CMA - California Medical Association

Top Story: Immediate action required to avoid the 1% e-prescribing penalty in 2012

A change in Medicare law will penalize physicians beginning in 2012 if they don't implement and employ a qualified e-prescribing system in the first six months of 2011. READ MORE

Also in this issue:

• CMA convenes forum to provide independent physicians with strategies to succeed under health reform
• Have you updated your CMA "Find a Physician" profile yet?
• Congress to get Medicare private contracting legislation
• CMA publishes resources to help physicians transition to the new HIPAA 5010 transaction standards
• CMA CEO and top lobbyist named among California's political power brokers
• Palmetto GBA to conduct E&M audit
• Leadership Academy early bird deadline is Friday, May 6
• Hospital accreditation organization standards
• Webinar (5/4): Dealing with Sensitive Personnel Issues
• Nominate an outstanding colleague for the CMA Foundation Leadership Awards

Featured Member Benefit:

EHR Best Practice Series Webinars
To help members begin to assess their HIT needs, CMA has partnered with Maxwell IT to provide members with complimentary registration to the EHR Best Practices Series webinars. READ MORE

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1. Immediate action required to avoid the 1% e-prescribing penalty in 2012

A change in Medicare law will penalize physicians beginning in 2012 if they don't implement and employ a qualified e-prescribing system in the first six months of 2011.

In 2009, Medicare introduced an e-prescribing program that encourages physicians to electronically transmit their prescriptions. The e-prescribing program provides payment incentives for physicians who e-prescribe and payment penalties for physicians who do not. Starting in 2012, Medicare will impose a 1 percent payment reduction penalty on all Medicare allowed charges for eligible professionals who do not electronically transmit their prescriptions. The penalty increases to 1.5 percent in 2013 and 2 percent in 2014.

The 2012 payment reduction penalty will be determined by e-prescribing activity between January 1 and June 30, 2011. To avoid the penalty in 2012, 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.

For more information, see CMA's 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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2. CMA convenes forum to provide independent physicians with strategies to succeed under health reform

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 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 will also 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:

• A checklist enabling physicians to analyze their local market conditions to see what opportunities/organizational structures are most practical;
• A list 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
Oakland: This conference, hosted by the Alameda-Contra Costa Medical Association, 6230 Claremont Avenue, Oakland, CA, will be held Saturday, May 7, 2011, from 9 a.m. to 2 p.m. Other sponsors include the Solano County Medical Society, 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: This conference, hosted by the Fresno/Madera Medical Society, 1382 East Alluvial Avenue, 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 members. There is a $20 charge for each guest.
Contact: Sandy Palumbo, (559) 224-4224.

French Camp: This conference, 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 Merced-Mariposa Medical Society.
Contact: (209) 952-5299.

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3. Have you updated your CMA "Find a Physician" profile yet?

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. One of the new features is our "Find a Physician."

To make sure that patients and your physician colleagues can find you using the Find a Physician search, we encourage you to log in to your web account and verify that your profile is complete and accurate.

You will also be able to specify what information you want to make public, what information you want available to members only, and what information you do not want shared at all.

Once you have logged in to your account, the process for updating your profile is as follows:

1. Visit your account dashboard by clicking on "My Account" at the top of the page.
2. In the left column, click "Edit Profile."
3. You will then see five tabs of information: basic information, address and phone, education, bio, and web account. Review each tab, make any changes necessary, and then click "save." Note: The fields that will appear in your website profile are marked with two check boxes, "public" and "members." If you would like a piece of information to be visible only to your physician colleagues, check "members." If you would like it to be available to both patients and physician colleagues, check both.

If you do not want to appear at all in the physician directory, please contact the CMA member help center at (800) 786-4262 or memberservice@cmanet.org.

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4. Congress to get Medicare private contracting legislation

The California Medical Association is urging the California Congressional Delegation to cosponsor a bill giving Medicare seniors increased freedom to see the physician of their choice. The Medicare Patient Empowerment Act will be introduced next week by Representative Tom Price, M.D., and would allow seniors to independently contract with a physician while retaining their Medicare coverage.

