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NEW 2017 LAWS What They Mean for You, Your Practice & Your Patients
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P RES IDEN T ’S LET T ER | VIT O IM B AS C IANI, M D
Opportunities to Serve Others
“Volunteerism is only infrequently discussed in medical circles, yet its benefits — both to the individuals offering their services and to those receiving them — are profound and indisputable.”
We celebrate holidays all year long; almost every month has one. But when you use the expression “the Holidays,” everyone takes you to mean the Judeo-Christian celebrations that come between Thanksgiving and the start of the new year. These specific holidays coincide with the winter solstice, the time of year associated, by early humans, with strong emotions, especially the fear of losing the light and heat of the sun, and a hope for the renewal of the earth’s fertility. Modern man has transformed these earlier celebrations of deep winter into ones centered on joy, renewal and hope. And generosity. Hanukkah and Christmas are the two most prominent of these events. Many people express their generosity during the Holidays in the form of gifts to family, friends, co-workers and business associates. Others show generosity by hosting dinners and parties. But physicians have the ability to be generous in other ways, too: by using their special talents to alleviate suffering, and to do so without regard for compensation. Volunteerism is only infrequently discussed in medical circles, yet its benefits — both to the individuals offering their services and to those receiving them — are profound and indisputable. I am referring to volunteer activities beyond the patients seen in our offices or emergency rooms pro bono publico. Every community has free clinics that would welcome doctors of all specialties who are able to donate a few hours a week or a month. Thousands of physicians each year travel to every continent (including Europe and North America) to offer medical and surgical treatment to indigenous peoples, many of whom have no other immediate source of medical care. Refugee populations, their numbers growing rapidly due to unending conflicts in many parts of the world, offer unique opportunities to serve others. Medical missions of varying lengths, intensity and risk are easy to find: Some are sponsored by churches; others by the military, the United Nations and hundreds of nonprofit organizations such as Doctors Without Borders. But most physicians, understandably, will opt for circumstances that do not require passports or exotic vaccines. In any case, if you have never participated in such an exercise of professional generosity, and if you are in a position (with your practice and your family) where you have some time that might otherwise be spent in less-rewarding activities, I commend it to you with the benefit of personal experience. This year, I traveled to the Philippines with the Philippine-American Medical Society of Northern California to do surgery for one week in a remote island of that nation-archipelago. The hours were long, the patients needy, the pathology florid. But the rewards to my spirit were enormous and lasting. It’s the Holiday season, and we at LACMA wish you all the best of health and professional satisfaction in the new year.
ON THE INSIDE
President’s Letter | Vito Imbasciani, MD
2 Start the New Year With New Focus Gustavo Friederichsen
2017
3 What’s New for LACMA in 2017 4 Interview with Mitch Katz, MD 6
4
6 New Healthcare Laws for 2017 9 LACMA Voices | Medical Student Jordan Rivera
LACMA BOARD OF DIRECTORS EDITOR GRAPHIC DESIGN
Sheri Carr 858.226.7647 sheri@physiciansnewsnetwork.com Rob Davis 916.709.2007 ADVERTISING SALES
DISPLAY AD SALES / DIRECTOR OF SALES
Dari Pebdani 858.231.1231 dpebdani@gmail.com
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Dari Pebdani 858.231.1231 dpebdani@gmail.com
EDITORIAL ADVISORY BOARD
David H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD HEADQUARTERS Physicians News Network Los Angeles County Medical Association 801 S. Grand Avenue, Suite 425 Los Angeles, CA 90017 Tel 213.683.9900 | Fax 213.226.0350 www.physiciansnewsnetwork.com LACMA OFFICERS
PRESIDENT PRESIDENT-ELECT TREASURER SECRETARY IMMEDIATE PAST PRESIDENT
Vito Imbasciani, MD William Averill, MD C. Freeman, MD Sion Roy, MD Peter Richman, MD
RESIDENT/FELLOW COUNCILOR CMA TRUSTEE COUNCILOR – DISTRICT 2 ALTERNATE RESIDENT/FELLOW COUNCILOR DISTRICT 1 COUNCILOR COUNCILOR – DISTRICT 3 ALT. MEDICAL STUDENT COUNCILOR/UCLA
Jerry Abraham, MD David Aizuss, MD Emil Avanes, MD Erik Berg, MD Robert Bitonte, MD Stephanie Booth, MD Amanda de la Cerda
COUNCILOR – DISTRICT 5
Troy Elander, MD
COUNCILOR-AT-LARGE
Samuel Fink, MD
