah.edu/pem/conference/about.html AAEM 611 East Wells Street Milwaukee, WI 53202 800-884-2236 Fax: 414-276-3349 E-mail: info@aaem.org Website: www.aaem.org ======================================================= -----Original Message----- From: AAEM [mailto:info@aaem.org] Sent: Thursday, January 15, 2004 10:54 AM Subject: New York Symposium on International Emergency Medicine The North Shore-LIJ Emergency Services, NYU/Bellevue Emergency Medicine and NY ACEP are co-sponsoring the "First Annual New York Symposium on International Emergency Medicine." This symposium will be held on March 19,2004, at NYU Medical Center. This conference has been approved for 7 category 1 CME Credits. To view the brochure on this program please go to: http://www.northshorelij.com/education/2004_emerg_med/2004_emerg_med.pdf To register, please call 516-465-2500. American Academy of Emergency Medicine 611 E. Wells Street Milwaukee, WI 53202 800-884-2236 Fax: 414-276-3349 E-mail: info@aaem.org Website: www.aaem.org You have received this message because you have had previous contact with the American Academy of Emergency Medicine. If you do not wish to be included in our mailing list, please forward this message to info@aaem.org. Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes --0-1705972205-1074663064=:66830 Content-Type: text/html; charset=us-ascii

-----Original Message-----

From: AAEM [mailto:info@aaem.org]

Sent: Monday, January 19, 2004 9:20 AM

Subject: Pediatric EM Conference Set for February 25-29

The Primary Children's Medical Center and the Department of Pediatrics at the University of Utah School of Medicine are jointly sponsoring Pediatric Emergency Medicine 2004, February 25-29, in Park City, UT.

This conference is designed for all physicians who provide acute care to children. The five-day course emphasizes the proper diagnosis and management of the acutely ill or injured child.

For more information or to register for the conference, please go to: http://www.uuhsc.utah.edu/pem/conference/about.html

AAEM

611 East Wells Street

Milwaukee, WI 53202

800-884-2236

Fax: 414-276-3349

E-mail: info@aaem.org

Website: www.aaem.org

=======================================================

-----Original Message-----

From: AAEM [mailto:info@aaem.org]

Sent: Thursday, January 15, 2004 10:54 AM

Subject: New York Symposium on International Emergency Medicine

The North Shore-LIJ Emergency Services, NYU/Bellevue Emergency Medicine and NY ACEP are co-sponsoring the "First Annual New York Symposium on International Emergency Medicine." This symposium will be held on March 19,2004, at NYU Medical Center. This conference has been approved for 7 category 1 CME Credits.

To view the brochure on this program please go to: http://www.northshorelij.com/education/2004_emerg_med/2004_emerg_med.pdf

To register, please call 516-465-2500.

American Academy of Emergency Medicine

611 E. Wells Street

Milwaukee, WI 53202

800-884-2236

Fax: 414-276-3349

E-mail: info@aaem.org

Website: www.aaem.org

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

Do you Yahoo!?
Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes --0-1705972205-1074663064=:66830-- From pottsbri@yahoo.com Sat Jan 24 01:45:59 2004 From: pottsbri@yahoo.com (CAL/AAEM News Service) Date: Fri, 23 Jan 2004 17:45:59 -0800 (PST) Subject: CDC Estimates Annual Cost of Accidental Injuries at $117 Billion Message-ID: <20040124014559.48984.qmail@web41302.mail.yahoo.com> --0-705117374-1074908759=:46924 Content-Type: text/plain; charset=us-ascii -----Original Message----- From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] CDC Estimates Annual Cost of Accidental Injuries at $117 Billion 01/16/2004 Injuries caused by falls, motor vehicle crashes and other accidents each year cost the U.S. economy $117 billion, or about 10% of U.S. medical spending, according to a CDC report released Thursday in its Morbidity and Mortality Weekly Report, Reuters/Houston Chronicle reports. For the report, the CDC examined data from the Medical Expenditure Panel Survey, which includes insurance and out-of-pocket cost information for 25,000 people who received medical care in 2000. The survey found that 44.7 million people, or 16% of the population, were treated for at least one injury. In addition, the CDC examined data from the National Health Accounts survey, which includes medical spending information about members of the military and people who are institutionalized. The CDC report found that of the $117 billion in annual costs att! ributed to accidental injuries, falls account for at least 33% of the total cost, and motor vehicle accidents account for at least 18% of costs. CDC Director Dr. Julie Gerberding said that the agency's cost estimate is low, adding, "When we add in productivity losses, decreased quality of life and the emotional toll that injuries and disabilities have on families, the problem is enormous." She added, "Motor vehicle crashes, homicides, suicide and debilitating falls are so common that unfortunately, many have accepted that injury is inevitable." Injuries are the leading cause of death among people who are under 35 years old and the fourth leading cause of death among the entire population, according to the CDC (Reuters/Houston Chronicle, 1/16). The report is available online . Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! SiteBuilder - Free web site building tool. Try it! --0-705117374-1074908759=:46924 Content-Type: text/html; charset=us-ascii

-----Original Message-----

From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM]

CDC Estimates Annual Cost of Accidental Injuries at $117 Billion

01/16/2004

Injuries caused by falls, motor vehicle crashes and other accidents each year cost the U.S. economy $117 billion, or about 10% of U.S. medical spending, according to a CDC <http://www.cdc.gov/> report released Thursday in its Morbidity and Mortality Weekly Report, <http://www.chron.com/cs/CDA/ssistory.mpl/health/2356265> Reuters/Houston Chronicle reports. For the report, the CDC examined data from the Medical Expenditure Panel <http://www.meps.ahrq.gov/> Survey, which includes insurance and out-of-pocket cost information for 25,000 people who received medical care in 2000. The survey found that 44.7 million people, or 16% of the popu! lation, were treated for at least one injury. In addition, the CDC examined data from the National <http://cms.hhs.gov/statistics/nhe/default.asp> Health Accounts survey, which includes medical spending information about members of the military and people who are institutionalized. The CDC report found that of the $117 billion in annual costs attributed to accidental injuries, falls account for at least 33% of the total cost, and motor vehicle accidents account for at least 18% of costs. CDC Director Dr. Julie Gerberding said that the agency's cost estimate is low, adding, "When we add in productivity losses, decreased quality of life and the emotional toll that injuries and disabilities have on families, the problem is enormous." She added, "Motor vehicle crashes, homicides, suicide and debilitating falls are so common that unfortunately, many have accepte! d that injury is inevitable." Injuries are the leading cause of death among people who are under 35 years old and the fourth leading cause of death among the entire population, according to the CDC (Reuters/Houston Chronicle, 1/16). The report is available online <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5301a1.htm> .