Under this legislation Medicare would pay its fair share of the medical services and allow patients, who voluntarily agree, to pay the rest. Current law stipulates that physicians must opt-out of the Medicare program entirely for two years if they want to privately contract with seniors. CMA was actively involved in crafting this legislation, which will help preserve choice and access in the Medicare system at no additional cost to the government.

Contact: Elizabeth McNeil, (415) 882-3376 or emcneil@cmanet.org.

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5. CMA publishes resources to help physicians transition to the new HIPAA 5010 transaction standards

A new version of Health Insurance Portability and Accountability Act (HIPAA) transaction and code set standards become effective on January 2, 2012. On that date, all covered electronic health care transactions will have to comply with the new 5010 standards. It is critical that physicians start preparing for the transition to the new 5010 transaction standards to avoid rejected claims and cash flow interruptions.

The HIPAA standards govern transactions involving claims and encounter information, payment and remittance advice, claims status, eligibility, enrollment and disenrollment, referrals and authorizations, and premium payment. If a covered entity conducts one of these transactions electronically, it is required to use the adopted standard, including standard code sets to identify diagnoses and procedures. Non-compliance with the HIPAA transaction standards may result in fines, exclusion from Medicare, and nonpayment of claims.

To assist physicians in this transition, CMA has published resource sheet, "Are you ready for the Transition to HIPAA Version 5010?" The sheet, which includes practice tips for implementation from the American Medical Association and a list of additional resources for physicians, is available free to members in CMA's resource library.

For more information, see also CMA medical-legal document #1606, "HIPAA Electronic Transaction Rule." Medical-legal documents are free to members in CMA's online resource library. Nonmembers can purchase medical-legal documents for $2 per page.

Contact: Samantha Pellon, (916) 551-2872 or spellon@cmanet.org.

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6. CMA CEO and top lobbyist named among California's political power brokers

CMA CEO Dustin Corcoran and CMA Vice President of Government Relations Jodi Hicks were both named to Capitol Weekly's Top 100, an annual ranking of the most powerful players in California politics. Corcoran, ranked #45, and Hicks, ranked #19, were two of only a handful of health care heavyweights named to the list.

"CMA, long a powerful force in the Capitol, has political smarts and is not afraid of a fight," Capitol Weekly stated in the article announcing its Top 100.

"Dustin and Jodi's unwavering commitment to California physicians and the patients they serve is evident in this recognition," says CMA President James G. Hinsdale, M.D. "Also indisputable is the respect they have with legislators as they strive to find solutions and compromise on often complex issues."

Corcoran has advocated tirelessly for California physicians and patients since 1998 when he joined CMA as the membership coordinator for its political action committee. For six years, Corcoran worked as a staff lobbyist, responsible for bills related to access to care, emergency medicine, hospitals, tobacco usage, public health and health care system reform. Corcoran went on to lead CMA's lobbying efforts for five years before becoming deputy CEO in 2009 and then being named CEO in January of last year.

Corcoran was named the most effective lobbyist under 40 in 2005 by Around the Capitol and has been named to Capitol Weekly's Top 100 list of the most powerful political brokers in California for three years running.

When Corcoran was promoted to CEO of the California Medical Association last year, he appointed Hicks his successor as the association's chief lobbyist. Hicks, the first woman to hold the post, joined CMA in 2006 as a staff lobbyist after serving as legislative director for the California chapter of the National Organization for Women. This is Hicks' second showing on the Top 100 list.

"Jodi exhibits grace under pressure daily as she moves from friendly to often contentious battles on corporate bar, medical malpractice and scope issues," says Corcoran. "She knows how to read the field and CMA members and I are proud she is in our corner."

Other health care industry professionals named to the list:

• Diana Dooley, Health and Human Services secretary (#7)
• Kim Belshe, former Health and Human Services secretary under Gov. Schwarzenegger and a current member of the new health insurance exchange board (#72)
• Liz Snow, chief operating officer of the California Dental Association (#73)
• Kassy Perry, president and CEO of Perry Communications Group, which represents a number of health care companies, including Aetna, GlaxoSmithKline, and Johnson & Johnson (#92)

Contact: CMA member help center, (800) 786-4262 or memberservice@cmanet.org.

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7. Palmetto GBA to conduct E&M audit

The Palmetto GBA Medical Review department will be performing a prepayment review of CPT code 99214 billed by physician specialties in cardiology, family practice, and internal medicine. Palmetto identified that California physicians are two to three standard deviations above the norm as compared to other jurisdictions. This is not an audit of individual physicians, but a random sampling of three to four claims for each provider selected.

