Q4 2020 | Los Angeles Medicine Magazine

OFFICIAL PUBLICATION OF THE LOS ANGELES COUNTY MEDICAL ASSOCIATION

WECANDOBETTER LACMA Launches Health Equity Council

QUARTER 4 2020

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PUBLISHER Gustavo Friederichsen | gustavo@lacmanet.org EDITOR Sheri Carr | editor@physiciansnewsnetwork.com HEADQUARTERS LOS ANGELES COUNTY MEDICAL ASSOCIATION 1055 West 7th Street, Suite 2290 | Los Angeles, CA 90017 Tel 213.683.9900 | Fax 213.226.0350 www.ladocs.org

VOLUME 151 ISSUE 4 | QUARTER 4 2020

LACMA OFFICERS PRESIDENT | Diana Shiba, MD PRESIDENT-ELECT | Jeffery Lee, MD TREASURER | Omer Deen, MD SECRETARY | Jerry Abraham, MD IMMEDIATE PAST-PRESIDENT | Sion Roy, MD

2 4 5

LACMA BOARD OF DIRECTORS COUNCILORS-AT-LARGE Sunny Jha, MD (1) Stacey Ludwig, MD (1) Karen Sibert, MD (5) Valencia Walker, MD (5)

PRESIDENT’S LETTER | Diana Shiba, MD

TRUSTEES & CHAIR DELEGATION Jerry Abraham, MD, CMA Trustee Po-Yin Samuel Huang, MD, Chair of the LACMA Delegation Sion Roy, MD, CMA Trustee

A MESSAGE FROM LACMA CEO Gustavo Friederichsen

Southern California Medical Society Presidents

COUNCILORS Robert Bitonte, MD, JD (D1) Emil Avanes, MD (D2) Stephanie Booth, MD (D3) Heather Silverman, MD (D5) Marc Mendes, MD (D6) Kambiz Kosari, MD (D7) Steven Sawelson, MD (D9) Sharon Jakus-Waldman, MD (D10) William Hale, MD (D14) Nancy Ellerbroek, MD (D17) Lisa Firestone, MD (SCPMG) Roxana Yoonessi, MD, JD (SCPMG) Troy Elander, MD (SSGPF) Muntu Davis, MD (LA County) Cristian Rico, MD (AltaMed) Po-Yin Samuel Huang, MD (1, YP Councilor) Hector Flores, MD (1, EPC Chair) Anna Yap, MD (Resident Councilor) Joshua Cenido, MD (Alt. Resident Councilor) Aileen Arevalo (Student Councilor, UCLA)

Council Launches #MedicineForMasks

WE CAN DO BETTER

6

LACMA Establishes Health Equity Council

LACMA’s Board of Directors consists of a group of dedicated physicians working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, VP of Operations and Strategic Initiatives, at lisa@lacmanet.org or 213-226-0304.

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9

CMA’s Legislative Roundup

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LACMA PRESIDENT

DIANA SHIBA, MD

2020 has been a year unlike any other in the 150-year history of the Los Angeles County Medical Association. Our state, nation, and the world continue to wage an unwavering fight against COVID-19. Yet nearly a year since the world was introduced to this novel virus, we now have a far better understanding of the disease and the effectiveness of various treatment options and have completed substantial vaccine research with breakthroughs on the horizon.

During this pandemic, the House of Medicine has demonstrated unswerving dedication, resilience, and solidarity. I am proud to announce the formation of the Southern California Medical Society Presidents Council, a new and historic partnership among the presidents of all eight Southern California county medical societies. This collaborative effort includes the Kern County Medical Society, the Ventura County Medical Association, the Orange County Medical Association, the San Diego County Medical Society, the Imperial County Medical Society, the San Bernardino County Medical Society, the Riverside County Medical Amid the pandemic, I Association, and LACMA. The Council has been meeting bimonthly to share best practices and to discuss am humbled, inspired, critical issues such as physician practice support during the pandemic, PPE and motivated by access, health inequities, and health-related legislation. Leveraging our combined leadership, influence, and community impact, the Council sent joint letters of each of you who daily support to every public health officer in Southern California in late November. answer the call to duty Through #MedicineForMasks, a regional broadcast and social media campaign, the Council engaged the broader Southern California community by promoting as physicians, healers, sound public health policy, including widespread masking, social distancing, and and leaders in the frequent handwashing.

