Posted on 05.31.10 by Executive Vice President Susan Hogeland, CAE

I am pleased to report that CAFP had good luck in the State Appropriations Committee last week, where five of our top priority bills were passed out, including AB 2093 (M. Perez), which requires health plans to pay physicians at a rate equal to or greater than the actual cost of acquiring vaccines, PLUS the cost of administration.  Other CAFP-supported bills addressed expansion of mental health coverage, requirement that plans provide coverage for maternity services, protection of patients from unfair insurance company practices and prevention of a requirement that Medi-Cal beneficiaries undergo semi-annual or quarterly eligibility determination, a requirement that adversely affects access to care.

CAFP also met with success last week in its first efforts to resist the Governor's budget proposal to enact a 12 percent reimbursement reduction for physician-administered drugs.  Our battle will continue in conference committee, however. 

On the federal front, CAFP is working to keep up the pressure in the US Senate for a permanent fix to the Medicare Sustained Growth Rate.  Thanks to temporary fixes putting off a 21.3 percent cut in Medicare payment a month or so at a time, the cut has not taken place.  AAFP's executive committee last week, however, decided that if Congress cannot provide a permanent fix for the Medicare physician payment formula, AAFP will not support any legislation that provides a temporary payment patch unless the legislation meets the Academy's new criteria, which are that any temporary measure must include a primary care payment differential and must extend at least through Dec. 31, 2012.

Last week we prepared information for members about Blue Shield's release on June 1 of California Physician Performance Initiative (CPPI)'s Measurement and Reporting Program data to launch a Physician Quality Recognition (PQR) program.  Director of Health Policy Leah Newkirk authored a document physicians in the Blue Shield network may use to guide their discussions with patients who have questions about the physician quality designations for a set of eight CPPI criteria scored in 2009. Some physicians have been designated as higher quality performing physicians for selective preventive screening and chronic care measures as a result of these scorings.  The Academy's document will be sent out via Academy in Action e-newsletter, but may also be obtained here. 

Ms. Newkirk also prepared an update for CAFP members on the Center for Medicare and Medicaid Services' (CMS) interim final rule for Medicare that creates new enrollment, ordering and referring and documentation requirements effective July 6. The provisions of the rule require that physicians ordering and referring specified items and services be enrolled in the Provider Enrollment Chain and Ownership System (PECOS) by July 6, 2010, changing the previously reported January 3, 2011 date given by CMS. All providers who enrolled in Medicare within the past six years, as well as those who enrolled more than six years ago and who have updated their enrollment information within the past six years, have enrollment records in PECOS. Those who enrolled more than six years ago and have not updated their enrollment information will need to submit applications to establish enrollment records in PECOS.  There is an exception to the requirement in the case of a provider who has validly opted out of Medicare, fortunately.  To obtain the CAFP-prepared PECOS document, please go here.

Last week, Callie Langton, CAFP's Associate Director for Health Care Workforce Policy, represented us at the State's Health Care Workforce Workgroup, a subcommittee of the Health Care Reform Taskforce charged with implementation of health care reform in California.  The Workgroup will focus on training and workforce development programs in Title V of the Health Care Reform Act.  The meeting in Sacramento was held to provide an opportunity for "stakeholders" to discuss and provide feedback on how California's implementation of the reform legislation will affect our health workforce and to provide insight on the health care industry's workforce development practices.   

Cynthia Kear, Senior Vice President for External Relations, represented the Academy at an important meeting on the Risk Evaluation and Mitigation Strategies (REMS) on long-acting opioids in Washington, DC on May 25 and 26. CAFP is concerned that too stringent restrictions on prescribing long-acting opioids will have a damaging impact on patients' access to care and pain relief and will be burdensome to physicians to the point of deterring some from prescribing these drugs. 

CAFP will be submitting two names to AAFP for consideration as appointments to the National Health Care Workforce Commission, established by the Affordable Care Act, the health law signed in March of this year.  The purpose of the Workforce Commission is to serve as a resource for the US Congress, Department of Health and Human Services and other agencies on the supply and demand for the nation's health care workforce.  The Commission will issue two reports:  the first will be a review of and recommendations for current policies and programs and the second will be on high priority areas such as GME or geographic distribution, for example.  The commission will work with the National Center for Health Care Workforce Analysis, in the Health Resources and Services Administration (HRSA).  CAFP will nominate Kevin Grumbach, MD and Kathy Flores, MD.

CAFP will propose Joe Scherger, MD and Diane Rittenhouse, MD to AAFP for nomination to the new Board of Governors of the Patient-Centered Research Institute to improve health care quality and enhance evidence-based research.  The purpose of the Institute is to establish a research agenda; develop methodological standards; contract with eligible entities; request public input; and disseminate results to patients and providers.  The Board of Governors will include the Director of AHRQ, the Director of NIH and 17 appointed members.

We're putting the finishing touches on a hectic schedule for next week's visit by Paul Grundy, MD, IBM's Global Director of Health Care Transformation.  The first stop Monday afternoon will be at a San Francisco General Hospital meeting with Kevin Grumbach, MD and others about policy changes to facilitate adoption of the Patient Centered Medical Home  (PCMH) in California.  Tuesday afternoon, we head to Sacramento for an informational briefing and discussion in the Capitol on how PCMH can transform public and private health care.  That evening, we'll meet with representatives of the Fresno Unified School District and other Fresno-based employers interested in the PCMH model, and on Wednesday morning from 7-9 am (!) we'll meet with Thomas Balsbaugh, MD, program director for the UC Davis family medicine residency program and others.  Dr. Grundy will make a return trip to California for more discussion the week of July 12.

CAFP extends its deepest sympathies to Deputy Executive Vice President Shelly Rodrigues and her family over the death of her mother, Nancy Beachly, on May 6, 2010.  In true Shelly fashion, her mother's memorial service was held off so Shelly could staff the CAFP's Annual Scientific Assembly, with the assistance of Cynthia Kear and Karen Brent.