- Improving practice workflows key to combating physician burnout
- Self-assessment: How burnt out are YOU?
- Brown's budget steals Prop. 56 revenue
- CMA publishes FAQ on Marijuana Act
- Are you exempt from ICD-10 PQRS penalties in 2016?
- Covered California tax credit mix-ups cause headaches for consumers
- NBC collecting stories showcasing problems with California workers’ comp system
Important Dates & Deadlines
Dr. Bryan Bohman is the Interim Director of Stanford's WellMD Center. Tennis helps him recharge and prevent professional burnout. (Photo courtesy of Stanford Medicine)
#CMAdocs: Bryan Bohman, M.D.
EMRs [electronic medical records] are perhaps the biggest pain point for our physicians. They need to be improved in terms of the end user. Connecting with patients is where physician satisfaction comes from. We cannot do a good job if we spend most of our time checking boxes." Read More
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(Photo courtesy of The Sacramento Bee)
Quotable: Doctors have long argued that the money they receive for serving Medi-Cal patients isn’t enough to sustain a practice, leading to a shortage of medical providers willing to treat California’s poorest residents in rural communities and other pockets of the state. Read More
Physicians in the News
- Jerry Brown doesn’t want to give doctors a cut of new tobacco tax money
Sacramento Bee - 1/12/17
- Federal Judge Blocks Aetna-Humana Merger on Antitrust Grounds
Wall Street Journal - 1/23/17
- It’s hard to be a small-time family doctor these days, new data shows
Washington Post - 1/9/17
- Los Angeles Doctor Sues Molina Healthcare Over Medi-Cal Reimbursements
Kaiser Health News - 1/12/17
- Where are California’s Latino doctors? New programs try to grow next generation
Sacramento Bee - 1/12/17
1. CURES mandate implementation date remains unclear
Under California law, all individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate (DEA Certificate) must be registered to use the Controlled Substance Utilization Review and Evaluation System (CURES). Currently, physicians are encouraged—but not required—to check the database before prescribing controlled substances. Checking the CURES database will eventually be mandatory, under a law passed by the California Legislature in 2016. The exact date the mandate will take effect is unclear, but will depend on the Department of Justice (DOJ) making a certification about the system’s readiness.
Under the new law (SB 482), prescribers will be required, except in certain limited circumstances, to consult the CURES database prior to prescribing a Schedule II, III or IV controlled substance for the first time and at least every four months when that controlled substance remains a part of a patient's treatment.
The California Medical Association (CMA) continues to assert the importance of adequate technical support for physicians who will have to rely on the system as a part of their prescribing workflow. For this reason, we negotiated into the final legislation a requirement that the mandate cannot take effect until DOJ certifies that the CURES database is ready for statewide use and that the department has adequate staff to handle the related technical and administrative workload. The mandate will go into effect six months after DOJ certifies that the database and the agency are ready.
CMA worked closely with the bill's author and other stakeholders to reach mutually agreeable language, which is reflected in the final version of the bill. Among the negotiated amendments are liability protections related to the duty to consult the database and changes to ensure that health care providers can meet the requirements under state and federal law to provide patients with their own medical information without penalty. The bill clarifies that health care providers sharing the information within the parameters of the Health Insurance Portability and Accountability Act and the Confidential Medical Information Act, including adding the CURES report to the patient’s medical record, are not out of compliance with the CURES statute.
Currently, the Medical Board of California’s “Guidelines for Prescribing Controlled Substances for Pain” recommend checking CURES as part of a comprehensive patient assessment and risk stratification when considering long-term opioids for chronic, non-cancer pain and as part of compliance monitoring. Whenever performed, the results of CURES data searches should be included in the patient’s medical record, per the medical board guidelines.
For more details about the new law, see CMA On Call document #3212, “California’s Prescription Drug Monitoring Program: The Controlled Substance Utilization Review and Evaluation System (CURES).” On Call documents are free to members in CMA's online resource library at www.cmanet.org/cma-on-call. Nonmembers can purchase documents for $2 per page.
