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Top Story: Assembly passes bill to provide parents with immunization information
The California State Assembly last week passed a CMA-sponsored bill that would ensure parents make informed decisions about getting their children immunized before they enter school. The bill (AB 2109) now makes its way to the Senate.
Also in this issue:
- Six weeks left to avoid the 2013 e-prescribing penalty
- Blue Shield of California fee schedule changes take effect June 1
- Medi-Cal primary care rates will increase to Medicare levels in 2013-2014
- CMA tells CMS proposed stage 2 "meaningful use" rules are too aggressive
- "Unholy alliance" on display at CMA Leadership Academy
- California projects among HHS Innovation Award recipients
- CMA mentor program promises bright future
- Reminder to physicians who applied for UnitedHealth Group settlement
- Save the date for the President's Reception and Awards Gala!
- CMA Foundation seeks medical student proposals for patient
safety grant -
Upcoming webinars:
- 5/16: Telephone Etiquette for Medical Personnel
- 5/17: California Workers' Comp eBill Part 1: Are You Ready?
- 5/23: Strategic Planning for Solo, Small and Medium Group Practices
- 5/24: California Workers' Comp eBill Part 2: Implementation
- 5/30: California's Changing Insurance Marketplace
- 5/31: California Workers' Comp eBill Part 3: Understanding Remittance Advice Rules
- 5/16: Telephone Etiquette for Medical Personnel
Featured member benefit:
Staples: Members get up to 80 percent off office supplies and equipment from Staples.
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1. Assembly passes bill to provide parents with immunization information
The California State Assembly last week passed a California Medical Association (CMA) sponsored bill that would ensure parents make informed decisions about getting their children immunized before they enter school. The bill (AB 2109) now makes its way to the Senate.
State law requires school-aged children to be immunized against certain diseases that pose an immediate threat to public health. Under the bill, sponsored by Sacramento pediatrician and Assemblymember Richard Pan, M.D., a parent seeking an exemption would need to first meet with a physician or other licensed health care professional, who would then sign a form attesting that they had discussed the risks and benefits of vaccinations with the parent.
CMA is also sponsoring two other bills regulating vaccination.
SB 1318 requires health care workers to wear masks wherever they deliver care if they are not vaccinated for the flu. This bill is currently on the Senate floor.
AB 2064 requires health plans and insurers to fully reimburse physicians for the costs to acquire and administer recommended vaccines. The bill passed out of the Assembly Health Committee and is currently in the Assembly Appropriations Committee.
Contact: Ryan Spencer, (916) 551-2878 or rspencer@cmanet.org.
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2. Six weeks left to avoid the 2013 e-prescribing penalty
The deadline to apply for an e-prescribing exemption for 2013 is June 30, 2012. Individual physicians can apply for an exemption from the 2012 e-prescribing penalty via an online web portal. Exemption requests from individual physicians must be submitted online. They will not be accepted via mail, email or fax.
Medicare’s e-prescribing program provides payment incentives for physicians who e-prescribe and payment penalties for physicians who do not. In 2012, Medicare imposed a 1 percent payment reduction penalty on all Medicare allowed charges for eligible professionals who did not electronically transmit their prescriptions in the first six months of 2011. The penalty increases to 1.5 percent in 2013 and 2 percent
in 2014.
The hardship exemption categories are as follows:
- The physician is unable to electronically prescribe due to local, state or federal law or regulation;
- The physician has or will prescribe fewer than 100 prescriptions during a 6-month reporting period (January 1 through June 30, 2012)
- The physician practices in a rural area without sufficient high-speed Internet access
- The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing
The 2013 payment reduction penalty will be determined by prescribing between January 1 and June 30, 2012. To avoid the penalty in 2013, eligible professionals must report e-prescribing activity using measure code G8553 for at least 10 eligible outpatient visits via claims submission. This is true even for physicians who are already reporting through an electronic health record system.
