CMA - California Medical Association

As a physician, Senator Richard Pan, M.D., has witnessed first-hand how vaccines protect our children and communities from dangerous diseases - but also how years of vaccine hesitancy, fueled by a fraudulent study linking vaccines with autism, have taken a toll on the community immunity needed to keep diseases at bay.

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1. Survey shows physicians feel unprepared for the business side of medicine

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A recent LinkedIn survey found that many physicians feel that their clinical training does not adequately prepare them for the reality of the business side of a career in medicine.

The survey, conducted in early February, asked 511 physicians about their professional goals and the non-clinical skills that they believe are most essential to their careers.

Three-quarters of respondents indicated that non-clinical business skills are more important than they were in the past because of how deeply and rapidly the health care industry is changing. More than two-thirds said their career goals include better work-life balance. Nearly half pointed to skills like business and finance, productivity and practice management as essential to take their career to the next level.

For more details on the LinkedIn survey, and related commentary from physicians, click here.

Did you know that the California Medical Association (CMA) provides physicians with assistance navigating the business side of medicine? Whether it’s identifying and fighting unfair payment practices, improving the efficiency of your practice, or guiding physicians through the contract evaluation and negotiation process, we have tools and resources to help. We also provide webinars, seminars and other live training opportunities to help physicians—and physicians in training—succeed. To find out more about how CMA can help you, click here or contact our Member Resource Center at (800) 786-4262 or memberservices@cmanet.org. 

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2. FAQ: Can I maintain a drug-free policy in my office?

With the ongoing implementation of California's Medical Cannabis Regulation and Safety Act of 2015 and passage of the Adult Use of Marijuana Act (AUMA) in 2016, physician offices may increasingly find themselves unsure of whether they are required to make accommodations for employees' use of marijuana, either for medical or recreational purposes.

California law does not require any accommodation of the use of medical cannabis on the property or premises of any place of employment or during the hours of employment. Further, the California Supreme Court, in Ross v. Ragingwire Telecommunications (2008) 42 Cal.4th 920, concluded that an employer did not violate either the Fair Employment and Housing Act by discharging a recently-hired employee who failed a pre-employment drug test because of his use of medical cannabis outside of the workplace. The Court determined that nothing in the text or history of the California's Compassionate Use Act of 1996 suggested that the voters intended for the initiative that legalized medical cannabis to impact the respective rights and obligations of employers and employees.

Although AUMA legalized recreational use of cannabis for adults, it does not change an employer’s rights and obligations to maintain a drug-free workplace, nor does it require an employer to permit or accommodate the use, consumption, possession, transfer, display, transport, sale or growth of cannabis in the workplace. AUMA also does not prevent employers from having policies that prohibit the use of marijuana by employees and prospective employees.

For more information on AUMA, see CMA’s “Control, Regulate and Tax Adult Use of Marijuana Act: Frequently Asked Questions.” Physicians can also find information on performing drug and alcohol tests on employees in CMA On-Call document #6100, “Employer Obligations Regarding Drug and Alcohol Use in the Workplace.” CMA On-Call document #3209, “Medical Cannabis,” discusses the laws enacted to control and regulate the use of cannabis in California.

CMA On-Call documents are available free to members in CMA’s online health law library at www.cmanet.org/cma-on-call. Nonmembers can purchase documents for $2 per page in the CMA bookstore.

For input regarding a specific circumstance, physician offices should consult an experienced labor and employment attorney.

Contact: CMA legal information line, (800) 786-4262 or legalinfo@cmanet.org. 

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3. California congressmen introduce bills to address physician shortage

Two important bills have been introduced in Congress to address our state’s serious physician shortage and improve access to care in California.

The first bill, the Training the Next Generation of Primary Care Doctors Act of 2017 (HR 3394), would reauthorize for an additional three years the Teaching Health Center Graduate Medical Education (GME) program that was established by the Affordable Care Act (ACA). The Teaching Health Center program is a community-based primary care physician training program that has been extremely successful in expanding the physician workforce in underserved areas. This bill would also expand the number of residency positions available within existing teaching health centers and establish sustainable funding. This bill has bipartisan cosponsorship by California Congressmen Raul Ruiz, M.D. (D-Palm Springs), Jeff Denham (R-Modesto) and David Valadao (R-Fresno).

