WOEMA Legislative Affairs Updates 

WOEMA Legislative Committee Broadens Agenda in 2012

WOEMA enters the 2012 legislative year hip-deep and ready to engage on a number of fronts.  The past year yielded many developments to cheer, some to wince at, and some merely continuing on (and on and on).  Here's a quick look at some of the good, bad and familiarly ugly, and where WOEMA's Legislative Affairs work moves from here:

WOEMA's opioid guidance document - The Legislative Committee last year developed a user-friendly grid comparing seven well respected opioid prescribing guidelines.  The work was done in response to a CWCI report highlighting the growing prescription of opioids in California, and in anticipation of legislation or rule-making to address the issue that will likely materialize this year.  The published grid has been circulated to policymakers, including DWC officials, as well as to other provider organizations. [comparison grid]

Work Comp quality - In 2012, WOEMA will continue its search for specific quality measures that could be incorporated into Workers' Comp system that improve outcomes and efficiencies.  In a meeting with DWC Administrative Director Rosa Moran, WOEMA representatives proposed to develop recommendations in this area - an idea that AD Moran eagerly endorsed.  In turn, she asked that WOEMA come up with recommendations for resolving treatment disputes in the courtroom, which represents a huge challenge for appeals judges.   The Legislative Committee is exploring possible recommendations from a variety of sources, including the Quality Improvement project led by Peter Vasquez, MD, as well quality measures being pursued in other states.  In December conference call, the committee learned from Lee Glass, MD, Associate Medical Director of Washington State's Dept. of Labor and Industries (and an ACOEM member) about measures being implemented in that state, with an eye toward evaluating their suitability for importation elsewhere.

Cal-OSHA Lead Standard - A contingent of WOEMA members plan to participate in a second meeting of Cal-OSHA Lead Advisory Committee, which met last to year to consider revisions to the state's lead standards.  WOEMA continues to be a lead advocate (as it were) for stiffening the standards, including the lowering of threshold blood levels.  WOEMA's Legislative Committee has been conferring with officials from the California Department of Public Health (CDPH), to coordinate advocacy. 

Worker's Comp Fee Schedule - US Healthworks sponsored legislation in California in 2011 to compel DWC to transition its Official Medical Fee Schedule (OMFS) to an RBRVS-based schedule.  WOEMA helped to successfully push that bill, SB 923 (De Leon), all the way to the Assembly Floor, where it stalled between pressure from: 

• Stakeholders such as Labor, who insisted that conversion be cost neutral
• Other stakeholders, such as the CMA and specialty organizations, who insisted that the conversion include no pay cuts to any providers.

WOEMA continues to work closely with the bill's sponsors to determine how to keep the bill moving this spring, while also continuing to push for the conversion at the regulatory level.  WOEMA will continue to support appropriate cost-saving measures elsewhere in the Work Comp system to help accommodate adoption of a physician fee schedule that better recognizes the value of primary treatment.

Other initiatives - Going forward, the Legislative Committee plans to engage in some new initiatives, including developing possible internal policy or guidance to members on the trend toward marketplace consolidation of Occupational Medicine and other specialty practices into larger, typically hospital-owned, groups.  In addition, WOEMA will push to have preventive health services included in small-business insurance policies offered through California's pending Small Business Health Options (SHOP) exchange, a pending feature of federal health care reform. 

As has come to be the case, one truly great feature of WOEMA's policy work has been the evolution of the Legislative Committee's informal weekly calls, which happen every Friday morning at 7:45 a.m.  To our knowledge, these calls are one of few venues anywhere for regular policy discussions of Occupational Medicine.  Depending on topic, the group often includes guests from in and around the WOEMA community, subject experts, and good allies, such as our friends at the CSAOHN.  If you are interested in serving on the committee, please contact committee co-chairs Paul Papanek, MD, latoxdoc@ca.rr.com, or Scott Levy, MD, scott.levy@kp.org.

 

 

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California Fee Schedule Bill Update [Oct 2011]

The Fee Schedule Conversion bill, SB 923 (de Leon), which was broadly supported by WOEMA's membership, stalled in the Assembly in September. The bill, sponsored by USHealthworks, would have required the Division of Workers Compensation (DWC) to convert the physician fee schedule (OMFS) to an RBRVS-based schedule by Jan. 1, 2013. WOEMA will work with the author and the sponsor help move the bill out of the Assembly in early 2012.

 

 

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SB 923:  Fee Schedule Conversion Bill advances to Assembly Floor

[8/31/2011]  WOEMA needs your immediate help!  All our California members should contact their respective Assemblymembers ASAP to urge them to vote for SB 923 (De Leon), which is likely be heard on the Assembly Floor this week.  SB 923 requires the Division of Workers Compensation to convert the physician fee schedule (OMFS) to an RBRVS-based schedule by Jan. 1, 2013.  SB 923 could come up for vote on the Assembly Floor this week.  If passed, the bill will move to the Governor's desk for signature.

The RBRVS conversion has been one of WOEMA's long-standing priorities.  In order for the bill to advance to its final floor vote, the author amended the bill to require that the conversion be phased in over three years, and that the initial conversion result in "no overall increased costs" to the system.  Attached is an op-ed piece by WOEMA Board President Roger Belcourt, MD, which explains the importance of the conversion.  (This version appeared last Thursday in the San Bernardino Sun).

What to do: 

Step 1:  CLICK HERE to find your Assemblymember's contact information.  Important: Use the information for their Sacramento office.    You may input either or both your home or office zip code. 

Step 2:  Please call or fax your Assemblymember ASAP!  You may use the language below as a model for your letter or for talking points. Please use your professional letterhead. Feel free to personalize your message based on your own role in the system and personal observations.

Thank you!