The COVID-19 pandemic has also revealed to a greater degree the grave social, community. economic, and health inequities that disproportionately impact racial and ethnic minority groups. According to data from the LA County Department of Public Health Case Summary report on November 29, the Hispanic/Latino population has nearly triple the number of case infections and double the number of deaths from COVID-19 than the next highest ethnic group. For this reason, LACMA has launched a new Health Equity Council to engage not only in purposeful dialogue within the House of Medicine but also to develop new, transformative, and actionable initiatives around structural racism and health disparities. Our new Health Equity Council is the highlight of this quarter’s Los Angeles Medicine edition.

I would like to recognize the new members of this Council, co-chairs Dr. Resa Caivano and Dr. Hector Flores, and our CEO, Gustavo Friederichsen, for their incredible work in launching the Health Equity Council. Through their combined efforts, we are building internal and external educational campaigns, community coalitions, and social and financial programs that have offered indirect and direct financial support to minority-owned physician practices. This work also extends to a new collaborative partnership between LACMA, the LA County Department of Health, and the UCLA Department of Community Health Sciences of the Fielding School of Public Health. Focused on social determinants of health and critical public health issues such as food insecurity and vaping, the collaborative reflects LACMA’s ongoing campaign of community outreach and engagement.

Amid the pandemic, I am humbled, inspired, and motivated by each of you who daily answer the call to duty as physicians, healers, and leaders in the community. We must maintain our resolve, we must not waver, and we must remain strong – for our colleagues and for our patients. Only together will we overcome the challenges of today and build a better tomorrow.

With gratitude, Diana

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LACMA CEO

G U S TAV O F R I E D E R I C H S E N

A More Inclusive Association When I think of health equity as defined— “The absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically or geographically”— I cannot help but think beyond genetics those conditions impacting where we live, where and what we learn, where we work and interchangeably what we do, part of the social determinants of health determining lifespan, quality of life and so much more.

The largest poll of its kind conducted to date, “Discrimination in America,” focused on personal experiences with discrimination across more than a dozen areas of daily life. Developed by the Harvard T.H. Chan School of Public Health, Robert Wood Johnson Foundation and National Public Radio (NPR), the findings reveal widespread experiences of discrimination across many groups in America, and the significantly different manifestations and experiences of discrimination across different groups.

Researchers interviewed 3,453 people, who were asked whether they believe they have ever personally experienced various forms of both institutional and individual discrimination. The groups surveyed included African Americans, Latinos, Asian Americans, Native Americans, Whites, LGBTQ adults, as well as men and women.

We may never arrive at a “more perfect Union,” but we have most certainly arrived at a more inclusive association.

FINDINGS: - Nearly half (45%) of African Americans experienced racial discrimination when trying to rent an apartment or buy a home.

- 18% of Asian Americans say they have experienced discrimination when interacting with police. Indian Americans are much more likely than Chinese Americans to report unfair police stops or treatment.

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- Nearly 1 in 5 Latinos have avoided medical care due to concern of being discriminated against or treated poorly.

- 34% of LGBTQ Americans say that they or a friend has been verbally harassed while using the restroom.

- 41% of women report being discriminated against in equal pay and promotion opportunities.

Decades of racial injustice across multiple institutions and industries, specifically healthcare, have led to horrific COVID-19 outcomes tied to race and ethnicity across the state and nation. People of color are at higher risk, lack adequate access to care and have higher exposure to the virus as many are frontline, essential, and critical infrastructure workers.

