JULY 2008

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UPDATE ON MEDICARE CUTS

Report on Medicare Fee Updates & Health Policy Report- May 15, 2008

By Jeffrey E. Kaufman, M.D., Past-President AACU & CUA, WSAUA Health Policy Committee

1. Medicare Fee Updates: The current Sustained Growth Rate formula, if unaltered, will cause fees to decrease 10.6% on July 1, 2008 and another 5.4% on January 1, 2009 (ultimately falling a full 40% by 2013).  Everyone in Washington recognizes that the formula is flawed and such dramatic cuts cannot go forward but they lack the political will to restructure the current program... 
  READ MORE...




Senate Medicare Victory -July 10, 2008
By Elizabeth McNeil, Vice President, Federal Government Relations, California Medical Association

In a stunning turnaround, the U.S. Senate voted 69-30 to pass HR 6331, legislation that would stop the 15% physician payment cuts in 2008-09 and provide a 1.1% update.  This is an important victory for physicians and their Medicare/Tricare patients.  Like the House, the Senate now enjoys a veto-proof margin to override a Presidential veto ... READ MORE...



LA TIMES ARTICLE "Senate Halts Medicare Reductions" - July 10, 2008
CLICK TO VIEW ARTICLE



OTHER CUA NEWS

Council on Legislation Report: Regarding California Legislation
By William Bonney, MD, CUA Representative to COL

On March 26th the California Medical Association convened its Council on Legislation, discussion and vote by delegates to finalize CMA's position on current issues in the California legislature.

It was my privilege to represent you at the Council.  While our organization lacked voting privilege, it was nonetheless a worthwhile and informative experience.

The purpose of this message is to provide an update on selected legislative issues of possible interest to our CUA members... READ MORE...



CUA Supports Daniel A. Nachtsheim, M.D. Nomination for AUA Treasurer
By Douglas Chinn, M.D., Past President, CUA

It is a distinct honor and privilege for us to write this letter asking your support for Dr. Daniel Nachtsheim as a candidate for Treasurer of the American Urological Association. The Officers, of the California Urological Association and the Officers, Board of Directors, Past Presidents of the Western Section of the American Urological Association and AUA Nominating Committee Representative are in complete support of Dr. Nachtsheim, and any one of us would be happy to provide individual recommendations... READ MORE...



UROLOGY TIMES ARTICLE "Recover audits require a new coding mindset" -
June 1, 2008
By Ray Painter, M.D. & Mark Painter, PRS
CLICK TO VIEW ARTICLE



Plan On Attending The Socioeconomic Forum!

The Socioeconomic Forum will be held Sunday, October 26, 2008 during the Western Section AUA meeting in Monterey, CA. For preliminary schedule
CLICK HERE





CMA House of Delegates Annual Meeting
October 4-6, 2008, Sacramento, CA


Western Section AUA Annual Meeting
Oct. 26-30, 2008, Portola Hotel
Monterey, California

MORE INFO

Socioeconomic Forum
October 26, 2008, Portola Hotel
Monterey, CA
MORE INFO

CUA Annual Meeting,
October 28, 2008, Portola Hotel
Monterey, California



Member Job Board
Make a connection by posting an opening for a job or post a job that you are looking for. Click Here


Support Update
Abbott and AstraZeneca are partners in urology with the California Urological Association.


Welcome New Members!
Click Here for list of new members. 