SAMPLE LETTER

 

Aug. 31, 2011

 

The Honorable [Your Assemblymember's First and Last Name]

State Capitol

Sacramento, CA   95814

     FLOOR ALERT

Urge Your SUPPORT for SB 923 (De Leon)

Dear Assemblymember [Last Name],

 

As a practicing physician and your constituent, I urge you to vote YES on SB 923 (De Leon) when the bill is heard on the Assembly Floor.  I work as a Primary Treating Physician in Workers' Compensation, and with my colleagues provide the frontline diagnosis, treatment, reporting, and case management services that are the cornerstone of the medical care provided to Californians injured in the workplace.

 

SB 923 calls for the long-overdue conversion of the Workers' Compensation physician fee schedule to a schedule based on the Resource Based Relative Value Scale. Importantly, SB 923, as amended, requires only that the DWC follow through on final adoption a new schedule by July 2012, completing a process that began almost a decade ago.  This conversion is essential to ensure the adequate participation in the system by primary care physicians, the proper alignment of incentives within the system, and the regular, rational, cost-effective updating of the schedule by the Division.

 

 

SB 923 appropriately leaves the details of the RBRVS conversion - the selection of billing ground rules, coding guidelines, geographic adjustments, inflation adjustors, etc.  - to the regulatory process, where the appropriate expertise and deliberation can be brought be bear.  

 

I urge your support and thank you for your consideration.

 

Sincerely,

 

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WOEMA Legislative Alert: [8/25/11]
WOEMA President says "California's Injured Workers Deserve The Right Care at The Right Time" [read more]

WOEMA has been working both in the California State Capitol, and now in the media, for passage of SB 923 (De Leon), a bill to require conversion of the Workers Compensation physician fee schedule to RBRVS by 2013.  With the bill resting in a critical committee this week, this op-ed piece from WOEMA ran Thursday in the San Bernardino Sun and the California Progress Report.

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Fee Schedule Bill to be heard in Senate Committee

[July 28, 2011] Once again, WOEMA urges our California members to contact key legislators and ask them to support SB 923 (De Leon), a bill that requires the Division of Workers Compensation to convert the physician fee schedule to an RBRVS-based schedule by Jan. 1, 2013.  The conversion has been one of WOEMA's long-standing priorities, and we need to ensure that SB 923 succeeds despite policymakers' caution about State finances and reluctance to add to the workload of regulatory agencies.  

SB 923 is scheduled to be heard Wednesday, Aug. 17, in the Assembly Appropriations Committee.  This committee will focus their attention on financial (rather than policy) implications of the bill.  So your message to your legislator should be:

1)     SB 923, in itself, does NOT necessitate adding more dollars to the system

2)     SB 923 would NOT require State General Fund expenditures for fee-scheduled implementation or updates, since DWC operations are 100 percent funded by carriers

What to do:  Check (using the link below) to see if your Assemblymember is on the Appropriations Committee.  Please call their office or fax them a brief letter urging their support the bill at the hearing.  At the bottom is sample language you may use for a letter or for talking points.

Step 1:  CLICK HERE to check if your Assemblymember is one of the legislators below.  You may check using either or both your home or office zip code. 

The Honorable Felipe Fuentes (D-Los Angeles), Chair

Phone: (916) 319-2039

Fax: (916) 319-2139

 

The Honorable Diane Harkey (R-Laguna Niguel), Vice Chair

Phone: (916) 319-2073

Fax: (916) 319-2173

 

The Honorable Bob Blumenfield (D-Van Nuys)

Phone: (916) 319-2040

Fax: (916) 319-2140

 

The Honorable Steven Bradford (D-Inglewood)

Phone: (916) 319-2051

Fax: (916) 319-2151

 

The Honorable Charles Calderon (D-Whittier)

Phone: (916) 319-2058

Fax: (916) 319-2158

 

The Honorable Nora Campos (D-San Jose)

Phone: (916) 319-2023

Fax: (916) 324-2123

 

The Honorable Mike Davis (D-Los Angeles)

Phone: (916) 319-2048

Fax: (916) 319-2148

 

The Honorable Tim Donnelly (R-Hesperia)

Phone:  (916) 319-2059

Fax:  (916) 319-2159

 

The Honorable Mike Gatto (D-Burbank

Phone: (916) 319-2043

Fax: (916) 319-2143

 

The Honorable Isadore Hall (D-Los Angeles)

Phone: (916) 319-2052

Fax: (916) 319-2152

 

The Honorable Jerry Hill (D-South San Francisco)

Phone: (916) 319-2019

Fax: (916) 319-2119

 

The Honorable Ricardo Lara (D-South Gate)

Phone: (916) 319-2050

Fax: (916) 319-2151

 

The Honorable Holly Mitchell (D-Los Angeles)

Phone: (916) 319-2047

Fax: (916) 319-2147

 

The Honorable Jim Nielsen (R-Biggs)

Phone: (916) 319-2002

Fax: (916) 319-2102

 

The Honorable Chris Norby (R-Fullerton)

Phone: (916) 319-2072

Fax: (916) 319-2172

 

The Honorable Jose Solorio (D-Santa Ana)

Phone: (916) 319-2069

Fax: (916) 319-2169

 

The Honorable Donald Wagner (R-Irvine)

Phone: (916) 319-2070

Fax: (916) 319-2170

 

Step 2:  Please call or fax your Assemblymember using the contact information above.  You may use the language below as a model for your letter or for talking points. Please use your professional letterhead and feel free to add any personal experiences or observations in your communication.

Step 3: Let us know who you contacted.  Just send a quick email to Don Schinske, dschinske@calcapitol.com

Thank you!

 

SAMPLE LETTER

July 27, 2011

The Honorable [Your Assemblymember's First and Last Name]
State Capitol
Sacramento, CA   95814

RE:  Urge Your SUPPORT on SB 923 (De Leon)

Dear Assemblymember [Last Name],

As a practicing physician and your constituent, I urge you to vote YES on SB 923 (De Leon) when the bill is heard Aug. 17 in the Assembly Appropriations Committee. I work as a Primary Treating Physician in Workers' Compensation, and with my colleagues provide the frontline diagnosis, treatment, reporting, and case management services that are the cornerstone of the medical care provided to Californians injured in the workplace.

