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Top Story: CMA supports San Francisco's ban of tobacco sales in stores with pharmacies
The California Medical Association (CMA) filed a brief last week in U.S. District Court supporting the City and County of San Francisco's ban on the sale of tobacco products in retail stores with pharmacies. READ MORE
Also in this issue:
- Register today for CMA's new website
- CMA working to allow greater physician participation in ACO shared savings program
- Senate votes to repeal 1099 requirement
- Medi-Cal begins processing claims using NCCI edits
- California Budget Watch: Overview
- Drs. Vito Imbasciani and Tanya Layne share first annual Dev A. GnanaDev Membership Award
- Nominate an outstanding colleague for CMA Foundation Leadership Awards
- Leadership and control of ACOs subject of Leadership Academy debate
- CMA schedules conferences to help physicians succeed in health reform era
- Webinar (4/20): What ACO rules mean for physicians
- Webinar (5/4): Dealing with Sensitive Personnel Issues
Featured Member Benefits:
Security Prescriptions
CMA members receive 15 percent off tamper-resistant security prescription pads and printer paper from Rx Security.
Staples
Members get up to 80 percent off office supplies and equipment from Staples. A members-only link is required to access this discount.
Magazine Subscriptions
Members receive 50 percent off subscriptions to hundreds of popular magazines, with a best price match guarantee. READ MORE
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1. CMA supports San Francisco's ban of tobacco sales in stores with pharmacies
The California Medical Association (CMA) filed a brief last week in U.S. District Court supporting the City and County of San Francisco's ban on the sale of tobacco products in retail stores with pharmacies.
"Unlike other retail outlets that sell cigarettes, stores that provide pharmacy services pose a unique problem if they also sell tobacco products," CMA's brief states. "Stores such as Safeway that contain a pharmacy are an integral part of the health care delivery system.
"Selling tobacco products in such institutions creates a conflict of interest and sends a mixed message that can undermine the campaign against smoking," the CMA brief asserts. "Furthermore, as a practical matter, making cigarettes available where patients go to fill prescriptions can frustrate the treatment protocols of physicians."
Safeway, Inc., argues that the ordinance distinguishes between retail stores that contain pharmacies and those that don't, thus violating equal protection provisions of the U.S. Constitution.
San Francisco City Attorney Dennis Herrera attacked Safeway's argument: "It strains credibility to argue that the City's ban on cigarette sales in stores with pharmacies is 'arbitrary' when leading health organizations like the California Medical Association and the San Francisco Medical Society have worked tirelessly for its enactment," Herrera said. "We are truly grateful for their leadership on this issue and for their brilliant courtroom advocacy on our behalf."
CMA has been a tireless advocate for stronger restrictions on the tobacco industry for decades. In 1970, 1978 and 1980, CMA supported ballot initiatives that would have banned smoking in many public places. In 1987, CMA took on its biggest tobacco-related challenge and won, with the passage of Proposition 99, which established a 25-cents-per-pack tax on cigarettes and a tax hike for other tobacco-related products.
CMA also joined labor, the California Restaurant Association and health-related groups in 1993 to pass the Indoor Clean Air Act, a law banning smoking in California workplaces, including restaurants and bars.
Contact: Samantha Pellon, (916) 551-2972 or spellon@cmanet.org.
2. Register today for CMA's new website
The California Medical Association (CMA) recently launched a new website designed for easier, more intuitive navigation and loaded with a suite of digital tools that will help you get the most from your membership.
All members will need to activate their new web account in order to access the full suite of members-only tools and resources. Existing passwords from the old website were not carried over for security reasons.
The process of activating your account is quick and easy, and will give you direct and immediate access to your account information and profile.
To register:
- Click on "activate web account" at the top of the page.
- Enter your first and last name to locate your record in our database. Click on your name.
- Verify your date of birth, enter your email address (this will be your username), and then select and verify your password (passwords must be at least 6 digits long).
Q. I created a new account and it's not giving me access to member-protected content. What did I do wrong? A: If you cannot find your record in the database, you will be given the opportunity to create a new account. Creating a new account will not automatically link your web profile to your membership record in our database. In order to access member protected content, you must link your account.