CMA strongly recommends that physicians submit more than 10 claims during the reporting period to ensure the minimum threshold is met.
For more information, see the CMA e-prescribing guide, Medicare Electronic Prescribing Overview: Payment Incentives and Payment Reductions.
Contact: Michele Kelly, (213) 226-0338 or mkelly@cmanet.org.
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3. Blue Shield of California fee schedule changes take effect June 1
The California Medical Association (CMA) has just learned that Blue Shield notified physicians in March of changes to its physician fee schedule that will take effect June 1, 2012. In the notice, Blue Shield informed physicians that it would be increasing payment for some Evaluation and Management (E/M) services.
Blue Shield also reports that it will continue reimbursing for inpatient and inpatient consultations and will not follow Medicare's 2010 policy change.
The new rates are available at the Blue Shield website (under Helpful Resources click "Professional Fee Schedule," then enter "06/01/2012" in the date of service field to view fees effective 6/1/12). Physicians can also request a copy of the new fees by completing the allowance review form enclosed with the notice, or by calling the Blue Shield Provider Services Department at (800) 258-3091.
Physicians are encouraged to carefully review all proposed amendments to health plan or medical group/IPA contracts. Physicians who do not agree with the proposed change have the option to terminate the contract. Because language can differ, physicians are encouraged to review their contracts for specific guidance on termination.
To help physicians understand their rights when a health plan has sent notice of a material change to a contract, CMA has published Contract Amendments: An Action Guide for Physicians. The guide includes a discussion of options available to physicians when presented with a material change to a contract. The guide also includes a financial impact worksheet that can be used to calculate the net impact of the fee schedule changes to a practice.
Click here to view a copy of the notice that was recently sent to physicians.
Contact: Reimbursement Helpline, (888) 401-5911 or economicservices@cmanet.org.
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4. Medi-Cal primary care rates will increase to Medicare levels in 2013-2014
Medi-Cal primary care physicians will receive a two-year, $11 billion pay increase, under a proposal released last week by U.S. Department of Health and Human Services. The proposal, which implements a provision of the Affordable Care Act (ACA), would on average result in a 50 to 60 percent increase in Medi-Cal rates for primary care physicians, including family medicine, pediatrics and internists, plus related subspecialties. The ACA calls for Medicaid payments to primary care physicians to be raised to Medicare levels for 2013 and 2014.
The increase, effective in 2013 and 2014, bring Medicaid payments to primary care physicians in line with those for Medicare. Although Medicaid is jointly funded by states and the federal government, the increase would be paid for entirely by the feds.
“The payment increase proposed today will be an important tool for states to ensure their primary care networks are prepared for increased enrollment as the health care law is implemented,” said Marilyn Tavenner, Acting Administrator for the Centers for Medicare & Medicaid Services (CMS), in a statement issued last Wednesday. “Today’s action will help encourage primary care physicians to continue and expand their efforts to provide checkups, preventive screenings, vaccines and other care to Medicaid beneficiaries.”
The California Medical Association (CMA) has been working closely with CMS to ensure that the definition of primary care used is as broad as possible. CMA believes this two-year pay increase is a step in the right direction; however, it is critical that we find a long-term solution that will ensure that the influx of new Medi-Cal patients will be able to find a doctor.
"This two-year pay bump will certainly prevent many primary care physicians from leaving the program," said Elizabeth McNeil, CMA Vice President of Federal Government Relations. "But it may not be enough to attract new physicians." Some primary care physicians will not want to enroll in the program and establish patient relationships, only to have to pull out in two years and leave their patients, she says.
CMA applauds Congress for recognizing that Medicaid reimbursement rates need to be improved to ensure access to care in California’s Medi-Cal program. Currently, California's rates rank 47th in the nation and are on average 50 percent below Medicare rates. Because of these low rates, two-thirds of California’s physicians cannot afford to participate in the program and more than 50 percent of Medi-Cal patients report they can’t find a doctor.