SB 923 calls for the long-overdue conversion of the Workers' Compensation physician fee schedule to a schedule based on the Resource Based Relative Value Scale. Importantly, SB 923, as amended, requires only that the DWC follow through on final adoption a new schedule by July 2012, completing a process that began almost a decade ago.  This conversion is essential to ensure the adequate participation in the system by primary care physicians, the proper alignment of incentives within the system, and the regular, rational, cost-effective updating of the schedule by the Division.

Importantly, the bill does NOT set the actual reimbursement levels, conversion factors, or any specific element that might affect access, physician pay, or medical costs.  Nor does the bill in affect State finances in any way, since DWC regulatory operations are not funded through the General Fund.

SB 923 appropriately leaves the details of the RBRVS conversion - the selection of billing ground rules, coding guidelines, geographic adjustments, inflation adjustors, etc.  - to the regulatory process, where the appropriate expertise and deliberation can be brought be bear.  

I urge your support and thank you for your consideration.

Sincerely,
(ADD YOUR NAME/TITLE)

---

 

July 19, 2011

CALIFORNIA: RBRVS bill advances to final committees

California legislators this week broke for summer recess, deferring several pieces of Workers' Compensation until mid-August and the waning weeks of the session.  These include two bills on which WOEMA has been actively engaged:

SB 923 (De Leon), sponsored by US HealthWorks, would compel the Division of Worker's Compensation to adopt an RBRVS-based physician fee schedule by 2013.  WOEMA has been aggressively lobbying the bill for several months, helping it to advance through the Senate policy and fiscal committees, Senate Floor, and the Assembly Insurance Committee, where Dr. Paul Papanek gave strong supporting testimony. 

So far, the bill has travelled a tightrope.  In its current form, SB 923 does not set conversion factors, billing ground rules, or any other factor that would suggest DWC arrive at any particular level of reimbursement for any group of codes.  However, specialty physician, other provider groups and the CMA are seeking protections for current procedural payments, while labor and employer groups have remained neutral precisely because the bill does not ask that more dollars overall be spent on physician services. 

WOEMA continues to work closely with the bill's sponsors in shepherd SB 923 through the legislative process.

Link to SB 923

AB 378 (Solorio) is an attempt to end the over-prescription and over-dispensing of compounds, convenience packs, and medical foods.  The bill sensibly requires that DWC develop a fee schedule for compounds, with most of the discussion centering on how compounds should be reimbursed until DWC can actually do the work.  Although WOEMA supports the bill, we are working with the author's office and our fellow physician organizations to change a provision that would cap reimbursement for any office-dispensed product at 120 percent of cost.  AB 378 is a complicated bill but it will almost surely advance out of the Legislature, as there is general recognition that the sharp growth in the use of compounds is not explained by medical need.

Link to AB 378

Meanwhile, WOEMA's Legislative Committee continues to work on a range of initiatives, including:

1) Creating a guidance document for members on opioid prescribing, with a comparison of the various guidelines from other states and provider organizations.

2) Exploring how occupational health data can be incorporated into electronic health records and "meaningful use" criteria.

3) Exploring how workplace wellness and prevention measures can be incorporated into policies offered through the small-employer SHOP Exchange, which California must launch by 2014 as part of implementing federal health care reform.

WOEMA physicians Paul Papanek, MD, Scott Levy, MD, Anne Searcy, MD, Roman Kownacki, MD and Gregg Sorensen, MD, along with Executive Director Kerry Parker and lobbyist Don Schinske briefed California Insurance Commissioner Dave Jones on these issues in Sacramento on July 17.  At the meeting, Commissioner Jones, Deputy Commissioner Janice Rocco, and SDI Senior Counsel Chris Citko identified several project on the list that the Department may be willing to help with.

 

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 Senate to vote this week on Fee Schedule bill - 6/1/2011

Please, we urge ALL of our California members to contact their State Senator and ask them to support SB 923 (De Leon), a bill to require the Division of Workers Compensation to convert the  current physician fee schedule to an RBRVS-based schedule by Jan. 1, 2013.  As you are probably aware, this conversion has been a long-standing priority for WOEMA, and is essential to ensuring fair payment for primary care, continued access, and the appropriate alignment of incentives in the system. 

SB 923, which is being sponsored by US HealthWorks, has advanced out of its first set of legislative committees.  It will be heard this week - probably Thursday -- on the full floor of the Senate.  WOEMA is directly advocating for SB 923 in the Capitol.  But your help is CRITICAL! 

Here's what WOEMA would like you to do: 

Step 1:  CLICK HERE to check to find out who your Senator is.  You may check using either or both your home or office zip code. 

Step 2:  Please call or fax your Senator's office in Sacramento ASAP!  You will find their Capitol phone number in the link above.  Click on their name (or Google it) to find the fax number of their Capitol office.  You may use the language below as a model for your letter or for talking points. Please use your professional letterhead and feel free to add any personal experiences or observations in your communication.

Step 3: Let us know who you contacted.  Just send a quick email to Don Schinske, dschinske@calcapitol.com

Thank you!

 

SAMPLE LETTER

June 1, 2011

The Honorable [Your Senator's First and Last Name]

State Capitol

Sacramento, CA   95814

RE:  Please VOTE YES on SB 923 (De Leon)

Dear Senator [Last Name],

As a practicing physician and your constituent, I urge you to vote YES on SB 923 (De Leon) when the bill is heard on the Senate Floor.  I work as a Treating Physician in Workers' Compensation, and with my colleagues provide the frontline diagnosis, treatment, reporting, and case management services that are the cornerstone of the medical care provided to Californians injured in the workplace.