As far as physicians, they, too, face incredible challenges. Burnout was at epidemic levels before COVID-19 and since March 2020, one can imagine the impact on their personal well-being due to the increase in their cases and workload, increased documentation, staff furloughs, exposure rates, practice transformation and sustainability, lives and livelihoods lost. And minority- and women-owned medical practices suffered disproportionately, which is why LACMA launched Rapid Response 2.0 to provide funding, technology assistance and PPEs. LACMA began its own journey relative to equity with the first Iranian American president in Dr. Pedram Salimpour, first African American female president in Dr. C. Freeman, first openly gay president in Dr. Vito Imbasciani, first Asian American female leader with current president, Dr. Diana Shiba, the launch of the Health Equity Council and Race Against Time Zoom series. And we continue to evolve thoughtfully, righteously and with a renewed spirit of inclusion that will catapult the organization into new, at times difficult, conversations.

We may never arrive at a “more perfect Union,” but we have most certainly arrived at a more inclusive association.

Southern California Medical Society Presidents Council Launches #MedicineForMasks In November, the helped propel another recently formed Southern aligned initiative: the California Medical Society convening of local Presidents Council, led healthcare leaders to discuss

by LACMA President Dr. how to bridge respective Diana Shiba, drafted a organizational efforts. letter signed by eight On November 27, Dr. Shiba presidents representing and Gustavo Friederichsen the medical associations were joined by Dr. Deborah in Kern, Ventura, Los Prothrow-Stith, Charles R. Angeles, Orange, Drew School of Medicine; Friday, Nov. 27, FOX11’s top story features media event with leaders Riverside, San Bernardino, Dr. Greg Moran, Olive from LACMA, Charles R. Drew School of Medicine, Olive View-UCLA Imperial, and San Diego View-UCLA Medical Center, Medical Center, MLK Comprehensive Health Center, Infection Control, Counties in support of our and UNITE HERE Local 11.

Emergency Department; public health officers and Dr. John Uyanne, MLK to implore residents to Comprehensive Health wear masks outside the home to save lives.

Center, Infection Control Los Angeles Department of Public The campaign, called #MedicineForMasks, alerts Health; and Kurt Petersen, UNITE HERE Local 11, for a Zoom the public about the importance of wearing masks in press event that was attended by nearly 20 media outlets public to prevent further loss of life, while also stressing that provided extensive coverage. the importance of handwashing and social distancing. An unprecedented regional effort, covering 56,000 square miles and nearly 23 million people, the #MedicineForMasks effort deploys social media, earned media and the membership and networks of the eight medical societies to reduce the spread of MEDI-CAL/M E D I C A R E COVID-19 as it collides with the annual flu MEDICAL PRACTICE PURCHASES, SALES AND MERGERS season.

The Council is also concerned about the potentially devastating impact that a severe annual influenza season could have when combined with rising coronavirus cases, leading to a “twindemic” that risks overwhelming hospitals and PPE supply. Additionally, the coalition recognizes the importance of Assisting physicians with promoting continued economic recovery legal issues for over three decades. and the safe reopening of schools and supports coordinated economic and Fenton Law Group, LLP public health measures that will facilitate 1990 South Bundy Drive these public goals.

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In the summer of 2020, amidst an overpowering pandemic and in the shadow of grave acts of racial injustice, members of the Board of Directors of the Los Angeles County Medical Association formed the Health Equity Council with Drs. Diana Shiba, Hector Flores, and Resa Caivano comprising the initial council members.

THE MISSION OF THE HEALTH EQUITY COUNCIL = In a mission statement established by the LACMA board, the mission of the Health Equity Council is “to foster an environment for LACMA which promotes the full health potential and well-being of every member of society, advocating for equality and justice for all.”

Dr. Diana Shiba, president of the Los Angeles County Medical Association and a founding member of the Health Equity Council, noted that “one of the roles of the HEC is educational. One goal is to spread awareness of health inequities not only within the medical community but also within the larger community we serve.”

Dr. Resa Caivano, also a founding member of HEC, noted that “the HEC can most effectively promote a healthy society by educating and engaging physicians, elected officials, and broader communities on the importance of equity.”

With the pandemic as a backdrop, the LACMA board observed: “Black, Latino and Pacific Islander residents of Los Angeles County have twice the mortality rate from COVID-19 than do white residents, according to new data from the LA County Department of Public Health, a troubling reminder of the role racism and inequity play in healthcare every day.”

As Dr. Caivano observed, “To achieve equity, we must understand historical and structural factors that have shaped our current health system and disparities within our community.”