If you are selected for sampling, requests for medical records will be sent to your practice. Physicians must respond to the requests for medical records or the claims will be denied. CMA suggests that physicians personally review the records returned to Palmetto in order to assure that there are no clerical errors. Records should include:

• Legible copy of the patient's medical record for the listed date(s) of service
• Physician signature and credentials, or an attestation statement to authenticate if the signature is not legible.
• Medication list
• Patient name and date of service on each office note
• Consultation report or progress notes
• Any diagnostic test results that help substantiate the level of service

Common problems that have accounted for 50 percent of claim denials are the result of missing signatures and illegible records. Lack of response from physicians is also a leading cause of denial. Physicians in the specialties mentioned above should look for letters from Palmetto in the mail in the coming weeks.

Contact: Michele Kelly, (213) 226-0338 or mkelly@cmanet.org.

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8. Leadership Academy early bird deadline is Friday, May 6

The early-bird registration deadline for the 14th Annual California Health Care Leadership Academy is Friday, May 6. Registrations received on or before that date qualify for a $100 discount, in addition to any applicable multiple-registration discount for three or more individuals registering together. May 6 is also the new deadline (originally May 2) to receive the guaranteed discounted room rate at the Renaissance Esmeralda Resort in Indian Wells, the host venue for the conference.

The 2011 Leadership Academy will convene June 3-5 and will focus on federal health reform, with emphasis on the restructuring of medical practice and payment, new quality initiatives, the role of health information technology, and physician workforce needs anticipated as a result of the Affordable Care Act. Mark Smith, M.D., M.B.A., president and CEO of the California HealthCare Foundation, will deliver the opening keynote on the challenges of implementing health reform and will moderate a panel of key stakeholder representatives. A slate of practice management and leadership development workshops also will be offered at the academy, along with a special program on strategies for independent physicians to compete and succeed in the era of reform.

The Leadership Academy is produced by CMA and cosponsored by the California Medical Group Management Association and the CMA Foundation. For more information and to register for the conference, log on to the Leadership Academy website or call (800) 795-2262.

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9. Hospital accreditation organization standards

The Joint Commission is no longer the sole accrediting organization of hospitals for Medicare purposes and hospitals are increasingly considering other organizations to accredit them.

Concerns have been raised that these other accrediting organizations do not utilize standards that assure quality of patient care through an explicit requirement that there be medical staff self-governance.

Pursuant to CMA policy (Resolution 625-09), CMA was asked to evaluate to what extent the accreditation standards of these other organizations are consistent with California law, particularly with respect to requirements for an independent self-governing medical staff.

To assist physicians and medical staffs in reviewing these accreditation standards as compared to California law, CMA has created medical-legal document #1248 "Hospital Accreditation Organization Standards Concerning Medical Staff Self-Governance."

As is demonstrated in the document, California law clearly mandates that hospitals have a self-governing medical staff with respect to the professional work performed in their facilities. These laws recognize that only the medical staff has the medical expertise and experience necessary to conduct quality assurance activities integral to patient safety. Accordingly, the Joint Commission has expressly required that medical staffs be self-governing.

Medical-legal document #1248, "Hospital Accreditation Organization Standards Concerning Medical Staff Self-Governance," as well as the rest of the medical-legal library, is available free to members in CMA's online resource library. Nonmembers can purchase medical-legal documents for $2 per page.

Contact: Samantha Pellon, (916) 551-2872 or spellon@cmanet.org.

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10. 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 CMA event calendar.

Contact: CMA member help center, (800) 786-4262 or memberservice@cmanet.org.

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11. Nominate an outstanding colleague for the 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.

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12. Featured Member Benefits:

EHR Best Practice Series Webinars
To help members begin to assess their HIT needs, CMA has partnered with Maxwell IT to provide members with complimentary registration to the EHR Best Practices Series webinars.

A members-only coupon code is required. To get yours visit the benefits page or contact the CMA member help line, (800) 786-4CMA.

For more information on these and other member benefits, click here or contact CMA at memberservice@cmanet.org or (800) 786-4262 (4CMA).

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