ETHNIC PHYSICIANS COMMITTEE REP COUNCILOR – DISTRICT 17 COUNCILOR – USC YOUNG PHYSICIAN COUNCILOR COUNCILOR – DISTRICT 7
Hector Flores, MD Sidney Gold, MD Stephanie Hall, MD Po-Yin Samuel Huang, MD David Hopp, MD
CHAIR OF LACMA DELEGATION
Marvin Kaplan, MD
COUNCILOR – DISTRICT 6
Kambiz Kosari, MD
COUNCILOR-AT-LARGE COUNCILOR – ALLIED ALLIED PACIFIC COUNCILOR-AT-LARGE COUNCILOR – SCPMG
Jeffery Lee, MD Paul Liu, MD Maria Lymberis, MD Ashish Parekh, MD
COUNCILOR – DISTRICT 14
Jinha Park, MD
COUNCILOR – DISTRICT 10
Anantjit Singh, MD
MEDICAL STUDENT COUNCILOR/USC COUNCILOR – SSGPF VLGPF TRUSTEE
Stacy Songco Heather Silverman, MD Diana Shiba, MD
COUNCILOR-AT-LARGE
Nhat Tran, MD
DISTRICT 9 COUNCILOR
Omer Deen, MD
COUNCILOR-AT-LARGE
Theressia Washington, MD
Physician Magazine (ISSN 1533-9254) is published monthly by LACMA Services Inc. (a subsidiary of the Los Angeles County Medical Association) at 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Periodicals Postage Paid at Los Angeles, California, and at additional mailing offices. Volume 143, No. 04 Copyright ©2012 by LACMA Services Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited. POSTMASTER: Send address changes to Physician Magazine, 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. Advertising rates and information sent upon request. LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Director of Governance, at lisa@lacmanet.org or 213-226-0304. SUBSCRIPTIONS Members of the Los Angeles County Medical Association: Physician Magazine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Physician Magazine, 801 S. Grand Avenue, Suite 425, Los Angeles, CA 90017. To inform us of a delivery problem, call 213-6839900. Acceptance of advertising in Physician Magazine in no way constitutes approval or endorsement by LACMA Services Inc. The Los Angeles County Medical Association reserves the right to reject any advertising. Opinions expressed by authors are their own and not necessarily those of Physician Magazine, LACMA Services Inc. or the Los Angeles County Medical Association. Physician Magazine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. PM is not responsible for unsolicited manuscripts.
J A N UA RY 2017 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 1
JANU ARY 2 0 1 7 | TAB LE OF C ON T EN T S
Volume 148 Issue 1
START THE NEW YEAR WITH NEW FOCUS The start of the new year is a time to focus on the expectations for 2017. Before I share what specifically will be happening in the new year, I want to thank each of you and our advertisers like this issue’s Office Ally, Sprint and Fenton Law Group. Without your help, guidance and support we wouldn’t exist.
“We will create a new future for LACMA, regardless of what happens inside the Beltway, based on trust and transparency, one physician relationship at a time.”
The year 2017 represents uncharted territory on many fronts and can be summed up in one word: unpredictable. That said, I want to grow our base of partners/sponsors as some, quite frankly, are being exceptionally cautious relative to their 2017 sponsor and ad budget investments. This is why if any LACMA members know any vendors or companies who would benefit from a LACMA partnership, please let me know! As always, thank you for your help as we try to elevate LACMA to another level. I also want to share a few thoughts on who and what got us to a position of strength. First, I want to personally thank the LACMA Board of Directors, in particular Peter Richman, MD, and Vito Imbasciani, MD, for their support through this first year. Each district president and committee chair and all our volunteer members who give their time to support the practice of medicine deserve the credit for helping LACMA reach solid ground. No leader can transform an organization without exceptional people around him/her. The LACMA staff adjusted to my style of leadership; they rose to the occasion when it came to a different focus, a more vigorous pace and rigorous workload. The successes we’ve mustered these past 10 months are the direct result of our board, committees, districts, staff, affiliates and consultants all working together to exceed all expectations. Ultimately and appropriately, the milestones reached in 2016 and goals set for 2017 are because of physicians like Bill Averill, MD; David Aizuss, MD; Hector Flores, MD; C. Freeman, MD; Emil Avanes, MD; Sion Roy, MD; Lemmon McMillan, MD; Howard Krauss, MD; Sam Fink, MD; Diana Shiba, MD; Jinha Park, MD; Jerry Abraham, MD; Troy Elander, MD; Nhat Tran, MD; and many others who are always available to offer help and advice. To those physician leaders I might have not included in the list, I will buy you a Starbucks coffee. We are ideally positioned for a resounding start to 2017 as we kick off the LACMA Calendar, which will be available on the new website. The new year, with all its unknowns, will certainly test each of us. I fully understand how a Trump presidency and the appointment of Tom Price, MD, as head of the U.S. Department of Health and Human Services raises concerns for some, optimism for others. Here is what I do know (as of late December): The White House announced the most numbers of uninsured signed up for insurance provided by the Affordable Care Act (ACA) on the deadline date Dec. 15 to have healthcare insurance on Jan. 1, 2017. An overwhelming majority of Democrats (90%) and Republicans (82%) have favorable views of allowing