Physicians who experience problems with the CURES database should contact the DOJ CURES Help Desk at (916) 227-3843 or firstname.lastname@example.org. Providers are also encouraged to report these technical issues to CMA's member service center at (800) 786-4262 or email@example.com so that we can ensure they are addressed before the mandate takes effect.
For more information on CURES, visit www.cmanet.org/cures.
2. Improving practice workflows key to combating physician burnout
Provider stress and burnout can have a significant impact on organizational productivity, morale, costs and the quality of care being delivered.
In our last issue of CMA Newswire, we looked at how "shared care" models can increase physicians' professional satisfaction and combat the epidemic of physician burnout. One of the key takeaways was that improving workflows within the practice is a powerful antidote to burnout.
The American Medical Association's STEPS Forward™ collection includes a number of "Workflow and Process" educational modules that provide practical guidance on practice redesign to improve workflow, communication and practice culture. Continuing medical education credit can be earned from each module.
For more information, visit www.stepsforward.org.
The American Medical Association's "Preventing Physician Burnout" module has a quick 10-question survey to help physicians determine their workplace stress levels and how they measure up against other physicians. After completing the survey, you will see your results compared to others in your region and in your specialty.
The survey is part of AMA's STEPS Forward™ collection, which includes 43 free interactive educational modules aimed at helping physicians redesign their medical practices to minimize stress and reignite professional fulfillment in their work. Continuing medical education credit can be earned from each module.
For more information, visit www.stepsforward.org.
Governor Jerry Brown on January 10 released his proposed state budget for the 2017-2018 fiscal year. Disappointingly, Brown's $120 billion budget appropriates $1.2 billion of the Proposition 56 tobacco tax money to cover cost increases for the Medi-Cal program. Although the measure was written to explicitly prohibit the governor from using the new revenue to offset general fund obligations, Governor Brown's budget does exactly that – rather than using those funds to improve California's dismal provider reimbursement rates, as the voters intended.
“We’re disappointed that Governor Brown’s budget ignores the will of voters who supported the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) by proposing to offset general fund obligations with tobacco tax revenues rather than investing in the overburdened Medi-Cal system to improve access to care,” said President Ruth E. Haskins, M.D., president of the California Medical Association (CMA). “The language of Prop. 56 was clear – the people voted overwhelmingly in support of improving payments for programs and providers to ensure that patients can see a doctor when and where they need one.”
Last year, CMA co-sponsored Prop. 56 to save lives put at risk by tobacco products and improve the access to and quality of medical services for all Californians – especially our most vulnerable communities who rely on Medi-Cal for basic care. Ample research demonstrates that the Medi-Cal system is struggling from persistent underfunding. As a result, California ranks among the lowest in the nation in payments to providers. These chronically low reimbursement rates have a direct effect on Medi-Cal patients’ ability to receive timely treatment from a physician.
Currently, poor provider reimbursement rates mean that only 40 percent of California’s physicians provide 80 percent of Medi-Cal visits. As a result, more than half of Medi-Cal enrollees report difficulty finding a primary or specialty care physician. Medi-Cal patients are more likely than those with private insurance or Medicare to postpone needed care due to long appointment wait times, leading to unnecessary, costly emergency room visits. Not only do these unnecessary emergency visits increase state costs; they inflate emergency room wait times for Californians experiencing true medical emergencies. To fix these problems, California must increase rates so that it is viable for more physicians to participate in the system.
With more than 14 million Californians relying on Medi-Cal programs to provide basic and specialty care for serious diseases, the stakes are high. Californians voted for the tobacco tax to remove these barriers to reliable and quality care. California cannot afford to continue starving this program by diverting Prop. 56 revenues to cover the state’s general fund obligations.
“We must honor the will of the voters and use the estimated $1 billion in new health care revenue for its intended purpose, instead of writing a blank check to the general fund,” said Dr. Haskins. “We look forward to working with the legislature and the Brown administration to develop a solution that doesn’t supplant the will of California voters or put low-income families and communities at risk.”