THE TASK AT HAND = The new LACMA Health Equity Council’s work will strive to promote every member of society’s full health potential and well-being and advocate for equity and justice for all. The long-term plan for the council is to educate members and the broader community and engage community organizations. In doing so, LACMA will:

= =

Advocate for the elimination of socioeconomic injustices that drive health inequities; Support the dismantling of policies and practices that uphold discriminatory systems adversely affecting our patients and communities;

= =

Lead the transformation of the local medical community towards anti-racism practice;

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Develop strategic collaborations with medical societies, other health professional organizations, community-based groups, and advocates to achieve the goal of health equity.

Create a platform to support organizations and communities working to end all forms of discrimination and oppression;

HEALTH EQUITY IS IMPORTANT = The Institute of Medicine, in 2000, defined health equity as an essential element of healthcare quality in the U.S. Disparities in healthcare, documented by research, are driven by ethnicity, race, health insurance, and socioeconomic status, sexual orientation, gender and gender identity, literacy, English proficiency, and other factors. As such, healthcare equity is an essential gauge of holes in our overall healthcare system, including access to care, equitable outcomes, variance in population health by ethnicity, and economic inequities.

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WHY IS HEALTH EQUITY IMPORTANT TO LACMA? The Los Angeles County Medical Association has served the broader Los Angeles community for 150 years. Equitable access to care and quality of care has long been at the center of the Association’s mission. According to the last U.S. Census, Greater Los Angeles has comprised one of the most diverse populations in the U.S. An unexpected example of this diversity is the presence of the largest Native American population of any county in the nation, with more than 150,000 people of indigenous descent calling Los Angeles County home. Most of these are from from Latin America but choose to identify their race as fully or partly American Indian.

Also, Los Angeles is home to populations representing African Americans, Chinese, Filipino, Korean, Japanese, Vietnamese, Indian, Cambodian, Thai, Pakistani and Samoan, and other ethnic groups.

Physician members of LACMA serve this diverse population daily.

Given this, members of the Association already practice health equity. However, as the LACMA board noted when establishing

MEET LACMA’S HEALTH EQUITY COUNCIL

CMA Updates Mission Statement to Reflect Focus on Health Equity The CMA House of Delegates voted in October to edit the association’s Articles of Incorporation and include in its mission statement an overarching permanent goal of achieving health equity and justice.

“CMA must adopt permanent institutions and institutionalized policies, practices and programs that promote, support and make actionable our aspirational principles on health equity and justice in order to eliminate health inequities that undermine our state’s public health and collective well-being,” said Robert Wailes, M.D., Chair of the CMA Board of Trustees.

CMA’s Board of Trustees also this year created a permanent committee—the Justice, Equity, Diversity and Inclusion (JEDI) committee—to ensure that CMA continues to consider its actions through a health equity lens similar to CMA’s longstanding “public health” guiding principle. CMA’s new mission statement is now as follows: “To promote the science and art of medicine, the care and well-being of patients, the protection of the public health, the betterment of the medical profession, and to achieve health equity and justice.”

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the Health Equity Council, LACMA can do more. The Association can use its influence to partner with like-minded organizations to promote health equity. The Association will use its stature to educate the general public about the importance of equitable access to healthcare.

And, as Dr. Caivano noted, equitable healthcare goes beyond medicine. “Housing is a major inequity that has been exacerbated by the current pandemic.” She further observed the implications of poor housing choices and availability in Los Angeles, which mean longer commutes, and the impacted indoor air quality in homes and schools, all affecting health.

WHY HEALTH EQUITY NOW? A crosscurrent of circumstances prompted action on the part of the Association.

According to Dr. Shiba, “COVID-19 has put a bright spotlight on the health inequities and disparities that already existed in our healthcare system. It is on us, as physicians who are often put in the spotlight as COVID-19 heroes now, to direct that attention to those patients and care gaps who need it the most.”

HOW TO GET INVOLVED = The Health Equity Council actively seeks the involvement of LACMA physicians and their associates. As noted by Dr. Shiba, one of the objectives of HEC is to reach outside the Association. Physicians making an introduction to organizations aligned with the mission of HEC will be an essential component of the HEC’s eventual impact on and engagement with the broader community.