2 P H Y S I C I A N M A G A Z I N E | J A N UA RY 2017
young adults to stay on their parents’ insurance until age 26. Similarly, 89% of Democrats and 77% of Republicans like that the law eliminates out-of-pocket costs for many preventative services. A majority of Democrats (75%) and Republicans (63%) also have favorable attitudes on the law’s stipulation that insurance companies cannot deny coverage based on pre-existing conditions or medical history (Kaiser Family Foundation Survey, December 2016). With the Budget Reconciliation process, the Senate needs just 51 votes to repeal spending and savings parts of ACA. Republican priorities include: • Cutting mandates for individuals and employer insurance and penalties. This would result in many healthy persons opting out of insurance, leaving the sick staying on insurance. • Supporting high risk pools for the states – insurance programs for those who cannot get insurance. • Stopping Medicaid expansion and the marketplaces (federal spending to the states). • Shifting risk to the individual with tax credits for buying insurance and with health savings accounts (HSAs). The other major Republican strategies to replace ACA would probably take place over three to four years (after the 2018 midterm elections) and include decreasing entitlement program spending from the federal government: Medicaid would be replaced by block grants to states with decreased funds for services and reimbursement for physicians; Medicare would be changed by increasing the age for eligibility and creating a voucher system that decreases funds to the program. Since the election I’ve been hearing from members on this issue, and I’m in regular contact with CMA for the latest information. If you’d like to weigh in, email me anytime. We will also hold our first “Thought Leader Roundtable” on Jan. 9 at LACMA, and we will record the session and share with membership. One thing is a certainty: We will create a new future for LACMA, regardless of what happens inside the Beltway, based on trust and transparency, one physician relationship at a time. Stay tuned!
Gustavo Friederichsen Chief Executive Officer
A Few Quick Things
What’s -Newfor LACMA in 2017?
IT’S BEEN A BUSY, MONUMENTAL SORT OF YEAR here at LACMA, in the healthcare community and for the nation as a whole. We’ve got our new CEO at the helm, MACRA, an historic presidential election, a heartbreaking rise in opioid abuse and a country waiting with bated breath to see what’s going to happen with healthcare coverage. On a smaller but still significant scale, LACMA grew in membership and as an organization in 2016. We’re pleased to welcome new members, groups and staff. At the same time, so much organizational growth means that we lean a little heavier on the leaders and staff members who are so adept at keeping things running smoothly. Thank you for your generous assistance. Looking ahead, we’re keeping up our busy, steady pace of expansion, communication and program development. As always, we want to hear what you need, what you’d like
• Rolling out Phase 2 and 3 of the new website. We’ll let you know as we add new features. • A podcast so you can keep abreast of healthcare news in LA County in the car, on the treadmill, wherever and whenever it’s convenient for you. • And finally, we’ve heard that LACMA needs more fun, social events. Comedy night, wine tasting, movie night, family picnic? Let us know what you’d like to see.
to see and even what you’ve had enough of! Here’s a quick rundown of a few things we’ve got in the works for the new year and beyond . . . • Continued advocacy and updates around MACRA. In just about
MEDICAL BOARD HOSPITAL STAFF F R A U D / A B U S E MEDI-CAL/M E D I C A R E
MEDICAL PRACTICE PURCHASES, SALES AND MERGERS
every district, we’ve heard how important this is to members. • Coordination between LACMA districts and divisions at the Department of Public Health on key issues in all the regions in LA County. • Expanding programs that emphasize diversity and inclusion. The Searing Journey was a start. We look forward to broadening that dialogue.