Contact: Elizabeth McNeil, (916) 882-3376 or emcneil@cmanet.org.
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5. CMA tells CMS proposed stage 2 "meaningful use" rules are too aggressive
The California Medical Association (CMA) last week submitted comments on the proposed criteria physicians would need to meet to qualify for financial incentives in stage 2 of the "meaningful use" program. CMA expressed concern that the proposed objectives and measures for stage 2 are too aggressive given the current capacity in the marketplace.
Meaningful use is the set of criteria on which physicians must report in order to receive federal incentive payments for electronic health record (EHR) adoption. Under the Medicare EHR Incentive Program, physicians can receive incentive payments as high as $44,000; under the Medicaid program, physicians can receive up to $63,750. Meaningful use is also the necessary foundation for all impending payment changes involving patient-centered medical homes, accountable care organizations, bundled payments and value-based purchasing.
Currently, only about one-third of physicians have made the transition to EHR. Among small practice physicians, the number is substantially lower – very few small practice physicians have successfully achieved stage 1 of meaningful use.
"There are myriad reasons that physicians have not made the transition to EHR – cost and difficulty of implementation, lost productivity, the lack of EHR solutions tailored to small practices, the high cost of interfaces, etc.," wrote CMA in the comments. "Because of all of these challenges, even many physicians who have attempted to make the transition are still some time away from achieving meaningful use."
While CMA appreciates that the Centers for Medicare & Medicaid Services (CMS) has delayed implementation of stage 2 until 2014, CMA remains concerned that it will be very difficult for small practice physicians to achieve meaningful use by that date.
CMA shares the administration's goal of wide-spread EHR adoption, and has helped many thousands of physicians to achieve stage 1 of meaningful use through direct physician education and as a founding member of the California Health Information Partnership and Services Organization.
"By setting the bar so high now, CMS risks physicians becoming discouraged and not entering the program at all or completing stage 1 and choosing not to continue," the comments said.
To make the stage 2 program more reasonable and achievable, CMA made the following recommendations:
- Eliminate measures or allow an exemption for measures that rely on infrastructure and circumstances outside a physician's control.
- Invest substantial resources into public health infrastructure to support implementation of health information technology at the local level.
- Support group reporting and group attestation of clinical quality measures, while allowing individual physicians to accept incentive payment or reassign to a group as they see fit.
- Work with specialty societies to refine the quality measures to ensure that they reflect current clinical practice.
For more information, including a copy of CMA's comments, click here.
Contact: David Ford, (916) 551-2554 or dford@cmanet.org.
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6. "Unholy alliance" on display at CMA Leadership Academy
The passage of the Patient Protection and Affordable Care Act (ACA) has already brought significant changes to health care delivery systems in California and across the nation.
In at least one sense, it’s also created some strange bedfellows.
“You may call it an unholy alliance,” said Dustin Corcoran, CEO of the California Medical Association (CMA), who was joined on stage at the California Health Care Leadership Academy by Duane Dauner, President and CEO of the California Hospitals Association, and Pat Johnston, President and CEO of the California Association of Health Plans, “but the risks to health plans, to hospitals and to providers are so significant that we have no choice.”
As leaders of the most influential health care stakeholder organizations in the state, these three individuals came together to discuss potential ramifications of the ACA. Each of the speakers seemed keenly aware that, despite having found themselves on opposing sides of many issues, the environment created by federal reform would force them to reevaluate their existing relationships.
“We realize that we are mutually dependent, and we must work together as such,” Johnston said.
While the three-way discussion touched on several issues, specifically those regarding payment and delivery of care in the presence of the coming Health Benefits Exchange, all sides agreed that the changes set in motion by the ACA’s passage were now inevitable.
“It’s not going to go back to the way it was,” Corcoran warned. “Those market force changes are here, and they’re going to stay.”
Even the possibility of the ACA’s individual mandate clause being thrown out by the Supreme Court would bring little change, the presenters noted, as it is likely that California would be quick to pass legislation to supplant the federal provision.