SB 923 calls for the long-overdue conversion of the Workers' Compensation physician fee schedule to a schedule based on the Resource Based Relative Value Scale. Importantly, SB 923, as amended, requires only that the DWC adopt a new schedule by January 2013, completing a process that began almost a decade ago.  This conversion is essential to ensure the adequate participation in the system by primary care physicians, the proper alignment of incentives within the system, and the regular, rational, cost-effective updating of the schedule by the Division of Workers' Compensation..

Importantly, the bill does NOT set the actual reimbursement levels, conversion factors, nor any specific element that might affect access, physician pay, or medical costs.  Nor does the bill affect State finances in any way, since DWC regulatory operations are not funded through the General Fund.

SB 923 appropriately leaves the details of the RBRVS conversion - the selection of billing ground rules and coding guidelines, geographic adjustments, and so on - to the regulatory process, where they can be sorted through with deliberation and the input of stakeholder expertise.

I urge your support and thank you for your consideration.

 

Sincerely,

Other points you could raise in your letter or conversation:

• The "relative values" for medical services in RBRSVS get reviewed and updated at least once every five years; the scale evolves according to changes in medical practice. The relative values underlying OMFS have gone largely unchanged for decades.
• Similarly, RBRVS allows for the regular incorporation of new procedure (CPT) codes and their valuations.
• RBRVS more fairly recognizes the value of primary care services and the role that appropriately incentivized primary care can play in moderating health care costs.
• The current OMFS is an artifact from a pre-managed-care era in healthcare, when schedules were drawn up based on physician's billed charges. In 1999, a study by UCLA noted that the valuations underlying OMFS were already out-of-date.
• In 2002, the Lewin Group noted that the work required under the primary care Evaluation and Management (E&M) codes in California required 28 percent more work than the same E&M codes in Medicare. That disparity has increased under the reforms of 2004. Impairment ratings, apportionment of disability, and additional reporting have all been added to the PTP's workload with no corresponding adjustment to the underlying OMFS work values.
• Right now, the main series of E&M codes, 99201-99205 and 99211-99215, are paid at roughly 100 percent of Medicare, despite the extra work required in the California Workers' Compensation system (and despite the fact the Medicare pays more quickly -- and often more fully -- than many Workers' Compensation insurers).
• Unfortunately, the current fee schedule does not value services that, if adequately recognized, could yield greater value to workers and employers alike. One example: In California, injured workers who are temporarily unable to perform their usual duties are eligible to report back to work for modified or light duty. Such a transition can be beneficial to all; the employer benefits from the timely return of an experienced worker, while the worker benefits from a speedier re-engagement with their professional purpose and workplace society. To facilitate such an arrangement, a physician typically must consult with both employer and \worker, often multiple times. In short, the process requires more clinical effort, case-management services that OMFS doesn't recognize but which can be partly addressed through the higher E&M payments of RBRVS.

 

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Fee Schedule Bill  - SB 923 (De Leon) - update as of 5/27/2011

On 5/23, WOEMA urged its California members to contact their State Senators serving on the Senate Appropriations Committee to support legislation that would compel the Division of Workers' Compensation (DWC) to update the Official Medical Fee Schedule. The bill was moved out of the Senate Appropriations Committee on 5/26. WOEMA continues to work with the bill's author and sponsors, US HealthWorks, on strategies to move the bill this year. Conversion of the outdated OMFS to a fee-schedule based on RBRSVS methodology has long been a WOEMA priority.  Such a conversion has been authorized in state statute since 2003.

As reported by WorkComp Central on 5/26/2011: At the Northern California Workers' Comp Forum at the San Francisco Airport Marriott which concluded Wednesday, May 26, Douglas Benner, MD coordinator of occupational health for Kaiser Permanente in Northern California, said utilization review is actually driving up medical costs. Currently, California employers trail only those in Texas and New Jersey when it comes to how much they pay for medical cost-containment programs, albeit with limited impact. Benner said there is additional regulatory work that can be done to help control medical costs, such as updating the Official Medical Fee Schedule. The current fee schedule is based on what California doctors were charging in the 1960s and 1970s, and that higher reimbursement rates for surgeries and other specialized procedures create an incentive for physicians to perform those procedures, he said. Benner said SB 923, which would require the Division of Workers' Compensation (DWC) to adopt a fee schedule based on Medicare's resource-based relative value system (RBRVS) by Jan. 1, 2012, would be good for California because it eliminates the incentives by tying reimbursement to the complexity of the procedure being performed. DWC has been looking at making the switch from its current fee schedule to an RBRVS system for more than 10 years. Susan Gard, chief of legislation and policy for DWC, said (at the WorkComp Forum) that it is possible even without the legislation that the division will have regulations ready later this year.

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Fee Schedule Bill to be heard in Senate Committee - update as of 5/23/2011

Please, we urge our California members to contact key State Senators and ask them to support SB 923 (De Leon), a bill that simply requires the Division of Workers Compensation (DWC) to convert the physician fee schedule to an RBRVS-based schedule by July 1, 2012.  The conversion has been one of WOEMA's long-standing priorities, and we are working to ensure that SB 923 succeeds despite policymakers' caution about State finances and reluctance to add to the workload of regulatory agencies. 
 
SB 923 is scheduled to be heard Monday, May 23, in the Senate Appropriations Committee.  This committee ostensibly does not weigh legislative proposal by their policy merits of a bill, but by their fiscal implications.  SB 923, which is being sponsored by US HealthWorks, has been amended to require only that the conversion be done.  It does not require that DWC adhere to any particular conversion factors or dollar amounts. And so your message to your Senator should be:

1)     SB 923 would not necessarily entail new costs to the system
2)     SB 923 would not require State expenditures for implementation, since DWC operations are 100 percent funded by carriers
 
What to do:
If your own State Senator is a member of the Appropriations Committee, we request that you call their office or fax them a brief letter urging them to support the bill when it is heard Monday.  At the bottom is sample language you may use for a letter or for talking points.
 
