Bill on Lease Arrangements for Imaging Services Passes Committee
AB 2794 (Blakeslee) would require direct billing of the technical component of CT, MRI and PET procedures by the actual provider of the service and who supervised the performance of the procedure. A physician who leased time from a facility could not be billed for the TC by the facility and the facility or imaging center would be required to bill the patient or their third party payer. AB 2794 passed the Assembly Business and Professions Committee last week on a unanimous vote of 10 to 0. It will now be heard in the Assembly Appropriations Committee in the next two weeks.
CRS supports AB 2794 and prohibits inappropriate mark-up of the actual charge by the provider. It will eliminate sham lease arrangements that are structured to avoid existing prohibitions in state and federal law. Medicare has adopted similar changes to reduce inappropriate utilization and increasing costs of imaging in healthcare. Radiologists compete for referrals based upon their competency, quality of service and equipment, and types of modalities and applications. These lease arrangements can allow financial reward to influence the referral and cause inappropriate utilization. You can view the provisions of AB 2794 by clicking on this link.
New Bills on Breast Cancer Screening
There have been a number of bills introduced this year dealing with expanded coverage for breast cancer screening and diagnostic tools other then film mammography. Those include coverage for digital mammography, CAD, breast MRI, and ultrasound. Several bills would expand coverage under the Breast and Cervical Early Detection Program (BCEDP) and Every Woman Counts programs to include digital mammography. Due to the difficult budget year for the State it will be difficult to pass any increase in spending in programs irrespective of the merits of the changes.
The CRS supports AB 2887 (Berg) which would require the Every Woman Counts program to cover digital mammography as well as the current analog screening. This program covers breast cancer screening and diagnostic services for women who are not Medi-Cal eligible but meet certain income limitations. The bill passed the Assembly Health Committee and is pending in the Assembly Appropriations Committee. This program was slated for a funding cut of almost $5M in the Governor’s budget proposal.
The CRS is working with the author on AB 2434 (Portantino) that would require private insurers to cover additional breast cancer screening modalities such as breast MRI, upon referral by a physician and according to the guidelines of the American Cancer Society. The bill passed the Assembly Health Committee over the objections of the health insurance lobby who oppose any mandates for coverage. Amendments were made to delete the list of specific modalities and leave it to the discretion of the referring health care practitioner.
Bill to Require Posting of MQSA Violations
SB 1529 (Oropeza) would require conspicuous public posting of notices of violation of MQSA or state mammography licensing requirements by the imaging facility and on the BRH website. The author believes that mammography facilities who receive violations are not posting them so that patients are aware of the violations.
We met with the author and explained that MQSA already requires posting of violations, though they categorize them by severity, i.e. Class 1 are those that impact image quality and proper equipment operation while Class 2 and 3 are less important. Likewise the BRH currently has discretion in what types of violations require public posting. We indicated that we would not oppose a state requirement for posting of significant violations that relate to image quality or equipment performance, but not posting of technical record keeping violations that did not impact patient care. Though the author was initially reluctant to accept our suggested amendments we were able to accomplish that goal during the hearing of the bill by the Senate Health Committee. We are in the process of crafting amendments to modify SB 1529.
New Bill on Patient Access to Medical Records
SB 1415 (Kuehl)- authored by Senate Health Committee Chair as introduced would have required all physicians, outside of the hospital setting, to retain medical records to 10 years, inform patients that they are archived, and notify all patients with records 60 days in advance of the physicians intent to destroy records. The author had heard from constituents who were unable to access their prior records because the physician practices had closed and destroyed their records.
Existing law does allow patient access to medical records but there is no statutory retention period or requirement for notice to patients prior to destruction. The CRS along with other medical specialties met with the author to express our concerns with the breadth of this new mandate and its effectiveness.
The author initially had agreed to remove everything from the bill but the requirement to provide notice to all patients of the physician’s record retention policy, how long, and a requirement to provide notice to all patients if they intended to destroy the records before that time period had elapsed. The CRS also advocated to exempt radiologists from even this requirement to notify since reports on your services are provided to ordering physician and are part of their medical record. You are also likely to see thousands of patients over that time period and it would be an onerous requirement. Senator Kuehl has agreed to this exemption and we are awaiting final language on the exemption. SB 1415 passed out of Senate Health Committee last week.
Bills Introduced to Modify Prohibition on Hospital Employment of Physicians
There have been three bills introduced dealing with the ability or either district hospitals or any acute care hospital to employ physicians. There is an existing pilot project authorized by statute 3 years ago to allow a limited number of district hospitals to employ a small number of physicians. The CRS opposed all three bills as introduced and is now working with one author on a more modest adjustment to the existing pilot project for district hospitals. SB 1294 (Ducheny) has passed both the Senate Health and Judiciary Committees and will extend the pilot for certain district hospitals to employ a limited number of physicians. SB 1640 (Ashburn) would have repealed the prohibition for any acute care hospital in a medically underserved area. The CRS joined with the CMA in opposing this bill and defeated it twice in senate Business and Professions Committee. A third bill AB 1944 (Swanson) has strong union support and is moving in the Assembly over our opposition. AB 1944 would repeal the prohibition for most district hospitals with a specific proviso that the hospital can’t interfere with the medical judgment of any physician so employed. We will continue to oppose this legislation.
CRS Establishes Fund on Balance Billing Prohibition
We have been providing our members with information on the escalating legislative and regulatory effort that would prohibit fair compensation to non-contracted hospital based physicians who choose not to contract with a patient’s health plan or their delegated medical plan.
Organized medicine, led by the CMA, has been a focal point in providing a means for discussion, debate and leadership in challenging the Department of Managed Health Care (DMHC) and their regulatory proposals that would eliminate the ability of hospital based physicians to negotiate and enter into contracts on equitable terms. The CRS has been an active participant in those discussions and strategies for challenging the regulations and possible legal action if the regulation package goes forward.
This kind of effort obviously comes with substantial new costs for legal and media activity and the recognition that the prospects of an ultimate legal challenge to the regulations would be costly. The CMA has established a budget of approximately $455,000 for the activities related to this issue. They have in turn asked each of the specialty societies to assist in providing funding for this important effort.
The CRS Executive Committee believes this issue is fundamental to the rights of physicians to be fairly compensated for their services and their right to freely contract for their services. They have taken the following actions; (1) CRS will contribute $5,000 from their reserves to this effort, (2) have asked and received financial support from the ACR for $10,000, and (3) are asking that each radiology group contribute $25 per member radiologist for this effort.
We have attached a form that can be used by groups to send a contribution for this fund which will in turn be provided to the CMA jointly on behalf of the radiology community. We ask that you discuss this issue within your group and contribute funds at your earliest convenience.
Thank you for your cooperation and support.
Vol Van Dalsem
President
