California Medical Association lobbyists plan a three-pronged legislative strategy for 2001 to combat what they say are the primary causes of physician group insolvency and a healthcare system on the brink of collapse.
The CMA is helping craft bills to strengthen the state's trauma and emergency care system, increase physician reimbursement rates from Medi-Cal, California's version of Medicaid, and establish an independent arbitration process for disputes between physician groups and health plans, says Steve Thompson, vice president for government affairs.
"These major issues are directly related to the financial instability of the system," Thompson says. More than a hundred California medical groups and IPAs have crumbled in recent years, according to CMA data. While the infant Financial Solvency Standards Board of the California Department of Managed Health Care is responsible for setting up financial regulations for medical groups and IPAs, the CMA is forging ahead with its own agenda to heal an ailing system.
Thompson says a large number of California's 7.3 million uninsured use emergency rooms for primary care, resulting in significant losses to the emergency care system and to the physicians who provide service to the system. A CMA white paper reports that 80% of California's emergency rooms lost $317 million in 1999. Emergency physicians provided an additional $100 million in uncompensated care, the report says.
Two CMA-drafted bills would allocate an additional $300 million to the emergency medical system and give stronger powers to local and state emergency planning authorities. Democratic state Sens. Joseph Dunn and Jackie Speier have agreed to
introduce the bills.
Dunn's bill would designate trauma and emergency care as an essential public service and create a $200 million Essential Emergency Service Fund to support local hospitals. Another $100 million would go to the existing Maddy Emergency Medical Services Fund for physicians
caring for uninsured patients.
Assemblyman Keith Richman, M.D., a southern California Republican and former chairman of the board of Lakeside Health Care in Los Angeles, also recognizes the problems caused by uncompensated care. Richman, the sole physician in the California Legislature, says insuring more people is the answer to the financial problems emergency and trauma centers face.
Richman introduced a bill in December with support from the CMA and the California Healthcare Association that would phase in the provision of certain basic healthcare services to all Californians.
His bill details a program in which the state would contract with health plans and insurers to offer a standard uniform benefit package to those with limited incomes. The insurance would be available for purchase at subsidized rates, and parents would be required to prove periodically that a child has coverage at least equivalent to the standard package. Small businesses and individuals also could buy basic insurance through purchasing cooperatives.
"Certainly one could take a piecemeal approach, but my belief is that would be like putting a Band-Aid on the problem without addressing the fundamental causes of it," he says.
Second on CMA's legislative agenda is to continue its push to bring Medi-Cal rates up to the national average, which Thompson says would help increase access for California's poor. California ranks 42nd in the nation in overall Medicaid spending, according to a study by the Robert Wood Johnson Foundation.
A lot of physicians don't participate in the program because reimbursement is inadequate, Thompson says. "It makes it especially difficult for Medi-Cal participants to get access to the appropriate specialists," he adds.
Legislation passed last year gave Medi-Cal doctors an average increase of 17%, Thompson says, the first increase since 1983. This year the CMA is pushing for a 20% or greater increase.
Republicans already have pledged to support a 25% increase for this year. The Democrats have been a little slower on this issue, Thompson says, because they usually follow the lead of Gov. Gray Davis. Calls to state Democratic leaders were not returned.
California doctors also are working to establish a process for the speedier resolution of managed care contract disputes, including both mediation and binding arbitration. They were successful last year in passing similar legislation related only to billing and payment issues, but this year the CMA wants to ensure independent arbitration for disputes of a broader scope, including risk responsibility and patient care decisions.
While California's energy shortage has dominated the current legislative session, Thompson says the healthcare system, too, is "near crisis," and he expects to see healthcare items move to the forefront.