- Congressional plan to repeal and replace the ACA is not clear
- Have you updated your DEA registration information lately?
- Next pertussis epidemic expected soon, CDPH urges action to prevent infant pertussis
- CURES 1.0 to be taken offline permanently in March
- Free CME: Six steps to improve physician resiliency
- CMS auditing physicians who inappropriately bill Medi-Medi patients
Important Dates & Deadlines
#CMAdocs: Karen Miotto, M.D.
Is it our problem that we're a group of burnt out doctors? It is our characteristics, our professionalism, our passion that makes us vulnerable to burnout. We're no stranger to exhaustion. It is not the exhaustion that is defeating us. It's the constellation of doing activities that aren't in keeping with our personal sense of meaning that creates a cynicism where people become disease categories or names because we don't have the capacity to continue to care. The system HAS to get better. The system HAS to get more workable." Read More
Featured member benefit:
Controlled Substance Prescription Pads: CMA members enjoy savings of 15 percent on all orders of tamper-resistant prescription pads and electronic health record printer paper with Rx Security. Read More
(Photo: Courtesy of CW6 News)
Quotable: Dr. Theodore Mazer is president-elect of the California Medical Association — and will soon be advising the nation’s president-elect. The Alvarado Hospital surgeon could be instrumental in providing alternative ideas to republicans looking to fix President Obama’s signature legislation. Read More
Physicians in the News
- Democrats say repealing Obamacare would “Make America Sick Again”
CW6 News - 1/4/17
- Doctors praise state program to improve Central Valley healthcare
Central Valley Business Times - 1/4/17
- Doctors group urges Congress not to dismantle Obamacare without a replacement plan
Stat - 1/3/17
- Telemedicine in Schools Helps Keep Kids in the Classroom
Stateline - 1/4/17
- Conjoined twins surgeon, of Sacramento, built prestigious career out of healing kids
Sacramento Bee - 12/26/16
1. Battling burnout: How "shared care" models can increase physicians' professional satisfaction
Being a physician is for many a calling. They are drawn to the practice of medicine, motivated by a deep-seated desire to help and heal. "Being a physician is not just something we 'do,' it is something we 'are,'" says Ruth E. Haskins, M.D., president of the California Medical Association. "What brings us joy, almost universally, is caring for patients."
Yet 75 percent of California doctors are showing signs of burnout, according to a 2016 Physicians Foundation study. This survey, conducted biennially since 2008, has consistently demonstrated that the professional morale of physicians is declining, due in large part to regulatory and paperwork burdens that limit the time physicians can spend with patients and a loss of clinical autonomy.
“We’d much rather have our hands on our patients than our hands on our keyboards,” says Dr. Haskins.
So how can physicians gain control of the things that burn them out and reclaim the joy in their practices? A 2013 study published in the Annals of Family Medicine looked at high-functioning primary care practices that had put into place innovations to help mitigate physician burnout. The authors found that a shift from a physician-focused care model to a "shared-care" model, with a greater focus on clinical support staff and more frequent daily staff and physician communication, could decrease the amount of tedious work that needs to be done, resulting in more personal satisfaction for physicians.
While the study’s authors said that no single practice they studied had solved every issue for physicians, they did find unifying themes that created greater physician satisfaction:
- Practices that build stable, well-trained teams that work together every day and meet regularly to improve their work can create efficient work flows and rewarding practice environments.
- Standardized work flows with higher levels of clinical support personnel can make practices less chaotic, save time and meet patients’ needs more quickly.
- Teamwork is facilitated by proximity of workstations and frequent forums for interaction. Thoughtful physical layout with co-location of staff and line of sight enhances communication.
- Face-to face verbal communication is often more effective, efficient and enjoyable than circulating asynchronous electronic messaging.
Researchers found that the most successful practices at balancing work/life for physicians had instituted changes like these:
- All patients received pre-visit planning that included lab tests. Lab tests were scheduled and performed several days in advance of the patient visit so that the results could be discussed. The pre-planning was done in conjunction with the physician by a medical assistant or nurse. In one practice, the medical assistant's role was expanded to include medication review, agenda setting, form completion and closing care gaps.
- Six of the practices entrusted support personnel to serve as a physician scribe for each patient visit. They captured the physician’s medical notes for the patient record, entered orders, prepared the after-visit summaries and reinforced the care plan with the patient.
- Prescription renewals were re-engineered so that stable prescriptions were renewed for a year during an annual comprehensive care visit. This prevented unnecessary interval handling of renewals.
- At many practices, nurses and medical assistants were entrusted, while operating under physician-designated protocol, with filtering electronic and paper information that would normally pass to physicians. These "physician extenders" passed on only information that specifically required a physician’s level of expertise. The physician was kept up-to-date verbally so nothing was lost between patient and physician. This decreased inbox work for physicians substantially and helped filter out normal laboratory results, prescription renewals and other requests that could be handled by delegates or well-trained assistants.