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

Do you Yahoo!?
Yahoo! SiteBuilder - Free web site building tool. Try it! --0-705117374-1074908759=:46924-- From pottsbri@yahoo.com Mon Jan 26 06:51:35 2004 From: pottsbri@yahoo.com (CAL/AAEM News Service) Date: Sun, 25 Jan 2004 22:51:35 -0800 (PST) Subject: Los Angeles Times Examines Hospital Closures Message-ID: <20040126065135.55743.qmail@web41304.mail.yahoo.com> --0-906889933-1075099895=:54761 Content-Type: text/plain; charset=us-ascii -----Original Message----- From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] Los Angeles Times Examines Hospital Closures 01/16/2004 The http://www.latimes.com/news/local/la-me-hospitals16jan16,1,4860153.story Los Angeles Times on Friday examined the increasing trend of hospital closures in California. According to the Department of Health Services , 60 hospitals have closed while 26 have opened in the last 10 years. Some officials contend that the hospital industry "could benefit from some pruning or consolidation," but communities affected by hospital closures "decry the loss of nearby emergency services and secure jobs," according to the Times. The Times reports that some hospitals, especially those in isolated or rural areas, do not have enough patients to support themselves, while hospital finances have been further affected by the migration of procedures such as biopsies and dialysis from hospitals to outpatient clinics; "paltry" Medi-Cal and Medicare reimbursements; "pinched" managed care pay rates; and increasing technology costs. Nurse-to-Patient Ratios, Seismic Retrofitting In addition, "two costly state laws" governing nurse staffing and seismic retrofitting of public buildings could accelerate the trend of hospital closures, according to the Times (Hymon et al., Los Angeles Times, 1/16). The new state nurse-to-patient ratio rules, which took effect Jan. 1, require that nurses not have to care for more than eight patients at a time. The rules also call for one nurse per five patients in medical-surgical units by 2005, as well as one nurse per four patients in specialty care and telemetry units and one nurse per three patients in step-down units by 2008. In addition, the regulations state that licensed vocational nurses can comprise no more than 50% of the licensed nurses assigned to patient care and that only registered nurses can care for critical trauma patients. The rules also require at least one registered nurse to serve as a triage nurse in emergency departments ( http://www.californiahealthline.org/members/basecontent.asp?contentid=50694&collectionid=3&program=1 California Healthline, 1/15). In addition, California law requires that all hospitals guarantee by 2008 that their buildings would not collapse in a significant earthquake, or by 2013 if the buildings are expected to remain in use 30 years from now. By 2030, hospitals must be able to withstand a major earthquake and continue functioning immediately afterward ( http://www.californiahealthline.org/members/basecontent.asp?contentid=50345&collectionid=3&program=1 California Healthline, 11/21/03). The nurse-to-patient ratio rules were the "dagger through the heart" in the closure http://www.californiahealthline.org/members/basecontent.asp?contentid=50642&collectionid=3&program=1 of Santa Teresita Hospital in Duarte, the Times reports. In addition, hospitals are calling the seismic standards an "unfunded mandate" because the state will not help pay! for the hospital retrofitting or new construction. Reaction Sister Michelle Clines, chair of Santa Teresita, said that the hospital closed because "[w]e didn't want to stand around and wait for the penalties to come in for being in noncompliance with the [nurse-to-patient ratios] law." Bob Reed, chief financial officer of the Sutter Health system in Northern California, said, "There is no question in my mind that the smaller hospitals will have to close programs or close their doors because they won't have the money to meet the law and serve their patients." However, Charles Idelson, a spokesperson for the California Nurses Association, said claims that the nurse-to-patient ratio rules are bankrupting hospitals are part of "a heavy-handed campaign by the hospital industry to sabotage California safe staffing law." The Times reports that David Hammer, counsel for Trinity County, which runs Trinity General Hospital ! , said that hospital officials "aren't even thinking about the seismic retrofits" because the county "doesn't have the funds to make payroll even today." However, according to Gerald Kominski, an associate director of the University of California-Los Angeles' Center for Health Policy Research, hospital profits are as high as they have been in the last 10 to 15 years. "This is, relatively speaking, a relatively profitable time," Kominski said, adding, "It doesn't mean individual hospitals are not struggling. It also doesn't mean the regulations aren't causing hospitals to be squeezed more than they would be otherwise. To say this is causing the industry severe financial threat sounds to me like an overstatement" (Los Angeles Times, 1/16). Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! SiteBuilder - Free web site building tool. Try it! --0-906889933-1075099895=:54761 Content-Type: text/html; charset=us-ascii

-----Original Message-----

From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM]

Los Angeles Times Examines Hospital Closures

01/16/2004

The http://www.latimes.com/news/local/la-me-hospitals16jan16,1,4860153.story Los Angeles Times on Friday examined the increasing trend of hospital closures in California. According to the Department of Health Services <http://www.dhs.cahwnet.gov/> , 60 hospitals have closed while 26 have opened in the last 10 years. Some officials contend that the hospital industry "could benefit from some pruning or consolidation," but communities affected by hospital closures "decry the loss of nearby emergency services and secure jobs," according to the Times. The Times reports that some hospitals, especially those in isolated or rural areas, do not! have enough patients to support themselves, while hospital finances have been further affected by the migration of procedures such as biopsies and dialysis from hospitals to outpatient clinics; "paltry" Medi-Cal and Medicare reimbursements; "pinched" managed care pay rates; and increasing technology costs.