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J A N UA RY 2017 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 3
RAISING THE BAR
BY DEBORAH STAMBLER COMMUNICATIONS CONSULTANT LOS ANGELES COUNTY MEDICAL ASSOCIATION
Raising Interesting Questions for 2017 An Interview with Mitch Katz, MD MITCH KATZ, MD, DIRECTOR OF LA COUNTY HEALTH AGENCY, is uniquely positioned to talk about what he sees as the big healthcare issues coming up in
2017 for Los Angeles. Late in 2015, the three big health agencies for LA County —
the Department of Public Health, Department of Mental Health and Department of Health Services — were brought together to form one super-agency with Dr. Katz
overseeing it. We were pleased to grab some time with him just after the election to find out what he thinks we should be watching for. The election dominated the news for months and months. What do you think the main issues for healthcare will be under the new administration and new Congress? Dr. Katz: In 2017, the dominant issue will be what the new president and Congress will do about the Affordable Care Act and how it will affect people, both patients and their physicians, in Los Angeles. The ACA has been dramatically effective in decreasing the number of uninsured people here and in other parts of the country. I’ve personally cared for many patients who come to our urgent care at Roybal Comprehensive Health Center and they say, “I used to be treated for hypertension or diabetes and then I lost my insurance and I haven’t filled my prescriptions for over a year, but now I got Medicaid and so I’m back.” I think the most important role for doctors during this turbulent time is to stay focused as advocates of our patients. The most important thing to me is that people have access to going to see their medical provider. That can occur through a variety of different systems, and I don’t think we have to be close-minded about what the vehicle is for paying for people to go to see their doctors. But I think to simply return to the era when people were uninsured and came into the emergency room for illnesses at the end stage would be a terrible mistake. And a terrible going back. 4 P H Y S I C I A N M A G A Z I N E | J A N UA RY 2017
For 2017, the issue for all of us to watch is this: Are we talking about an alternative way of making sure people get the coverage they need? Are they able to see their doctors when they are sick, or are we talking about taking away the rights of people to get medical care when needed? I can work with a variety of different mechanisms of ensuring that people get the care they need. What I am against is the idea that we would just return to an era where people with chronic or acute illnesses are not able to get the care they so badly need.
As of our press date, Presidentelect Trump will not yet have taken office, so there’s a lot we don’t know about his plans. He’s said that he would repeal ACA but might keep parts of it. Overall, are you aware of any concrete alternatives to ACA being floated? Dr. Katz: Again, my view is that as physicians our role is to advocate for highquality care with excellent access for our patients. That’s the standard. So the ACA has markedly improved access and quality of care, and it seems to me the burden of anybody who wishes to change the system is, okay, well, how will you guarantee highquality care and access? I’ve spent my career as a change-maker. I’m not against different ways of doing
things. I feel in some ways it’s a mistake to get too deeply involved, especially as physicians, with the mechanics of how care gets paid for. But what we should be very focused on is what our standard is. We need to stand up for the right of people to be able to see a doctor when they’re sick or receive preventive care, and against the idea of cutting off access. If people have alternative ways, then I’m all in favor of listening to how that’s going to produce the same outcome.
Staying focused on the standard of care makes a lot of sense. That’s a clear suggestion for waiting out the limbo stage. What else should we look at for 2017? Dr. Katz: An interesting and very topical issue on the public health side that doctors need to think about is the passage in California that will make recreational marijuana use legal. That issue has huge implications for physicians as well as the community. I think the advocates of recreational marijuana correctly point out that when a substance like marijuana is illegal, it just pushes the substance into the underground, where it cannot be regulated, it cannot be taxed. It becomes part of illegal ways of earning money. It leads to crime. So the legalization of marijuana offers us an opportunity to appropriately regulate and tax this psychoactive substance. On the other hand, the challenges it
poses in terms of people who are harmed by chronic marijuana use, people who are driving under the influence of marijuana, people who are at work while they are using marijuana, the possibility that, although it won’t be for sale for minors, greater access might make it easier for minors to get marijuana — all have quite a lot of implications for physicians. The law is now set, so it’s not a question of what if — the law is set. The job here of physicians is to recognize when our patients’ marijuana use is unhealthy and how to counsel them, how to get them to seek treatment. In that sense, as physicians we’ve always counseled people about alcohol use. In fact, small amounts of alcohol for most people who don’t have addiction issues is a positive thing in terms of heart health if they’re drinking wine. Obviously, large amounts of alcohol are unhealthy and lead to all kinds of problems, including liver disease and death. I think this is the model that we should be thinking about with what will happen under the law change. Those states which have [legalized marijuana] have experienced increased use of marijuana. It’s unavoidable if you make it easier because people who don’t want to break the law will now not be breaking the law. The question then becomes, with easier availability, how do we make sure that it’s not harming people.
One challenge seems to be in simply defining harm. Could you comment on that? Dr. Katz: For young people it seems that the harm can be that marijuana does impair brain development. That is thought to be less true for older people. People who use it chronically, every day, in large amounts are often impaired in other ways that need to be addressed. I think that would be a good public health issue to highlight.