Step 1:  CLICK HERE to check if your Senator is one of the committee members below.  You may check using either or both your home or office zip code.
 
The Honorable Christine Kehoe (D-San Diego), Chair
Phone: (916) 651-4039
Fax: (916) 327-2188
 
The Honorable Mimi Walters (R-Laguna Niguel), Vice Chair
Phone: (916) 651-4033
Fax: (916) 445-9754
 
The Honorable Elaine Alquist (D-Santa Clara)
Phone: (916) 651-4013
Fax: (916) 324-0283
 
The Honorable Bill Emmerson (R-Riverside)
Phone: (916) 651-4037
Fax: (916) 327-2187
 
The Honorable Ted Lieu (D-Torrance)
Phone: (916) 651-4028
Fax: (916) 323-6056
 
The Honorable Fran Pavley (D-Agoura Hills)
Phone: (916) 651-4023
Fax: (916) 324-4823
 
The Honorable Curren Price (D-Los Angeles)
Phone: (916) 651-4026
Fax: (916) 445-8899
 
The Honorable Darrell Steinberg (D-Sacramento)
Phone:  (916) 651-4006
Fax:  (916) 323-2263
 
Step 2:  Please call or fax your Senator using the contact information above.  You may use the language below as a model for your letter or for talking points. Please use your professional letterhead and feel free to add any personal experiences or observations in your communication.
 
Step 3: Let us know who you contacted.  Just send a quick email to Don Schinske, dschinske@calcapitol.com
 
Thank you!
 
 
SAMPLE LETTER
 
May 19, 2011
 
The Honorable [Your Senator's First and Last Name]
State Capitol
Sacramento, CA   95814
 
RE:  Urge Your SUPPORT on SB 923 (De Leon)
Dear Senator [Last Name],
 
As a practicing physician and your constituent, I urge you to vote YES on SB 923 (De Leon) when the bill is heard May 23 in the Senate Appropriations Committee. I work as a treating physician in Workers' Compensation, and with my colleagues provide the frontline diagnosis, treatment, reporting, and case management services that are the cornerstone of the medical care provided to Californians injured in the workplace.
 
SB 923 calls for the long-overdue conversion of the Workers' Compensation physician fee schedule to a schedule based on the Resource Based Relative Value Scale. Importantly, SB 923, as amended, requires only that the DWC follow through on final adoption a new schedule by July 2012, completing a process that began almost a decade ago.  This conversion is essential to ensure the adequate participation in the system by primary care physicians, the proper alignment of incentives within the system, and the regular, rational, cost-effective updating of the schedule by the Division.
 
Importantly, the bill does NOT set the actual reimbursement levels, conversion factors, nor any specific element that might affect access, physician pay, or medical costs.  Nor does the bill in affect State finances in any way, since DWC regulatory operations are not funded through the General Fund.
 
SB 923 appropriately leaves the details of the RBRVS conversion - the selection of billing ground rules and coding guidelines, geographic adjustments, and so on - to the regulatory process, where they can be sorted through with deliberation and the input of stakeholder expertise.
 
I urge your support and thank you for your consideration.
 
Sincerely,
 

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Proposed Budget Cuts to NIOSH-funded ERCs and Ag Health Centers: Letters/E-Mails Needed NOW!

April 23, 2011 - WOEMA Member Alert -- The President's Fiscal 2012 budget signals the elimination of the Education and Research Centers (ERCs) and the Agricultural Health Centers, currently funded in large part by the National Institute for Occupational Safety and Health (NIOSH). These proposed cuts would in effect terminate these very important institutions nationwide, including the Northern California ERC, the Southern California ERC, the Utah ERC, and the Agricultural Health Center at the University of California, Davis.

The ERC and Ag Center budgets have been temporarily spared in the 2011 Federal Budget, however, these programs are still slated for elimination in the proposed 2012 Federal budget.  We must continue our efforts to reverse these proposed cuts--which in the context of the Federal budget deficit are triflingly small at about $43 million.  If these cuts go through, then next year nearly all of the 17 Education and Resource Centers (ERCs) in the nation would probably have to close, and further training of Occupational Health professionals would be drastically curtailed in the entire country.  In our own area, the ERCs at UCLA, UC Irvine, UC San Francisco, and in Utah, as well as the Agricultural Health Center at UC Davis, would be targeted for closure.  We have only a few more weeks to persuade Congress and the Administration to reverse these short-sighted proposed cuts.

On-going training of Occupational Safety and Health professionals, including Occupational Medicine residents and nurse practitioners, is crucial for the well being of our field, and is also pivotally important for the health and productivity of the American workforce. The United States currently has a shortage of Occupational Physicians by a factor of 10 to 50 per capita, compared with almost all other industrialized nations--and this finding is independent of the political leanings of the country. Why have other countries deployed so many more Occupational Physicians?   Simply put, they have discovered that the workplace is a very efficient site for delivering preventive services.  And their investment in Occupational Medicine has paid off in lower costs for national health care, as well as safer and more productive workplaces. Now, at this pivotal time for us as America begins to change our national healthcare system, we will need MORE Occupational physicians, not fewer.  Accordingly, we should be expanding the ERCs, not cutting them.  So, we need your help to send Congress a message -- DO NOT CUT the very modest NIOSH budget for the ERCs, as the current 2012 Federal budget would propose to do. WOEMA urges our members to contact their Congressional Representatives and Senators once again, asking them to oppose these short-sighed proposed budget cuts.

