- California’s kindergarten vaccination rates hit new high
- AMA urges quick action to stabilize individual insurance market
- California insurance commissioner to speak at Western Health Care Leadership Academy
- It's Health Care Decisions Week: Talk to your patients about their end-of-life wishes
- CMA updates MACRA preparation checklist
- CHPI publishes physicians' quality ratings for cycle 2
- Open Payments review and dispute period now open
- Free CME: Diabetes prevention webinar
- Encourage your patients to participate in National Prescription Drug Take Back Day
Important Dates & Deadlines
- 4/18/17: Legislative Advocacy Day
- 4/19/17: Webinar: Gender Identity & Cultural Competency in Health Care
- 4/24/17: Deadline for Q2 Report Testimony
- 4/26/17: Webinar: Aligning Clinical Practice with Diabetes Prevention
- 4/27/17: Deadline for Mode of Practice Forum Nominations
- 4/29/17: National Prescription Drug Take Back Day
- 5/5-7/17: Western Health Care Leadership Academy
- 5/15/17: Open Payments Review and Dispute Period Ends
Medical students in the PRIME Health Equity Program at UC San Diego are trained to help create health equity in their communities.
Future #CMAdocs: Milli Desai
I believe we have a commitment to care for patients and keep them healthy beyond the time we spend with them in our offices or operating rooms. The future of health care in California relies on health professionals and future physicians to be aware of health disparities and be dedicated to eliminating them.” Read More
Featured member benefit:
Special Workers’ Compensation Insurance for Members: Discounted workers' compensation insurance rates and exclusive savings for members are continuing into 2017! Members who take advantage of the California Medical Association’s sponsored insurance program save 5 percent. Read More
(Photo courtesy of Fierce Healthcare)
Quotable: Hospitals are up against the clock to apply for “premium processing” for foreign international residents who last month were offered jobs as medical residents. Read More
Physicians in the News
- How California should spend tobacco tax revenues
San Jose Mercury News - 4/10/17
- TRMC: Doctors, hospital battle in court
Visalia Times-Delta - 4/3/17
- Should naturopaths be allowed to perform sports physicals?
Southern California Public Radio - 4/6/17
- Eye doctors battle over bill to expand exams for students
Sacramento Bee - 4/6/17
- Hospitals race to fast-track visas for foreign medical residents
Fierce Healthcare - 4/3/17
1. #MatchedinCA: Making dreams come true for UCR medical students
Cheers erupted from a crowd of newly minted physicians at UC Riverside (UCR) School of Medicine on March 17 – Match Day – when the medical school's first graduating class of students opened envelopes telling them where they would spend the next few years as residents.
UCR School of Medicine, which welcomed its first class in 2013, was the first public medical school created in California in more than 40 years. This year it graduated 40 students, 33 of whom will stay in California for their residencies. Ten of these students will attend residency programs in the Inland Empire and serve the immediate community.
The medical school is dedicated to expanding and diversifying the physician workforce in inland Southern California, and to developing research and health care delivery programs to improve the care of the region’s underserved populations. In 2010, it was estimated that the region had a shortage of 3,000-physicians, with a primary care supply of just 43 physicians for every 100,000 people, according to the California HealthCare Foundation.
Despite the high numbers of candidates matching with residency programs this year, hundreds of qualified California students must leave the state to study elsewhere due to a lack of funding for graduate medical training (GME). California has invested in these medical students, but the lack of adequate funding for graduate medical education means another state will reap the rewards.
This is a big problem for our state – statistics show that physicians who leave the state for training are less likely to return to practice in California. And California has the nation’s highest resident retention rate. So, when they train here, they stay here.
UCR medical student Sarah Gomez is preparing to serve her residency at Desert Regional Medical Center in Palm Springs as a family physician. She emigrated as a child with her family from Mexico to the area; her plan is to stay and assist local residents. Forty-seven percent of the population in Riverside is Latino and lives in poverty.
“I would like to serve this population, perhaps in a county clinic when I finish my residency," she said.
Gomez is a strong supporter of the UCR medical school. She envisions serving on the faculty and helping other students with similar backgrounds get a good medical education and stay to practice in the immediate area. “I hope that more Latinos get into medicine,” she says. “We need to close the gap.”