Do you think that down the road these things are going to be spelled out more? What chronic use looks like, when it’s harmful, how to counsel? Doctors have been doing these things, but they haven’t been quantified, right? Dr. Katz: Correct, correct. In some ways, legalization makes health issues
easier for doctors to talk about and to address. There’s always a reluctance to discuss and document in your medical records somebody’s illegal activity. But now if it’s no longer illegal, then that’s no longer an issue for us. Now the issue becomes, how do we deal with it? There are some very common problems. For example, many lay people may not be aware that it’s easy to diagnose someone who is intoxicated from alcohol at the job or while driving because there are alcohol tests; it is not easy to diagnose somebody who is high on marijuana while driving or at the job because there’s not a quantifiable test. How do you decide, in the employee health point of view, you have a substance now that’s legal like alcohol, but that doesn’t mean we allow people to be intoxicated while they’re at their job. And we have an objective standard for intoxication. How does that relate to, then, when somebody is using marijuana? An employer might say, “Well, you can’t use marijuana while you’re at the workplace.” That makes sense because we don’t generally let people drink alcohol at their workplace. But what would that mean if they used it before they came to work? Again, you would assume that the standard would be — are you impaired? But then when you go to do an objective assessment, you don’t have a test, so it’s much more complicated.
You raise really good points. Are we close to finding answers? What else is on your radar for the upcoming year? Dr. Katz: Well, you asked me about interesting issues, so I don’t feel obligated to have answers to these questions. Sometimes I think it’s more interesting to raise questions that people don’t have the answer to. I think two strongly related issues that you may not hear about immediately but will be hot and have a lot of impact on doctors in the next year or two are drug prices and resistance to existing antibiotics. On drug prices, pharma has been successful at creating more and more specialized agents to address specific diseases, especially some of the new cancer drugs, some of the new rheumatological drugs, hepatitis C drugs. But the prices are extremely high, and it is unclear as the number of new agents
proliferate how we as physicians will be able to continue to prescribe things, even with insured patients, because, ultimately, somebody has to pay. Insurers have to be able to make money if they’re for profit, or break even if they’re non-profit. That means that as the number of expensive drugs proliferates, premiums will have to go up. If premiums go up, people will be less and less able to afford insurance and will have to make other decisions. I think as a society we’re having tremendous difficulty even deciding what do we consider to be the appropriate standard. For example, I’ve often heard people say, “Can you believe that this is $20 a pill?” Well, is the standard cost per pill? Is the standard per treatment? Is the standard per benefit? Is the standard the cost for the pharmaceutical company to develop the drug? How exactly do we believe drug prices should be set? Part of why I think this is so challenging is that there is no consensus on how drugs should be priced. How could you possibly resolve an issue where there’s not even general agreement on the basis for how to decide? And then related is [that] the pipeline of new antibiotics does not have a lot of new agents coming, and we’re increasingly facing resistant organisms that don’t respond to the antibiotics that we have. There are some at least short-term steps that we can take to minimize drug resistance, but they’ve been extremely hard to implement. For example, we still are treating livestock throughout the U.S. with antibiotics, not even because of any infection but simply because livestock fed antibiotics grow fatter. So we continue to use the antibiotics in this way, for food production, while compromising our future in terms of ability to deal with resistant organisms. Also on this one, in surveys that are done of our practice, physicians continue to prescribe antibiotics for conditions such as upper respiratory infections which are shown to not benefit from antibiotics, or to use antibiotics for longer than necessary for most infections. It has been challenging to get physicians to use antibiotics more sparingly.
Thank you, Dr. Katz, for sharing your thoughts with us and raising some good questions. We look forward to following up with you.
J A N UA RY 2017 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 5
2017
New Healthcare Laws
What They Mean for You, Your Practice & Your Patients
BY MARION WEBB PNN STAFF WRITER
T H I S Y E A R , A N U M B E R O F C A L I F O R N I A B I L L S will take effect that could have a significant impact on you, your practice and your patients. Below, we have listed the ones we think will warrant your attention and generate some discussion with other healthcare providers and with your patients.
YOU
AB 2024 | Critical Access Hospitals: Employment
AB 38 | Mental Health: Early Diagnosis and Preventive Treatment Program
AB 2024 lifts a century-old ban on direct physician employment. It allows California’s smallest and most remote hospitals to directly employ physicians rather than hire them as independent contractors. AB 2024 will apply only to critical access hospitals, small hospitals with 25 or fewer beds that are typically located in remote areas of the state, and has been in effect since Jan. 1.
AB 38 establishes the Early Diagnosis and Preventive Treatment (EDAPT) Program Fund in the state Treasury to provide funding to the Regents of the University of California for the purpose of providing reimbursement to an EDAPT program using an integrated system of care for early intervention, assessment, diagnosis, treatment plan and necessary services for individuals with severe mental illness and children with emotional disturbances.
SB 1177 | Physician and Surgeon Health and Wellness Program This California Medical Association (CMA)-sponsored bill authorizes the Medical Board of California (MBC) to establish a Physician and Surgeon Health and Wellness Program for early identification and appropriate interventions to support a physician or surgeon in his or her rehabilitation from substance abuse. It requires the Board to contract for the program’s administration. Program participants are required to pay for services, including expenses related to treatment, monitoring and laboratory tests, as provided. It creates an account to support the program and prohibits funds in the account from being used to cover costs of participation.
