Tackling the most pressing issues for California physicians, the California Medical Association House of Delegates convened in late October in Sacramento. The policy-making body of about 750 physicians debated a range of matters from legislation and public health to practice management and managed care contracting--all with the goal of guiding the CMA's advocacy efforts.

Several participants spoke about the need for unity among doctors from various practice modes and counties, but there were many contentious topics, including the recently quashed Proposition 86 tobacco tax, a physician's right to bill for noncontracted services rendered and the ongoing battle over Medicare's reimbursement formulas and impending cuts.

In the Proposition 86 issue, the CMA had for months held a position of support for the ballot measure, but large factions of the organization were not in favor of it. In the end, the house voted to postpone the discussion instead of change the CMA position, which meant the issue would die due to the timing of the November election. However, the tussle did lead to the approval of a resolution designed to better ensure that the CMA's positions on ballot measures reflect its members' opinions.

Regarding the right to bill for noncontracted services rendered, also known as balance billing, the delegates passed a resolution directing the CMA to vigorously oppose the Department of Managed Health Care's proposed regulations and that the CMA take all action necessary, including legal or legislative action, to oppose any and all efforts to prevent physicians from billing for services rendered.

On the Medicare front, delegates crafted two resolutions instructing the CMA to "set forth a distinctive plan" to communicate with Congress about the need to fix the Sustainable Growth Rate formula and to continue seeking revisions to the flawed Geographic Practice Cost Index. Honored guest William Plested, MD, president of the American Medical Association, spoke about Medicare as well, decrying the cuts planned for Jan. 1, 2007. "Congress wants to see how little you will take for seeing Medicare patients," he said.

Here are a few other adopted resolutions:

Advertisement of Controlled Drugs: The delegates voted that the CMA oppose direct-to-consumer advertising of controlled drugs and support legislation to ban such advertising in California.

Security Prescriptions: The delegates voted that the CMA continue to pursue repeal of the requirement to use security prescriptions for Schedule II-V drugs and that the CMA work to make the Controlled Substance Utilization Review and Evaluation System database available to physicians in real time.

Personal Medication Supply in Times of Disaster: As a means of disaster preparedness, the delegates asked the CMA to urge appropriate regulators and pharmacy benefits managers to allow and pay for patients to stockpile up to a one-month supply of medications for chronic medical conditions.

Verbal Orders for Prescription Drugs: The delegates adopted a resolution directing the CMA to continue advocating for the elimination of California's Title 22 requirement that verbal orders for prescription drugs be authenticated with the prescribing physician's signature within 48 hours.

Medical Necessity: The delegates voted that medical-necessity denials or modifications to a physician's request for authorization should only be made by California-licensed physicians who are competent to evaluate the specific clinical issues involved because they have similar certification or training as the treating physician.

Physician Aid in Dying: The delegates reaffirmed the CMA's opposition to the legalization of physician-assisted suicide and recognized the need for appropriate end-of-life care, including aggressive treatment of pain and compassionate care for physical and spiritual suffering.

New Leadership Appointed
During the California Medical Association House of Delegates, Anmol Singh Mahal, MD, was inaugurated as the 139th president of the CMA, Richard Frankenstein, MD, was named president-elect, and Joe Dunn, a former state senator, was appointed CEO and executive vice president.

In his address, Dr. Mahal said he will focus on building membership and defeating regulations proposed by the Department of Managed Health Care that would limit a physician's right to bill for services rendered. He also intends to work on improving access to healthcare for all Californians. Dr. Mahal, a Fremont gastroenterologist, is the first physician of Indian origin to head the CMA.

Affiliated with the Orange County Medical Association, Dr. Frankenstein is a specialist in pulmonary medicine from Garden Grove. As president-elect, he will participate in the seven-doctor executive committee of the CMA board of trustees.

Members of the House of Delegates also selected new leadership for the policy-making body. A family physician in San Diego County, James Hay, MD, was promoted to speaker from vice speaker, and Luther Cobb, MD, was elected to vice speaker. Dr. Cobb is a thoracic and vascular surgeon from Arcata, in Humboldt County.