In particular, we are aware that Representatives George Miller, Mike Thompson, and Jerry Lewis of California may be key voices in this debate.  WOEMA members living or working in the Districts of these House members may be especially influential in bringing this message to their elected officials.  We would urge even a brief phone call to these Representatives: 

George Miller: (202) 225-2095 (See attached support letter from Representative Miller to Director Jack Lew of the OMB)
Mike Thompson: (202) 225-3311
Jerry Lewis: (800) 233-1700

The voices of business leaders are likely to be especially persuasive with Congress.  If you have business contacts who might be willing to join with us in opposing these proposed cuts, we would ask that you use your influence to obtain additional business support for our position. " Here is a draft letter/message you could send to your representative.

What does this mean? NIOSH supports 17 university-based ERCs whose mission is to reduce work-related injuries and illnesses in the U.S. by conducting prevention research and by educating Occupational Health professionals. The ERCs provide training and research resources to every Public Health Region in the United States. Many centers are collaborative efforts among several institutions in their region, training occupational health physicians, occupational health nurses, industrial hygienists, safety specialists, and other related professionals. America currently has a shortage of Occupational Health professionals, and in fact lags far behind other industrial nations in our per capita supply of Occupational Medicine physicians and nurses. With regard to America's need for disaster preparedness, our attention has been recently drawn to the unimaginable environmental and workplace tragedy that has befallen the people of Japan. Now more than ever, we believe it is critically necessary to support both research and the training of occupational and environmental professionals.

Your help is needed. We need you to raise the alarm to your federal elected representatives about how NIOSH funding has benefited not just the training of occupational health professionals, but ESPECIALLY how it has benefited companies/businesses/employers. In fact, the ERCs and Agricultural Health Centers deserve to be expanded, not cut -- particularly at this time in history when our health care system is facing huge changes that will focus more than ever on public health prevention.

WOEMA MEMBERS: Use this template letter to send to your legislator [Template Letter]

Download copies of letters sent by ACOEM: [ACOEM letter to Congress] [ACOEM letter to Senate]

Write your member of congress an email today - simply enter your zip code and the system will address it directly to your representative.

Contact your own Senators via email using the links below:

HAWAII:
Senator Dan Akaka
Senator Dan Inouye

CALIFORNIA:
Senator Diane Feinstein
Senator Barbara Boxer

UTAH:
Senator Orrin Hatch
Senator Mike Lee

ARIZONA:
Senator Jon Kyl
Senator John McCain

NEVADA:
Senator John Ensign
Senator Harry Reid

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February 15, 2011 -- The WOEMA Legislative Committee has the active participation of about 15 members, under the leadership of our two vigorous co-Chairs, Drs. Scott Levy and Paul Papanek, and with designated legislative "liaisons" from each of WOEMA's five member states. Of note, WOEMA continues to be the only ACOEM Component with a paid lobbyist on staff, and we believe that the decision by the WOEMA Board five years ago to retain the advocacy services of Mr. Don Schinske has been of pivotal importance in increasing WOEMA's footprint in the legislative and advocacy arena.

The basic task of the Legislative Committee is to track new bills and new regulations related to Occupational and Environmental Medicine in our five member states. To this end, the Committee schedules detailed teleconferences on a quarterly basis, to review bills of importance, and to plan coordinated advocacy with other interested groups, especially the state Medical Associations and various state agencies.

To further WOEMA's goals, the Legislative Committee has developed specific active collaboration with two state medical associations -- the Arizona Medical Association (ArMA), where Dr. Robert Orford is this year's ArMA President, and with the California Medical Association (CMA), where Dr. Levy serves as WOEMA's representative at the CMA House of Delegates and earned the post of Secretary of CMA's Specialty Delegation, and where Dr. Steve Schumann has served as our representative at the Council on Legislation and the Workers' Compensation Technical Advisory Committee. This liaison work is both challenging and rewarding, and WOEMA is always seeking new volunteers to help represent our interests at other medical societies.

Moving to specific accomplishments -- in the past year, WOEMA is proud to have helped catalyze a decision by Cal-OSHA to form an Advisory Committee to revise the General Industry Lead Standard. We have long known that the Lead Standard is outdated and fails to offer sufficient protection to lead-exposed workers. Over the past two years, the members of the Legislative Committee have had frequent contact with the Cal-OSHA Administrative Director and other staff, and have brokered many fruitful conversations between staff within the California Department of Public Health (CDPH) and other stakeholders in the area of occupational lead exposure, including the California Occupational Health Nurses and industry stakeholders. Through our efforts, coupled with creative initiatives from both CDPH and Cal-OSHA, we now developed the proposed fundamentals of a much improved and long-overdue Lead Standard. The first meeting of the Cal-OSHA Advisory Committee is set for later this month (February, 2011), with a roughly six-month timetable to bring new proposed regulatory language to the Cal-OSHA Standards Board. We are optimistic that a revised California Standard would trigger similar action on the national stage with Federal OSHA.

The intricacies and oddities of the California Workers' Compensation system are a frequent topic of discussion within the Legislative Committee. In nearly every one of the past 15 years, the California Division of Workers' Compensation (DWC) has proposed new and often complex regulations, which the Legislative Committee continues to track. Over the past year, we have submitted detailed comments on an almost monthly basis on such topics as:

- the California Workers' Compensation fee schedule (OMFS), which sadly continues to be among the lowest in the nation;

- the proposed shift to an RBRVS methodology for workers' comp billing-a step which is likely to rationalize payment among various specialties and improve the rates for primary care practice, but which has occasionally been challenged by other physician groups;

- electronic billing and reporting, a topic on which DWC is finally poised to implement regulations, several years after a legislative mandate to do so.

- compounded medications and food packs, an area of sporadic but increasing billing abuses in the past few years; and

- orthopedic office supplies and other durable medical equipment (DME) dispensed as part of workers' compensation medical care.

In the past year, the Legislative Committee has developed closer working relationships with staff of the California Commission on Health and Safety in Workers' Compensation (CHSWC), and has provided detailed input on a recent CHSWC proposal related to medical liens. CHSWC recently responded by inviting WOEMA volunteers to serve on expert panels for new research studies funded by CHSWC on the subject of medical quality in the workers' compensation arena.