SB 1261 | Physicians and Surgeons: Residency Fee Exemption SB 1261 amends the Medical Practice Act that provides for the licensure and regulation of physicians and removes the requirement that a physician and surgeon reside in California in order to receive a license fee waiver when the license is for the sole purpose of providing voluntary and unpaid services.
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AB 1668 | Investigational Drugs, Biological Products and Devices AB 1668 addresses the national “right to try” movement, which seeks to expand access to not-yet-approved treatments for people who fail to get into clinical trials. AB 1668 authorizes the manufacturer of an investigational drug, biological product, or device not yet approved by the U.S. Food and Drug Administration (FDA) to make the investigational product available to an eligible patient with a serious or immediately life-threatening disease or condition, as specified, when that patient has considered all other treatment options currently approved by the FDA, has been unable to participate in a relevant clinical trial, and for whom the investigational drug has been recommended by the patient’s primary physician and a consulting physician.
YOUR PRACTICE AB 1676 | Employers: Wage Discrimination Existing law prohibits an employer from paying an employee at wage rates less than the rates paid to employees of the opposite sex in the same establishment for equal work and establishes exceptions to the prohibition based on any bona fide factor other than sex. This bill specifies that prior salary cannot, by itself, justify any disparity in compensation under the bona fide exception to the above prohibition.
New Healthcare Laws SB 482 | Controlled Substances: CURES Database SB 482 requires a prescriber to consult the Controlled Substance Utilization Review and Evaluation System (CURES) no earlier than 24 hours or the previous business day prior to prescribing a Schedule II, III and Schedule IV controlled substance to the patient for the first time and at least once every four months thereafter, if the substance remains part of the patient’s treatment. This bill would exempt a veterinarian and a pharmacist from this requirement. It would also exempt healthcare practitioners from this requirement under specified circumstances including if prescribing, ordering, administering or furnishing a controlled substance to a patient receiving hospice care, to a patient admitted to a specified facility for use while on facility premises, or to a patient as part of a treatment for a surgical procedure in a specified facility if the quantity of the controlled substance does not exceed a non-refillable five-day supply of the controlled substance. The measure seeks to crack down on a practice called “doctorshopping” in which addicts use multiple providers to obtain prescriptions for narcotic painkillers. SB 482, sponsored by Sen. Ricardo Lara (D-Bell Gardens), seeks to prevent opioid overdose deaths, which, according to state officials, have increased by 200% since 2000. California is the first of 49 states that currently have prescription drug monitoring programs.
AB 72 | Healthcare Coverage: Out-of-network Coverage AB 72 requires a healthcare service plan contract or health insurance policy issued, amended or renewed on or after July 1, 2017, to provide that if an enrollee or insured receives covered services from a contracting health facility and covered services by a non-contracting health provider, the enrollee would be required to pay the non-contracting provider only the “in-network cost-sharing amount.” The bill would prohibit the insured from owing the noncontracting health provider anything more than the in-network cost-sharing amount. The bill makes an exception from this prohibition if the insured provides written consent that satisfies specified criteria. The bill would require a non-contracting health provider who collects more than the in-network cost-sharing amount from the insured to refund any overpayment to the enrollee or insured, as specified, and would provide that interest on any payment not refunded to the enrollee or insured accrue at 15% per annum, as specified. Shortly after Gov. Jerry Brown signed the law in October 2016, the Association of American Physicians and Surgeons (AAPS) filed a lawsuit in the U.S. District Court requesting the court to block the new law. According to court documents, the complaint by AAPS names the governor and the head of the state Department of Managed Health Care as defendants and states that the law violates the U.S. and California constitutions in at least three ways. PNN reported the Act violates the Due Process Clauses of the U.S. and California constitutions by delegating rate-setting authority to private insurance companies with respect to physicians who are not under any contract with the insurance companies. It
also says the Act is unconstitutional under the Due Process Clauses by requiring arbitration for the out-of-network physicians for their reimbursements, thereby denying them their due process rights in court for their claims. Furthermore, PNN reported, the Act violates the Takings Clause of both the U.S. and California constitutions because the Act empowers private insurance companies to deprive out-of-network physicians of the market value of their services, and arbitrarily denies them just compensation for their labor. The Act also reportedly violates the Equal Protection Clause of both the U.S. and California constitutions by having a disparate impact on minority patients for whom the availability of medical care will sharply decline as out-of-network physicians are coerced by the Act to withdraw services from predominantly minority communities. Others see the Act as protecting patients and their well-being.