Nurse-to-Patient Ratios, Seismic Retrofitting

In addition, "two costly state laws" governing nurse staffing and seismic retrofitting of public buildings could accelerate the trend of hospital closures, according to the Times (Hymon et al., Los Angeles Times, 1/16). The new state nurse-to-patient ratio rules, which took effect Jan. 1, require that nurses not have to care for more than eight patients at a time. The rules also call for one nurse per five patients in medical-surgical units by 2005, as well as one nurse per four patients in specialty care and telemetry units and one nurse per three patients in step-down units by 2008. In addition, the regulations state that licensed vocational nurses can comprise no more than 50% of the licensed nurses assigned to patient care and that only registered nurses can care for critical trauma patients. The rules also require at least one registered nurse to serve as a triage nurse in emergency departments ( http://www.californiahealthline.org/members/basecontent.asp?contentid=50694&collectionid=3&program=1 California Healthline, 1/15). In addition, California law requires that all hospitals guarantee by 2008 that their buildings would not collapse in a significant earthquake, or by 2013 if the buildings are expected to remain in use 30 years from now. By 2030, hospitals must be able to withstand a major earthquake and continue functioning immediately afterward ( http://www.californiahealthline.org/members/basecontent.asp?contentid=50345&collectionid=3&program=1 California Healthline, 11/21/03). The nurse-to-patient ratio rules were the "dagger through the heart" in the closure http://www.californiahealthline.org/members/basecontent.asp?contentid=50642&collectionid=3&program=1 of Santa Teresita Hospital <http://www.santa-teresita.org/> in Duarte, the Times reports. In addition, hospitals are calli! ng the seismic standards an "unfunded mandate" because the state will not help pay for the hospital retrofitting or new construction.

Reaction

Sister Michelle Clines, chair of Santa Teresita, said that the hospital closed because "[w]e didn't want to stand around and wait for the penalties to come in for being in noncompliance with the [nurse-to-patient ratios] law." Bob Reed, chief financial officer of the Sutter Health <http://www.sutterhealth.org/> system in Northern California, said, "There is no question in my mind that the smaller hospitals will have to close programs or close their doors because they won't have the money to meet the law and serve their patients." However, Charles Idelson, a spokesperson for the California <http://www.calnurse.org/> Nurses Association, said claims that the nurse-to-patient ratio rules are bankrupting hospitals are part of "a heavy-handed campaign by the hospital industry to sabotage California safe staffing law." The Times reports that David Hammer, counsel for Trinity County, which runs Trinity General Hospital <http://www.trinitycounty.org/Departments/Hospital/hospital.htm> , said that hospital officials "aren't even thinking about the seismic retrofits" because the county "doesn't have the funds to make payroll even today." However, according to Gerald Kominski, an associate director of the University of California-Los Angeles' Center for Health <http://www.healthpolicy.ucla.edu/> Policy Research, hospital profits are as high as they have been in the last 10 to 15 years. "This is, relatively speaking, a relatively profitable time," Kominski said, adding, "It doesn't mean ind! ividual hospitals are not struggling. It also doesn't mean the regulations aren't causing hospitals to be squeezed more than they would be otherwise. To say this is causing the industry severe financial threat sounds to me like an overstatement" (Los Angeles Times, 1/16).

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

Do you Yahoo!?
Yahoo! SiteBuilder - Free web site building tool. Try it! --0-906889933-1075099895=:54761-- From pottsbri@yahoo.com Tue Jan 27 06:34:25 2004 From: pottsbri@yahoo.com (CAL/AAEM News Service) Date: Mon, 26 Jan 2004 22:34:25 -0800 (PST) Subject: CDC Injury Center Update at the AAEM Assembly Message-ID: <20040127063425.43098.qmail@web41303.mail.yahoo.com> --0-584713330-1075185265=:42182 Content-Type: text/plain; charset=us-ascii -----Original Message----- From: AAEM [mailto:info@aaem.org] Sent: Monday, January 19, 2004 2:47 PM Subject: CDC Injury Center Update at the AAEM Assembly On Friday, February 20 at 2pm, members will have an opportunity to hear Dr. Richard Sattin give a CDC Injury Center Update. ***"Updating the Centers for Disease Control and Prevention (CDC) Injury Research Agenda: Acute Care Treatment". Background: CDC's Injury Center is the only organization in the federal government with the responsibility to address all phases of the injury research framework-from foundational research through dissemination research-for all major causes of injury among all age groups. To reach its goal of translating science into effective programs and policies, the Injury Center collaborates with other federal agencies and partners to document the incidence and impact of injuries, understand the causes, identify effective interventions, and promote their widespread adoption. The Injury Center has recognized its current research agenda does not adequately address the area of acute care treatment and has begun the process of updating its research agenda. This presentation will provide the rationale for beginning this process, will provide information on the status of the process, and will encourage continuing input by AAEM members in helping to update the Injury Center research agenda. Richard W. Sattin, M.D., F.A.C.P Associate Director for Science Division of Injury and Disability Outcomes and Programs National Center for Injury Prevention and Control Centers for Disease Control and Prevention & Associate Clinical Professor of Medicine Emory University School of Medicine & Associate Director for Clinical Research Center for Health in Aging Emory University School of Medicine (Please watch the Syllabus for Room Location). American Academy of Emergency Medicine 611 E. Wells Street Milwaukee, WI 53202 800-884-2236 Fax: 414-276-3349 E-mail: info@aaem.org Website: www.aaem.org You have received this message because you have had previous contact with the American Academy of Emergency Medicine. If you do not wish to be included in our mailing list, please forward this message to info@aaem.org. Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! SiteBuilder - Free web site building tool. Try it! --0-584713330-1075185265=:42182 Content-Type: text/html; charset=us-ascii

-----Original Message-----

From: AAEM [mailto:info@aaem.org]

Sent: Monday, January 19, 2004 2:47 PM

Subject: CDC Injury Center Update at the AAEM Assembly

On Friday, February 20 at 2pm, members will have an opportunity to hear Dr. Richard Sattin give a CDC Injury Center Update.

***"Updating the Centers for Disease Control and Prevention (CDC) Injury Research Agenda: Acute Care Treatment".

Background:

CDC's Injury Center is the only organization in the federal government with the responsibility to address all phases of the injury research framework-from foundational research through dissemination research-for all major causes of injury among all age groups. To reach its goal of translating science into effective programs and policies, the Injury Center collaborates with other federal agencies and partners to document the incidence and impact of injuries, understand the causes, identify effective interventions, and promote their widespread adoption. The Injury Center has recognized its current research agenda does not adequately address the area of acute care treatment and has begun the process of updating its research agenda. This presentation will provide the rationale for beginning this process, will provide information on the status of the process, and will encourage continuing input by AAEM members in helping to update the Injury Center research agenda.