- Some practices allowed time in their schedules for brief team meetings throughout the day. In one large practice, physicians decided to co-locate their work stations so they sat side by side with their nurses and medical assistants, allowing for an easy flow of information between physicians and team members.
To see the full study, click here.
2. Congressional plan to repeal and replace the ACA is not clear
A budget resolution establishing procedural instructions to set up the repeal of the Affordable Care Act (ACA) was introduced in the U.S. Senate on Tuesday. This move by the Senate’s budget committee chairman on the first day of the new Congress has set into motion the GOP promise to repeal the ACA as its first legislative act. The House is expected to vote on the Senate budget resolution shortly after the Senate vote. However, the repeal process could take months, while developing a replacement plan could take years.
Senate Republicans have agreed to use a budget resolution, allowing them to repeal ACA funding without any Democratic votes. Budget resolutions require a simple majority to pass in the Senate, instead of the 60 votes required to clear procedural hurdles. There are 52 Republicans in the 100-seat chamber.
While the Senate budget resolution is a statement of priorities and lays the groundwork for the repeal of the ACA, it does not have the force of law. To repeal the law, the House Energy & Commerce and Ways & Means committees and the Senate Finance Committee need to meet to develop replacement legislation. The Senate plan introduced Tuesday includes a “repeal and replace” strategy that would require passage of two separate bills.
Looming over the whole process of repealing the ACA are the actions of the health care marketplace. Congressional plans to repeal the ACA without a replacement plan in place could result in more uncertainty in an already fragile marketplace, prompting insurers to leave the individual market and creating chaos for the 20 million Americans insured through the ACA.
In addition to working on a replacement plan, Congress must also act on a handful of health care programs before they expire, including the Children's Health Insurance Program; Prescription Drug User Fee Act; Medical Device User Fee and Modernization Act; and the Veterans' Access, Choice and Accountability Act.
The California Medical Association (CMA) is closely following these issues as they play out in Congress and will be actively engaged in shaping the future of health care reform at the national level. CMA will work to ensure that any resulting legislation will benefit the patients and physicians in California and the nation as a whole. We will also work to keep you up-to-date on any breaking news from the nation’s capital.
Below are the principles that will guide CMA’s advocacy on health care reform.
- Ensure Californians do not lose coverage or access to care.
- Protect the billions in current state and federal health care funding.
- Ensure appropriate and broad-based financing.
- Advocate for patient choice of physicians, health plans and coverage through private contracting, health savings accounts, health plans and state and federal government programs.
- Continue tax policies and subsidies that help low-income patients afford coverage.
- Maintain the insurance industry reforms that protect physicians and patients.
Contact: Elizabeth McNeil, (800) 786-4262 or firstname.lastname@example.org.
Physicians are urged to check their contact information on file with the Drug Enforcement Administration (DEA) to ensure that they receive critical updates, including registration renewal notices. Every physician who administers, prescribes or dispenses any controlled substance must be registered with DEA.
DEA recently announced that it will no longer send a second registration renewal notification by mail and instead will send the second renewal notice to the email address associated with the registration.
DEA will otherwise retain its current policy and procedures with respect to renewal and reinstatement of registration. This policy is as follows:
- If a renewal application is submitted in a timely manner prior to expiration, the registrant may continue operations, authorized by the registration, beyond the expiration date until final action is taken on the application.
- DEA allows the reinstatement of an expired registration for one calendar month after the expiration date. If the registration is not renewed within that calendar month, an application for a new DEA registration will be required.
- Regardless of whether a registration is reinstated within the calendar month after expiration, federal law prohibits the handling of controlled substances or List 1 chemicals for any period of time under an expired registration
If you want to check your registration expiration date, contact the DEA Registration Service Center at (800) 882-9539 or email email@example.com and include your DEA number in your email.
Providers may also renew their DEA registration on the DEA website.
Since 2010, over 2,500 cases of pertussis (whooping cough) have been reported in infants younger than 4 months of age in California. Eighteen of these infants died, and more than half were hospitalized. In 2016, two babies died from pertussis in California, one a healthy, full-term baby. These deaths are a devastating reminder that all prenatal care providers should have a Tdap vaccination plan in place to ensure moms and their babies are protected.
The federal Advisory Committee on Immunization Practice recommends that all pregnant women be immunized with Tdap at the earliest opportunity, between 27-36 weeks gestation of every pregnancy. Tdap vaccination of women during pregnancy is the optimal strategy to protect infants who are too young to be vaccinated. Infants can start the childhood whooping cough vaccine series (DTaP) as early as 6 weeks of age. Even one dose of DTaP may offer some protection against fatal whooping cough disease in infants. As pertussis incidents peak every three to five years, most recently in 2014, prenatal care providers must act now to protect infants before the next epidemic peak is expected in 2017-19.