If you already created a new account, you can still link it to your membership record. To do so, log into your account and click on "My Account" at the top of the page. You will see a button "Link My CMA Account" in the left sidebar. Click on that button and you will be given the opportunity to look up your record by your medical license number or by name. You will also need to verify your date of birth. Once you have successfully linked your account, you will see the following message: "Thank you, your account has been successfully linked with your membership record."
If you have any questions, please do not hesitate to contact CMA's member help center at (800) 786-4262 or memberservice@cmanet.org.
3. CMA working to allow greater physician participation in ACO shared savings program
The long-awaited proposed regulations for the voluntary Medicare Shared Savings/Accountable Care Organization (ACO) program have been issued by the Center for Medicare and Medicaid Services (CMS), and the California Medical Association (CMA) is working to shape the regulations to allow more California physicians to participate and to reflect CMA's principles that ACOs should be physician-led and patient-centric.
The regulations, as drafted, appear unlikely to encourage California physicians or medical groups to participate. The regulatory framework and requirements are burdensome and the upside financial potential may not be worth the effort and may not cover the substantial start-up costs. Moreover, in a controversial move, CMS is requiring all ACOs to accept downside financial risk in the third year of operations by requiring ACOs to pay back Medicare for any expenditures above their spending benchmark.
CMS is encouraging medical groups that want to accept at-risk contracts, or small independent physician practices that want to organize or develop innovative models, to pursue funding through the newly formed CMS Innovation Center. CMA will be helping to obtain federal funding for California physicians who want to pursue different models.
In an effort to provide guidance on antitrust law concerns, the Federal Trade Commission (FTC) and the Department of Justice (DOJ) issued a joint statement establishing anti-trust safety zones in which qualifying ACOs may operate. The Office of Inspector General issued a proposed waiver for Medicare ACOs from the self-referral, anti-kickback and civil monetary penalty laws. And finally, the IRS issued a proposal on the tax treatment of ACOs.
For a summary of the proposed ACO rules and what CMA is doing to help physicians, see the letter from CMA President James Hinsdale, M.D., on April 7 to all CMA physicians. A more detailed summary can be found in CMA's medical-legal library (document #0201, "Legal and Practical Considerations Concerning Accountable Care Organizations").
CMA and the CMA Board of Trustees' Technical Advisory Committee on Physician-Hospital Alignment is reviewing hundreds of pages of the proposed regulations and will be working on developing comments based upon the ACO principles adopted by the CMA House of Delegates in October 2010. Public comments on the ACO regulations are due on June 6, 2011.
Contact: Elizabeth McNeil, (415) 310-2877 or emcneil@cmanet.org.
4. Senate votes to repeal 1099 requirement
The U.S. Senate has voted to eliminate a provision of the Patient Protection and Affordable Care Act (ACA) that requires businesses, including physicians' offices, to file an IRS 1099 form for purchases from every vendor selling them $600 or more a year in goods or services.
Filing of 1099 forms already was required by the IRS when businesses purchased $600 or more in services annually, but the ACA provision that was repealed would have extended the requirement to the purchase of goods, starting in 2012.
The California Medical Association (CMA) and the American Medical Association (AMA) supported the repeal, which would have been burdensome to physicians in private practice because they are business owners.
The legislation passed by a bipartisan vote 87-12, and will now be sent to the White House for the President's signature into law. "We are pleased Congress has acted to correct a flaw that placed an unnecessary bookkeeping burden on small businesses," said White House spokesman Jay Carney.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
5. Medi-Cal begins processing claims using NCCI edits
As required by the federal Patient Protection and Affordable Care Act (ACA) signed into law in March 2010, all state Medicaid programs, including Medi-Cal, began applying National Correct Coding Initiative (NCCI) edits for claims processed on or after March 28, 2011, with dates of service on or after October 1, 2010.
The Centers for Medicare and Medicaid Services (CMS) developed NCCI edits in 1996 to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Medicare Part B claims. NCCI code pair "edits" are developed based on coding guidelines defined in the American Medical Association's Current Procedural Terminology (CPT) book, current standards of medical and surgical coding practice, input from specialty societies, and analysis of current coding practice.
NCCI edits are pairs of CPT codes that are not separately payable except under certain circumstances. The edits apply to services billed by the same physician for the same patient on the same date of service.