Richard W. Sattin, M.D., F.A.C.P

Associate Director for Science

Division of Injury and Disability Outcomes and Programs

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Associate Clinical Professor of Medicine

Emory University School of Medicine

Associate Director for Clinical Research

Center for Health in Aging

Emory University School of Medicine

(Please watch the Syllabus for Room Location).

American Academy of Emergency Medicine

611 E. Wells Street

Milwaukee, WI 53202

800-884-2236

Fax: 414-276-3349

E-mail: info@aaem.org

Website: www.aaem.org

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

Do you Yahoo!?
Yahoo! SiteBuilder - Free web site building tool. Try it! --0-584713330-1075185265=:42182-- From pottsbri@yahoo.com Wed Jan 28 05:10:31 2004 From: pottsbri@yahoo.com (CAL/AAEM News Service) Date: Tue, 27 Jan 2004 21:10:31 -0800 (PST) Subject: WSJ: Health and Taxes Message-ID: <20040128051031.96413.qmail@web41310.mail.yahoo.com> --0-1297114306-1075266631=:93873 Content-Type: text/plain; charset=us-ascii Submission from Paul Windham, MD =========================== Monday, January 19, 2004 Health and Taxes By MARTIN FELDSTEIN The Health Savings Accounts that President Bush recently signed into law may well be the most important piece of legislation of 2003. These new tax and medical insurance rules have the potential to transform health-care finances, bringing costs under control and making health care reflect what patients and their doctors really want. It is remarkable that this legislation has received so little public attention. Today's high cost of health care reflects the way that the tax law has subsidized the use of insurance to pay for health care. Private insurance now pays 70% of all nongovernment health-care costs and more than 90% of nongovernment hospital costs. Because out-of-pocket payments at the time of care are only a small fraction of the total cost of producing that care, individuals naturally want "the best care" that medical science can provide. And the demand for that high-tech care drives medical innovation toward new and more expensive modes of treatment. The demand for the typical health-insurance policy reflects the tax provision that allows employees to exclude payments for health insurance from their taxable income. Since the annual premium for a family may be as much as $10,000, the resulting tax saving is a very large subsidy for the purchase of the kind of comprehensive, low-deductible insurance policy that drives up health-care costs and that has led to the imposition of controls on patient choice. In the aggregate, this exclusion reduces Federal income-tax collections by $120 billion a year, essentially a $120 billion subsidy for purchasing the wrong kind of insurance. Although HMOs and other forms of managed care that aim at controlling health costs have become increasingly common in recent years, health costs continue to take a growing share of GDP. And neither patients nor doctors are happy when HMOs restrict the health care that can be given, or limit the time that doctors can spend with each patient, or appear to deny patients information about the care that might benefit them. The new HSA law (a part of the recent Medicare reform bill) eliminates the preferential subsidy for comprehensive insurance by giving the same tax treatment to individuals who set aside income to pay cash for a larger share of their own health care. Anyone under the age of 65 can establish a Health Savings Account if they have a "qualified" health-insurance plan. A "qualified" plan is an insurance policy that has a minimum deductible of $2,000 for a family and a $10,000 limit on the family's annual out-of-pocket expenses. The deductible is designed to make individuals more cost-conscious in their consumption of health care, and the annual limit on out-of-pocket expenses is there to prevent financial hardship or a lack of care because of an inability to pay. Individuals or their employers can make annual pretax contributions to Health Savings Accounts of up to 100% of the health-plan deductible, with a maximum of $5,150 in 2004. An individual can withdraw funds from his HSA without paying tax if the money is used for any kind of health bills, including prescription drugs, dental care and long-term care. Any funds not used in one year are automatically carried forward to the future. Individuals can also withdraw funds from these Health Savings Accounts for nonmedical expenses by paying tax as they would for any IRA withdrawal. And the individual pays no tax on the interest, dividends or capital gains earned on the HSA investment. Here's an example of how such a "qualified plan" and an HSA can substantially reduce costs for a family without increasing its financial risk. California Blue Cross now offers a traditional low-deductible plan (a deductible of $500 per family member, up to a maximum of two) with an annual premium of $8,460. It also offers a high-deductible plan that is similar except that the deductible is $2,500 per family member, also up to a maximum of two. The annual premium for the high-deductible plan is only $3,936, a premium saving of $4,524. The premium saving is so large that it actually exceeds the maximum additional out-of-pocket cost that the family would face if it reached the maximum deductible for both individuals! The traditional tax rules are the only reason why someone in the past would have chosen the low deductible policy. A family that earns $50,000 faces a marginal tax rate of about 45% (a 27% federal income tax rate, 15% payroll tax rate and a state income tax rate of about 5%). If the $4,524 premium saving was turned into taxable salary, the individual's net income would rise by only 55% of $4,524, or $2,488. But when the saving of $4,524 is put into a Health Savings Account, there is no tax to pay and the funds can accumulate tax-free. High-deductible policies give individuals and their doctors an incentive to avoid wasteful health spending. When spending comes from the individuals' own Health Savings Accounts, individuals and their doctors have a strong reason to balance the costs of medical procedures against the potential favorable impact on health. The same incentive can influence the choice among hospitals and among different prescription drugs. And because these cost incentives reduce the need for HMO rules that limit the availability of care, individuals can have greater scope for choosing the care that they want. In short, the new HSA tax and insurance rules can be the beginning of successfully controlling medical spending and bringing it in line with what patients and their doctors really think is best. Mr. Feldstein, chairman of the Council of Economic Advisers under President Reagan, is an economics professor at Harvard and a member of the Journal's Board of Contributors. Updated January 19, 2004 Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! SiteBuilder - Free web site building tool. Try it! --0-1297114306-1075266631=:93873 Content-Type: text/html; charset=us-ascii

Submission from Paul Windham, MD

===========================

Monday, January 19, 2004

Health and Taxes

By MARTIN FELDSTEIN

The Health Savings Accounts that President Bush recently signed into law may well be the most important piece of legislation of 2003. These new tax and medical insurance rules have the potential to transform health-care finances, bringing costs under control and making health care reflect what patients and their doctors really want. It is remarkable that this legislation has received so little public attention.

