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May 7, 2012 

Bill on Out of Network Billing for PPOs   


SB 1373 ( Lieu) as introduced was trying to provide a specific notice to PPO patients when they would receive services from an out of network physician. The effort was to alert patients that even though they may go to a hospital that was in-network there might be other physicians, like pathologists, radiologists or anesthesiologists, that were out-of-network and would bill patients at their UCR. Initially the bill would have required the physician who was out of network in the hospital or office setting to provide a notice, an estimate of the potential charges, and suggest that the patient contact their PPO to get a referral to an in-network provider. It did not apply to emergency services only scheduled in or outpatient visits. It would also have required that any physician group that held themselves out as in-network would warrant that all physicians in that group were participating.


The CSP opposed the early versions both on the practical problems of being able to provide such a notice in the hospital setting, i.e. how would you know the patient's insurance status, and how could you accurately determine the services cost estimate? The CSP worked with the author to refine the bill and remove the objectionable provisions. When it was heard in the Senate Health Committee it was amended to require the notice to be provided by the hospital for any patient in that setting and deleted the provisions requiring an estimate or referral to another provider. SB 1373 was still opposed by the hospitals on the basis that most hospitals already provide notice of potential charges by physicians on their patient admission form. The bill remained with the Committee due to concerns over all the late amendments and will not move further in this Legislative session.



Bill to Alter Current California Law on Electronic Access of Lab Results by Patients    


Current law allows patients to access their clinical lab results electronically if both the physician chooses to allow such access and the patient consents. Current law would not allow the use of electronic access for patients if the test involved certain procedures involving HIV antibodies or anatomic pathology procedures that demonstrate a malignancy. That limitation is justified since those results should first be reviewed by the referring physician and discussed with a patient before those results are made available electronically directly to the patient.


AB 2253 ( Pan)  would remove the limitation on these types of tests if both the patient and referring health care professional agree with electronic access and the results are discussed in advance with the patient. This provides reasonable safeguards to allow for an informed discussion over the implications of the test results. It is consistent with comments made by both the CSP and CAP to a regulatory proposal from CMS last year that would have required all clinical laboratories to allow patients electronic access to their lab results, i.e. there should be some limitations.


The CSP supports AB 2253 which will be heard in the Assembly Health Committee next week. There may be amendments to continue a limitation for HIV testing since current law already has requirements for pre-and-post test counseling. We will update you on the status of this bill as it moves through the process.




Diagnostic Errors: What, Me Worry?


Despite dramatic advances in the quality and availability of diagnostic tests, diagnostic errors remain a leading cause of preventable morbidity and mortality. There is growing recognition that physician factors like fatigue and resource or time constraints contribute to these poor but avoidable outcomes.


A study of consecutive malpractice claims at The Doctors Company, the nation's largest insurer of physician and surgeon medical liability, from 2000 to 2007 revealed that over 50 percent of claims were related to diagnosis. Of that amount, more than 75 percent were due to failure to diagnose.


Overall, diagnostic errors account for nearly half of all malpractice claims in nonsurgical specialties. One of the most frequently cited process errors is management of test results. Most breakdowns in the diagnostic process occur because of failure to order an appropriate diagnostic test, create a proper follow-up plan, and obtain an adequate history or perform an adequate physical examination. Breakdowns also include incorrect interpretation of diagnostic tests.


Review the following tips to refresh your diagnostic process.


  1. Practice by standards: Organize yourself with routines and checklists.
    • Document all encounters.
    • Develop and document a plan of care for each patient.
    • Ensure an adequate history and physical are completed and recorded.
    • Maintain a medication list for each patient and update the list at each visit.
  1. Involve the patient and family when appropriate.
    • Give clear, written follow-up instructions.
    • Include the patient and family in the "redundancy process." Tell them: "We will call you with your lab results. If you don't hear from me or my office staff within 10 business days about your lab report, call the office at [number]."   
    • Communicate! The more open and transparent the communication, the better.
    • Develop a plan or process to overcome communication or language barriers, hearing impairment, and health illiteracy.
  1. Determine who is coordinating the care.
  • If you are the primary care physician, make sure all tests and consultations are tracked back to you.
  • If you are the consultant, know who ordered the consultation, who should receive the report, and who will provide treatment.
  • If you are the hospitalist, know when and how to transition the care back to the admitting physician.
  1. Communicate effectively, using the teach back or Ask Me 3™ method.


Risk Tips content contributed by The Doctors Company. For more information on diagnostic errors, visit the Knowledge Center at www.thedoctors.com.





CSP Annual Convention

November 27 - December 1, 2012

Hyatt Regency Embarcadero

San Francisco, CA



California Society of Pathologists
One Capitol Mall Suite 320
Sacramento, CA 95814 
Tel : 916-446-6001
Fax :  916-444-7462