The second bill, the Comprehensive Additional Residency Expansion Act (HR 3451), introduced by Congressman Jeff Denham (R-Modesto) and sponsored by the California Medical Association (CMA), would build on HR 3394. The Teaching Health Center GME program currently supports 742 residents at 59 teaching health centers. This bill would add an additional 240 residency slots to train new physicians and authorize 10 new teaching health centers. It would also require the new teaching health centers be located in areas with a disproportionate share of Medicaid patients to help alleviate physician shortages and access to care in underserved regions.

These bills are critically important because California is experiencing a severe shortage of primary care physicians, particularly in the rural and Central Valley regions of the state. Our state has one of the lowest primary care physician to patient ratios in the nation. Only 10 percent of physicians practice in rural areas nationwide, although 25 percent of the population resides in these regions.

Training more physicians to meet the growing demands of an aging population with multiple chronic conditions is a CMA priority. We support efforts to encourage more physicians to practice in underserved areas to improve access to care. The underserved Central Valley region of California in particular has experienced difficulty attracting and retaining physicians.

Data shows that most physicians set down roots in the areas where they train and remain there after their training to care for their communities. These two bills will help to create a new generation of rural physicians and ensure that patients in those areas have access to essential preventive and primary care to diagnose and treat health problems early.

These are important bills that represent a practical approach to improving the physician shortage crisis and access to care challenges in California’s underserved areas.

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4. CMS now accepting QPP hardship applications for 2017

The Centers for Medicare and Medicaid Services (CMS) is now accepting hardship exceptions from the Medicare Quality Payment Program (QPP) for the 2017 reporting year. Beginning with this reporting year, physicians who do not participate in QPP will see a negative 4 percent payment adjustment in 2019. Physicians who do participate may qualify for bonus payments.

Physicians and groups that qualify for the QPP’s Merit-Based Incentive Payment System (MIPS) can submit a hardship exception application for one of the following reasons:

• Insufficient internet connectivity
• Extreme and uncontrollable circumstances
• Lack of control over the availability of certified electronic health record technology

If you meet one of the criteria above, you may qualify for a reweighting of the Advancing Care Information performance category score to 0. The 25 percent weighting of the advancing care information category would be reallocated to the quality performance category

There are also some MIPS eligible clinicians who are considered “special status,” who will be automatically reweighted (or exempted in the case of MIPS eligible clinicians participating in a MIPS alternative payment model) and do not need to submit a QPP hardship exception application.

Hardship exception applications can be submitted via the QPP website. You can also contact the QPP Service Center at (866) 288-8292 or QPP@cms.hhs.gov and work with a representative to submit an application.

Once an application is submitted, you will receive a confirmation email that your application was received and is pending, approved or dismissed. Applications will be processed on a rolling basis.

Physicians should also be aware that 2017 is a transition year, with CMS offering “pick your pace” options for participation. Participating at any level in 2017 will ensure that you will not be hit with payment penalties in 2019. The most lenient participation option would allow physicians to simply "test" the program to ensure that their systems are working and that they are prepared for broader implementation in 2018 and beyond. While physicians who choose this option will not receive bonus payments, they will avoid a negative penalty.

Providers with less than $30,000 in Medicare payments or fewer than 100 Medicare patients are exempt from the MIPS reporting requirements. Physicians who exceed this threshold are subject to MIPS and are encouraged to participate in MIPS for the 2017 transition year to avoid the negative payment adjustment. If you are unsure of your MIPS participation status, click here.

California physicians in practices of 15 or fewer can receive free assistance to prepare and participate in Quality Payment Program through CalHIPSO. For more information visit www.hsag.com/CalHIPSO.

The American Medical Association has also published a short instructional video to help physicians avoid being penalized under the QPP. The video offers step-by-step instructions on how to report on one patient for one measure to avoid a negative 4 percent payment penalty in 2019.