As Dr. Shiba observed, “Racism has plagued us for centuries. But what is important is that the HEC continues to do the work, even if the result at times produces a small change. Because even a small change is progress, and I believe incremental change will get us to where we need to be.”

Backing Dr. Shiba, fellow HEC member Dr. Caivano noted, “Coalition-building is something we are actively working on.

For example, we are exploring partnerships with academic institutions, residencies, and physicians’ teaching and training institutions to initiate discussions about health inequities early on in their careers. Early exposure to these concepts is important to bring about change in the system. We need to start upstream where the training begins to move away from the individual illness-based approach and towards a more holistic systems-based approach that acknowledges all aspects of an individual’s life to provide the most effective care.”

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CALIFORNIA’S COMPLETELY UNPREDICTABLE,

TOTALLY CHAOTIC LEGISLATIVE YEAR

As 2019 concluded, reasonable assumptions about 2020 began to emerge. The year was expected to be busy and more polarizing due to the presidential election occurring in November. Large-scale issue-based campaigns calling for new state programs supported by the expected state budget surplus were being announced. State legislators were finalizing their legislative packages. And lastly, the California Medical Association (CMA) was preparing to defeat yet another attempt to eliminate the cap on noneconomic damages incorporated in California’s longstanding professional liability reform law, the Medical Injury Compensation Reform Act (MICRA).

In March, the world changed, and California politics and the legislative process went through an unprecedented transformation.

On March 19 Governor Gavin Newsom issued the nation’s first statewide stay-at-home order in response to the arrival

of the novel coronavirus (SARS-coV2) in California. All nonessential businesses, such as restaurants, entertainment centers/activities, etc., were immediately shut down until further notice. The State Legislature was forced to take multiple extended recesses, and all in-person lobbying was prohibited, leading to the cancellation of CMA’s annual Legislative Advocacy Day. The legislative process was completely upended. CMA staff worked diligently to adjust to ever-changing dynamics, as both houses of the Legislature scrambled to implement social distancing guidelines and condense their calendars.

In the end, CMA successfully maintained state funding for physician services, defeated proposals to increase or add new administrative burdens onto physicians, and secured a number of Executive Orders to protect medical practices as they faced a pandemic unlike any seen in the past century.

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However, CMA did not escape the legislative session unscathed. The legislature passed, and the governor signed AB 890 (WOOD), which created two new classifications for nurse practitioners (NP). While this measure was passed into law, this matter is far from settled, as the fight to ensure patient safety now moves into the regulatory process. All of CMA’s advocacy centers have prioritized this issue, developed an action plan, and are coordinating with the American Medical Association (AMA) as well as various specialty associations to ensure the bill is implemented in a manner that protects patients and physician practices.

BUDGET – ACCESS TO CARE California began this year with a strong economy, historic reserves and a projected surplus of $5.6 billion. Due to the COVID-19 pandemic, the state’s economy took a significant hit, which meant the Governor had to make several difficult decisions when revising his proposed budget in May. The Governor’s May Revision was a complete redrafting of the state budget proposal released on January 10, 2020.

In January, the budget proposal increased our state’s investment in health care, which included growing California’s physician workforce. The May Budget Revision, however, sought to reverse course, proposing to cut Proposition 56 funding for increased physician reimbursements, reduce patient benefits in Medi-Cal and strike all investments seeking to expand the physician workforce. Through the budget process in the Legislature, CMA was able to protect: •

$1.2 BILLION in Proposition 56 (tobacco tax) funding, which provides supplemental payments for physician and dental services, family health services, developmental screenings, non-emergency medical transportation and value-based payments. This includes the continuation of all future cohorts of the Proposition 56 Physician and Dentist Loan Repayment Program (years 2-5 of the 5-year program).

•

$1.5 MILLION in General Fund monies to maintain the Proposition 56 Graduate Medical Education program at an ongoing total of $40 million.

•

$33.3 MILLION in ongoing General Fund monies for the continuation of the Song-Brown Healthcare Workforce Training Program.

