A group of CSA members led by President James Moore, MD recently attended CMA Legislative Day in Sacramento. One of CSA’s strategic initiatives this year is to forge a closer relationship with the CMA and its component societies. Attendees included CSA Past Presidents Peter Sybert, MD and Paul Yost, MD, President-Elect Mark Zakowski, MD, Secretary Karen Sibert, MD, UC San Diego Resident Robbin Robbins, MD, Executive Director David Butler and myself.
During the course of the day, we visited the offices of 23 legislators from key districts. Our legislative advocates Bryce Docherty and Vanessa Cajina of KP Public Affairs helped navigate our team throughout the halls of the State Capitol. We also attended a morning session led by CMA CEO Dustin Corcoran and current CMA President Steven Larson, MD, which was followed by a keynote address by Assembly Republican Leader Chad Mayes of Yucca Valley.
The evening prior to legislative day, CSA leaders attended a reception hosted by CMA’s political action committee, CMA-CALPAC, and had the opportunity to mingle with legislators, including the newly-elected Assemblymember from Kingsburg, Joaquin Arambula, MD, who had just been sworn in to office. The evening of legislative day, we attended a dinner with the Assembly Moderate Democrat Caucus, an unofficial, yet very influential pro-business caucus co-chaired by Assemblymember Jim Cooper (D-Elk Grove) and Assembly Business & Professions Committee Chair Rudy Salas (D-Bakersfield).
CSA’s legislative visits focused on legislation specific to physician anesthesiologists, including:
Assembly Bill 533 (Bonta): Above all else, the most important bill to CSA and CMA members is AB 533, aimed at addressing out-of-network (OON) surprise billing issues. Unfortunately, this bill seeks to tie OON rates to Medicare, which would disincentivize insurers from having to negotiate fair and reasonable contracts with physicians.
CSA and CMA agree that patients should not be in the middle of disputes when insurers fail negotiate fair and reasonable contracts with physicians. “Surprise” medical bills are a symptom of inadequate insurance networks, which leads to patients having to go outside their network, with or without being notified. Refusal by insurance companies to enter into fair and reasonable contracts with physicians for medical care undermines the entire healthcare delivery system. This has resulted in fewer choices, higher premiums, and more out-of-pocket expenses for consumers. Yet as the OON discussion evolves throughout the country, the whole debate is unfairly “framed” as the physician’s fault. Not fair!
AB 533 originated in the Assembly last year and passed in the Senate. CSA and CMA played a critical role in advocating against the bill to key legislators up until the midnight deadline of the last day of the 2015 legislative session. The bill failed passage, but is still eligible for another vote.
Consumer advocates, insurers, and labor groups have been the main proponents of Bonta’s bill. However, CSA, CMA and other stakeholders have been working diligently on a favorable compromise that will provide a more effective solution to protect patients’ access to care, while offering a fair approach to network and contracting issues.
- Assembly Bill 2235 (Thurmond): This legislation would require that parents of children undergoing oral surgery be notified of the increased risks of anyone other than a physician anesthesiologist, or those working under their supervision, administering anesthesia. CSA consistently advocates for physician-led anesthesia care and supports AB 2235, because patient safety is always our highest priority. Anesthesia carries risk and therefore, we are committed to working with the California Dental Board and other stakeholders to ensure the optimum level of safe anesthesia care for all patients.
- Assembly Bill 890 (Ridley-Thomas): Licensure of Certified Anesthesiologist Assistants – CSA continues to educate legislators about the physician-led anesthesia care team model, and advocates for the licensure of Certified Anesthesiologist Assistants (CAAs) in our state. Regrettably, AB 890, which would have paved the way for CAA practice in California, failed passage last year. We will continue to advocate for these providers as highly trained members of the anesthesia care team who can help us meet growing health care demands.
Our meetings with legislators also focused on CMA priority legislation, including:
- Senate Bill 1177 (Galgiani) Physician Health and Wellness Program (CMA Sponsor/CSA Support): This bill would allow the Medical Board of California (MBC) to contract with a third party to administer a program to oversee physician referrals for chemical dependency, mental health issues, burnout, and related conditions. Since the termination of the MBC Diversion Program in 2008, the MBC has not had the means to deal with physician referrals in this regard. Of note, California currently provides wellness and treatment programs to other licensed professionals, including attorneys, pharmacists, nurses and veterinarians.
- Senate Bill 22 (Roth): Expanded Primary Care Physician Training (CMA Supports) – This bill would increase funding for primary care physician training by $100 million per year. By 2030, it is projected that California will face a shortage of over 8,000 primary care physicians. The bill recently passed in the Senate 39-0, and will now be considered by the State Assembly.
- Assembly Bill 2121 (Gonzalez): Responsible Beverage Service Training (CMA Sponsor) – This would require servers or managers of alcoholic beverages to complete a safety course every three years. Eighteen other states and the District of Columbia have such laws in place. Training covers intervention and management techniques to prevent the sale of alcohol to individuals who are underage or intoxicated.
- Senate Bill 1174 (McGuire): Foster Youth (CMA Opposes) – SB 1174 would require Medi-Cal to share prescribing data with the MBC, which would then be required to initiate investigations into physicians deemed as “high prescribers,” a vague term not defined in the bill. CMA believes there is already proper oversight, and this bill will disincentivize physicians from treating Medi-Cal patients.
- Senate Bill 1033 (Hill): Physician Probation Requirements (CMA Opposes) – This would require physicians on probation due to gross negligence, repeated negligent acts, inappropriate prescribing, chemical dependency, or felony conviction to disclose their probationary status to patients before each visit while the licensee is on probation. CMA believes the practical outcome of this legislation would effectively be the same as a suspension (i.e. – inability to practice) and circumvent due process. Of note: probationary status of a physician is already publicly available on the MBC website.
So what is next in Sacramento? On the legislative side, the OON surprise billing issue has a lot of momentum. Expect this to receive heightened attention in the media and amongst policymakers in the coming weeks and months, as a solution emerges or a compromise is negotiated. A small group of stakeholders is meeting overtime to work out the details. We hope the physician community continues to influence this issue in order to solve the surprise billing problem in a responsible way that protects patient access to care, and encourages the creation of sufficient medical care networks.
Finally, I ask that you PLEASE consider a donation to GASPAC. I promise you there are people in Sacramento working very hard on your behalf EVERY day. We cannot do it alone.
GASPAC allows CSA to represent you and your interests, alongside other physician groups within the House of Medicine. Together, we make our voices heard with policymakers in the State Capitol and with the public. Please show your support by contributing today. We need your help!