The best way to do this is to make sure that California’s teaching hospitals have the money to increase the available residency slots so we can keep our home-grown physicians here in the state.
One step forward, two steps back
The California legislature last year passed a budget that included historic support for and expansion of primary care GME in medically underserved areas like Riverside. California committed to investing $100 million over three years ($33.4 million each year) to fund the Song-Brown Program.
However, just one year later, these funds are in jeopardy. Instead of giving these funds to schools like UCR, Governor Jerry Brown is proposing to eliminate $33.4 million for health care workforce expansion from the 2016-17 budget and does not include the second $33.4 million installment in his 2017-18 budget proposal. Gov. Brown's budget proposal also takes $50 million in tobacco tax revenues (from Proposition 56) that was intended to go to the University of California to expand GME programs and instead, backfills General Fund money that was cut from the UC’s base budget.
“This money matters. It matters to our school and is important for our community,” says Gomez.
Another graduating UCR medical student, Trina Mansour, has dreams that are similar to Gomez’s. As an Afghan-American and part of the first generation of her family born in the U.S., Mansour dreams of caring for women as an OB/GYN after hearing her mother’s tales of how women in Afghanistan suffered without care. “Women’s rights are not the same [in Afghanistan] as they are in America,” Mansour notes.
Mansour is thrilled that she will be staying at UCR to complete her residency. She also plans on staying in the Inland Empire to open a medical practice for those in the area that are underinsured.
A growing problem
California’s physician shortage is expected to get worse as the population continues to grow and our aging physician workforce moves toward retirement. California will require an additional 8,243 primary care physicians by 2030, a 32 percent increase.
The funds that Gov. Brown wants to take for the general fund – some $83 million – are best spent expanding graduate medical education for the benefit of Californians who will need care.
“A robust, well-trained primary care workforce is essential to meeting the health care demands of all Californians,” said California Medical Association (CMA) President Ruth E. Haskins, M.D.
CMA believes Brown’s budget cuts are irresponsible and will make a bad situation worse. “’Access to health care’ is a hollow talking point when there aren’t enough physicians to support California’s patients,” said Dr. Haskins.
“I hope in the near future we have [these] funds available for [medical education in] California,” says fourth-year UCR medical student Doug Grover, who graduates this spring and will begin his residency in psychiatry at UCR this summer. “UCR needs these funds too. We want to see more residencies open up [here in our county].”
CMA is working through the budget negotiation process to restore this critical funding. We are also urging physicians, residents and medical students to ask their legislators to oppose Governor Brown’s budget proposal to eliminate the physician workforce funding.
For more information on the budget as it relates to health care, including GME funding talking points, see CMA's budget summary.
2. California’s kindergarten vaccination rates hit new high
Vaccination rates among California kindergartners are at their highest point since 2001, according to new data from the California Department of Public Health (CDPH). Compared to 2015-16, the percentage of students attending kindergarten in 2016-17 who had received all required vaccines rose from 93 percent to 96 percent.
California's new vaccine law (SB 277), which was sponsored by the California Medical Association and took effect last year, eliminated the personal belief exemption and requires all children to be up-to-date on their vaccinations prior to enrolling in a public or private elementary school or child care center, unless the child has a medical exemption.
“This success is a first step toward reducing the number of unimmunized people putting our families at-risk for preventable diseases, thereby restoring community immunity throughout our state in the coming years, ” said pediatrician and Senator Richard Pan, M.D., who co-authored the bill with Senator Ben Allen.
The CDPH data shows that while vaccination rates rose for this kindergarten class, there are still large numbers of unvaccinated children who were exempted from vaccination when they entered school in previous years. A study in JAMA Pediatrics determined it will take California six years for the benefits of its new school vaccination law to be fully realized.
3. AMA urges quick action to stabilize individual insurance market
With the window quickly closing to properly price individual insurance products for 2018, the American Medical Association (AMA) is urging President Trump and Congressional leaders to commit to continued funding for the cost-sharing reductions that are critical to stabilizing the individual market.
