The topics tackled and resolutions adopted by the California Medical Association House of Delegates in October displayed some of the new aggressiveness that the association has been developing, especially within the past year.

"There's a new generation of leadership at CMA," said CMA CEO Joe Dunn in his Oct. 27 State of the CMA address at the meeting's outset. "Yes, it's new--and yes, you need to get comfortable with us. We're edgy, we're aggressive, and we're risk-takers," he said. "We are not going to succeed by trying to make a lot of friends. We are only going to succeed in the struggle by making a very long list of powerful interests very angry. That's the only way we are going to get this profession back."

At the HOD, the delegates seemed to echo Dunn's remarks in their actions, aiming to truly assert an agenda of promoting physicians' and patients' interests at the same time they hit back at adversaries. Here is a look at some leading resolutions adopted this year, with an emphasis on aggressive measures.

Calling Out Adversaries

Unfair Practices of Health Plans and Insurers--Singles out Blue Cross of California and requires the CMA to take legal, legislative and other action when health plans employ unfair practices. The CMA is to continue filing complaints under the Compliance Dispute Process and enforcing the terms of the RICO settlement agreements. Further, the resolution asks the CMA to sponsor legislation requiring health plans to spend a minimum of 85 percent of premium payments on healthcare services, rather than on administrative costs or profits.

Demeaning Characterizations of Ethnic Physicians--Requests that the ABC television network rectify demeaning characterizations of ethnic physicians, particularly Filipino-American doctors, whose medical credentials the network insulted in an episode of "Desperate Housewives."

Apology and Retraction From [the California Association of Physician Groups]--Demands an apology and retraction from CAPG for remarks made by its representative about balance billing at the Oct. 24 California Department of Managed Health Care hearing in Burbank. The representative likened balance billing by physicians to "throwing a grenade in a crowded theater."

Asserting Doctors' Interests

California Health System Reform--Guides the CMA to continue supporting mandates for universal healthcare coverage without taxing doctors. The resolution also instructs the CMA to develop guiding principles in health reform similar to those adopted by the Los Angeles County Medical Association.

Full Medicare Payment for Service Rendered--Obligates the CMA to pursue changes in Medicare law allowing physicians to bill for their standard fees.

State Health Programs and Physician Payment--Requires the CMA to advocate that publicly financed health plans pay physicians at competitive rates.

Resources and Services for CMA Members--Calls on the CMA to work on using its collective clout to obtain cheaper services and resources for physicians.

Balance Billing for All Physicians--Requires the CMA to push the American Medical Association to pursue national legislation to put Medicare balance billing in place, ending budget neutral restrictions on the current payment structure. This approach will supercede state laws and insurance contracts prohibiting balance billing. It also calls for the CMA to support state legislation prohibiting fiduciary relationships, laws and regulations from interfering with the doctor-patient relationship. Finally, it requires the CMA to develop language that doctors can insert into health plan contracts, in order to maintain balance-billing rights.

Physician Collective Bargaining--Obligates the CMA to fight laws that prevent physician collective bargaining.

Hospital-Based Contracted Physician Evaluation--Calls for the CMA to support legislation by which hospital governing bodies considering the contracts of hospital-based physicians must abide by the advice and consent of the hospital medical staff.

RICO Settlement Funds and Physician Foundations--Requires the CMA to report on the expenditures and activities of each foundation receiving RICO settlement funds.

Protecting Physicians

Physician Prescribing Policy--Asks the CMA to push the AMA for a simple Web site tool allowing physicians to prevent the AMA from releasing their primary source data on prescribing habits.

Access to Care and Lists of Participating Providers--Requires that the CMA work with others to develop a database on patient complaints about access to care, and that the association support requirements that health plans keep accurate lists of participating providers.

Reimbursement for Vaccines and Vaccine Administration--Requires the CMA to support legislation requiring health plans to reimburse physicians for new and existing vaccines at a minimum of 100 percent the RBRVS Medicare allowable.

Tax Relief for Provision of Uncompensated Care--Calls on the CMA to support tax breaks for physicians who provide uncompensated care.

State Procurement of Vaccines--Requires the CMA to support legislation that obligates the state to use pooled insurance money to purchase vaccines, and to distribute these to physician offices in a method resembling the Vaccines for Children program.