AB 1671 | Confidential Communications: Disclosure Distributing secret recordings involving healthcare conversations will become a crime in California in 2017. Introduced by Los Angeles Assemblyman Jimmy Gomez in the wake of an undercover Planned Parenthood investigation, AB 1671 makes it a crime for a person who unlawfully eavesdrops upon or records a confidential communication with a healthcare provider to intentionally disclose or distribute the contents of the confidential communication in any manner, in any forum, including on Internet websites and social media, or for any purpose without the consent of all parties to the confidential communication unless specified conditions are met.
SB 1478 | Committee on Business, Professions and Economic Development. Healing Arts. Existing law requires the Medical Board of California to keep a copy of a complaint it receives regarding the poor quality of care rendered by a licensee for 10 years from the date the board receives the complaint, as provided. This bill deletes that requirement. Existing law requires a CURES fee of $6 to be assessed annually, at the time of license renewal, on specified licensees to pay the reasonable costs associated with operating and maintaining CURES for the purpose of regulating those licensees. This bill, beginning July 1, 2017, except as specified, exempts licensees issued a license placed in a retired or inactive status from the CURES fee requirement. The bill also creates changes to statutes related to dentists, podiatrists, opticians, licensed marriage and family therapists, licensed professional clinical counselors and clinical social workers. It also deletes obsolete provisions, makes conforming changes and other non-substantive changes.
AB 2503 | Workers’ Compensation: Utilization Review AB 2503, backed by CMA, requires a physician providing
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New Healthcare Laws treatment to an injured worker to send any requests for authorization for medical treatment, with supporting documentation, to the claims administrator for the employer, insurer or other entity, according to rules adopted by the Administrative Director of the Division of Workers’ Compensation.
SB 1175 | Workers’ Compensation: Requests for Payment. SB 1175 requires that, for treatment provided on or after January 1, 2017, the medical provider must submit the request for payment within 12 months of the date of service or 12 months of the date of discharge for inpatient facility services. The bill also requires that for medical-legal services or expenses, to submit the request for payment to the employer within 12 months of the date of service. Unless otherwise allowed, any request for payment and bills for medical-legal charges are barred unless timely submitted.
YOUR PATIENTS AB 1823 | California Cancer Clinical Trials Program AB 1823 establishes the California Cancer Clinical Trials Program to increase access to cancer clinical trials for patients, especially women and under-represented communities. This makes the state the first in the country to legally recognize the financial burdens afflicting cancer patients seeking treatment in clinical trials. The new law distinguishes between inducement and reimbursement. It recognizes ancillary costs as a barrier to clinical trial participation, encourages industry support of these costs, and identifies the allowable expenses that can be reimbursed to patients. The California Cancer Clinical Trials Program will be administered by the University of California, which will raise funds and distribute privately funded grants aimed at reducing barriers to trial participation. The funds will be used to help connect patients with appropriate clinical trials and to cover expenses stemming from participation in those trials. It will authorize industry, public and private foundations, individuals and other stakeholders to donate to the program directed by UC, as well as to other nonprofit corporations and public charities that specialize in the enrollment, retention and increased participation of patients in cancer clinical trials. “The California Cancer Clinical Trials Program will transform how we connect patients with cancer trials in California and engage with industry and businesses in the oncology field,” said Assemblywoman Susan Bonilla (D-Concord), the author of the bill. “Research and clinical trials are keys to treatment success, but just as important is the access and participation to those trials by a diverse population.”
