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medico news

Board urges State Fund to reconsider restrictions on opioids for intractable pain The California State Compensation Insurance Fund (SCIF), the state’s largest workers’ compensation insurer, recently notified the physicians in its medical provider network (MPN) that they must agree to refrain from prescribing opioids for a period longer than two months and not prescribe compounded medications without prior authorization from the insurance adjuster or by order of a workers’ comp judge. The new rules, detailed in SCIF’s “General Provisions and Criteria” document, also stipulate that MPN physicians cannot even prescribe certain medications at all, regardless of medical necessity. The California Medical Association (CMA) believes that these new provisions are an attempt by SCIF to exert control over physicians’ practice of medicine and clinical judgment, require physicians to treat injured workers differently than other patients and violate state law, which allows for prescribing, dispensing, furnishing, or administering controlled substances for the treatment of a condition causing pain, including but not limited to intractable pain. The restrictions also violate the Medical Board of California’s Guidelines for Prescribing Controlled

Substances for Pain. In addition to the concerns above, SCIF’s notice required physicians to agree to the new preauthorization rules within two weeks or be kicked out of the MPN. State law requires insurers to provide physicians with at least 45 business days’ notice of a material change to a contract. The law also gives physicians the right to terminate the contract prior to implementation of the change. At CMA’s request, the California Medical Board reviewed SCIF’s preauthorization requirements for opioid prescriptions and has informed CMA that it shares the association’s concerns. The board recently sent a letter to SCIF, urging the fund to review the board’s guidelines for the treatment of intractable pain and to reconsider whether the preauthorization requirements are “a necessary component of effective treatment provided in the workers’ compensation arena.” If SCIF doesn’t voluntarily withdraw the provisions, the medical board has told CMA that it will take further action. (CMA Alert, September 6, 2011 issue)

CMA applauds passage of resolution to increase physician supply in California The California State Senate recently gave bipartisan support to a joint resolution that urges the President and Congress to provide resources to increase the supply of physicians in California to improve access to care in underserved areas. The resolution also encourages the President and Congress to consider solutions that would increase the number of graduate medical education residency positions to keep pace with the growing need for physicians in California and the United States. “With the baby boomers beginning to retire, national health care reform expanding coverage to millions of previously uninsured citizens, obesity rates hitting epidemic levels, and the repercussions of the national recession and California’s own severe budget deficit still playing out, it is more important than ever that we continue to assess, address, and reform the obstacles facing California’s health care system,” said California Medical Association (CMA) President James G. Hinsdale, MD. “The most important of these obstacles, and one that is projected to grow substantially in the coming years, is ensuring sufficient and timely physician access for every Californian in need of a physician’s care.” The Council on Graduate Medical Educa-

tion (COGME) recommends that a state have between 60-80 primary care physicians per 100,000 people. In California, there are on average 63 primary care physicians for every 100,000 people. However, 42 out of California’s 58 counties fall below COGME’s minimum recommendations regarding adequate physician supply for primary care. “Our state is barely meeting the recommended supply of primary care physicians and those numbers are unevenly dispersed throughout the state, leaving some communities without access to care for miles,” Dr. Hinsdale added. CMA has been active on a number of fronts to address the challenges of physician supply and distribution, including: • Working with the legislature to create the Steve Thompson Scholarship program. The program would provide up to $105,000 in scholarships to selected participants who agree in writing prior to completing an accredited medical or osteopathic school to serve a minimum of three years in “medically underserved areas” or where unmet propriety needs for physicians exist, as determined by the

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California Healthcare Workforce Policy Commission; • Creating the Steve Thompson Loan Repayment Program that provides grants to pay off medical loans for physicians working in underserved areas. Each participating physician receives up to $105,000 in exchange for a three-year service commitment in a medically underserved area of the state; • Supporting new medical schools, UC Merced and UC Riverside, and pushing an expedited timeline to build them; • Supporting efforts to increase the diversity of the physician workforce through CMA’s Ethnic Medical Organization Section; and • Promoting increased incentives for pursuing primary care and supporting primary care physicians to keep their practices viable. “On behalf of the California Medical Association, I want to thank Assembly Member Ricardo Lara for his leadership in seeing this resolution through,” Dr. Hinsdale said. “Clearly, this is an issue that we can all agree needs attention, as the need for physicians is certainly not going away.” (CMA Alert, September 6, 2011 issue)

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