While the vast majority of billing and payment policies listed in the Medi-Cal Provider Manual follow AMA CPT coding guidelines and, by default, NCCI code pair logic, it is advisable for physicians to familiarize themselves with these rules to ensure accurate coding and avoid denials, costly rework, and appeals.
NCCI edits consist of two types:
- Procedure-to-procedure(Column1/Column2) edits that define pairs of HCPCS/ CPT codes that should not be reported together for a variety of reasons; and
- Mutually Exclusive Edits/Medically Unlikely Edits, which are units of service edits, that define for each HCPCS/CPT code identified, the allowable number of units of service; units of service in excess of this value are not feasible for the procedure under normal conditions (e.g., claims for excision of more than one gall bladder or more than one appendix).
More information about Medi-Cal's policy on NCCI code pair edits can be found at the Medi-Cal website or on the CMS website.
Contact: CMA's reimbursement help line, (888) 401-5911 or economicservices@cmanet.org.
6. California Budget Watch: Overview
The State of California started 2011 with a projected budget deficit of $25.4 billion – a $7.2 billion current-year deficit and an $18.2 billion deficit for the coming year. In order to close the deficit and build a $1 billion prudent reserve, the Legislature must pass a $26.4 billion mix of cuts, revenues, and fund shifts.
The Legislature has already passed more than $14 billion in cuts and other spending reductions, including deep cuts to health programs. If the remaining solutions come from additional cuts, we can expect some dramatic and severe changes to core state-funded programs.
The package of budget bills already approved by the Legislature contains more than $1.7 billion in cuts to Medi-Cal, including:
- A 10 percent across-the-board cut to provider rates ($730 million)
- Mandatory copayments on physician office visits, pharmacy, inpatient hospital stays, and non-emergency use of emergency rooms ($557 million)
- A "soft cap" on office visits of seven per year ($60 million)
In addition, the Legislature approved increases in Healthy Families premiums and copayments, as well as an elimination of vision services in that program (total cut of $30 million).
The current-year budget deficit is the result of a confluence of negative factors. This year alone, California will face the loss of federal stimulus funding for Medi-Cal, the expiration of temporary tax increases passed in 2009, and the continuing economic recession.
In addition, previous legislatures have relied heavily on shaky assumptions and one-time fixes and fund shifts to cover projected deficits. For example, last year the budget assumed $3.6 billion in increased federal funding that did not materialize. Also, a heavy reliance on using bonds to cover state functions has left California spending large amounts of money just to cover accrued debt ($2.9 billion this year).
Overall, over 80 percent of budget solutions in the last three state budgets were either temporary, did not materialize, or added to California's debt problem.
In March, the Legislature passed a mix of spending reductions and fund shifts to address more than half of the projected deficit ($14 billion).
Governor Jerry Brown had proposed to cover the remaining deficit by calling a special election to ask voters to extend expiring increases on state income and sales taxes, and motor vehicle registration fees, for another five years. In order to call the election, the governor needs a vote of two-thirds of both houses of the Legislature, requiring two Republicans in each house to vote for it. The negotiations needed to secure those two votes abruptly ended in the last week of March, when Governor Brown declared an impasse.
A special election is not legally necessary. The Legislature could approve the tax extensions by a two-thirds vote of both houses. During the election last fall, and in subsequent speeches, Governor Brown promised the voters that he would seek their approval before raising any taxes.
The Legislature could pass the budget on a simple majority vote. The voters gave them this power when they approved Proposition 25 last fall. However, the State Constitution still requires a two-thirds vote of the Legislature to raise taxes. In addition, the voters also approved Proposition 26, which requires a two-thirds vote to approve any new or increased fees of any kind. There is no way for the Legislature to raise revenue without some Republican support.
Even if the current deficit is "solved," more budget problems may arise. Many of the budget solutions passed by the Legislature and signed by the Governor include changes to Medi-Cal that require federal approval. The advocacy efforts of the California Medical Association and other organizations are now focused on the Centers for Medicare & Medicaid Services (CMS), which oversees all state Medicaid programs, including Medi-Cal. It is possible that CMS could deny the state's request to implement the devastating cuts for which the governor is asking.
