You may have a problem finding one, since it appears that many practitioners of the healing arts can be found in Sacramento these days, rubbing elbows with the powerful in an effort to get back some of the piece of the pie they lost in the most recent rounds of workers' compensation reform. Figuring out the dynamics of these bills is an interesting exercise in complexity even by Capital standards. If some of this doesn't make sense, well, join the crowd.

For the sake of simplicity, consider the status of four bills, two in the Assembly and two in the Senate. The two Assembly bills, Assembly Bill 681 (Vargas) and Assembly Bill 757 (Chan) are bills that in essence would stem the tide of cuts to physicians' fees. The first bill delays implementation of the changes to the official medical fee schedule created by SB 228 a few years ago until 2010. It is supported by a coalition of various provider specialties who are disadvantaged by the move to a Medicare-based fee schedule. The powerful California Medical Association (CMA) has taken a support if amended position on this bill. AB 681 is opposed by organized labor, who has taken upon itself the mantle of telling everyone involved in workers' compensation how much they should be paid for their services. This bill is alive and well in the Assembly Appropriations Committee.

AB 757 is more complex. This legislation delves once again into the murky world of "phantom PPOs". While this conjures up images of HMO administrators lurking in alleys waiting to snare unsuspecting physicians, it really has to do with HMO administrators in their offices putting together networks and snaring unsuspecting physicians. This bill is sponsored by the CMA and a host of other physician organizations. It is opposed by the health care plans. One of the aspects of this bill that affects the workers' compensation community is that it would essentially require any physician who is part of a Medical Provider Network (MPN) to expressly agree to be part of the MPN. This, in turn, makes the formation of MPNs far more difficult. Organized labor has not taken a position on this bill. Then again, neither has anyone from the employer community. Odd, don't you think?

On the Senate side, a storm is brewing over Senate Bill 292 (Speier). Senator Speier's bill addresses the issue of "repackaged" drugs which are dispensed by physicians and fall outside the pharmacy fee schedule adopted in SB 228. Most, but not all, of the medical community has taken a pass on this legislation. Since it has to do with what providers can charge for prescription medications, it can come as no surprise that organized labor is supporting the bill. This bill is likely to move out of the Senate shortly, where it will then be sent to the Assembly Insurance Committee. This would seem to be a bill that can be fast tracked to the Governor's Office. Appearances, however, can sometimes be deceiving. Not all bills dealing with medical cost containment in the workers' compensation system sail through the Assembly, or at least sail through in their most advantageous form.

Then there is Senate Bill 46 (Alarcon), the legislation that would set workers' compensation insurance rates by a committee made up of the Governor, Attorney General, and Insurance Commissioner. Now what, you may legitimately ask, is this bill doing in a discussion about medical providers? Well, a review of the support and opposition to this legislation reveals one surprise. SB 46 is supported by none other than the California Medical Association! Go figure. It's sort of a you did us now we'll do you bill.

This makes some sense, of course, if you view these bills as upholding the time honored tradition of blaming someone else for the abuses of the workers' compensation system. The provider community doesn't like the new fee schedule and doesn't like managed care arrangements. Consequently, they support insurance rate regulation because, well, we all know that if insurance companies weren't making obscene profits then providers could charge what they feel they are entitled to and the business community would be happy campers.

The fact of the matter is that it makes absolutely no sense for the CMA to support SB 46, although they certainly would disagree with that. It is entirely inconsistent with their message that doctors should be more empowered over how they practice and how they get reimbursed for their practice. It is entirely inconsistent with their claims that state enforced reimbursement rates are driving them out of the business, whether in their practice or in other profit centers they identify through loopholes in the law.

But then, Sacramento isn't exactly known for its consistency, is it? Or, in the vernacular of those in the Capital, it's not a position, it's a strategy.