Today's high cost of health care reflects the way that the tax law has subsidized the use of insurance to pay for health care. Private insurance now pays 70% of all nongovernment health-care costs and more than 90% of nongovernment hospital costs. Because out-of-pocket payments at the time of care are only a small fraction of the total cost of producing that care, individuals naturally want "the best care" that medical science can provide. And the demand for that high-tech care drives medical innovation toward new and more expensive modes of treatment.

The demand for the typical health-insurance policy reflects the tax provision that allows employees to exclude payments for health insurance from their taxable income. Since the annual premium for a family may be as much as $10,000, the resulting tax saving is a very large subsidy for the purchase of the kind of comprehensive, low-deductible insurance policy that drives up health-care costs and that has led to the imposition of controls on patient choice. In the aggregate, this exclusion reduces Federal income-tax collections by $120 billion a year, essentially a $120 billion subsidy for purchasing the wrong kind of insurance.

Although HMOs and other forms of managed care that aim at controlling health costs have become increasingly common in recent years, health costs continue to take a growing share of GDP. And neither patients nor doctors are happy when HMOs restrict the health care that can be given, or limit the time that doctors can spend with each patient, or appear to deny patients information about the care that might benefit them.

The new HSA law (a part of the recent Medicare reform bill) eliminates the preferential subsidy for comprehensive insurance by giving the same tax treatment to individuals who set aside income to pay cash for a larger share of their own health care. Anyone under the age of 65 can establish a Health Savings Account if they have a "qualified" health-insurance plan. A "qualified" plan is an insurance policy that has a minimum deductible of $2,000 for a family and a $10,000 limit on the family's annual out-of-pocket expenses. The deductible is designed to make individuals more cost-conscious in their consumption of health care, and the annual limit on out-of-pocket expenses is there to prevent financial hardship or a lack of care because of an inability to pay. Individuals or their employers can make annual pretax contributions to Health Savings Accounts of up to 100% of the health-plan deductible, with a maximum of $5,150 in 2004.

An individual can withdraw funds from his HSA without paying tax if the money is used for any kind of health bills, including prescription drugs, dental care and long-term care. Any funds not used in one year are automatically carried forward to the future. Individuals can also withdraw funds from these Health Savings Accounts for nonmedical expenses by paying tax as they would for any IRA withdrawal. And the individual pays no tax on the interest, dividends or capital gains earned on the HSA investment.

Here's an example of how such a "qualified plan" and an HSA can substantially reduce costs for a family without increasing its financial risk. California Blue Cross now offers a traditional low-deductible plan (a deductible of $500 per family member, up to a maximum of two) with an annual premium of $8,460. It also offers a high-deductible plan that is similar except that the deductible is $2,500 per family member, also up to a maximum of two. The annual premium for the high-deductible plan is only $3,936, a premium saving of $4,524. The premium saving is so large that it actually exceeds the maximum additional out-of-pocket cost that the family would face if it reached the maximum deductible for both individuals!

The traditional tax rules are the only reason why someone in the past would have chosen the low deductible policy. A family that earns $50,000 faces a marginal tax rate of about 45% (a 27% federal income tax rate, 15% payroll tax rate and a state income tax rate of about 5%). If the $4,524 premium saving was turned into taxable salary, the individual's net income would rise by only 55% of $4,524, or $2,488. But when the saving of $4,524 is put into a Health Savings Account, there is no tax to pay and the funds can accumulate tax-free.

High-deductible policies give individuals and their doctors an incentive to avoid wasteful health spending. When spending comes from the individuals' own Health Savings Accounts, individuals and their doctors have a strong reason to balance the costs of medical procedures against the potential favorable impact on health. The same incentive can influence the choice among hospitals and among different prescription drugs. And because these cost incentives reduce the need for HMO rules that limit the availability of care, individuals can have greater scope for choosing the care that they want.

In short, the new HSA tax and insurance rules can be the beginning of successfully controlling medical spending and bringing it in line with what patients and their doctors really think is best.

Mr. Feldstein, chairman of the Council of Economic Advisers under President Reagan, is an economics professor at Harvard and a member of the Journal's Board of Contributors.