Contact: David Ford, (916) 551-2554 or dford@cmanet.org.
7. Drs. Vito Imbasciani and Tanya Layne share first annual Dev A. GnanaDev Membership Award
The California Medical Association has awarded Vito Imbasciani, M.D., and Tanya Layne, M.D., the first annual Dev A. GnanaDev Membership Award. The award, made possible thanks to a generous endowment from CMA Past President Dev A. GnanaDev, M.D, will be presented annually to CMA members who have helped to grow CMA membership.
Dr. Imbasciani , a urologist at the Department of Genitourinary Surgery at Kaiser Medical Center, West Los Angeles, is a CMA Trustee who has made a concerted effort to increase CMA membership among his physician colleagues.
Since 2008, Dr. Imbasciani has worked tirelessly to inform Permanente physicians of the value that CMA brings to physician practices and patients. In 2010, his efforts were credited with a CMA membership increase of 441 physicians.
Dr. Imbasciani also serves as a colonel in the National Guard and has been abroad several times caring for America's combat troops. He donated his $500 award to the Butte-Glenn Medical Society in honor of Dr. Layne, his co-recipient, who he said "probably had to work a lot harder to get her members."
Dr. Layne, a family practice physician in Chico, has made membership growth in both CMA and the Butte-Glenn Medical Society (BGMS) her focus for the past four years.
"She believes in organized medicine and believes that it is the responsibility of her colleagues to join in the mission," said BGMS President Mark Lundberg, M.D., when he nominated Dr. Layne for the award.
Dr. GnanaDev is medical director and chairman of the surgery department at Arrowhead Regional Medical Center (ARMC) in Colton, CA.
8. Nominate an outstanding colleague for CMA Foundation Leadership Awards
The CMA Foundation is accepting nominations for the 2011 Leadership Awards, which celebrate the efforts of individuals or organizations that make a difference in the health of Californians. The Robert D. Sparks, M.D., Leadership Award, the Ethnic Physician Leadership Award, and the Adarsh S. Mahal, M.D., Access to Health Care and Disparities Award recognize the compassion and commitment of California's health care professionals. The deadline to submit nominations is June 23. Nomination information and packets for each award are available at the CMA Foundation website.
Contact: Carol Lee, (916) 779-6622 or clee@thecmafoundation.org.
9. Leadership and control of ACOs subject of Leadership Academy debate
Leadership and control of Accountable Care Organizations (ACOs), a health care delivery and payment model incentivized under the federal health reform law, will be a topic of debate at the 14th Annual California Health Care Leadership Academy. The Leadership Academy convenes June 3-5, 2011 at the Renaissance Esmeralda Resort in Indian Wells.
This year's Academy, "The Next Step: Successfully Negotiating Health Reform," will focus on ACOs and other aspects of implementing federal health reform. Harold Miller, Executive Director of the Center for Healthcare Quality and Payment Reform, and Duane Dauner, CEO of the California Hospital Association, will present differing views on whether physicians or hospitals are best suited to lead and control ACOs and other models of "physician-hospital alignment."
Other Academy sessions will offer guidance to physicians on assessing alignment opt-in offers and strategies for independent physicians to compete in the new environment.
In addition to policy discussions, a variety of nuts-and-bolts practice management workshops will be offered.
For more information and to register, visit the Leadership Academy website or call (800)795-2262. Registrations received on or before May 6 qualify for a $100 early-bird discount.
10. CMA schedules conferences to help physicians succeed in health reform era
Physicians face dramatically different market and economic forces created by passage of the Patient Protection and Affordable Care Act (ACA). The sweeping health reform law mandates a host of payment reforms and calls for creation of new physician networks organized to improve quality of care and reduce cost.
To assist independent physicians in navigating these uncharted reform waters, the California Medical Association (CMA) is working with county medical societies and associations to schedule a series of conferences called "Strategies for Independent Physicians to Collaborate and Succeed in the Era of Reform."
The conferences, the first of which is in San Francisco on April 30, 2011, will provide information on the various business models that can help physicians pool their talents to effectively compete in the new health care marketplace. Topics also will include ways to provide improved quality of care through clinical integration, and whether it is feasible to form physician-led networks, including new Accountable Care Organizations (ACOs).