The Legislative Committee typically schedules meetings with key staff in the California Department of Industrial Relations, either in Sacramento or Oakland, two or three times a year, and schedules visits with members of the California legislature on an ad hoc basis.

Recently, a subgroup of the Legislative Committee began a policy review of recent decisions by the California Department of Pesticide Regulation to license the sale and use of the agricultural fumigant Methyl Iodide within California. A report by this working group is expected by mid-2011.

During 2010, in an effort to be more pro-active and focused, the Committee launched a new undertaking - the preparation of a "WOEMA Advocacy/ Legislative Agenda," comprising a set of twelve general advocacy goals for WOEMA. By mid-year last year, we had distributed copies of the Advocacy Agenda widely in our five state capitols, and also shared the document with the ACOEM Public Policy Committee and with the ACOEM House of Delegates as a model for advocacy by other Components. Our Advocacy Agenda proved to be a useful "calling card" in visits to state officials, and in conversations with political candidates who were seeking cooperation from WOEMA in their campaigns.

At the beginning of 2011, the Legislative Committee revised and expanded the WOEMA Advocacy Agenda, in collaboration with several other stakeholders, including the California Medical Association, insurers, representatives from the community of Occupational Health Nurses, and various academic leaders within the NIOSH ERC's (Education and Research Centers). Once again, we will again distribute the Advocacy Agenda widely during the year. [Advocacy/Legislative Agenda]

As in past years, members of the Legislative Committee meet informally every Friday by teleconference, from 7:45 am to 8:15 am. New members are warmly welcomed to join us, and help with the important work of shaping public policy in the field of Occupational and Environmental Health.

Finally, the leaders of the Legislative Committee are proud to assert that our hard work, sometimes frustrating but always engaging, has helped to greatly expand WOEMA's footprint in the field of Occupational and Environmental Health. This work is vital for us. Helping to shape legislative and regulatory policy showcases WOEMA's medical leadership on medical quality in our field, and has a direct bearing on our members' practices and on the health and safety of the American workplace.

 

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Previous Legislative Updates:

Sept. 28, 2010

2010 has been a busy year forWOEMA's legislative activity, with the California Division of Workers'Compensation formally launching its effort to revise Official Medical FeeSchedule at time when while pressure is growing to control medical costs andrevise the permanent disability schedule.   Also this year, WOEMA has also offered to engage withCal/OSHA on revision of the lead standard and other regulatory activities.   And while relatively little legislationpertaining to Occupational Medicine was advanced in the state legislatures,WOEMA did lobby Sacramento policymakers on several bills that would affect ourmembers' practices and patients. 

Representation: Dr. Schumann, Dr. Levy and Don Schinske, representingthe interests of WOEMA, participated in discussion at the CMA Council onLegislation, where the CMA begins to develop policy on proposed legislation.

As well, Dr. Schumann sits onthe CMA Workers' Compensation Technical Advisory Committee, joining indiscussion and debate regarding the CMA's position on legislative andregulatory issues. Don Schinske participated in parallel discourse with the CMAand legislative analysts also on legislative and regulatory matters.

Official Medical Fee Schedule:  Over themonths of March through July, DWC issued three different proposals for a newRBRVS-based fee schedule, collecting input on each.  WOEMA has:

• Commented on each proposal
• Issued an alert to our members, urging them to comment directly to DWC
• Testified in an August stakeholder meeting (Dr. Levy, Dr. Swann, and Don Schinske)
• Met with DWC staff several times as well as Dept. of Industrial Relations Director John Duncan (Dr. Schumann, Dr. Levy and Don Schinske)

WOEMA has worked closely withCMA and the other specialties on the DWC proposals.  Understandably, physicians are a split on the latestproposals, largely depending on how their reimbursement would be affected.  However, all specialties have been ableto advocate together for certain features, such as the inclusion of CPT codesfor consultation and a medical inflation index, and against others, such as thewholesale adoption of Medicare billing ground rules. 

As of yet, DWC has yet toenter formal rulemaking on a revised OMFS.  (And time grows short, with a new Administration taking overin January).  Although the latestproposal is far short of ideal, WOEMA generally supports its use of threeconversion factors that boost payments for the Evaluation & Managementcodes while some surgery and radiology codes are potentially decreased by alittle. 

Other Workers Compensationissues:  Driven by industry proposals for double-digit premiumincreases, the California Insurance Commissioner and the Commission on Health,Safety and Workers Compensation (CHSWC) have been exploring the drivers ofsystem costs.  Medical liens andcompounded medications have received particular attention.  Dr. Paul Papanek represented WOEMA andCMA at a meeting in Insurance Commissioner Steve Poizner's office to discuss medicalliens.  In addition, WOEMA engagedin some late-session maneuvering around AB 2779 (Solorio), a bill to requiringprior authorization for prescription of compounded medications.  WOEMA representatives met with theauthor's staff and CHSWC representatives to discuss amendments to thebill.  Ultimately, the bill stalledin policy committee (WOEMA stayed neutral, while CMA and CSIMS opposed) butwill surely be resurface in some form next year.  Likewise, we can expect to see bills next year that addressthe issue of medical liens, as CHSWC is considering data that suggests thatalmost a quarter of the medical dollars spent in the system are part of alien.  Dr. Levy and Don Schinskeattend CHSWC meetings. 

Cal/OSHA:  Drs.Papanek, Levy, and Don Schinske met with Cal/OSHA Chief Welsh to exploreopportunities in which WOEMA could participate in the Division'sactivities.  Several ideas werediscussed, including WOEMA participation in updating the state's lead standards- a move we are pursuing currently with Cal/OSHA staff.  In addition, the three WOEMArepresentatives attended an August workgroup of federal OSHA in Sacramento onthe subject of expanding California's Injury and Illness Prevention Program nationwide.

