2009 CRS Annual Meeting
Here is the link for our program to be held October 24-25, 2009 in Newport Beach. This meeting combines the best opportunity for a quality medical education program combined with important information on the economics of radiology practice, effective group management, and the latest information on legislative and regulatory issues. This is our second year of combining part of the program with the California Chapter of the RBMA to enhance the educational contact. Please join us! Click here to register.
Bills to Allow District Hospitals to Employ Physicians
California law prohibits hospitals from employing physicians with exceptions for some county hospitals and purely charitable institutions. This is the bar on the corporate practice of medicine intended to allow physicians to practice without interference from business interests though an employment situation. It allows the medical staff to function independently in the best interests of the patient.
Several years ago legislation was adopted to create a program for about to 20 physicians to be employed by district hospitals that met certain criteria, i.e. rural, financial operating losses, and have at least 50% Medi-Cal patient base. That pilot program also required the Medical Board of Ca. to issue a report on the pilot, which they did this last October. That report was inconclusive since the number of actual physicians employed by district hospitals under the pilot was only five.
We previously informed you of three bills, AB 646 (Swanson), AB 648 (Chesbro) and SB 726 (Ashburn), introduced to either allow district hospitals to employ a limited number or any number of physicians or to allow any acute care hospital to employ physicians. District hospitals cite the difficulty in recruiting physicians to rural and poor performing hospitals and that being able to employ physicians will make that easier. We have opposed any broad change to the current prohibition except one that focuses on certain types of troubled hospitals and with only modest expansion of the number of physician who can be employed.
SB 726 did pass the Senate with substantial amendments that narrowed the bill and limited its impact on radiology. Those amendments were not welcomed by the author but it was the will of the Senate Health Committee. The other two Assembly bills continued to be opposed by organized medicine and are now on two year track, meaning they will not be considered finally in the until next year.
Meanwhile SB 726 has been changed substantially during its Assembly hearings and is now no longer acceptable to CMA and other specialties including the CRS. SB 726 would expand the pilot project allowing district hospitals to employ an unlimited number of physicians in Ca., though any one individual hospital could employ no more then 5. It also now would apply to any specialty and not just "core" specialties that previously did not include radiologists. SB 726 will be heard in the Assembly Appropriations Committee in the next few weeks. We will continue to oppose SB 726.
Screening Mammography for Every Woman Counts (EWC) program
The CRS has been involved in discussions over the coverage and reimbursement for digital vs. analog mammography in the EWC program, which is part of the Breast and Cervical Cancer Early Detection Program. This program is funded in part by CDC dollars and from Prop. 10 tobacco tax dollars. It provides education, screening, and therapeutic services for low income women who are not Medi-Cal eligible. The EWC did not cover digital mammography due to the fact that CDC does not see the cost benefit of digital for all women over analog mammography and lack of adequate dollars to pay higher cost. That CDC policy has changed in the last several months so the policy is no longer a problem. Analog machines are being phased out and EWC beneficiaries are having a hard time finding providers. It would cost the EWC program $2.3 million more to screen all their beneficiaries with digital vs. analog, i.e. $70 vs. $133 under Medi-Cal rates.
The CRS supported legislation last year which would have required EWC to cover digital mammography and pay a differential. The bill failed to pass the Assembly Appropriations Committee due to the increased costs and the lack of state funds for any program enhancements. The CRS continued discussions with EWC program officials and breast cancer advocacy groups to try and find a solution. Two years ago the CRS had convinced Medi-Cal to cover digital and to provide a payment differential. The problem is becoming more acute as more radiology groups are phasing out analog units. We have stated that radiologists can't be put in the position of miss-coding the service they provide, e.g. bill for analog and perform digital, and that we can't absorb the cost of this new technology in a screening modality that has its other challenges.
This year AB 359 (Nava) was introduced this year to try and deal with issue but solution is unclear since money is the problem and increased funding is unlikely. In this current state budget environment we have been unable to fix what really is a problem of inadequate funding of the EWC program. AB 359 currently states that the EWC program can reimburse a screening mammography provider for the provision of digital mammography and the analog rate under two conditions, (1) the provider does not have analog screening available, and (2) the provider is willing to accept the lower reimbursement rate. It allows this to occur only until 2013.
This is not a solution and relies on the generosity of radiology groups to provide a higher cost service and an inadequate level of reimbursement. We believe that access will only continue to be impaired for women under the EWC program but there is no funding solution in the short term.
Congressmen Anthony Weiner (D-NY) and Bruce Braley (D-IA) to Offer Self-Referral Amendment to House Healthcare Reform Package!!!!
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