At each conference, a comprehensive resource manual will be provided. Items included will be:
- A checklist enabling physicians to analyze their local market conditions to see what opportunities/organizational structures are most practical;
- An identification of various business models to consider, as well as an analysis of the economic efficiencies that can be achieved by forming an organization;
- A discussion of the tools needed to improve quality, maximize reimbursement, and clinically integrate for the purposes of joint contracting under the antitrust laws
- Health information technology (HIT) as a fundamental practice tool, HIT readiness and financing opportunities;
- Legal issues to consider when partnering with hospitals.
Conference Schedule
San Mateo: The first conference, hosted by the San Mateo County Medical Association, 777 Mariners Island Blvd., Ste. 100, San Mateo, CA, will be held Saturday, April 30, 2011, from 9 a.m. to 2 p.m.
Other sponsors include the San Francisco Medical Association, the Santa Clara County Medical Association, the Santa Cruz County Medical Association and the Monterey County Medical Association. The conference is free to association members.
Contact: Astrid Meghrigian, (415) 350-3966 or ameghrigian@cmanet.org.
Oakland: Conference number two, hosted by the Alameda-Contra Costa Medical Association, 6230 Claremont Avenue, Oakland, CA, will be held Saturday, May 7, 2011, from 10 a.m. to 2 p.m. Other sponsors include the Solano County Medical Society, the Napa County Medical Society, Sonoma County Medical Society and Marin Medical Society. The conference is free and open to members only.
Contact: Ashleigh Strasheim, (415) 924-3891 or ashleigh@marinmedicalsociety.org.
Fresno: Conference number three, hosted by the Fresno/Madera Medical Society, 1382 East Alluvial Ave., Suite 106, Fresno, CA, will be held Wednesday, May 11, 2011, from 6 p.m. to 9 p.m. The Kern County Medical Society also is sponsoring the conference, which is free to society members. There is a $20 charge for each guest.
Contact: Sandy Palumbo, (559) 224-4224.
French Camp: Conference number four, hosted by the San Joaquin Medical Society, will be in the Community Room for the Health Plan of San Joaquin at 7751 South Manthey Road, French Camp, CA, on Saturday, May 14, 2011, from 8:30 a.m. to 2 p.m. Other sponsors include the Stanislaus County Medical Society, Sierra-Sacramento Medical Society, Tuolumne County Medical Society, and the Merced-Mariposa Medical Society.
Contact: (209) 952-5299.
11. Webinar (4/20): What ACO rules mean for physicians
The Centers for Medicare & Medicaid Services (CMS) recently released proposed regulations for the Medicare accountable care organization (ACO) program. The American Medical Association (AMA) is hosting a webinar on April 20, 2011, at 4 p.m., to provide information about the major provisions of the proposed regulations.
AMA members and Federation staff can register for free. Nonmembers can register for $39. Register for the webinar.
Contact: Elizabeth McNeil, (415) 310-2877 or emcneil@cmanet.org.
12. Webinar (5/4): Dealing with Sensitive Personnel Issues
A discrimination or harassment complaint can lead to huge legal expenses and a massive jury verdict. Please join us for an informative webinar "Dealing with Sensitive Personnel issues," presented by Debra Phairas of Practice and Liability Consultants. This program is an informative discussion of state and federal laws and best practices managers can use for handling difficult employee issues. Phairas will also discuss the dos and don'ts for avoiding lawsuits.
The one hour webinar will be presented twice on May 4, 2011, at 12:15 p.m. and again at 6:15 p.m. For more information or to register, visit the events page.
Contact: CMA member help center, (800)786-4262 or memberservice@cmanet.org.
13. Featured Member Benefits:
Security Prescriptions
CMA members receive 15 percent off tamper-resistant security prescription pads and printer paper from Rx Security. For more details, visit http://www.rxsecurity.com/cma.php.
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 the member benefits page or call 800/786-4CMA (4262) to get the link.
Magazine Subscriptions
Members receive 50 percent off subscriptions to hundreds of popular magazines, with a best price match guarantee. Visit http://www.buymags.com/cma for details.
For more information on these and other member benefits, click here or contact CMA at memberservice@cmanet.org or (800) 786-4262 (4CMA).