Governor Brown's proposed budget ignores the will of Proposition 56 voters; further burdens Medi-Cal system -AND- MedPAC wants to give hospitals and doctors raises, flag offsite ER claims

CAL/AAEM News Service at
Thu Feb 2 17:44:45 PST 2017



January 10, 2017


Governor Brown's proposed budget ignores the will of Proposition 56 voters;
further burdens Medi-Cal system 



udget-ignores-the> California Medical Association



The California Medical Association (CMA), representing over 43,000
physicians statewide in all modes of practice and specialties, today issued
the following statement in response to Governor Jerry Brown's proposed
2017-18 state budget:


"We're disappointed that Governor Brown's budget ignores the will of voters
who supported the California Healthcare, Research and Prevention Tobacco Tax
Act of 2016 (Proposition 56) by proposing to offset general fund obligations
with tobacco tax revenues rather than investing in the overburdened Medi-Cal
system to improve access to care," said CMA President Ruth E. Haskins, M.D.
"The language of Prop 56 was clear - the people voted overwhelmingly in
support of improving payments for programs and providers to ensure that
patients can see a doctor when and where they need one." 


Last year, CMA co-sponsored Prop 56 with the intent of saving lives put at
risk by tobacco products and improving the access and quality of medical
services for all Californians - especially our most vulnerable communities
who rely on Medi-Cal for basic care. Ample research demonstrates that the
Medi-Cal system is struggling from persistent underfunding. As a result,
California ranks among the lowest in the nation in payments to providers.
These chronically low reimbursement rates have a direct effect on Medi-Cal
patients' ability to receive timely treatment from a physician.


Currently, poor provider reimbursement rates mean that only 40 percent of
California's physicians provide 80 percent of Medi-Cal visits. As a result,
more than half of Medi-Cal enrollees report difficulty finding a primary or
specialty care physician. Medi-Cal patients are more likely than those with
private insurance or Medicare to postpone needed care due to long
appointment wait times, leading to unnecessary, costly emergency room
visits. Not only do these unnecessary emergency visits increase state costs;
they inflate emergency room wait times for Californians experiencing true
medical emergencies. To fix these problems, California must increase rates
so that it is viable for more physicians to participate in the system.  


With more than 14 million Californians relying on Medi-Cal programs to
provide basic and specialty care for serious diseases, the stakes are high.
Californians voted for the tobacco tax to remove these barriers to reliable
and quality care. California cannot afford to continue starving this program
by diverting Prop 56 revenues to cover the state's general fund obligations.


"We must honor the will of the voters and use the estimated $1 billion in
new health care revenue for its intended purpose, instead of writing a blank
check to the general fund," said Dr. Haskins. "We look forward to working
with the legislature and the Brown administration to develop a solution that
doesn't supplant the will of California voters or put low-income families
and communities at risk." 




January 12, 2017


MedPAC wants to give hospitals and doctors raises, flag offsite ER claims 



mpaign=financedaily> Modern Healthcare



By Virgil Dickson 


The Medicare Payment Advisory Commission wants hospitals and doctors to get
raises in 2018. Ambulatory surgery centers, skilled-nursing facilities and
inpatient rehabilitation facilities should get no increases because they're
already making plenty of money.


MedPAC also unanimously agrees that all services provided at off-site
emergency departments should be flagged by a modifier on claims.


MedPAC commissioners Thursday unanimously approved recommendations that
Medicare boost payments for hospital inpatient and outpatient services in
2018 as outlined under current law, which is an estimated at 1.85%.
Physicians would receive 0.5%.


The panel again said ambulatory surgery centers in 2018 did not need raises,
arguing those outpatient facilities appear to be financially healthy. In
2015, those facilities saw 3.4 million Medicare beneficiaries at a cost of
$4.1 billion.


MedPAC similarly thought skilled-nursing facilities, hospices and
long-term-care hospitals don't need higher rates. The group suggested modest
cuts for home-health agencies and inpatient rehabilitation facilities since
both groups of providers have profit margins ranging from 18% to 41.5%.
MedPAC says inpatient rehabilitation facilities see Medicare payments
substantially exceed the costs of care.


In recent years, Congress has oddly rejected MedPAC's recommendations
regarding post-acute settings. And on Thursday, MedPAC revealed that
Medicare would have saved $11 billion between 2009 and 2016 had Congress
implemented its suggestions for home health and SNF settings.


Congress considered the panel non-partisan, unlike its counterpart, the
Medicaid and CHIP Payment


and Access Commission.


MedPAC's rationale behind the modifier flagging off-site ER claims is to
determine whether off-site ERs are unfairly benefiting from an exemption to
the site-neutral payment law since Medicare generally pays more for services
performed in an ER that in other settings. The site-neutral law exempted
stand-alone ERs to ensure access to care.


Claims to the CMS are currently submitted in bulk.


There 363 off-campus ERs affiliated with hospitals and about 200 independent
ERs, but those facilities can't bill Medicare unless they are teamed up with
providers. MedPAC believes about 400 off-site ERs now are billing Medicare.


Groups like the American Hospital Association and the Association of
American Medical Colleges support the idea of a modifier as long as it's not
too difficult to implement.


But both industry stakeholders and America's Essential Hospitals, which
represents the nation's safety net hospitals, oppose the data being used to
repeal the off-site ER exemption.


"Congress statutorily carved out free-standing emergency departments from
the payment cuts because lawmakers understood the harm to access that could
result in communities across the country," said Erin O'Malley, director of
policy at America's Essential Hospitals.


"That potential harm is no less a threat today than when the law passed, and
would come on top of the reduced access to care we believe the other
outpatient department cuts will cause." 




Jeff Wells
Deputy Editor, CAL/AAEM News Service


Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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