For more information about the QPP, implemented with the Medicare Access and CHIP Reauthorization Act (MACRA), visit www.cmanet.org/macra.

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5. August is National Immunization Awareness Month; talk to your patients about the importance of vaccination

August marks National Immunization Awareness Month (NIAM), a national effort to promote vaccinations and protect children and adults from serious, and sometimes deadly, preventable diseases. According to the Centers for Disease Control and Prevention (CDC), immunizations are one of the top 10 public health accomplishments of the 20th century. Among children born between1994-2013, vaccination will prevent an estimated 322 million illnesses, 21 million hospitalizations and 732,000 deaths over the course of their lifetimes.

As part of this important effort, the California Medical Association (CMA) and its county medical societies are encouraging physicians to talk to their patients about the importance of vaccinations – for people of all ages.

"Immunizations represent one of the greatest public health accomplishments of the 20th century," said CMA President Ruth Haskins, M.D. "As an OB-GYN, I see the life-preserving benefits of vaccines every single day in my patients and their babies. The science is crystal clear on this issue – vaccines are safe and effective at preventing potentially deadly diseases."

To help get the word out about the importance of vaccination at every age, the National Public Health Information Coalition, in collaboration with the CDC’s National Center for Immunization and Respiratory Diseases, has developed toolkits to help you communicate with your patients about vaccines. Each week of #NIAM17 focuses on a different stage of the lifespan:

• Babies and young children (July 31-Aug. 6)
• Pregnant women (Aug. 7-13)
• Adults (Aug. 14-20)
• Preteens and teens (Aug. 21-27)

The NIAM toolkit contains key messages, vaccine information, sample articles, social media messages, FAQs, and web links and resources. You can also get eye-catching NIAM logos and banners to highlight your NIAM participation on your social media profiles. Download the toolkit at www.nphic.org/niam.

NIAM also provides a back-to-school toolkit for to help you remind parents to get their children vaccinated before the school year starts. As you know, last year marked the implementation of California's landmark legislation (SB 277) that eliminated personal belief exemptions from school vaccinations. CMA sponsored this critical legislation, which will help protect the most vulnerable Californians – including babies too young to be immunized and people who are immunocompromised – from the risks associated with contracting these diseases. It will also protect the community at large from increased outbreaks of vaccine-preventable disease.

CMA has compiled a list of valuable resources on both vaccinations in general and on California's mandatory school vaccination requirements, visit www.cmanet.org/vaccinations. 

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6. Free CME: Patients' right of access under HIPAA

The U.S. Department of Health and Human Services Office for Civil Rights (OCR) has launched a new training module for providers on patients' right of access under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

With limited exceptions, the HIPAA Privacy Rule provides individuals with the right to see and receive copies upon request of the information in their medical and other health records maintained by their health care providers and health plans.

The new module provides an in-depth review of the components of the HIPAA right of access and ways in which it enables individuals to be more involved in their own care. It also provides helpful suggestions about how health care providers can integrate aspects of the HIPAA right of access into their medical practices.

The module is available via Medscape or at OCR's Training and Resources webpage. Physicians can receive 0.5 units of continuing medical education (CME) credit.

For more information on the permitted uses and disclosures of protected health information under HIPAA as well as California law, see California Medical Association (CMA) On-Call document #4205, “Patient Access to Medical Records.” This and other documents in CMA's health law library are free to members at www.cmanet.org/cma-on-call. Nonmembers can purchase documents for $2 per page.

For more CMA HIPAA resources, visit www.cmanet.org/hipaa. 

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7. Learn how to challenge the interim payment for out-of-network services at in-network facilities

On July 1, 2017, a new law (AB 72) took effect that changes the billing practices of non-participating physicians providing covered, non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. The law was designed to reduce unexpected medical bills when patients go to an in-network facility but receive care from an out-of-network doctor.