The California Department of Public Health (CDPH) and California Department of Health Care Services (DHCS) recently issued a joint letter to providers urging them take steps now to help protect infants against pertussis. Included in the letter is detailed guidance for providers who vaccinate on-site as well as for those referring for vaccination off-site. All prenatal care providers are urged to provide a strong recommendation to their patients to receive Tdap and document receipt of Tdap vaccination (or refusal) in their chart. Providers who must refer patients for vaccination off-site should assist patients in locating a local immunization provider/clinic that is covered by their insurance and follow up in subsequent visits to ensure patients have received the vaccine.
Click here to read the CDPH and DHCS advisory letter.
One year ago, the California Department of Justice (DOJ) upgraded the state's prescription drug monitoring program database, the Controlled Substance Utilization Review and Evaluation System (CURES). The upgraded prescription drug monitoring system – commonly referred to as “CURES 2.0” – has a significantly improved user experience and features a number of added functionalities, including the ability to delegate report queries and new practitioner-identified patient alerts.
Because CURES 2.0 requires a secure, up-to-date web browser (i.e., Internet Explorer version 11.0 or higher, Apple Safari, Mozilla Firefox or Google Chrome), physicians still using older browsers have been routed to the old CURES 1.0 interface, which has remained available during the transition. Effective March 5, 2017, however, CURES 1.0 will no longer be available. All remaining 1.0 users must update their web browsers to access CURES 2.0.
Users who have not updated their browsers will no longer be redirected to the old system, but will instead view a message containing information as to why they cannot access the site with an unsecure browser.
Existing CURES 1.0 users do not need to reregister, and will be able to access CURES 2.0 with their current user ID and password if using a supported browser.
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 must be registered to use CURES.
Physicians who experience problems should contact the DOJ CURES Help Desk at (916) 227-3843 or firstname.lastname@example.org. Providers are also encouraged to report any technical issues to CMA's member service center at (800) 786-4262 or email@example.com.
Increasing administrative responsibilities—due to regulatory pressures and evolving payment and care delivery models—reduce the amount of time physicians spend delivering direct patient care. Physicians often experience burnout caused by demanding workloads, nights on call and other common stressors. Learning resiliency helps physicians have longer, more satisfying careers and reduces the risk of burnout.
The American Medical Association (AMA) STEPS Forward™ collection includes a module, "Improving Physician Resiliency," that includes six ways to improve resiliency in a demanding practice environment and ways to prevent burnout. The module will help physicians identify tools and resources to increase resiliency, assess personal and professional contributors to stress, and identify and prioritize values in all aspects of their lives.
Launched by AMA in June 2015, STEPS Forward now 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 (CME) credit can be earned from each module.
For more information, visit www.stepsforward.org.
The Centers for Medicare and Medicaid Services (CMS) recently instructed Medicare contractors to begin issuing compliance letters to physicians who inappropriately bill Qualified Medicare Beneficiaries (QMB) for Medicare cost-sharing. QMB is a Medicaid program that assists low-income beneficiaries with Medicare premiums and cost-sharing.
Federal law bars Medicare providers from charging QMBs for Medicare Part A and B deductibles, coinsurances or copays. Medicare providers must accept the Medicare payment and Medicaid payment (if any) as payment in full for services rendered to a QMB individual. Medicare providers who violate these billing prohibitions are violating their Medicare Provider Agreement and may be subject to sanctions.
A July 2015 CMS study found that, despite federal law against the practice, erroneous balance billing of QMB individuals is relatively commonplace and that confusion about billing rules persists among providers and beneficiaries.
CMS has increased its policing activities of inappropriate billing and has engaged in new protocols to verify that physicians know the billing rules and that beneficiaries are educated about their rights and protections under federal law.
Physicians found to be in violation of the federal law prohibiting balance billing of QMBs will receive a compliance letter from their Medicare contractor, instructing them to review their records for efforts to collect Medicare cost-sharing from QMBs, to recall any past or existing billing (including referrals to collection agencies) and to refund to the patients any amounts already paid.
Patients will also receive letters from the Medicare contractor informing them of their rights.
Physicians are urged to ensure that their billing staff are aware of these rules and that their billing software exempts individuals enrolled in the QMB program from all Medicare cost-sharing billing and related collection efforts.
For more information, see the California Medical Association (CMA) “Ask the Expert: Billing Medi-Medi patients” resource, available free to members in CMA's online resource library. Additional details can also be found in Medicare Learning Network (MLN) Matters® article "Prohibition on Balance Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program."
If you have questions, please contact California's Medicare contractor, Noridian, at (855) 609-9960.
Controlled Substance Prescription Pads: California Medical Association (CMA) members enjoy savings of 15 percent on all orders of tamper-resistant prescription pads and electronic health recrod printer paper with Rx Security. Click here for more information.
Contact: CMA member help center, (800) 786-4262 or firstname.lastname@example.org.