Updated January 19, 2004

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

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Yahoo! SiteBuilder - Free web site building tool. Try it! --0-1297114306-1075266631=:93873-- From pottsbri@yahoo.com Thu Jan 29 06:52:24 2004 From: pottsbri@yahoo.com (CAL/AAEM News Service) Date: Wed, 28 Jan 2004 22:52:24 -0800 (PST) Subject: NYT: Schwarzenegger Budget Denies Some Health Care Message-ID: <20040129065224.83366.qmail@web41314.mail.yahoo.com> --0-502680997-1075359144=:83350 Content-Type: text/plain; charset=us-ascii Submission by Paul Windham, MD ========================= --------------------------------- January 18, 2004Schwarzenegger Budget Denies Some Health CareBy JOHN M. BRODER OS ANGELES, Jan. 17 � It is nearly impossible for many Californians to comprehend the sum of $14 billion, the current estimate of the state's budget deficit next year, and the cuts and contortions that Gov. Arnold Schwarzenegger has proposed to make it disappear. So think about $320 a month, the price for Esther Bush to include her 8-year-old daughter, Natalia, on her employer-paid health plan. She says she cannot afford it. Governor Schwarzenegger says the state cannot afford to insure Natalia, either. Ms. Bush, a medical social worker at a nonprofit agency in Los Angeles, is not poor � she earns nearly $30,000 a year � but neither has she climbed into the middle class. Ms. Bush, 33, shares a two-bedroom apartment in a dicey Los Angeles neighborhood with her sister and brother-in-law and their three children. She drives a 1989 Ford Tempo, pays $300 a month for after-school care for her daughter and lives, she said, from paycheck to paycheck. Until last spring, Natalia received medical coverage under Medi-Cal, the state's Medicaid program. But when Ms. Bush received a small increase in her salary, she no longer qualified for the program and instead was told to apply to Healthy Families, a state-federal health insurance program for the near-poor. Because of computer and paperwork problems, her application was delayed, as the state's fiscal situation continued to deteriorate. Governor Schwarzenegger, in his budget presentation last week, proposed capping enrollment in the Healthy Families program at the current level, 732,000 children. An estimated 300,000 additional children are eligible, but could be enrolled only as new slots open under the cap. New applicants, like Natalia, will be placed on a waiting list, as Ms. Bush put it, "for God knows how long." In the meantime, Ms. Bush prays that no emergencies befall her. As it is, she spends four hours waiting to see a doctor at a neighborhood clinic when her daughter has an ear infection or stomachache. In his campaign last fall, Mr. Schwarzenegger, a Republican, praised the Healthy Families program and vowed to do whatever he could to make sure all those who qualified for the program were enrolled. But in his budget, which is certain to be modified by the Legislature, Mr. Schwarzenegger proposed $2.7 billion in cuts in social service programs, including the cap on enrollment in Healthy Families. Virtually every state safety net program for the poor � including Medi-Cal, welfare and programs for the infirm, the aged, the severely disabled and those living with AIDS � faces substantial reductions under the governor's spending plan. Mr. Schwarzenegger also proposed a 10 percent reduction in fees to doctors and other medical providers under the Medi-Cal program, a move some fear will drive many providers out of the overburdened system. A court has blocked a 5 percent reduction in Medi-Cal reimbursements imposed last year, so the $462 million Mr. Schwarzenegger hopes to save from the larger reduction is hypothetical at this point. The governor's proposal would cap health care payments for illegal immigrants, reduce state payments for in-home care of the elderly and disabled and suspend the scheduled 2005 cost-of-living increase in the state's share of the Supplemental Security Income program. More than 75,000 legal and illegal immigrants and 110,000 children in low-income families would lose health coverage in the first year of the plan, according to Health Access, a nonprofit group that advocates expansion of coverage. The California HealthCare Foundation estimates that the plan would add 350,000 Californians to the ranks of the uninsured over the next two years. State Senator John Burton, the liberal leader of Senate Democrats, called Mr. Schwarzenegger's first budget "unworthy" of the progressive tradition of California. "I don't think people voted for him to take away money from the elderly, blind and disabled," Mr. Burton said this week. "I don't think they voted for him to take health care away from young children." Mr. Burton and other Democrats say they believe tax increases will be needed to balance the budget without devastating cuts in programs for the poor. Passage of the budget requires a two-thirds vote of the Legislature, which is dominated by Democrats. "It seems the only people being asked to share in the pain are those that are the most vulnerable," said Francisco Estrada, public policy director in Sacramento for the Mexican-American Legal Defense and Educational Fund. "The most affluent are not being asked at all to share in the pain of resolving California's fiscal crisis." Schwarzenegger aides defended the decisions as necessary to correct the state's troubled finances. They said cuts were not aimed at the poor. They noted that health and human services would consume nearly a quarter of the state's $99 billion in spending for the fiscal year starting July 1, so it appeared the poor would take a disproportionate hit. "Anyone who characterizes it as balancing the budget on the most vulnerable is just not accurate," said Rob Stutzman, the governor's communications director. "The pain is balanced throughout government." Mr. Stutzman said social services cuts were made with "scalpels rather than battle axes" and were designed to slow the growth of expensive programs to bring deeper savings in future years. According to the Center on Budget and Policy Priorities, a national group that analyzes the impact of government programs on the poor, 34 states have imposed cuts or caps on Medicaid and children's health plans, causing as many as 1.6 million low-income recipients to lose health coverage. Florida, which froze enrollment in its children's health program last year, had a waiting list of more than 40,000 children by late fall. The Florida official who helped Gov. Jeb Bush design his most recent budget, Donna Arduin, is now Mr. Schwarzenegger's budget director. "These are not easy decisions, to be sure," said H. D. Palmer, spokesman for Ms. Arduin, "but we tried to strike a balance between unsustainable rates of growth and going in and removing people who are currently receiving services. We think we found a middle ground." In addition to the cuts in state social programs, the governor has proposed a $1.3 billion reduction in payments to local governments. City and county officials warned that those cuts imperiled local health and welfare programs, as well as public safety and other services. David E. Janssen, the chief administrative officer for Los Angeles County, said that his county, the state's most populous with 10 million residents, would lose $289 million under the governor's plan, even as it had to cope with the cuts in services. "This really represents a frontal assault on health and human services programs," Mr. Janssen said. He said denying basic health coverage to thousands of low-income residents would drive them to underfinanced community clinics and overcrowded emergency rooms. The counties and cities foot the majority of the bills for those services, he said. Mr. Janssen also noted that Mr. Schwarzenegger's budget depended largely on California voters approving a $15 billion deficit-reduction bond on the March ballot. Without that money, the state will run out of cash in June and the budget hole next year will be at least $3 billion deeper. Mr. Janssen said that borrowing to finance current spending was fiscally irresponsible, but utterly necessary given the state's plight. "It's lousy government," he said, "but it has to pass." Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! SiteBuilder - Free web site building tool. Try it! --0-502680997-1075359144=:83350 Content-Type: text/html; charset=us-ascii

Submission by Paul Windham, MD

=========================

January 18, 2004

Schwarzenegger Budget Denies Some Health Care

By JOHN M. BRODER

OS ANGELES, Jan. 17 � It is nearly impossible for many Californians to comprehend the sum of $14 billion, the current estimate of the state's budget deficit next year, and the cuts and contortions that Gov. Arnold Schwarzenegger has proposed to make it disappear.

So think about $320 a month, the price for Esther Bush to include her 8-year-old daughter, Natalia, on her employer-paid health plan. She says she cannot afford it. Governor Schwarzenegger says the state cannot afford to insure Natalia, either.

Ms. Bush, a medical social worker at a nonprofit agency in Los Angeles, is not poor � she earns nearly $30,000 a year � but neither has she climbed into the middle class. Ms. Bush, 33, shares a two-bedroom apartment in a dicey Los Angeles neighborhood with her sister and brother-in-law and their three children. She drives a 1989 Ford Tempo, pays $300 a month for after-school care for her daughter and lives, she said, from paycheck to paycheck.