•

THE EXPANSION OF POST-PARTUM MENTAL HEALTH SERVICES for individuals diagnosed with a maternal mental health condition.

Through the budget process in the Legislature, CMA was able to protect $1.2 billion in Proposition 56 (tobacco tax) funding, which provides supplemental payments for physician and dental services, family health services, developmental screenings, nonemergency medical transportation and value-based payments.

In addition, the revised budget proposal included a 47% increase to the Medical Board of California’s physician and surgeon licensing fee. Through CMA’s advocacy, the Legislature rejected that proposal. Still, the Legislature could revisit the discussion in 2021 when the Medical Board is subject to a review of all of its operations through the Sunset Review process. It is anticipated that the Medical Board will seek a license fee increase in the context of that process.

SURPRISE BILLING – AB 72 FIX Since the implementation of AB 72 (Bonta) related to surprise billing, CMA has been working with the Legislature to mitigate the negative impacts on the physician community. This year, AB 2157 (WOOD) was introduced to address the issues surrounding the independent dispute resolution process (IDRP). Along with several specialty societies, CMA was able to secure amendments that allowed physicians to provide more substantial evidence to better defend their claims during an AB 72 payment dispute. Through CMA’s advocacy in the legislative process and with the Department of Managed Health Care (DMHC) directly, an IDRP determination has been in the physician’s favor, a first since the law became effective. However, our work on this issue does not end there. CMA continues to work with regulators and legislators to further ensure a process that is fair and accessible to any physician needing to use it.

PUBLIC HEALTH Flavored tobacco products are often the entry point for young people who use tobacco. Over the last several years, a spike in e-cigarette use among the nation’s youth

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has been linked to targeted advertisements of flavored tobacco. Menthol cigarettes, sweet cigars, candy vapes and other flavored tobacco products serve one purpose: to mask tobacco’s harshness and get users hooked to a dangerous life-long addiction. In 2020, CMA combined forces with a large coalition of health care, youth and community organizations to support SB 793 (HILL), which prohibits tobacco retailers, or any tobacco retailers’ agents or employees, from selling, offering for sale, or possessing with the intent to sell or offer for sale, a flavored tobacco product or a tobacco product flavor enhancer. This ban includes e-cigarettes and vaping products, as well as traditional tobacco products. SB 793 crossed the legislative finish line and was quickly signed by Governor Newsom once it reached his desk. The new law will take effect on January 1, 2021.

DECREASING ADMINISTRATIVE BURDENS CMA worked with ASSEMBLYMEMBER LORENA GONZALEZ ON AB 2257 to further address challenges for physician practices resulting from a bill passed last year (AB 5) that made significant changes to the definitions of independent contractors and employees, in an attempt to be consistent with the court decision in the Dynamex case. Last year, AB 5 included an exemption for physicians, but there continued to be a need to address business-to-business and referral agency arrangements.

CMA successfully secured amendments to address those outstanding concerns, and the bill was signed into law.

CMA also helped lead a coalition to defeat SB 977 (MONNING), which sought to expand the California Attorney General’s existing authority related to mergers and acquisitions in the health care industry. Although CMA policy supports governmental actions designed to ensure hospital market competition, this broadly drafted legislation established a wide definition of health care transactions, which included leasing and other medical contracting arrangements. SB 977 ultimately failed to move off the Assembly floor.

CMA worked with Senator Dr. Richard Pan to exempt independent medical practices from the mandate, and secured physician involvement in future rulemaking and guidance on this issue and supply chain sustainability.

In addition to the above, CMA worked with multiple legislative offices to stop the creation of new administrative burdens related to the COVID-19 pandemic. AB 685 (REYES) requires employers to provide written notification within 24 hours to their employees if they were potentially exposed, at the workplace, to a person who has COVID-19.

As this would have required physician practices to report this information daily, CMA secured amendments that exempted employees who conduct COVID-19 testing or screening or that provide direct care to individuals known to have tested positive for COVID-19. This approach balanced CMA’s support for notifying employees of possible exposure and protecting physician practices from being overburdened.