AMA, along with other groups representing insurers, hospitals, health plan purchasers and physicians, sent a letter urging quick action to deliver short-term stability and affordable coverage while broader marketplace stabilization efforts are developed.
Nearly 60 percent of all individuals who purchase coverage via the exchange receive financial assistance to make health care affordable. These subsidies reduce out-of-pocket costs for patients who might otherwise be unable to afford health care services despite being insured.
The funding helps those who need it the most access quality care: low- and middle-income consumers earning less than 250 percent of the federal poverty level. If the cost-sharing subsidies are not funded, Americans will be dramatically impacted:
- Choices for consumers will be more limited, leaving individuals with fewer coverage options.
- Premiums for 2018 and beyond will go up by at least 15 percent, both on and off the exchange. Higher premium rates could drive out of the market those middle-income individuals who are not eligible for tax credits.
- If more people are uninsured, providers will experience more uncompensated care, which will further strain their ability to meet the needs of their communities and will raise costs for everyone, including employers who sponsor group health plans for their employees.
- Hardworking taxpayers will pay more, as premiums grow and tax credits for low-income families increase.
The California Medical Association shares the sentiments of the letter and looks forward to working with Congress and the Trump Administration to take positive actions to stabilize the health care marketplace.
4. California insurance commissioner to speak at Western Health Care Leadership Academy
Dave Jones, California’s Insurance Commissioner, will speak to attendees at the 2017 Western Health Care Leadership Academy on “The Future of Insurance.” During the conference, May 5-7 in San Diego, Jones will offer insights into what’s on the horizon for insurance, including ongoing merger attempts, the expansion and/or contraction of the insurance marketplace, and how the Trump administration might change everything.
Jones played a key role in the blocking of mergers between Anthem-Cigna and Aetna-Humana by demonstrating how the mergers would harm California consumers, businesses and the California health insurance market. Insurers collect $259 billion a year in premiums in California, making it the nation's largest insurance market.
With a dramatic shake-up happening in Washington, D.C., Leadership Academy is THE place and time for physician leaders who want to stay on top of policy and political changes to shape the future of health care. Join us to hear from health care thought leaders, network with your physician colleagues from across the state and earn up to 16.75*units of continuing medical education!
Conference Breakout Sessions
The 2017 Western Health Care Leadership Academy offers six educational tracks for easy navigation. Sessions are designed to be educational for all attendees, so mix and match workshops for a meaningful program that fits your needs. Tracks include:
- Running Your Practice
- Improving Quality of Patient Care
- Future Trends in Health Care
- Physician Leadership
- Organizational Leadership
- Student and Resident Future Leaders
*The California Medical Association/Institute for Medical Quality (CMA/IMQ) is accredited by the Accreditation Council for Continuing Medical education (ACCME) to provide continuing medical education for physicians.
The California Medical Association/Institute for Medical Quality designates this live activity for a maximum of 16.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The California Medical Association (CMA) recognizes National Health Care Decisions week by encouraging physicians to speak with their patients about the importance of completing an advance directive to make sure their end-of-life wishes are known. Experts say only about 20-30 percent of Americans have completed an advance directive, even though all people age 18 and older should have one.
In California, advance directives are the legally recognized format for “living wills.” An advance directive enables individuals to make sure that their health care wishes are known in advance and considered if for any reason they are unable to speak for themselves. Advance directives also allow patients to appoint a health care "agent" who will have legal authority to make health care decisions in the event that the patient is incapacitated, or immediately upon appointment if the patient expressly grants such authority.
“While it is understandable that people would put off discussing the topic of serious illness and death, it’s essential to have this family conversation in advance,” says CMA President Ruth Haskins, M.D. “It’s a discussion that should take place in the living room, not in the hospital waiting room when it may be too late.”
CMA encourages Californians to think and talk with loved ones about their wishes for end-of-life medical care before a serious illness or injury occurs. CMA has developed a number of guidelines, forms and other resources to assist providers, patients and loved ones with making important end-of-life decisions.
The information, available in English and Spanish, includes legally recognized documents such as Advance Directives, Do-Not-Resuscitate forms and Physician Orders for Life-Sustaining Treatment (POLST). CMA's Advance Health Care Directive and POLST kits also include wallet identification cards and answer frequently asked questions from patients.