Until last spring, Natalia received medical coverage under Medi-Cal, the state's Medicaid program. But when Ms. Bush received a small increase in her salary, she no longer qualified for the program and instead was told to apply to Healthy Families, a state-federal health insurance program for the near-poor.

Because of computer and paperwork problems, her application was delayed, as the state's fiscal situation continued to deteriorate. Governor Schwarzenegger, in his budget presentation last week, proposed capping enrollment in the Healthy Families program at the current level, 732,000 children. An estimated 300,000 additional children are eligible, but could be enrolled only as new slots open under the cap.

New applicants, like Natalia, will be placed on a waiting list, as Ms. Bush put it, "for God knows how long." In the meantime, Ms. Bush prays that no emergencies befall her. As it is, she spends four hours waiting to see a doctor at a neighborhood clinic when her daughter has an ear infection or stomachache.

In his campaign last fall, Mr. Schwarzenegger, a Republican, praised the Healthy Families program and vowed to do whatever he could to make sure all those who qualified for the program were enrolled. But in his budget, which is certain to be modified by the Legislature, Mr. Schwarzenegger proposed $2.7 billion in cuts in social service programs, including the cap on enrollment in Healthy Families.

Virtually every state safety net program for the poor � including Medi-Cal, welfare and programs for the infirm, the aged, the severely disabled and those living with AIDS � faces substantial reductions under the governor's spending plan.

Mr. Schwarzenegger also proposed a 10 percent reduction in fees to doctors and other medical providers under the Medi-Cal program, a move some fear will drive many providers out of the overburdened system. A court has blocked a 5 percent reduction in Medi-Cal reimbursements imposed last year, so the $462 million Mr. Schwarzenegger hopes to save from the larger reduction is hypothetical at this point.

The governor's proposal would cap health care payments for illegal immigrants, reduce state payments for in-home care of the elderly and disabled and suspend the scheduled 2005 cost-of-living increase in the state's share of the Supplemental Security Income program.

More than 75,000 legal and illegal immigrants and 110,000 children in low-income families would lose health coverage in the first year of the plan, according to Health Access, a nonprofit group that advocates expansion of coverage. The California HealthCare Foundation estimates that the plan would add 350,000 Californians to the ranks of the uninsured over the next two years.

State Senator John Burton, the liberal leader of Senate Democrats, called Mr. Schwarzenegger's first budget "unworthy" of the progressive tradition of California.

"I don't think people voted for him to take away money from the elderly, blind and disabled," Mr. Burton said this week. "I don't think they voted for him to take health care away from young children."

Mr. Burton and other Democrats say they believe tax increases will be needed to balance the budget without devastating cuts in programs for the poor. Passage of the budget requires a two-thirds vote of the Legislature, which is dominated by Democrats.

"It seems the only people being asked to share in the pain are those that are the most vulnerable," said Francisco Estrada, public policy director in Sacramento for the Mexican-American Legal Defense and Educational Fund. "The most affluent are not being asked at all to share in the pain of resolving California's fiscal crisis."

Schwarzenegger aides defended the decisions as necessary to correct the state's troubled finances. They said cuts were not aimed at the poor. They noted that health and human services would consume nearly a quarter of the state's $99 billion in spending for the fiscal year starting July 1, so it appeared the poor would take a disproportionate hit.

"Anyone who characterizes it as balancing the budget on the most vulnerable is just not accurate," said Rob Stutzman, the governor's communications director. "The pain is balanced throughout government."

Mr. Stutzman said social services cuts were made with "scalpels rather than battle axes" and were designed to slow the growth of expensive programs to bring deeper savings in future years.

According to the Center on Budget and Policy Priorities, a national group that analyzes the impact of government programs on the poor, 34 states have imposed cuts or caps on Medicaid and children's health plans, causing as many as 1.6 million low-income recipients to lose health coverage. Florida, which froze enrollment in its children's health program last year, had a waiting list of more than 40,000 children by late fall.

The Florida official who helped Gov. Jeb Bush design his most recent budget, Donna Arduin, is now Mr. Schwarzenegger's budget director.

"These are not easy decisions, to be sure," said H. D. Palmer, spokesman for Ms. Arduin, "but we tried to strike a balance between unsustainable rates of growth and going in and removing people who are currently receiving services. We think we found a middle ground."

In addition to the cuts in state social programs, the governor has proposed a $1.3 billion reduction in payments to local governments. City and county officials warned that those cuts imperiled local health and welfare programs, as well as public safety and other services.

David E. Janssen, the chief administrative officer for Los Angeles County, said that his county, the state's most populous with 10 million residents, would lose $289 million under the governor's plan, even as it had to cope with the cuts in services.

"This really represents a frontal assault on health and human services programs," Mr. Janssen said. He said denying basic health coverage to thousands of low-income residents would drive them to underfinanced community clinics and overcrowded emergency rooms. The counties and cities foot the majority of the bills for those services, he said.

Mr. Janssen also noted that Mr. Schwarzenegger's budget depended largely on California voters approving a $15 billion deficit-reduction bond on the March ballot. Without that money, the state will run out of cash in June and the budget hole next year will be at least $3 billion deeper.

Mr. Janssen said that borrowing to finance current spending was fiscally irresponsible, but utterly necessary given the state's plight.

"It's lousy government," he said, "but it has to pass."