The new law requires fully insured commercial plans and insurers to make “interim payments” to non-contracted physicians for non-emergent services performed at in-network health facilities, and places limitations on the ability of physicians in such circumstances to collect their full billed charges. However, it also includes mechanisms for physicians to challenge the interim payment.

To dispute the interim payment, physicians must first appeal to the plan/insurer. If the physician is unable to resolve the issue through the payor’s internal appeal process, the new law requires the Department of Managed Health Care (DMHC) and California Department of Insurance to establish an Independent Dispute Resolution Process (IDRP) by September 1, 2017. To view the California Medical Association’s (CMA) comments to the DMHC on the IDRP, click here.

CMA has published a number of resources to help physicians navigate this new system, including a sample letter physicians can use to appeal to the plan/insurer and an FAQ. These resources are available free to members only in our AB 72 Resource Center at www.cmanet.org/ab-72.

CMA is also hosting a free members-only webinar on the different options for challenging the interim payment on September 27, 2017. The webinar will include an overview of the dispute options, details on how the IDRP will work and CMA resources available to assist physician members. Click here to register for the webinar.

If your practice has experienced a change in payor behavior regarding contract negotiations, claims payment or network adequacy concerns, or is experiencing other challenges, CMA wants to hear from you.

For more information, visit www.cmanet.org/ab-72 or call our Reimbursement Helpline at (888) 401-5911. 

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8. Updated payor profiles for 2017 now available

The California Medical Association’s (CMA) Center for Economic Services is publishing updated profiles on each of the major payors in California including Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, Health Net, UnitedHealthcare, Medicare/Noridian and Medi-Cal. Each profile includes key information on health plan market penetration; a description of the plan’s dispute resolution process; and the name and contact numbers for medical directors, provider relations, and other key contacts.

Don’t waste your time searching the internet for this information – members can download CMA’s Payor Profiles free of charge in the CMA Resource Library. 

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9. Reminder: Leadership award nominations due August 18

The California Medical Association (CMA) Foundation and its Network of Ethnic Physician Organizations (NEPO) are seeking nominations for the Foundation's 2017 Leadership Awards, which celebrate the efforts of extraordinary individuals and organizations who make a difference in the health of Californians. All nominations are due by August 18, 2017.

The four awards include:

The Ethnic Physician Leadership Award
This award recognizes an individual physician for his or her contributions toward the health of various ethnic communities, who has shown great success in eliminating health disparities, addressing access to care, and improving cultural competency and patient advocacy. The purpose of the award is to honor an outstanding physician; inspire other physicians; and to promote leadership, caring and compassion in medicine.

Outstanding Ethnic Physician Organization Award
The Frank E. Staggers, Sr., M.D., Outstanding Ethnic Physician Organization Award honors an ethnic physician organization that has taken significant action in improving the health of its community. Applicants will be evaluated based on their contribution to improving the health of their community, success at engaging physicians to be community advocates and efforts to reduce health disparities.

Access to Health Care and Disparities Award
The Adarsh S. Mahal, M.D., Access to Health Care and Disparities Award honors an individual or organization that has demonstrated extraordinary interest in and efforts to improve access to health care or reduce health care disparities in California.

Leadership Achievement Award
The Robert D. Sparks, M.D., Leadership Achievement Award recognizes an individual or organization that has demonstrated extraordinary interest in and efforts to improve community health, consistent with the mission of the CMA Foundation—to champion improved individual and community health through a partnership of leaders in medicine, related health professions and the community.

The Ethnic Physician Leadership Award and the Ethnic Physician Leadership Award will be presented at the annual NEPO Building Healthy Communities Summit, held October 19-20, 2017 in Anaheim. The Leadership Achievement Award and the Access to Health Care and Disparities Award will be presented at the CMA Foundation’s President’s Reception and Awards Gala on October 21, 2017 in Anaheim

Nomination information and packets for each award are available at the CMA Foundation website.

Contact: Anita Charles, (916) 779-6623 or acharles@thecmafoundation.org. 

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10. ‘Drive for Our Lives’ bus tour stops in Sacramento to rally for health care

On Monday, July 31, the "Drive For Our Lives" bus stopped at the Capitol in Sacramento to hold politicians accountable for threatening the lives and financial security of millions of families.