California Urological Association
1950 Old Tustin Ave.
Santa Ana, CA 92705
TEL: 714-550-9155
FAX: 714-550-9234
EM:
info@cuanet.org
WEB: www.cuanet.org

 



Report on Medicare Fee Updates & Health Policy Report
By Jeffrey E. Kaufman, M.D., Past-President AACU & CUA, WSAUA Health Policy Committee

1. Medicare Fee Updates: The current Sustained Growth Rate formula, if unaltered, will cause fees to decrease 10.6% on July 1, 2008 and another 5.4% on January 1, 2009 (ultimately falling a full 40% by 2013).  Everyone in Washington recognizes that the formula is flawed and such dramatic cuts cannot go forward but they lack the political will to restructure the current program.  The cost attached to simply freezing all fees and "scrubbing" pay back for the past several years of freezes or small increases is estimated at $300 billion. Such costs must be accounted for elsewhere in a budget that is already broken from Iraq and other economic challenges.  The best of several current pieces of legislation to address the short term challenge will freeze the current rate (0.5% over 2007) for the remainder of this year and provide another 1.1% raise in 2009.  This 18 month extension will allow Congress to reconsider the fundamental formula underlying updates after the upcoming election. Unfortunately, although we were promised at the April Joint Advocacy Conference that a fix would be voted on before the drop dead date at the end of June, the latest word from Rep. Pete Stark, chair of the House Ways and Means Health subcommittee is that the Senate is dragging its feet and may not have legislation back to the House before July 1. We are hoping that the chairman of the Senate Finance committee is successful taking this vote directly to the floor and having a bill signed by Bush in time but there is a great chance that we will have to rely on a bill passed after the cut off date allowing retroactive relief. This very important issue is still very much up in the air.  At the same time, there is a great deal of pressure in Washington to pay more to primary care providers at the expense of specialists. If they are successful, any increase in the overall Medicare payment structure may be more than offset by budget neutrality adjustments causing a significant net loss to urology.

2.  The Recovery Audit Contractors hired by CMS as bounty hunters to audit past Medicare payments up to 3 years previous caused California urologists a great deal of stress last summer when they focused on prior LHRH payments. We were successful in defeating those demands and working with CMS to improve the program. However, the program is now expanding to cover all 50 states with authorization to target any past payments up to 3 years old in an effort to demand reimbursement to CMS for any charges not upheld under audit.  This program is extremely onerous and threatening to physicians who have been responsible for the smallest percentage of money returned (over 85% of recovered money coming from rehabilitation and acute hospitals). Legislation (HR 4105) from Rep Lois Capps, D-Santa Barbara, is pending that would put a one year moratorium on the program to allow CMS and Congress time to reconsider whether it is functioning as designed.  Such a moratorium would provide us a window of opportunity to lobby to have physicians excluded from its authority or at least to reduce some of the more aggressive aspects.

3.  Although pressure from federal agencies for urologists to demonstrate certification of training and expertise before performing various imaging studies has lessened, it continues from private payers. The AUA has been successful in convincing payers that residency programs and post-graduate training seminars are sufficient to allow our members to continue to perform those studies necessary to the practice of urology. Pat Fulgham, MD, working with AUA leaders and the AUA Health Policy Committee has created programs on ultrasound which are now acceptable to Blue Cross/Blue Shield carriers. We expect more discussions with other private carriers and an expanded series of post-graduate courses to certify member urologists to continue to perform these studies and qualify for reimbursement by private and government payers. However, pressure continues from organized radiology interests at the national and state levels to prevent anyone but a board certified radiologist from providing any type of study. Other specialists are similarly busy fighting to protect what they consider to be their "turf". Pathologists and radiation oncologists have been outspoken with respect to urology groups organizing to retain more control over their patients in these areas.  The AUA health policy committee has been extremely active addressing these challenges. 

4.  The concept that government money spent on health care must be based on Value Purchasing is behind continued efforts to expand Pay for Performance programs. Although the Congress is not very interested, the Senate has taken it on faith that such programs are necessary to controlling future medical costs and insuring that quality care is rewarded (or that poor quality care is not reimbursed).  CMS has issued an expanded list of medical events for which no increased payment will be made (such as post-operative DVT, catheter caused urinary tract infections, post-operative wound infections, etc). At the same time, PQRI programs have expanded from last year to this and on to 2009. These programs demand reporting of performance that will allow government auditors to alter future payment schedules in order to reward what they consider quality outcomes (and presumably financially penalize those they do not value).  David Penson, MD from our section (the AUA's first Gallagher Health Policy scholar), has led AUA efforts to go out front in developing appropriate criteria that will keep urologists in charge of quality assessment in those areas within our specialty. 