You can find a complete list of CMA's end-of-life health care resources with summaries at www.cmanet.org/endoflife.
The California Medical Association’s (CMA) Center for Economic Services has published an update to its Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) preparation checklist. The checklist, “MACRA: What Should I Do Now to Prepare?”, is available in CMA's MACRA resource center at www.cmanet.org/macra.
CMA published this important checklist to help physicians understand MACRA payment reforms and what they can do now to start preparing for the transition. Also available in the MACRA resource center is an overview of MACRA, and a comprehensive list of tools, resources and information from CMA, the American Medical Association and the Centers for Medicare and Medicaid Services.
On March 22, 2017, the California Healthcare Performance Initiative System (CHPI) released its second cycle of physician quality ratings to the public. The ratings can be accessed at CHPI’s newly launched website, CAqualityratings.org, which allows consumers to search ratings on approximately 10,000 California physicians.
As previously reported in September 2016, approximately 13,000 physicians in California received their individual quality measurement scores for the second cycle of the CHPI quality rating program. The program rates physicians using claims data from Medicare fee-for-service, Anthem Blue Cross, Blue Shield of California and UnitedHealthcare. This claims data includes both commercial and self-funded health plan data from HMO, PPO, POS and Medicare Advantage products.
The individual quality measurement scores were based on claims data for patient care provided January 1, 2012, through December 31, 2014. Physicians were assigned a star rating of one to four stars, based on where they fall as a percentile within a “peer group,” for each measure as well as a composite score.
For more information on the CHPI Cycle 2 rating methodology, visit the CHPI website at www.chpis.org. CHPI has also published an FAQ on its rating program. If you have questions or concerns about the CHPI rating results, email email@example.com and expect a response within 48 hours.
Drug and medical device manufacturers have completed their submission of data to the Open Payments system on payments or transfers of value made to physicians during 2016. Physicians now have 45 days to review and dispute records attributed to them. The review and dispute period is open until May 15, 2017. The review and dispute process is voluntary, but encouraged.
The Centers for Medicare and Medicaid Services (CMS) will publish the 2016 payment data, along with updates to the 2013 and 2014 data, on June 30, 2017. Disputes that are initiated before the May 15 deadline will be flagged in the public release on June 30.
Under the Sunshine Act, drug and medical device manufacturers are required to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research grants and other gifts. Any payments, ownership interests and other “transfers of value” are reported to CMS for publication in the online database.
Physicians who are not already registered should be aware that there is a two-step process to register for the Open Payments program. The first step requires physicians to register at the CMS Enterprise Identity Management System portal, a step many physicians may have already completed as the gateway enables access to a number of other CMS programs. Step two is to register in CMS’ Open Payments system.
Physicians who have already registered but who have not accessed their account in the past 60 days will need to unlock their account by going to the CMS Enterprise Portal, which will prompt you to enter your user ID and correctly answer all challenge questions. You will then be prompted to enter a new password.
Users who registered last year, but who have been inactive for more than 180 days, will need to reactivate their account by contacting the Open Payments Help Desk at firstname.lastname@example.org or (855) 326-8366.
Diabetes remains one of California’s fastest-growing and costliest diseases, and the burden is only expected to accelerate in the coming years. An estimated 2.5 million California adults have been diagnosed with diabetes, while 13 million – nearly half of the state’s adult population – have prediabetes, increasing their risk of developing diabetes over the next few years.
Prediabetes is a condition in which blood glucose or hemoglobin A1C (HbA1C) levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. Among prediabetes patients, up to 30 percent are expected to develop diabetes within five years and up to 70 percent are expected to develop the disease in their lifetime. Fortunately, prediabetes can be reversed, and the sooner patients find out they have prediabetes, the better their chances of preventing the onset of type 2 diabetes.
The National Diabetes Prevention Program is a Center for Disease Control and Prevention (CDC)-recognized evidence-based lifestyle change program for persons with prediabetes that has been demonstrated to prevent or delay the development of diabetes.
