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SAMEER V. AWSARE, MD, FACP President, Santa Clara County Medical Association

Your Voice is Key to Our Success By Sameer V. Awsare, MD, FACP President, Santa Clara County Medical Association Critical issues affecting physicians in our state are being decided by our legislature. Health care reform, medical liability and insurance reform are just a few of the issues that are being debated and voted on in Sacramento. April 21st was CMA’s 40th Annual Legislative Leadership Conference. In our county, this means that physicians from various modes of practice – solo, group, academic, county and specialty – arrive at our Santa Clara County Medical Association at 6:00 AM to take the bus to Sacramento. This is an opportunity for us to meet as colleagues, and to speak to our legislators with the single voice of the house of medicine. And speak we did, on behalf of all the physicians in our county and our state. Below, I will highlight some of the issues that we discussed on your behalf. Before I discuss the specific issues, it is important to understand that elected officials have very little time to meet with us and appointments with them have to be made in advance. It is important to state things concisely, and personal stories are very useful. If possible, it is important to try and get a commitment from the elected official and to also let them know that you will be following up. It is also important to understand how elected officials think. They consider if a particular issue is good public policy, whether it affects their district or them politically. They also consider who else supports or opposes the particular issue. Finally, in today’s fiscal environment, they always want to know if it will cost money. Following are some of the key issues that we discussed with our elected officials in the Assembly and Senate. Restoring the 10% Cut to Medi-Cal Provider Rates: If you recall, Medi-Cal rates were cut by 10% in 2011, hence, California’s Medicaid reimbursement currently ranks at 47th in the nation. With Covered California, many of our uninsured citizens now have access to Medi-Cal, yet the cuts in reimbursement have forced many physicians and health care centers to close their doors. One of our colleagues recalled that he was on Medi-Cal as a child. Since he became a physician, almost 20 years ago, he has always cared for Medi-Cal patients. Recently he had to make the sad decision to not accept Medi-Cal patients since he was losing money on every patient he saw (his reimbursement is now less than the price of the delivery of a large pizza to your house). As California’s economy improves, AB 1805 authorizes the director of the Department of Health Care Services to restore the 10% cut in Medi-Cal provider reimbursement rates. All Product Clauses: These are provisions in physician contracts that require them to participate in all of a health insurer’s products, sometimes even extending to future products without the physician’s express knowledge. An SCCMA surgical colleague reported that his recent Blue Shield 6 | THE BULLETIN | MAY/JUNE 2014

contract included a 70% reduction in reimbursement for Covered California patients. They were trying to force him to sign the contract by telling him that he would not get to see his Blue Shield PPO patients if he did not sign. Physicians should not be forced to assume such obligations as a condition for maintaining access to their patients covered by commercial plans, hence, we asked our legislators to support AB 2400, which allows physicians to affirmatively participate in each of an insurer’s or health plan’s network or product. Reimbursement for Telephone/Electronic Patient Management: This requires insurance companies licensed in the state of California to pay contracted physicians for telephone and electronic patient management services. This lets our patients have faster and more convenient access to treatment, while reducing their lost time from work. It is simply the right thing to do in the 21st century, and we lobbied our legislators to support AB 1771. Sugar-Sweetened Beverages Safety Warning Label: Obesity now riSameer V. Awsare, MD, FACP, is the 2013-2014 president of the Santa Clara County Medical Association. He is a board certified internist and is currently practicing with The Permanente Medical Group in Campbell.

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