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

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Yahoo! SiteBuilder - Free web site building tool. Try it! --0-502680997-1075359144=:83350-- From akazzi@uci.edu Thu Jan 29 09:59:11 2004 From: akazzi@uci.edu (Kazzi, A. Antoine) Date: Thu, 29 Jan 2004 01:59:11 -0800 Subject: FW: Register Now for Emergency Airway Course - - February 5-6, 20 04 - Three spots available Message-ID: <59CDD9FF884EAE4AB86132E86110D72202E09C97@wicket.ndc.mc.uci.edu> -----Original Message----- From: AAEM [mailto:info@aaem.org] Sent: Wednesday, January 28, 2004 12:46 PM To: akazzi@attglobal.net Subject: Register Now for Emergency Airway Course Dear AAEM Member: Call soon to reserve your space in the Practical Emergency Airway Management Courses scheduled for 2004 in Baltimore, MD. Three spots are still available in the Feb. 5-6 course! Here's what past participants have said about the course: "The best EM / CME course I've ever had in 15 years. The ability in this to formally learn directed laryngoscopy course in a realistic way is unique for EM physicians and far surpasses standard mannequin teaching." "Thank you for such a great airway management course. Few CME courses have ever changed my practice of medicine. Yours is an exception as I will indefinitely incorporate the techniques I have learned from you in my management of patients' airways. I will recommend your course to my colleagues unconditionally." "Excellent. Cadaver model is unequaled and I will recommend the course to colleagues." "Thanks again for a great course. First hour I was back at work I had to intubate an older gentleman with an immobile neck, but it was so easy. The larynx looked as big as a barn and the cords like pillars to a temple--could've driven a truck through them. Your emphasis on anatomy served me well." The 2004 course calendar has been increased to seven offerings with 16 seats in each section. Course dates available include: - February 5-6, 2004 - Three spots available - March 11-12, 2004 - April 1-2, 2004 - May 6-7, 2004 - June 10-11, 2004 - November 4-5, 2004 - December 1-2, 2004 This unique two-day workshop focuses on Advanced Laryngoscopy and Intubation Techniques, Rescue Ventilation Devices and Surgical Airways, with a full day fresh cadaver lab: 16 cadavers for 16 participants and NO plastic manikins. This course is intended for the emergency physician already familiar with commonly used RSI medications. It is not a review of RSI pharmacology nor a parade of every "difficult airway" device. It is an in-depth look at effective approaches to airway management that have a proven track record under emergency conditions. The course was developed by Richard M. Levitan, MD; Emergency Medicine, Hospital of the University of Pennsylvania; Assistant Professor of Emergency Medicine, University of Pennsylvania. The course faculty includes Dr. Levitan and Dr. William Levin, who is residency-trained in both EM and Otolaryngology/Head and Neck Surgery, and practices in both fields. Dr. Levin is also an Assistant Professor of Emergency Medicine at New York Medical College. The course fee is $1,095 for AAEM members and $1,195 for non-members. The first day of the Practical Emergency Airway Course is held at the Baltimore Marriott Inner Harbor and the second day is held at the State Anatomy Board, which is within walking distance of the hotel. To register for the course, call AAEM at 800-884-2236. For hotel reservations, contact the Marriott directly at 800-228-9290 or 410-962-0202. The Baltimore Inner Harbor hotel has set aside a block of rooms for course participants at a discounted rate of $169 per night. Cancellation policy: Full refunds are provided for cancellations made to AAEM 45 days or more prior to the course. Cancellations made between 45 and 11 days prior to the course incur a $400 non-refundable fee. No refunds will be given if registration is cancelled 10 or fewer days prior to the course date. AAEM 611 East Wells Street Milwaukee, WI 53202 800-884-2236 Fax: 414-276-3349 E-mail: info@aaem.org Website: www.aaem.org You have received this message because you have had previous contact with the American Academy of Emergency Medicine. If you do not wish to be included in our mailing list, please forward this message to info@aaem.org. This e-mail/fax message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail/fax and destroy all copies of the original message. From pottsbri@yahoo.com Sat Jan 31 06:16:52 2004 From: pottsbri@yahoo.com (CAL/AAEM News Service) Date: Fri, 30 Jan 2004 22:16:52 -0800 (PST) Subject: Study: Liability premiums 17% lower in states that have capped awards Message-ID: <20040131061652.51333.qmail@web41314.mail.yahoo.com> --0-2026053577-1075529812=:48376 Content-Type: text/plain; charset=us-ascii =================================== AHA NEWS NOW The Daily Report for Health Care Executives www.ahanews.com =================================== Wednesday, Jan. 21, 2004 4) Study: Liability premiums 17% lower in states that have capped awards An analysis published today by Health Affairs finds medical liability insurance premiums are 17.1% lower in states that have capped court awards. The report by Kenneth Thorpe, chairman of the health policy and management department at the Emory University Rollins School of Public Health, examines recent trends in liability insurance and the impact of tort reform on premiums. Thorpe, who advised the Clinton administration on health policy issues, said three factors have mainly driven the increase of malpractice premiums: growing awards and settlements, increased frequency of lawsuits, and declines in the investment incomes of insurance companies. Curtis Rooney, AHA senior associate director and counsel for federal relations, said the study "is very encouraging because it adds to the bipartisan recognition that premiums in states that cap awards are lower than in states that don't." The report can be found at http://www.healthaffairs.org under 'Web Exclusives.' +++ ================================== Copyright 2004 by the American Hospital Association. All rights reserved. For republication rights, contact Craig Webb. AHA News is a registered trademark of the American Hospital Association. The opinions expressed in AHA News Now are not necessarily those of the American Hospital Association. Brian Potts Managing Editor, CAL/AAEM News Service MS-IV, UC-Irvine --------------------------------- Do you Yahoo!? Yahoo! SiteBuilder - Free web site building tool. Try it! --0-2026053577-1075529812=:48376 Content-Type: text/html; charset=us-ascii

===================================

AHA NEWS NOW

The Daily Report for Health Care Executives

www.ahanews.com

===================================

Wednesday, Jan. 21, 2004

4) Study: Liability premiums 17% lower in states that have capped awards

An analysis published today by Health Affairs finds medical liability insurance premiums are 17.1% lower in states that have capped court awards. The report by Kenneth Thorpe, chairman of the health policy and management department at the Emory University Rollins School of Public Health, examines recent trends in liability insurance and the impact of tort reform on premiums. Thorpe, who advised the Clinton administration on health policy issues, said three factors have mainly driven the increase of malpractice

premiums: growing awards and settlements, increased frequency of lawsuits, and declines in the investment incomes of insurance companies. Curtis Rooney, AHA senior associate director and counsel for federal relations, said the study "is very encouraging because it adds to the bipartisan recognition that premiums in states that cap awards are lower than in states that don't." The report can be found at http://www.healthaffairs.org under 'Web Exclusives.'

+++

==================================

AHA News is a registered trademark of the American Hospital Association. The opinions expressed in AHA News Now are not necessarily those of the American Hospital Association.

Brian Potts
Managing Editor, CAL/AAEM News Service
MS-IV, UC-Irvine

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