5.  CMS has reorganized Medicare administration in an effort to streamline their lines of authority and increase efficiency.  This has led to the creation of MAC regions (Medicare Administration Carriers) which are now being organized to meld several states into larger, coordinated jurisdictions.  California, Nevada, Hawaii, Guam and the Marianas islands are now incorporated in the new J-1 MAC administered by Palmetto out of South Carolina.  Transition efforts are underway in preparation for the September 1 start up date.  Our new J-1 medical director is Arthur Lurvey, MD who has worked closely with California urologists for many years in his previous capacity as medical director for NHIC, California's Medicare administrator. Payment policies that differ from one state to another are currently being reviewed and reconciled to provide more uniform coverage throughout the MAC. Urology advisors to Medicare are involved and offering advice on appropriate policy decisions. We have been assured that we will continue to have an advisory role in new policy decisions. 

6.  Please find attached our latest preliminary agenda for the upcoming Socioeconomic Forum in Monterey. We have attempted to cover a wide range of issues of great interest to our members in this time of turmoil, increasing overhead demands and falling reimbursement.  I will present more information on the nature of the presentations at the Orlando board meeting.  Representatives from our section have been very much involved in state, regional and national discussions.  We continue to work very closely with the AACU and various AUA committees on these issues. As always, I am available and eager to discuss any aspect of urology health policy you may question.

Respectfully submitted,

Jeffrey Kaufman M.D., F.A.C.S.
Chair, Health Policy Committee




Senate Medicare Victory 
By Elizabeth McNeil, Vice President, Federal Government Relations, California Medical Association

In a stunning turnaround, the U.S. Senate voted 69-30 to pass HR 6331, legislation that would stop the 15% physician payment cuts in 2008-09 and provide a 1.1% update.  This is an important victory for physicians and their Medicare/Tricare patients.  Like the House, the Senate now enjoys a veto-proof margin to override a Presidential veto.  Despite the White House veto threats, it is unclear whether the President will still veto HR 6331  given the number of Republicans who supported the bill.  As many of you are aware, the President has threatened to veto any Medicare physician payment fix that is funded by reforming the Medicare Advantage health plan program.

Please Thank the California Senators
CMA thanks all physicians who worked so hard to bring about the successful passage of HR 6331 in the U.S. House of Representatives and the U.S. Senate.  Both Senators Feinstein and Boxer voted for the bill.  CMA asks physicians to please call their offices and thank them for their YES votes. 

Senator Feinstein  202 224 3841      Senator Boxer 202 224 3553

AMA
The AMA and the other state and specialty organizations must be given major credit for launching the enormously successful media and grassroots lobbying campaings over the last week to swing the 9 additional Republican Senators. 

Next Steps
The CMA will keep you informed as we know more about the intentions of the White House. We believe the President will either sign or veto the bill as soon as possible so as not to  prolong the physician payment cuts.  If the President vetoes the bill, both the House and the Senate have the votes to override his veto.  Both Houses will act as soon as possible.

Senate Roll-Call Vote
One final note on the Senate vote, Senator Kennedy came back from his cancer chemotherapy treatments today just to cast a vote on this important health care bill.  He was not expected back until the fall.  Senator Obama was also present and voting yes.  Unfortunately, Senator McCain did not make it back to Washington today to vote on the bill.  He was the only Senator not voting.  I will send the roll-call vote as soon as it is posted.   

CMA will keep you informed as events develop.  Thanks to all of you again.  This is a significant victory for physicians and their patients.  Great work! 

Elizabeth McNeil
Vice President
Federal Government Relations
California Medical Association



Council on Legislation Report: Regarding California Legislation
By William Bonney, MD, CUA Representative to COL

To Members of the California Urological Association,

On March 26th the California Medical Association convened its Council on Legislation, discussion and vote by delegates to finalize CMA's position on current issues in the California legislature.