This free one-hour webinar on April 26 is open to the public and will describe the clinical practice burden and trends in prediabetes and type 2 diabetes in California; review the evidence that supports systematically screening patients for prediabetes and referring to a community-based program, like the National Diabetes Prevention Program; and recognize the tools available to identify patients with prediabetes and establish a referral process. The program will offer 1 unit of continuing medical education (CME) credit*.
Jessica Núñez de Ybarra, M.D., MPH, FACPM, is board-certified in public health and general preventive medicine and is a fellow of the American College of Preventive Medicine. She serves as chief of the Chronic Disease Control Branch of the California Department of Public Health. She has a variety of experience working with teams, partners and stakeholders in disease prevention, promoting health equity and team-based care, among other health-related topics.
Kate Kirley, M.D., M.S., is the director of chronic disease prevention for the American Medical Association’s (AMA) Improving Health Outcomes group. Prior to joining AMA, she was a practicing family physician and health services researcher at NorthShore University HealthSystem, as well as a clinical assistant professor in the Department of Family Medicine at the University of Chicago.
Janet Williams is the senior program manager for AMA’s Improving Health Outcomes group. She is responsible for AMA’s work on bridging the gap between clinical care and community resources to improve health outcomes. She manages AMA’s prediabetes initiative with the YMCA of the USA. She also leads a team that, along with the CDC, analyzes and develops clinical tools and resources for engaging health systems, clinicians and health departments in diabetes prevention.
Participants should register at least one hour before the webinar. If you do not register an hour before the webinar start time, we cannot guarantee your attendance.
To register, click here.
Contact: CMA Member Help Center (800) 786-4262 or email@example.com.
*The California Medical Association/Institute for Medical Quality (CMA/IMQ) is accredited by the Accreditation Council on Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The California Medical Association/Institute for Medical Quality (CMA/IMQ) designates this live internet activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
On-demand webinars are not available for CEU or CME credits.
Saturday, April 29, 2017, is National Prescription Drug Take Back Day. On this day, hundreds of locations throughout California will be accepting and properly disposing of unused prescription drugs, including controlled substances. Proper disposal of unused prescription drugs helps prevent diversion and misuse associated with these medications.
This one-day event will provide patients with free, anonymous collection of unwanted and expired medicines. In addition to providing a safe, convenient and responsible means of disposal, the event also aims to educate the general public about the potential for abuse of these medications. A significant component of the prescription drug abuse and diversion problem stems from misuse of unused drugs.
According to the Substance Abuse and Mental Health Administration, over 71 percent of prescription pain medications are obtained from family and friends, and 5 percent took the medication from a friend or relative without asking.
Physicians can take action by encouraging their patients to participate in Take Back Day. To find a collection site near your practice, click here.
The California Medical Association (CMA) has produced a flyer to educate patients about proper disposal of prescription medication and National Prescription Drug Take Back Day, which can be placed in offices and waiting rooms.
The American Medical Association Task Force to Reduce Opioid Abuse, of which CMA is a member, has also released a new resource that physicians can use to promote safe use, storage and disposal of opioids and other medications.
These and other resources are available on CMA's safe prescribing webpage at www.cmanet.org/safe-prescribing.
Special Workers’ Compensation Insurance for Members: Discounted workers' compensation insurance rates and exclusive savings for members are continuing into 2017! Members who take advantage of the California Medical Association’s (CMA) sponsored insurance program save 5 percent.
As you know, if you have employees, workers’ compensation is required in California. Looking to CMA for a comprehensive insurance program is one of the best ways to make use of your member benefits. CMA partners with Mercer and Preferred Employers Insurance to provide safety, stability, service and savings to members who participate in the program.
It’s easy to get a premium indication through the sponsored program. Simply call Mercer today at (800) 842-3761, or visit CMAMemberInsurance.com for more information, including premium indication form.
78960 (4/17) Copyright 2017 Mercer LLC. All rights reserved. • 777 South Figueroa Street, Los Angeles, CA 90017 • (800) 842-3761 • CMACounty.Insurance.firstname.lastname@example.org • www.CountyCMAMemberInsurance.com • Program Administered by Mercer Health & Benefits Insurance Services LLC • CA Insurance License #0G39709