CAPM President’s Report on 2014 CMA Council on Legislation, Legislative Leadership Conference, and Specialty Society Meeting

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California Academy of Preventive Medicine (CAPM)

 REPORT from

CALIFORNIA MEDICAL ASSOCIATION (CMA)

Council on Legislation (COL)

(Sacramento, 20 March, 2014)

40th Annual Legislative Leadership Conference

(Sacramento, 22 April, 2014)

Specialty Society Meeting

(Sacramento, 23 April, 2014)

The CMA held three annual meetings in March/April in Sacramento.  CAPM was represented at each by our President, Donald Lyman.  This is a brief report summarizing all of them together, with special attention to currently pressing matters for the profession as-a-whole.

Council on Legislation: This is the governing Board of the CMA PAC.  CAPM has one vote on the Council of about 100 participants.  It considers CMA’s position on legislative bills and then sends it’s lobbyists into the Capitol to advocate for/against the measures.

 40th Annual Legislative Leadership Conference:  This is CMA’s annual “Lobby Day” at the State Capitol.  It draws more than a thousand CMA members to a briefing on current issues and legislative bills and then sends them into the Capitol to meet legislators with CMA’s position on those bills.  The premium is on the legislative visits by conference participants to advocate for/against targeted bills now under consideration by the legislature.

Specialty Society Meeting: This is a group of Specialty Society Presidents, CEOs and other officials to coordinate efforts and hash out disagreements on policy.

BRIEFINGS:  Clearly CMA is laser-focused on the fall 2014 initiative sponsored by the Trial Lawyers Association to repeal MICRA (Medical Injury Compensation Reform Act).

MICRA: This Act was enacted in 1975 to limit permissible awards for pain and suffering in malpractice suits.  It was almost universally seen as an abused legal-loophole to permit trail lawyers to realize enormous rewards for themselves at the expense of their clients.  Following the enactment, malpractice rates went down and that cost-center became a more stable part of the medical care cost structure.  States which did not enact a MICRA-like statute suffered high attrition rates of specialists (New York has 17 counties with no obstetricians at all) and disincentives for many specialists to stay in those states.

  • Initiative: The trial lawyers have failed to get the statute repealed in the state legislature and so have turned to the initiative process.  The MICRA piece of it is hidden behind an emotional appeal addressing the current heroin epidemic (see: Controlled Substances Misuse below).  It blames wayward physicians for causing the current epidemic with over prescription of opioids and then mandates solutions like random drug/alcohol testing of all physicians.  BUT, the real target is clear – MICRA!  They will clearly run an ugly anti-physician campaign.
  • CMA Response: CMA has lined up an all-star-cast to campaign against the initiative.  Many other CMA priorities are now on the back-burner as they enter this fray.  Most of the strategies and tactics discussed at these meetings are highly confidential (so, I will not put them in this eMail).  We may expect solicitations to join in the effort as election day approaches.

CAPM position:  We are opposed to the initiative as is almost the entire medical care community.  The benefits it would bring to the public are just not there; the damage it would do is considerable.  Does that mean there is no room for amendment of the MICRA law downstream?  NO; that will happen with time.  However, the initiative process is not the place to do that.

OTHER BRIEFING ISSUES:

  • The other Trial Lawyers initiative on the fall 2014 ballot is one addressing rate regulation for medical care.  It would award the State Insurance Commissioner authorities over rate setting.  While all seem to agree the current system of multiple regulation loci needs to be changed,  all also seem to agree this is not the solution and the wrong way to find it à Right Problem / Wrong Solution.  It instead builds more redundancy into the system and is yet-another way for the trail lawyers to stretch-out the appeals process with more-and-more hours charged for their services. (NOTE: CAPM has not yet taken a position on this initiative)
  • Covered California (California’s part of the Federal Affordable Care Act {ACA}):  California has been unusually successful in enrolling people into the new system.  Nationally ACA signed up 8 + million people; California signed up 1.4 million in the Covered California system and another 1.9 million as new MediCal patients.
  • Controlled Substances Misuse:
    • Some 15 years ago, advocates for better pain management (that is,  greater use of opioids)  leveraged mandatory physician continuing medical education (CME) of “End of Life and Pain Management.”  Since then, the number of opioid prescriptions has increased 400%.  Concurrently, the frequency of opioid overdose deaths from illicit use of the prescribed drugs has increased 400%.  Also concurrent with this, the State’s CURES system (registry of opioid prescriptions for use by physicians and pharmacists to prevent abuse) fell into disrepair due to its age and to budget cuts at the State Department of Justice.
    • In 2012, the L.A. Times published a seven part exposé on the deaths (“Dying for Relief”) and blamed it all on irresponsible physicians.  Since then, the problem has been identified as a national one with multiple causes.
    • The response to these dynamics is several as it effects California physicians:
      • The Trail Lawyers initiative for fall 2014 builds on this story to blame physicians for the problem and call for rather ugly solutions – all of which are there to clearly mask their real intent to repeal MICRA.
      • The Medical Board of California (MBC) is considering new guidelines for opioid uses.  The CMA has produced a White Paper to help the MBC in its work (on the CMA web site.  http://www.cmanet.org/resource-library/detail?item=prescribing-opioids-care-amid-controversy ).

ADVOCACY (Legislative Bills):  These are bills actively pursued by CMA during these meetings –

SUPPORT:

AB 1771 (V. Manuel Pérez) – Reimbursement for Telephone/ Electronic Patient Management.

AB 1805 (Skinner, Pan) – Restores 10% cuts to MediCal Provider rates.

AB 2400 (Ridley-Thomas) – Elimination of all Product Clauses.

AB 2458 (Bonilla) – Medical Residency Training Program Grants.

SB 1000 (Monning) – Sugar Sweetened Beverages labelling act.

OPPOSE:

SB 1215 (Hernandez) – Self referral

Donald O. Lyman, MD, President CAPM

25 April, 2014; Sacramento

 

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