It was my privilege to represent you at the Council.  While our organization lacked voting privilege, it was nonetheless a worthwhile and informative experience.

The purpose of this message is to provide an update on selected legislative issues of possible interest to our CUA members.

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Sources of additional information:
Official California Legislative Information  www.leginfo.ca.gov/
-- Home Page
-- Updates on specific Assembly or Senate bills
-- To contact legislative members from your own district


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Specific bills:

DENIAL OF CARE  BY HEALTH CARE SERVICE PLANS
This bill, sponsored by the California Medical Association (CMA), seeks to shift the burden of proof to a health care plan in any legal action challenging a health care plan's denial of medical coverage.  This bill would create a presumption that any medical treatment ordered by the provider is "medically necessary," and thereby shift the burden of proof to the plan to show that the treatment was not  necessary.
CMA recommends support.


MEASURE      :  A.B. No. 2847
AUTHOR(S)   :  Krekorian.
COMMITTEE : APPROPRIATIONS
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MANDATORY ELECTRONIC TRANSMISSION OF ALL PHARMACEUTICAL PRESCRIPTIONS
This bill would, commencing January 1, 2010, require a prescriber to ensure that any prescription issued or made by him or her be type-written and electronically transmitted to the patient's pharmacy of choice, except as specified.
CMA recommends oppose.

MEASURE      :  A.B. No. 2516
AUTHOR(S)   :  Mendoza.
COMMITTEE: BUSINESS AND PROFESSIONS

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SIX MONTH LIMIT FOR CANCELLATION OF INDIVIDUAL HEALTH CARE COVERAGE
This bill would prohibit a health care service plan or health insurer from rescinding an individual health care service plan contract or individual health insurance policy for any reason after 6 months following the issuance of the contract or policy. The bill would authorize a subscriber, enrollee, policyholder, or insured who believes his or her individual contract or policy was wrongfully rescinded to request review of that rescission.
CMA recommends support.

MEASURE      :  A.B. No. 2549
AUTHOR(S)   :  Hayashi.
COMMITTEE: APPROPRIATIONS

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REGULATORY APPROVAL BEFORE A HEALTH PLAN/INSURER CAN CANCEL A CONTRACT OR POLICY
This bill would additionally require a health care service plan or health insurer to seek and obtain final approval from its regulator prior to rescinding a plan contract or insurance policy, as applicable. The bill would require the director and commissioner to contract with one or more appropriately qualified independent review organizations in this regard. The bill would also authorize each regulator to suspend or revoke the license or certificate of a plan or insurer in violation of this prohibition or to assess administrative penalties.
CMA recommends support.

MEASURE      :  A.B. No. 1945
AUTHOR(S)   :  De La Torre.
COMMITTEE: APPROPRIATIONS

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REIMBURSEMENT DIRECTLY TO PROVIDER
This bill would require health care service plans to authorize assignment of a patient's reimbursement (for covered services) directly to the provider furnishing those services.   Under current practice, some health plans provide service reimbursement to the patient--and require the physician to bill the patient--even when the patient specifies that the provider be paid directly.
CMA recommends support.

MEASURE      :  A.B. No. 2805
AUTHOR(S)   :  Ma.
COMMITTEE: APPROPRIATIONS

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REGULATORY AGENCY MUST APPROVE CANCELLATION OF HEALTHCARE PLAN OR INSURANCE
This bill would require a health care service plan or health insurer to obtain final approval from its regulator prior to rescinding a plan contract or insurance policy. The state Director and Commissioner would then contract with one or more appropriately qualified independent review organizations to investigate the matter.
CMA recommends support.