The California Medical Association (CMA) has published an FAQ on California's new law that legalized recreational use of marijuana. The law, known as the Adult Use of Marijuana Act (AUMA), was approved by California voters this past November and legalizes the use of marijuana for those 21 years of age and older.
CMA's FAQ provides answers to the most frequently asked questions regarding the new state requirements under AUMA. This document is available for members only in CMA's online resource library at www.cmanet.org/resource-library.
On October 1, 2016, new ICD-10 code sets went into effect that will impact the ability of the Centers for Medicare and Medicaid Services (CMS) to process data reported on certain quality measures for the fourth quarter of 2016. Because of this, CMS announced that it will waive 2017 or 2018 Physician Quality Reporting System (PQRS) payment adjustments, if applicable, for any physician or group practice that fails to satisfactorily report for 2016 solely as a result of the impact of ICD-10 code updates on quality data reported for the fourth quarter of 2016.
Physicians and group practices must still report on 2016 PQRS measures, regardless of whether they believe they will be unable to satisfactorily report due to the ICD-10-CM code updates. CMS will determine after the data is submitted whether the clinician or group practice was among those impacted. The affected practices will be removed from the PQRS penalty prior to the release of the 2016 feedback reports.
CMS is anticipating that the following measure groups may be affected by the ICD- 10 code updates:
- Cardiovascular Prevention
- Diabetic Retinopathy
The 2016 reporting deadline is February 28, 2017.
Click here to read the CMS FAQ on the ICD-update and its impact on PQRS.
Physicians should be aware that approximately 35,000 Californians insured through Covered California were in for a shock when they received their premium bills this month. The source of the problem is two-fold, both related to clerical errors by the state health exchange.
Roughly 9,600 beneficiaries have, at least temporarily, lost federal premium subsidies because Covered California was unable to verify their income. The premium subsidies that enrollees receive are determined based on income. In order to verify income against a federal database, Covered California needs consent from enrollees. In December, Covered California discovered some enrollees hadn’t provided the necessary consent and as a result have, at least temporarily, lost their subsidies as of January 1, 2017. Affected patients are now receiving bills from plans for the full, unsubsidized amounts of their premiums. Once an enrollee provides the needed consent, Covered California has pledged to recalculate the tax credits and apply them retroactively to the beginning of the year.
Another group of 25,000 Covered California policy holders are also facing higher-than-expected premium bills because the exchange initially sent incorrect tax credit information to their health plans. Covered California confirmed that it provided incorrect subsidy information for some policy holders, resulting in inaccurate premium bills. The information has been corrected, and insurers are now sending out new bills. In most cases that means higher premiums than consumers had initially been quoted, and health plans are entitled to bill them for the difference.
Patients should be aware that if their updated premiums are more than they can afford, there’s still time to switch health plans before open enrollment ends on Jan. 31.
Physicians who receive questions from their patients about either of these issues should direct them to contact Covered California directly at (800) 300-1506.
For physician practices, these two issues could result in changes to patient eligibility. Physicians are urged to be diligent in verifying patients' eligibility and benefits each time they are seen to ensure they will be paid for services rendered.
After NBC Bay Area News aired a series of stories about the workers’ compensation system last year, they received more than 150 emails, phone calls and Facebook messages from injured workers, doctors and attorneys about their struggles navigating the system.
Since then, George Parisotto, Acting Director of the California Division of Workers’ Compensation, has agreed to hear these stories. NBC Bay Area News is working to compile such information to send on to Parisotto. Their deadline is January 27, 2017.
Individuals who wish to share their stories should contact Liz Wagner, an investigative reporter with NBC Bay Area News, at firstname.lastname@example.org.
Physicians should ensure that proper patient authorizations are obtained prior to disclosing protected health information to the media for advocacy purposes. In addition, such disclosures will need to be logged in an accounting of disclosures that must be provided to the patient upon request.
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