The rally and press conference was part of an 18-state, cross-country bus tour, with stops in targeted districts of Congressional representatives who voted to repeal the Affordable Care Act (ACA).

Speaking at the rally was Sacramento emergency physician Adam Dougherty, M.D. He joined other physicians, as well as members of Planned Parenthood and the Homecare Providers Union, to advocate for affordable, quality care for all Californians.

“When the President now states, ‘let Obamacare fail,’ he is hoping for the demise of successful programs like Covered California and the vital Medi-Cal program, which have improved health care access, created jobs and saved lives,” said Dr. Dougherty. “So when our state’s Republican Congresspeople, some of whom represent communities with majority Medi-Cal patients, vote to cut funding, it is our responsibility to tell them just how damaging this is.”

Dr. Dougherty drew on his experiences as an emergency physician to express his concerns that cutting Medicaid would cause patients to delay care or lose access to physicians altogether. Although he acknowledged that Medi-Cal and health insurance exchanges should be improved, he emphasized that Medi-Cal has "literally been a lifesaver for our most vulnerable populations," and that cutting it "would be extremely threatening, both financially and for the livelihood of our patients."

He urged lawmakers to work together and communicate with health professionals to increase the number of Americans with access to affordable health insurance instead of pursuing policies that have the opposite effect.

Health care activist Charis Hill also expressed the importance of Medi-Cal to patients like herself.

Both she and her father were diagnosed with ankylosing spondylitis (AS), a form of arthritis that affects the spine, causing inflammation and chronic pain. She described her extensive medical needs, and the pain of watching her father pass away due to untreated AS.

Without Medi-Cal coverage, Hill said she would be at risk for a similar fate.

"What if I lose access to [life-saving] medications because of cuts to Medicaid?" she asked. "My future will look just as grim as my dad's... I fear for my life."

Family physician Trudy Singzon, M.D., shared firsthand experiences working with uninsured, underserved patients to defend the vital impact of Medi-Cal and the ACA.

"As a provider for many years in the safety net, I can attest to the fact that Medi-Cal is very important...I think lawmakers need to understand that this is not a game. It's not politics," she said during an interview after the event. "It's people, it's real people's lives, real suffering and death."

Dr. Singzon explained how a former patient suffered from a chronic condition that could be easily managed. However, this patient was denied health insurance and delayed care as his condition gradually worsened. He arrived at urgent care too late, and died.

Moved by this preventable tragedy, Dr. Singzon vowed to keep resisting damaging health care policies.

"If the ACA is destroyed, either by repeal or sabotage, then people will die," she said. "That is not an exaggeration. That is a fact."

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11. Register today for CMA webinar on mental health in young adults

The California Medical Association (CMA) is hosting a one-hour webinar about depression treatment and suicide prevention in young adults on Wednesday, August 16, from 12:15 to 1:15 pm.

The presenter, Michelle Famula, M.D., is an Assistant Clinical Professor at the UC Davis School of Medicine Department of Public Health. She has spent the past 30 years providing young adult primary care and developing her interests in sexual, transgender and mental health care.

This webinar, "The Pursuit of Happiness: A Practical Approach to Depression Treatment and Suicide Prevention in Young Adults," will present information about the demand for integrated care, barriers to mental health access, communicating with patients and families, and resources for patients in need. It will also emphasize prevention through stigma reduction and early detection of symptoms and risk factors.

This webinar is free for CMA members; nonmembers may attend for $99. Click here for more information or to register.

Contact: Juli Reavis, (916) 551-2046 or jreavis@cmanet.org.

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12. Featured member benefit

Staples Advantage: The Staples Advantage CMA member program provides a one-source provider for all your supply needs including office supplies, facility, technology, furniture, custom printing and more, with discounts up to 80 percent. Click here for more information. Not taking advantage of Staples Advantage yet? Click here to register for your online account.

Contact: CMA member help center, (800) 786-4262 or memberservice@cmanet.org.

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