MEASURE      :  A.B. No. 1945
AUTHOR(S)   :  De La Torre.
COMMITTEE: APPROPRIATIONS

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PHARMACY INSTRUCTIONS MAILED TO PATIENTS
This bill would allow a pharmacy to mail specified written communications to a patient, without the patient's authorization. The written communication instructs the patient to contact the prescribing or dispensing healthcare professional if:

(A) The patient has questions about the medication. 
(B) The patient is having difficulty adhering to the medication due to adverse effects, dosing requirements, or other causes.

CMA policy regards this as interference with doctor-patient relationship.
CMA recommends oppose.

MEASURE      :  S.B. No. 1096
AUTHOR(S)   :  Calderon.
COMMITTEE:  SEN JUDICIARY

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RETENTION OF INDIVIDUAL PATIENT MEDICAL RECORDS
This bill would require health care providers, at the time an initial patient record is created, to provide a statement (to be signed by the patient) which sets forth the patient's rights, as specified, and the intended retention period for the records.

This bill would also require health care providers, who plan to destroy patient records earlier than the period specified in the signed statement, to notify the patient no fewer than 60 days before the records are to be destroyed.

CMA recommends further study/referral to Committee on Medical Services.

MEASURE      :  S.B. No. 1415
AUTHOR(S)   :  Kuehl.
COMMITTEE:  SEN JUDICIARY

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HEALTH INSURERS AND SERVICE PLANS: 
OF ALL PREMIUM PAYMENTS RECEIVED, 85% MUST GO TO BENEFITS

This Senate bill would require health care service plans and health insurers to expend on health care benefits no less than 85% of the aggregate payments they receive with respect to plan contracts or policies issued, amended, or renewed on or after January 1, 2009. The bill would require those plans and insurers to provide written affirmation of compliance.  

A roughly comparable Assembly bill would
require the Insurance Commissioner to establish the minimum % of income expended as benefits (reasonable "pure loss ratio") for all workers' compensation insurers.

CMA recommends support for both bills.


MEASURE    :  S.B. No. 1440
AUTHOR(S)  :  Kuehl.
COMMITTEE:  SEN APPROPRIATIONS

MEASURE      :  A.B. No. 2692
AUTHOR(S)   :  Hernandez.
COMMITTEE: INSURANCE



CUA Supports Daniel A. Nachtsheim, M.D. Nomination for AUA Treasurer
By Douglas Chinn, M.D., Past President, CUA

It is a distinct honor and privilege for us to write this letter asking your support for Dr. Daniel Nachtsheim as a candidate for Treasurer of the American Urological Association. The Officers, of the California Urological Association and the Officers, Board of Directors, Past Presidents of the Western Section of the American Urological Association and AUA Nominating Committee Representative are in complete support of Dr. Nachtsheim, and any one of us would be happy to provide individual recommendations.

Officers of the American Urological Association have served in that capacity as either honorific or service/expertise-oriented individuals. Dan is exemplary of  both. He has attended every California Urological Association, Inc., Western Section and AUA Meeting throughout his career and has been an extremely active committee participant in all organizations. He has led the CUA as the President and has been in leadership over 10 years as treasurer, CUA and JAC liaison. Dan's contributions have made the CUA the strongest State Society in theU.S.A. He has also led the Western Section of the AUA as the President, and served on the Board of Directors and as chairman of various committees for many, many years. He has served on the AUA Board of Directors for three years and has been actively involved in the finances on the AUA Audit Committee. In addition, he has extensive experience in financial management with his practice of 400 doctors in clinical administrative, leadership and service roles. He was Chairman of the Retirement and 401K plan at Scripps for the last seven years, meeting with Schwab and other financial advisors assessing risk for over $200,000,000.00 in assets. He has been President and Treasurer of the California Urological Association. All of this was accomplished while maintaining an extremely busy and productive clinical practice, including education and clinical research duties.

We might also point out that over the last 40 years; the Western Section has served the AUA admirably. Including, two Western Section Members, Dr. Roy Correa and Dr. Earl Nation having served as AUA Treasurers. We know that there is no formal rotation for this office, but it seems appropriate at this juncture to include and strongly consider a Treasurer from the Western Section.

