1. CANS Board Meeting a zinger
2. Legislation of note
3. CMA House of Delegates actions
4. Agenda for Board Meeting
5. Nobody’s perfect

1. CANS Board Meeting
The CANS Board meeting on April 30th at 9 AM at the LAX Sheraton Gateway should be the most pivotal one for our organization to be held in the last 40 years. The issues that are likely to be addressed are the future of CANS and engaging a lobbyist.

Of the 230 active CANS members as of 1/1/05 , 106 have paid the increased dues of $500. This pencils out to just $3K in new income beyond our previously collected $50K from the old dues structure of $250 which in the past has been consumed in running the organization. I cannot predict what the 15 voting members of the Board will decide but in light of this degree of member support, a strategic decision about CANS continuing to function effectively will probably have to be addressed.

Presuming the continuation of CANS and in light of the amount of dues income and our 30K in reserve, the proposals from 5 lobbyists for somewhat varying services at prices ranging from 2K to 10K a month will be discussed. All of them already represent other organizations so choosing may be influenced by which lobbyist will likely encounter the least conflict if representing two or more groups with different views on the same legislative issue.

The call for interest in having a “Town Meeting” of general CANS members as part of the April 30th meeting of the Board was met with a certain amount of apathy. Twenty-one members responded, 17 not interested with 4 in favor. So much for grass roots input.

An agenda for the Board meeting is listed below. Any CANS member is welcome to attend the meeting.

2. Legislative Goings-On
Last month we reported on AB681, the bill designed to protect Work Comp fees for 5 years which CANS co-sponsored. As of this writing, the bill is due to be heard by the Assembly Insurance Committee on 4/27/05 . Please note that the CMA House of Delegates voted to support the concept of this bill (see Don Prolo’s report below) and did not remain on the sidelines as I predicted. Kudos to the House.

Another bill, AB516, would make it illegal for docs to refer a patient for an MRI, CT or PET if they have an ownership position in the machines even if the machines are located in the doc’s offices, which up to now has been legal. Radiologists claim this legislation, introduced by Assemblyman Leland Y. Yee, PhD (D-San Francisco), is necessary to rein in over-utilization of tests, said radiologists exempted from this rule presumably because of the mantra that they only do the tests but don’t order them so utilization of the machines in which they may have an ownership interest will be above suspicion. This over-utilization argument, which can suffer from lack of good supporting data, embraces the old saw that if temptation exists, so does the sin. The CANS Board has voted to oppose this bill with our opposition carried forth by the California Orthopaedic Association’s lobbyist, the group most opposed to this bill. The bill has been pulled by Assemblyman Yee and in a letter on April 5 stated he is considering new language for the bill. Maybe he is looking for some good data.

3. CMA House of Delegates report
Don Prolo, CANS delegate to the CMA House of Delegates, submitted the followingreport regarding the 134th Annual Session of the House held March 18-21, 2005 in Anaheim :

Michael J. Sexton, M.D., an EM physician from Novato , assumed the mantle of President from outgoing San Diego anesthesiologist Bob Hertzka, M.D. 544 delegates and alternates, trustees, officers, past-presidents, and Council on Scientific Affairs members accounted for a total of 636 physicians who carefully considered 153 Resolutions and Reports. Neurosurgeons representing CANS were Pat Wade and myself, and Phil Lippe represented Pain Medicine in the Specialty Delegation. John Bonner was part of the District 6 Delegation from Fresno .

Four Resolutions were submitted by CANS; three were passed:

Res. 105-05: that CMA support legislation to repeal the mandate for the use of security prescription forms for Schedule II, III, IV and V controlled substances and that the CMA support implementation of an on-line system for pharmacists to enter information on a 24/7 basis into the California Utilization Review and Evaluation System (CURES) database at the time of dispensing any controlled substances; and for physicians and pharmacists to have available this information.

Res. 208-05: that CMA support legislation that grants Californians who have Health Savings Accounts the same tax preferences (e.g. tax credit, deductions) granted to them by the Federal Tax Code.

Res. 203-05: that the CMA study and report back physician state income tax credits for services rendered to Medi-Cal patients.

Res. 513-05: that CMA seek legislation to allow collective bargaining under the State Action Exemption failed because of the experience of two recent previous attempts to enact this legislation (SB-2007 and AB-1600).