“The Supreme Court decision, in reality, will have very little to do with what California does,” Dauner said.
While noting that a “physician-led” model of health care delivery would certainly be best for California, Corcoran agreed with his fellow presenters that these three sides – physicians, hospitals and health plans – must continue to work together, sharing victories – as well as potential defeats – as implementation moves forward.
“We must create win-win-win in order for us to survive,” Dauner said, “which also means we could be in a situation where it’s lose-lose-lose.”
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7. California projects among HHS Innovation Award recipients
Three California projects were among those selected to receive a combined $122.6 million in grant awards in the first round of the U.S. Department of Health and Human Services’ (HHS) Health Care Innovation Awards.
The awards program, which was created as part of the Patient Protection and Affordable Care Act and administered by the Centers for Medicare & Medicaid Services (CMS), is expected to give roughly $1 billion in grant funding to projects seeking to deliver care at a lowered cost to those enrolled in Medicare, Medicaid and Children's Health Insurance Programs.
In California, grants were awarded to Lifelong Medical Care, based in the San Francisco Bay Area; the Regents of the University of California, Los Angeles; and South County Community Health Center of San Mateo County.
The National Health Care for the Homeless Council also received a grant for a project whose scope will include California.
These projects, along with 22 others who were awarded grants, are expected to improve the quality of care received by roughly 750,000 patients and reduce health care spending by $254 million over the next three years, according to HHS officials.
More information on the projects receiving the Health Care Innovation Awards can be found at the CMS Innovation Center website, www.innovation.cms.gov.
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8. CMA mentor program promises bright future
Inside the offices of the Orange County Medical Association, a collection of promising young medical students took their first steps on a unique and formative journey.
Here, the 2012 cohort of the eXchange Learning (XL) mentorship program – a project of the California Medical Association's (CMA) Ethnic Medical Organization Section (EMOS) – recently participated in the program's official kick-off mixer, exchanging handshakes and conversation with not only their fellow mentees, but also prominent members of the state government and the profession they hope to one day represent.
From now until the time these students finish medical school, they will be paired with a physician mentor who will help guide them through the long, and sometimes arduous, educational process that comes with a career in medicine.
For Mai-Phuong Nguyen, M.D., the founder of the XL program who also serves as a mentor, the connection between mentor and mentee runs much deeper than a purely professional relationship.
"Health care binds all of us, because health care comes from the heart level," Dr. Nguyen said.
Back in 2009, recognizing a lack of outreach to ethnic medical students on the part of organized medicine, Dr. Nguyen worked with EMOS leadership to launch the XL program.
Najim Mohammady, a fourth-year student at the UCSF-UC Berkeley joint medical program, was present as a mentee in the program's early days, and recalls the frenetic zeal from which the program was born.
"That energy," he said. "I really fed off of that energy."
For Mohammady, who was born in Afghanistan, the XL program offered a view of the medical profession that is seldom seen by the state's medical students.
"In medical school, there's not a lot of diversity, especially among the faculty," he said. "It's important to see diverse physicians. I think it really helps."
Looking at the crowded room of mentees and event guests, Mohammady commented that one of the best pieces of advice he could give the newest crop of mentees appeared to have already been taken.
"I think the fact that they're here right now shows that they're doing the right thing," he said.
Aside from the value of demonstrating the success of ethnic physicians in the practice of medicine, those involved with the XL program note the value of having a real-world example of why students chose to pursue a career in medicine in the first place so close at hand.
"I can remember being real discouraged in my first and second year in medical school, because I wasn't connecting with patients," said Doug Wilson, M.D., president of the Napa County Medical Society and mentor for both the 2009 and 2012 XL cohorts.
Dr. Wilson noted that a close relationship with a practicing physician would have been immensely helpful when he was in school, and hopes the same is true for those he is paired with in the XL program.