You will find Dan as an engaging, hard-working, loyal individual who has the best interests of organized urology and the medical profession at heart. We cannot think of a better person to serve in this important position.

Sincerely,

Douglas Chinn, M.D.                      

Past President, CUA




Welcome 2007-2008 New Members!

Gary J. Alter, M.D. - Beverly Hills, CA
Aytac
H. Apaydin, M.D. - Salinas, CA
Arie
S. Belldegrun, M.D. - Los Angeles, CA
Patrick
M. Bennett, M.D. - Greenbrae, CA
Mohamed
 Bidair, M.D. - San Diego, CA
Tomi
Lin Bortolazzo, M.D. - Mammoth Lakes, CA
Philip
P. Brodak, M.D. - Murrieta, CA
James
D. Brooks, M.D. - Stanford, CA
Jill
G. Byers, M.D. - Newport Beach, CA
Julie
A. Chacko, M.D. - Santa Barbara, CA
Stuart
A. Chalfin, M.D. - Los Alamitos, CA
T.
Debuene Chang, M.D. - Danville, CA
Junghwan
 Choi, M.D. - Irvine, CA
Richard
J. Conner, M.D. - Murrieta, CA
John
A. Connolly, M.D. - Burlingame, CA
Jeffrey
P. Cooper, M.D. - Palos Verdes Estates, CA
Ralph
W. de Vere White, M.D. - Sacramento, CA
Ganesh
L. Devendra, M.D. - Simi Valley, CA
James
J. Elist, M.D. - Beverly Hills, CA
Christopher
P. Evans, M.D. - Sacramento, CA
Patricia
D. Fone, M.D. - Roseville, CA
Michael
S. Gazzaniga, M.D. - Fullerton, CA
Martin
K. Gelbard, M.D. - Burbank, CA
Lawrence
S. Greenberg, M.D. - San Pedro, CA
H.
Albin Gritsch, M.D. - Los Angeles, CA
Gary
D. Grossfeld, M.D. - Greenbrae, CA
Michael
P. Guerena, M.D. - Oceanside, CA
Reynaldo
D. Hernandez, M.D. - Baldwin Park, CA
Lawrence
Y. Hwong, M.D. - San Jose, CA
Thomas
L. Johnson, M.D. - Inglewood, CA
J.
Christopher Julian, M.D. - Fresno, CA
Christopher
 Kane, M.D. - San Diego, CA
Luke
S. Kao, M.D. - Bellflower, CA
Mark
J. Kelly, M.D. - Santa Monica, CA
William
A. Kennedy, II, M.D. - Stanford, CA
David
I. Kleinerman, M.D. - Lafayette, CA
Samuel
K. Lee, M.D. - Los Angeles, CA
Roger
K. Low, M.D. - Sacramento, CA
Paul
D. Lui, M.D. - Loma Linda, CA
Kiarash
 Michel, M.D. - Los Angeles, CA
Andrew
K. Nguyen, M.D. - Sherman Oaks, CA
Robert
B. Pompa, M.D. - Beverly Hills, CA
Girdhari
S. Purohit, M.D. - Hemet, CA
Eugene
C. Rajarantnam, M.D. - Lancaster, CA
Soroush
A. Ramin, M.D. - Los Angeles, CA
William
F. Reynolds, M.D. - Glendale, CA
Winston
H. Richards, M.D. - Riverside, CA
Peter
G. Schulam, M.D. - Los Angeles, CA
Tadd
L. Selby, M.D. - Chico, CA
Marshall
L. Stoller, M.D. - San Francisco, CA
Carl
 Thomas, M.D. - San Francisco, CA
Philip
E. Werthman, M.D. - Los Angeles, CA
Brad
Alan Wolfson, M.D. - Palm Springs, CA
Stephen
A. Worsham, M.D. - Salinas, CA
Felix
C. Yip, M.D. - Monterey Park, CA
Scott
I. Zeitlin, M.D. - Santa Monica, CA


 



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