Other Resolutions of great interest to Neurosurgeons:

Res. 212a-05: that all Americans have at a minimum catastrophic and preventive health coverage with refundable tax credits to support purchase of health insurance by individuals with income between 200 and 400% of federal poverty levels (about $32,000 to $64,000 for a family of three)

Res. 109a-05: that the CMA study the feasibility of establishing a panel of independent physicians to make final medical determinations on a patient’s ability to hold a driver’s license when denied by the DMV screening/examination process.

Res. 618a-05: that the CMA endorse the Medical Board Program for substance abuse and ensure its future viability.

Res. A-2-05: that the CMA make fixing the Medicare Sustainable Growth Rate (SGR) formula the highest federal legislative priority. Unless fixed, Medical reimbursements will decline 35% over the next 7 years with expenses projected to increase 19%.

Res. 410a-05: that the CMA oppose “silent PPOs”, the practice of third-party payers utilizing a physician’s discounted rate without that physician’s knowledge and consent, a fraudulent practice common among health plans, PPOs, and other organizations.

Res. 712a-05: that to combat childhood obesity, school cafeterias and restaurants list nutritional information on menus, including at a minimum the caloric information by serving size.

Res. 505a-05: that the CMA educate physician about appropriate use of hospice care and support increased coverage by payers for palliative and hospice care.

Res. 626-05: that the Medical Staff through its Medical Executive Committee (MEC) shall approve the selection of any medical directors, that job descriptions (e.g. qualifications, responsibilities and reporting relationships) be reviewed and approved by MEC to avoid conflicts of duties between the medical director and any medical staff leader, and that the performance of the medical directors be reviewed by the MEC periodically and results be transmitted to the hospital board for consideration.

Res. 120-05: that the CMA oppose any California legislation restricting the right of physicians to utilize in-office diagnostic imaging services.

Res. 414-05: that the CMA oppose all efforts to coerce physicians to accept fees lower than the Workers’ Compensation Official Medical Fee Schedule (WC OMFS) as a condition of participation in a Workers’ Compensation Medical Provider Network (MPN) and that the CMA consider legislation to restore the WC OMFS as the minimum standard fee schedule. Significance: This Resolution places the CMA against the effort to introduce RBRVS or variants in Workers’ Compensation reimbursement and is supportive of the Vargas Bill (AB-681).

Thanks, Don.

4. Agenda for 4/30/05 Board Meeting
AGENDA – CANS Board of Directors Meeting
Saturday, April 30, 2005 , Sheraton Gateway Hotel, Los Angeles Airport
I. Formal Call to Order

II. Approval of Minutes – January 21, 2005

III. Unfinished Business
A. Medical Justice Services
B. LA County Trauma – Dr. Caton
C. Failure of Townhall Meeting
D. Lobbying Proposals

IV. Reports of Officers and Committees
A. Presidents’ Report – Dr. Edwards
B. Secretary Report – Dr. Caton
1. Membership Report
2. Request for Membership Changes
C. Treasurer’s Report – Dr. Robbins
2005 Operating Income/Expenses
D. Annual Meeting
1. 2005 Financials
2. 2005 Program Evaluations
3. 2006 Draft Program Planning
E. Executive Office Report – Dr. Hunstock
F. Workers’ Compensation

V. New Business
A. AANS Professional Liability Committee – Dr. Kusske

B. EMTALA – Dr. Kusske
C. Collective Bargaining – Dr. Kusske
D. Legislation
1. AB681 (Vargas) Workers’ Comp OMFS
2. AB516 (Lee) In-office MRIs
E. CMA/Council on Legislation – Dr. Robbins
F. CMA House of Delegates – Dr. Prolo
G. AMA House of Delegates – Dr. Prolo
H. Medicare Carrier Advisory Committee (CAC) Meeting – Dr. Lippe
I. Access to Specialty Care Coalition
1. CANS drop letter
2. Meeting Minutes

VI. Next Board Meeting – The Resort at Squaw Creek, September 17, 2005.

5. Errata
In last month’s newsletter, I stated that Medical Justice Services, the firm that is in the aggressive malpractice defense business, had 100 prepaid clients. Actually, they have 1000.

Randy Smith, M.D.

The newsletter is a mix of fact, rumor and opinion. The facts are hopefully clearly stated. The rest is open to interpretation. The opinion is mine. R.S.