Legislation:  Inaddition to AB 2779 (above), WOEMA lobbied on the following bills:

AB 933 (Fong), a CSIMS-sponsored bill to require UR physicians to belicensed in state.  Governorvetoed.

AB 1600 (Beall) - WOEMA urged Governor Schwarzenegger to sign thisbill, which requires coverage of mental health by all full-service Knox-Keenehealth plans.  AB 1600 is still onthe Governor's desk

AB 2253 (Coto), extends length of time that cancer in firefighters ispresumed to be work-related;

AB 2269 (Adams), extends the presumption to hospital securityofficers who get heart trouble;

AB 1994 (Skinner) extends the presumption to hospital workers who getMRSA, H1N1, or neck or back impairment. 

WOEMAexpressed concerns on all three bills, on narrow grounds that such extensionsare not supported by scientific evidence. Only AB 2253 has reached the Governor's desk.

SB 1050 (Yee) - WOEMA-supported bill to remove two naturopathicdoctors from the Osteopathic Medical Board of California.  Governor signed.

 

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August 5, 2010

WOEMA's Voice Heard at FedOSHA Conference

Federal OSHA is poised to enact new regulations on preventive planning for workplace health and safety that may be among the most significant steps OSHA has ever taken to protect American workers, as it considers a new Standard on Hazard Communication that would be modeled after California's requirement for Injury and Illness Prevention Plans (IIPP's). On Tuesday, August 4, 2010, Dr. Paul Papanek represented WOEMA at a stakeholder meeting held by Federal OSHA in Sacramento, aimed at gathering information about how best to craft such a Standard. WOEMA and ACOEM have championed such a step by Federal OSHA, arguing that a national requirement for Injury and Illness Prevention Programs would raise the bar on worker safety, and level the national playing field, since over 20 states in addition to California already require some version of IIPP's.

Among the nearly 40 stakeholders at the meeting, most of whom spoke strongly about the likely benefits of such a new regulation, WOEMA argued for more involvement by Occupational Medicine physicians in preparing IIPP's, particularly in workplaces where medical surveillance is required. WOEMA also urged Federal OSHA to explore mechanisms to incorporate health and wellness planning into IIPP's, particularly since we know that reducing health risk factors correlates with decreased reported injury rates.

OSHA announced that it will probably require another 18 months before the promulgation of a final rule, and OSHA is expected to publish the proceedings of this and other stakeholder meetings on its website in the fall.

 

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July 15, 2010

The California Division of Workers' Compensation (DWC) issued a new draft revision of its fee schedule for physician services.  WOEMA members were alerted and urged to send comments (by July 20) on the draft Official Medical Fee Schedule (OMFS) to the DWC's online forum: DWCForums@dir.ca.gov.   

 

DWC's new proposal contained the following key features:
 
1)    Implementation on Jan. 1, 2011 of an RBRVS-based schedule with three conversion factors: one for surgery, one for radiology, and one for all other codes.
 
2)    Transition to current CMS (Medicare) ground rules for determining E&M codes.
 
3)    No changes in reimbursement for completing PR-2 forms (the current rate is $11.69).
 
For Primary Treating Physicians who bill under the Evaluation & Management codes, the anticipated change in reimbursement under the proposed schedule would depend on a number of factors, including the specific code, changes in coding practice under the CMS ground rules, and the loss of any current adjustments based on geographic practice area (GPCI).  Early calculations suggest modest increases for each E&M CPT code.
 
WOEMA made the following comments as an organization sending comment to the DWC Forum:
 
1)    The minimum conversion factor for all codes should be set at 45.  The proposed conversion factor of 42 for E&M codes is simply too low, given the historic underpayment for cognitive services.  In its March 2010 updated report on the RBRVS conversion, the Lewin Group calculated a conversion factor of 45 based on adoption of a single conversion factor and dollar neutrality.  Although it may be necessary to adopt more than one conversion factor, the minimum conversion factor for all codes should be set at 45 to adequately align incentives within the system.
 
2)    The conversion factors must be indexed to medical inflation, preferably the Medicare Economic Index (MEI).
 
3)    The new proposal should not adopt the CMS (Medicare) ground rules in total.  Medicare patients and injured workers have different profiles and different treatment needs.  Each specific ground rule should be considered for applicability to Workers Compensation and for the effect of any downcoding on payment and treatment.
 
4)    Payment for completing PR-2 reports should equal that of the PR-4 and other reports.
 
5)    The new schedule should set appropriate fees for the E&M consult codes, series 9924x.
 
6)    The proposed fee schedule continues the practice of the multiple procedure payments or "cascading" of fees associated with Physical Therapy.  This process of cascading is not followed by Medicare. The value of each procedure and the work required to provide those services are not reduced just because multiple services are delivered on the same date.
 
WOEMA's advocacy requires the support and participation of all its members, and we very much appreciate your help. Questions? Contact WOEMA Lobbyist Don Schinske.

May 28, 2010

Cal/OSHA and WOEMA Explore Areas for OEM Physician Service

In a May 27 meeting initiated by WOEMA Chairman Steve Schumann, MD with WOEMA representatives, California Dept. of Industrial Relations Director John Duncan and Cal/OSHA Chief Len Welsh invited experts among the WOEMA membership to "roll up their sleeves" with Cal/OSHA officials to explore where WOEMA can assist the division in its regulatory efforts.

Chief Welsh proposed holding a working meeting in the next three weeks in which several WOEMA representatives could meet with him and his staff in Oakland to explore who has particular expertise and where it can be deployed. Welsh listed a range of areas in which WOEMA members might possibly be of service, including as advisors for development of Permissible Exposure Limit (PEL) standards, the division's effort of gain permanent approval for its State Plan, or as expert witnesses.

WOEMA will recruit members with relevant expertise to participate in this effort. It represents a fantastic opportunity for public service and to build the profiles of both WOEMA and Occupational Medicine.

WOEMA Board Chairman Steve Schumann, M