Senator Richard Pan, M.D., introduced legislation requiring the state and health care employers to procure a stockpile of personal protective equipment (PPE) as a means of addressing future equipment shortages like the one experienced at the outset of the pandemic. As introduced, the bill would have created a significant burden on independent physician practices. CMA worked with Dr. Pan to exempt independent medical practices from the mandate, and secured physician involvement in future rulemaking and guidance on this issue and supply chain sustainability.

IMPLEMENTING TELEHEALTH At the onset of the statewide public health emergency, CMA worked to build upon AB 744 (AGUIAR-CURRY, 2019), which required commercial health plans to implement payment parity for services provided via telehealth. An association-wide advocacy effort allowed CMA to secure widespread payor coverage across the entire health care system that required all commercial, Medi-Cal and workers’ compensation payors to immediately cover telehealth services at the same rate as in-person services. To achieve this outcome, CMA worked with each independent agency and department to ensure consistency between the DMHC and the Department of Health Care Services (DHCS) as well as the California Department of Insurance (CDI) and employers under the Department of Workers’ Compensation (DWC). Each agency continued to post updated guidance consistent with CMA’s input, and often referenced CMA’s sponsored telehealth legislation (AB 744) as their models.

CMA also advocated for the Governor to waive existing laws requiring consent prior to providing telehealth services. During the COVID-19 state of emergency, these waivers ensure that no enforcement action would be authorized against covered health care providers providing telehealth services via remote communication technologies that may not fully comply with these privacy laws. CMA was successful in receiving these waivers at the state and federal levels.

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DECREASING LIABILITY FOR MEDICAL PRACTICES CMA worked with a coalition of health care and other business organizations to defeat AB 2570 (STONE). This bill would have exposed physicians and their practices to frivolous lawsuits, making it more difficult for physicians to maintain the viability of their practices.

SCOPE OF PRACTICE As discussed earlier, ASSEMBLYMEMBER JIM WOOD’S AB 890 creates two new categories of nurse practitioners, who would be allowed to provide services without standardized procedures. Despite the fervent work of CMA, the AMA and numerous specialty societies, the bill passed the legislature and was enacted in law. The bill does not eliminate physician supervision and leaves room for interpretation regarding the role supervision can still play in the physician-NP relationship. It should also be noted that existing NPs are not impacted by AB 890 and must continue practicing under standardized procedures. In addition, the measure includes a delayed implementation of three years to allow for the completion of the regulatory process. A detailed factsheet on this bill can be found on the CMA website at cmadocs.org.

Despite this setback, the fight to protect patient safety will now roll into the regulatory process. CMA will continue to work in tandem with AMA and our grassroots network to keep physicians engaged on this issue.

CMA will always be in the midst of every critical political and legislative battle, utilizing our resources to advance an agenda that protects physician practices and empowers the physician voice.

In other scope developments, CMA and the American College of Obstetricians and Gynecologists (ACOG) resolved a long-standing issue with the certified nursemidwives (CNM) through SB 1237 (DODD). This bill creates a framework for CNMs to perform certain functions within the scope of midwifery independently while maintaining a collaborative relationship with a physician and surgeon. The measure also includes a requirement for informed patient consent as well as patient outcome reporting requirements.

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UNCERTAINTY CONTINUES Although the 2019-2020 legislative session has finally concluded, uncertainty continues. In November, a new fiscal outlook will reveal whether the state budget is still facing a multi-billion shortfall. December will provide an idea of whether the Legislature will reopen the Capitol and allow for in-person lobbying. The political process will continue to be uncertain. However, there will be a consistent truth among all the unpredictable chaos: CMA will always be in the midst of every critical political and legislative battle, utilizing our resources to advance an agenda that protects physician practices and empowers the physician voice.

On the following pages, you will find details of the major bills that CMA followed this year.

In unity,

Janus L. Norman CMA Senior Vice President Centers for Government Relations and Political Operations

For more details on the major bills that CMA followed this year, visit cmadocs.org/leg-wrap-2020. Subscribe to CMA’s free biweekly Newswire and stay informed on CMA’s legislative efforts and other issues critical to the practice of medicine at cmadocs.org/subscribe.

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