8 P H Y S I C I A N M A G A Z I N E | J A N UA RY 2017
8 Key Changes to the 2017 Medicare Fee Schedule In November, CMS released its final 2017 Medicare physician fee schedule aimed to improve Medicare payments for services provided by primary care doctors with a focus on chronic care management and behavioral health. Bakers Hospital Review published eight key changes that doctors need to be aware of. 1. Data on post-operative visits: Starting July 1, 2017, doctors in practices with 10 or more physicians must report data on postoperative visits for high-volume/high-cost procedures. 2. Screening: Providers and suppliers must be screened and enrolled in Medicare to contract with a Medicare Advantage organization to provide items and services to those enrolled in Medicare Advantage health plans. This provision will start two years after publication of the final rule and will be effective on the first day of the plan year. 3. Telehealth services: Additional codes include those for endstage renal disease-related dialysis, advanced care planning and critical care consultations. The critical care consultations provided via telehealth will use the new Medicare G-codes. 4. Improve data transparency: Medicare Advantage organizations use a bidding process to apply to participate in the Medicare Advantage program. The bids reflect the organization’s estimated costs to provide benefits to enrollees. Under the final rule, Medicare Advantage organizations are required to release data associated with these bids every year. CMS also requires Medicare Advantage organizations and Part D sponsors to release medical loss ratio data on a yearly basis to help beneficiaries make enrollment decisions. 5. Geographic practice cost indices: CMS adjusts payments under the physician fee schedule to reflect local differences in practice costs using geographic practice cost indices, which will also overhaul California’s outdated geographic payment localities. This reform will raise payment levels for 14 urban California counties classified as rural while holding the remaining rural counties permanently harmless from cuts (the hold harmless provisions will take place in 2018). 6. Expansion of Medicare Diabetes Prevention Program (MDPP): The MDPP expanded model seeks to help prevent onset of type 2 diabetes among Medicare beneficiaries diagnosed with prediabetes, CMS said. Payment for MDPP services will begin in 2018. 7. Billing codes: Among the changes are new codes to pay primary care practices that use interprofessional care management resources to treat patients with behavioral health conditions. 8. Pay increase: Physician payment rates will increase by 0.24% in 2017 compared to 2016, accounting for a 0.5% increase required by the Medicare Access and CHIP Reauthorization Act and mandated budget neutrality cuts, according to the American Hospital Association. For more information, visit the CMS.gov page at: https://goo.gl/D2xu7l
LACMA VOICES
Social Realities BY JORDAN RIVERA, MEDICAL STUDENT, USC KECK SCHOOL OF MEDICINE
T H E H A L L S E C H O E D A S M Y D R E S S S H O E S hurriedly clacked on the floor with each step. Reciting “SIG E CAPS” and “DASH” mnemonics in my head, I was ready for day one of my psychiatry inpatient rotation. Although my heart was already set on family medicine, I was determined to make a stellar impression. I turned the key in the lock and pulled back the heavy door, not exactly sure what to expect when I got to the other side. If I went solely off of psychiatric inpatient facilities from movies, I would have expected a cacophony, yet the halls remained calm. Patients were awake, pacing around or tinkering on crafts for loved ones. As I moved from room to room meeting new faces, I could not help but notice how most individuals I encountered had black or brown skin. I would not recognize why this was significant until later in the rotation. A couple of weeks later, as I was reading the overnight chart, I was shocked to find a female patient I was following — one I had likened to my own mother due to her sassy wit down to her boisterous laugh — had been sedated because her personality appeared “aggressive” to one of the psychiatrists. It was not until that psychiatrist and I saw the patient together that I realized three things: This physician has not had enough experience with cultures different from his own; it was no coincidence that most of these beds were filled with people of color; and lastly, there were no other doctors who looked like me. As a black and Mexican man, I have the opportunity to consciously choose my role in addressing disproportionate
social realities faced by minorities. “But what about my passion for family medicine?” I thought to myself.
“I choose both.” As an up-and-coming physician, I am no longer comfortable fitting into spaces that perpetuate the status quo. It is time to create new roles that push this country forward and challenge the outdated biases that bleed into our healthcare system. It is time to create spaces for people of color to get high-quality, culturally responsive care that will ensure that our stories, experiences and behaviors are no longer misinterpreted as “wrong.” Now is the time to foster doctors who are yearning to create innovative solutions. I have grown tired of wrestling with limited professional choices that do not measure up to my own values or the demands of our healthcare system, so I’m determined to fill critically unique roles until they are no longer unique.
ABOUT THE AUTHOR: Most recently, Jordan Rivera was accepted into the Gold Humanism Honor Society, Keck School of Medicine’s inaugural chapter, after being recognized by his classmates and faculty as an exemplar of compassionate patient-centered care. Jordan’s dedication to improving healthcare delivery was also noticed by the American Academy of Family Physicians as he was appointed to be on one of its national committees. “It’s an honor to be recognized by my colleagues as a champion for equitable care who is on his way to doing remarkable things. Talk about empowering!” We are so happy you are a part of LACMA, Jordan, and we can’t wait to see what the road ahead has in store!
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Target At LACMA we’ve been reassessing and regrouping in order to provide members with great service. No organization can survive without growth. To that end, we’ve created Target 270, a campaign for 2017 to add 270 new members to LACMA.
In 2017 LACMA will provide • Consultative services for solo/small to large group practices • Problem solving for physicians across all specialties • Economic, legal, technological, regulatory assistance • Legislative and policy advocates • Personalized and relevant support when physicians need it the most • 24/7 support for any issue, no matter how small • Strategic business guidance and resources • Networking and social events • Education and insights on your time • Reimbursement know-how • Personnel, IT, payroll, accounting and documentation best practices • Practice transformation support • Innovations that make a difference in today’s practice • We listen. We’re here to help when it matters most to you. Join us in expanding the spiral of growth as we regroup, reassess and develop into an even more vibrant, physician-centered community that speaks directly to the healthcare needs of Los Angeles and the professionals dedicated to serving their patients. Stay tuned for a Target 270 campaign coming soon to your district.
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