Medi-Cal Budget Update on Radiology Reimbursement Reductions

The previously announced rate reductions for radiology under Medi-Cal have still not been implemented. That change would limit reimbursement to no more than 80% of the average Medicare reimbursement in California for the same service. Click here to view information previously sent to our members, which includes a detailed letter and legal fund contribution request which will be used to pursue a legal challenge to this reduction. If you have not yet contributed, we ask you to do so.

The Medi-Cal rate reduction adopted in the 2010-11 state budget in October was intended to take effect on 10/01/10. DHCS has announced their intent to recoup higher payments made since 10/01 via EPC (Electronic Payment Correction). To date the rates of payment have not been reduced and no EPC has occurred. The CRS has retained outside counsel and has made several Freedom of Information Act requests to DHCS to determine the source and justification for their rate methodologies.

The CRS is prepared to seek legal relief once the new Medi-Cal rates have been implemented. We will provide additional information at that point.

Click here to access the legal fund donation form.

Meanwhile, the additional 10% across-the-board Medi-Cal provider rate reduction that was adopted by the Legislature to be effective on June 1, 2011 is still somewhat in limbo since CMS has yet to authorize a state plan amendment to make that and other budget savings changes to the Medi-Cal program. The U.S. Supreme Court will likely issue a ruling this Fall on the previous 10% Medi-Cal rate cut from 2009 that was enjoined by the federal court. The only thing certain is that if a new 10% cut is implemented, further litigation is likely.

Bills to Allow District Hospitals to Employ Physicians Stall for This Year

Two bills were introduced this year, AB 1360 (Swanson) and AB 824 (Chesbro) that would have allowed certain types of district hospitals to employ a limited number of physicians, either 5 or 10 per hospital, with varying degrees of medical staff approval. Those district hospitals would be limited to rural areas, have 50% or greater Medicare/Medi-Cal patient census, and have demonstrated a difficulty in recruiting the specific type of physician/specialist.

Both bills had been scheduled to be heard in Assembly Health Committee but were subsequently removed from the calendar and thus have become two year bills (i.e. will not be heard until next year). With CMA leadership, CRS joined with other medical specialties in opposing these bills and looking for a compromise that will assist rural district hospitals but not erode the important corporate practice of medicine bar.

Legislation to Mandate Reporting of Breast Density to Patients Undergoing Screening Mammography

CRS has been actively opposing SB 173 (Simitian) seeking amendments to this proposal introduced last year. The bill initially required that a patient undergoing screening mammography who was found to have dense breast tissue according to the ACR BIRADS reporting system would have to be informed of that fact, that additional screening modalities such as US or MRI may be appropriate, and that if the patient was covered by a health plan or health insurance that the additional screening modalities would be required to be covered. Prior to the bill being heard in Senate Health Committee it was amended to remove the insurance coverage mandate. SB 173 then simply stated that if the patient had either heterogeneously or extremely dense breasts, as determined by the radiologist, then the patient would have to be informed in writing that, "you might benefit from supplementary screening tests, depending on your individual risk factors...you should contact your physician".

The issue is a difficult one, and the bill as amended is to oppose since it seeks to provide information to women and does refer to additional risk factors. The radiology community is still not convinced that the use of breast ultrasound for a woman who's only risk factor is dense breast is appropriate. There are questions regarding the false positive rates for breast US, additional biopsies, and patient angst in the follow-up process. We would support legislation to require coverage for US or MRI where medically appropriate or ordered by a physician. Providing this information directly to patients will likely result in a dramatic increase in the use of breast US when there may be out of pocket costs for many patients since coverage might not be available. Many physicians would now feel the need to refer patients for additional screening modalities based upon potential additional malpractice liability if the mammogram is negative but a cancer might be detected in a small percentage of patients. It is better to allow referring physicians to consider the array of risk factors and await a change in the practice standard regarding the impact of breast density if that is forthcoming.

SB 173 is currently in the Senate Appropriations Committee where the analysis has raised questions on the potential higher costs to the state via CalPERs and state employee benefits if the utilization of US would increase dramatically. We will keep you informed of the progress of SB 173.

July 8-10 Cardiovascular Multidisciplinary Imaging Symposium

Location: San Diego

Cost: $200 

The Departments of Radiology and Cardiology at the Naval Medical Center, San Diego are hosting a 3-day multidisciplinary Cardiovascular Imaging Symposium on July 8-10 (Fri-Sun) in San Diego. Registration is only $200 for 22 hours of CME (before June 6th). Local speakers will include experts from Scripps, Sharp, UCSD, Kaiser, as well as the Navy, and will highlight the excellence in cardiovascular care available in San Diego.

Seating is limited to 400 and may sell out quickly.

Click here to register online.