February 27, 2001
To: California members and supporters of AAPS
Re: CMA letter to the Attorney General
One of our California members alerted us to the California Medical Association's comments about “whether it is lawful under California law for an individual to establish a list of preferred physician providers for underprivileged persons who would subscribe to the list for a small fee in the hope of bringing those in need of quality health care together with physicians willing to provide that care at more affordable prices, where the individual neither actively refers nor recommends any given physician on the list but rather acts as a merely passive facilitator.”
The CMA objects to such a list, stating that it might discourage people from signing up for Medi-Cal or Healthy Families, thereby reducing the risk pool and exposing the uninsured individuals to the risk of catastrophic costs in the event of illness. It views the listing as a form of “fee-splitting” in that physicians are presumed to be accepting a lower fee to get referrals. (For-profit referrals are a misdemeanor punishable by a year in the county jail and/or a fine of $5,000.) Further, the listing agency does not supervise the practice of listed physicians to assure quality. The CMA calls this listing a “dangerous scheme” that “violates laws designed to protect against overutilization.” Additionally, it would probably be available on the Internet, “allowing any individual to access it regardless of income.”
An AAPS member points out: “the alert is indicative of organized medicine's wrong- headedness toward empowering consumers to take responsibility for their own care. No one disputes the need for catastrophic coverage, but why do we raise barriers to consumers shopping more cost- effectively for day-to-day care?
“Is it bad that people would choose to pay for their own day-to-day costs instead of going on the public dole?”
To bring down costs, it is necessary to reduce wasteful insurance overhead for processing small claims. Why shouldn't patients reap the benefit of the savings? Why shouldn't they be able to find out whether their physician offers an affordable price? And how can a simple directory constitute fee-splitting when managed care is perfectly ok?
If you wish to read the CMA's report, go to www.cmanet.org. If you wish to make your views known, write to Anthony Da Vigo, Deputy Attorney General, PO Box 944255, Sacramento, CA 94244-2550. If you would like to post your views for other AAPS members to read and discuss, go to aaps.forums.commentary.net. And maybe the CMA should hear from you too!
Jane M. Orient, M.D., Executive Director