Meanwhile, many of the program's newest additions look to be eagerly awaiting such a resource.
"I really don't know what I want to do yet," said Ruth Hsu, a first-year student at the University of California, Irvine, School of Medicine.
For many first-year students, the task of selecting a career path and potential specialty immediately takes a backseat to rigorous academic coursework, she said.
"It's easy to get lost, as a first-year, in the books and classes. You lose sight of what's important," Hsu said.
Christine Thang, Hsu's fellow 2012 mentee and a first-year medical student at UCLA, said that she had similar motivations when first applying for the XL program and was excited to begin her relationship with one of the program's talented physician mentors.
"A lot of times you feel lost and you're looking for anyone that's going to reach out and help you," she said.
Despite being further along in her education than most of her fellow mentees, Angela Echeverri, a fourth-year student at UCSF's medical program and member of the 2012 cohort, echoed the importance of this guidance.
"There's always room for mentorship," she said, noting that after taking off eight years between her undergraduate and medical education, the role of mentors has been an invaluable one.
"A lot of people have helped me get here; it would be hard road if you didn't have people guiding you," she said.
Other mentees added that the program's unique focus on the role of ethnic physicians in California's health care system served as a major draw when they first heard about the XL program.
"Their focus wasn't that ethnic physicians need special help, but that their unique backgrounds could make them better physicians in the communities they serve," said James Xie, a second-year student at Stanford Medical School.
Xie, who along with his fellow 2012 mentee Rachel Elise Aquino-Rizal work with Stanford's Flu Crew to help increase accessibility to the influenza vaccine across California, noted that part of his motivation for becoming involved with the XL program came from wanting to help tackle health care disparities in certain ethnic communities.
In the Asian American community, he points out, an immensely disparate portion of the population are not immunized from Hepatitis B, despite the vaccine's availability in California. By working with his XL mentor, Xie hopes to better understand how to address such problems.
"They [XL] are saying ‘here's a way that we're going to help future physicians engage their communities,'" Xie said.
For all those involved in the XL program, mentors and mentees alike, their participation is also a testament to the value of organized medicine and EMOS, in particular, which hopes to affect policy specifically tailored to the needs of ethnic physicians.
Adam Dougherty, a second year medical student at UC Davis and the program's lone mentee of Caucasian descent, was quick to point out this aspect when discussing his involvement in the program.
"I thought it would be a great opportunity to branch out and grow in an area that differed from what I had experienced previously," he said.
Having previously completed his Master of Public Health degree, Dougherty tends to view his involvement and organized medicine and policy as a "counterweight" to the clinical aspects of his medical education.
Given the volatile political environment surrounding the nation's health care, such a counterweight should be viewed as a necessity, he said.
"We need so many more well-informed physicians to make those big health care decisions," he added.
For the time being, however, these young medical students will be working hand-in-hand with their physician mentors to learn how they themselves fit into this rapidly changing health care landscape, and how they can best serve the communities with which they identify.
Meanwhile, the roughly one dozen physicians who have volunteered as mentors will likely learn a thing or two about their own profession. Dr. Wilson, the two-time mentor, noted that the XL program is as much about learning as it is about teaching.
"It's ongoing," he said. "We never stop learning from one another."
Photos from the mixer can be viewed on the XL Facebook page at www.facebook.com/exchangelearning.
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9. Reminder to physicians who applied for UnitedHealth Group settlement
Physicians who filed claims in the $200 million UnitedHealth Group disbursement should have received their compensation by April 15, 2012. This disbursement, ordered by a federal court, was to settle claims from physicians for 15 years of artificially low payments the insurer paid for out-of-network health services.
Spearheaded by the Litigation Center of the American Medical Association (AMA), the California Medical Association and other state medical societies, this decade-long legal battle exposed a fundamental conflict of interest at UnitedHealth. The Litigation Center’s work with organized medicine, state regulators and U.S. senators succeeded in calling into question the system for paying out-of-network medical bills, which has been controlled completely by insurers.
If you have not received your disbursement contact the following:
Claims sent direct to Claims Administrator
Most physicians will receive checks from Berdon Claims, LLC, in the next couple of months, but if you have not received your check by April 15 and filed a claim directly to the Claims Administrator, contact Berdon Claims, LLC, by:
- Toll-free phone: (800) 443-1073
- Fax: (516) 222-0271
- E-mail: unitedhealthcare@berdonclaimsllc.com
Claims sent through the Managed Care Advisory Group
Most physicians will receive checks from the Managed Care Advisory Group (MCAG) in the next couple of months, but if you have not received your check by April 15, 2012, and filed through MCAG, you should contact MCAG to inquire about the status of your settlement check by:
- Toll-free phone: (800) 355-0466; press option 4
- E-mail: physicianservices@mcaginc.com
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10. Save the date for the President's Reception and Awards Gala!
The California Medical Association (CMA) and the CMA Foundation invite you to attend the 2012 President's Reception and Awards Gala, October 14 in Sacramento. Honored at the gala will be incoming CMA president Paul Phinney, M.D., and the CMA Foundation's leadership award recipients.
This annual awards dinner is hosted in conjunction with the CMA’s annual House of Delegates meeting. The event hosts more than 600 California physician leaders, key staff from both CMA and the Foundation, and national and state health care stakeholders.
For more information or to purchase tickets, click here.
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11. CMA Foundation seeks medical student proposals for patient safety grant
The importance of addressing patient safety has received increasing attention over the past decade. No hospitals and ambulatory care centers have developed systemic approaches to addressing these concerns. The purpose of this request for proposals is to encourage medical students to begin to think about patient safety as they embark on their medical careers. Up to six grants will be awarded in the amount of up to $5,000.
Contact: Leslie Barron at (916) 779-6630 or lbarron@thecmafoundation.org.
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12. Upcoming webinars
5/16: Telephone Etiquette for Medical Personnel: Proper telephone etiquette is one of the hardest things for people working in a medical office to value highly. The quality of your telephone contact with customers is vital to the quality customer services offered throughout the practice. This webinar will discuss focusing on quality customer service first, as well as being able to adjust to the customer’s needs, which is proper telephone etiquette.
5/17: California Workers' Comp eBill Part 1: Are You Ready? This extended webinar will provide you with an overview of what eBill is, how it works, and the benefits and tools to help you evaluate your practice’s eBill readiness. This webinar is free for all attendees.
5/23: Strategic Planning for Solo, Small and Medium Group Practices: Strategic planning and performance coaching are essential processes and tool to ensure your time, resources and focus are leading you down the right track. Learn how strategic planning and performance coaching can get you, your practice or your organization where you want to go.
5/24: California Workers' Comp eBill Part 2: Implementation: This extended webinar will provide an overview of the eBill compliance requirements and focus on electronic claims and attachment submission requirements including acknowledgement transactions. This webinar is free for all attendees.
5/30: California's Changing Insurance Marketplace: This year, the Exchange Board and legislature will choose the package of benefits that all Exchange plans must cover and largely determine the standards that plans must meet to be offered on the Exchange, which include delivery system reforms. In this presentation, you will learn more about California’s Health Benefit Exchange and what it will mean for physicians.
5/31: California Workers' Comp eBill Part 3: Understanding Remittance Advice Rules: This extended session will provide an overview of the eBill electronic remittance advice rules and how to use these rule as a tool to help automate your back office workflow processes. This webinar is free for all attendees.
Contact: CMA's member help center, (800) 786-4262 or memberservice@cmanet.org.
13. Featured member benefit:
Staples: Members get up to 80 percent off office supplies and equipment from Staples. A members-only link is required to access this discount. Visit CMA's website or call (800) 786-4CMA (4262) to get the link.
Contact: CMA member help center, (800) 786-4262 or memberservice@cmanet.org.