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Top Story: Urge Governor Brown to veto breast density notification bill
The California Medical Association, the American Congress of Obstetricians and Gynecologists – District IX, the Medical Oncology Association of Southern California and the Association of Northern California Oncologists are urging Gov. Jerry Brown to veto a bill on his desk that would require physicians to notify mammography patients with highly dense breasts about the density of their breast tissue and the possibility that they may require additional imaging services (including ultrasound or MRI).
Also in this issue:
- Help set CMA policy: All members invited to provide online testimony on this year's resolutions and reports
- FAQ: How long do you need to keep medical records?
- U.S. Supreme Court hears oral arguments in Medi-Cal lawsuit
- MedPac mulls SGR repeal with 10-year payment freeze
- Last chance to stop Medicare cuts: Tell Congress that repealing the SGR makes economic sense
- IOM offers additional ideas for revamping Medicare geographic payment formula
- There's still time to RSVP for the 15th Annual President's Reception and Awards Crystal Gala
- Expecting a CALS survey in 2012? Register today for IMQ's PreCALS conference
- Earn free CME at CollaborativeCARE Conference, November 15-20 in Long Beach
- Upcoming webinars:
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.
Magazine Subscriptions: Members receive 50 percent off subscriptions to hundreds of popular magazines, with a best price match guarantee.
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1. Urge Governor Brown to veto breast density notification bill
The California Medical Association (CMA), the American Congress of Obstetricians and Gynecologists – District IX, the Medical Oncology Association of Southern California and the Association of Northern California Oncologists are urging Gov. Jerry Brown to veto a bill on his desk that would require physicians to notify mammography patients with highly dense breasts about the density of their breast tissue and the possibility that they may require additional imaging services (including ultrasound or MRI).
While the intent of the bill (SB 791) is to give women more power and control over their health, the legislation is vague, without scientific backing and outlines a course of action that is in many cases unnecessary. Because the scope of who must receive the notice is so broad, it will lead thousands—and possibly millions—of women to believe that that their mammograms aren't providing accurate enough information and that they need additional expensive screenings. The notices would lead to substantial cost increases that would hugely impact state funded programs like Every Woman Counts.
Because high breast density is not currently by itself a risk factor for cancer in medical guidelines, in cases where prior authorization is required for additional screening, the tests may not be covered—imposing undue cost burdens on the patient.
For the state to mandate that information be provided to patients, the information must be clear. There is not yet clarity on what "dense breasts" means and what should be done clinically. CMA doesn't believe it makes sense to mandate language that suggests women may need additional screening without this medical clarity.
"As part of the mammography report, the radiologist already reports density information to the referring physician," says CMA President James. G. Hinsdale, M.D. "The patient's physician should consider dense breasts as a factor along with other risk factors, such as age, history of breast cancer in family and prior mammograms."
Information is voluntarily being collected through the national American College of Radiology Breast Imaging Reporting and Data System to enable data analysis so that it will become clearer about what actions should be taken in the case of high breast density. Once data is sufficient, professional medical guidelines will change to reflect this new information.
Physicians are asked to call the governor's office (916/445-2841) or visit the governor's website and urge him to veto this bill.
Contact: Carolyn Ginno, (916) 551-2547 or cginno@cmanet.org.
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2. Help set CMA policy: All members invited to provide online testimony on this year's resolutions and reports
The California Medical Association's annual House of Delegates (HOD) will convene in Anaheim October 15-17. The HOD is CMA's legislative body and establishes the policies that govern the association.
At this year's meeting, physicians from across the state will debate and set policy on important health care issues including vaccinations, disaster preparedness, health information technology, and peer review.
During the three-day meeting, the 500 delegates will address more than 100 resolutions on these and other key issues that affect the practice of medicine.
CMA invites all members to visit its online forum to discuss or comment on the resolutions and reports that will be considered by the delegates. To participate in the online discussion, log in to your web account and click on "My Account" at the top of the page. Once there, you will see a button on the left side called "House of Delegates."
To provide online testimony on resolutions and reports, click on the "Resolutions and Reports" tab, and then click on the "Post Comment" button below any of the resolutions on which you wish to provide testimony. You can also download the reports and resolutions in both Word (.doc) and Acrobat (.pdf) formats by clicking on the "Documents" tab.
Written testimony will be accepted until October 7, 2011.
If you have any questions, please contact the CMA member help center at (800) 786-4262 or memberservice@cmanet.org.
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3. FAQ: How long do you need to keep medical records?
Medical record retention is an issue that routinely arises in a physician's medical practice and one that should be evaluated when you are developing appropriate office policies and procedures. In California, there are several statutory authorities that specifically regulate the retention of medical records. For instance, a physician who treats Medi-Cal patients must retain the records of Medi-Cal patients for three years after the date that the last service was rendered under the Medi-Cal program, while physicians who are Qualified Medical Examiners in Workers' Compensation cases must retain all medical-legal reports for five years from the date of the employee's evaluation.
As there are differing statutory requirements, potential contractual obligations, and the California statute of limitations on when a suit may be filed for professional negligence, CMA offers several recommendations for possible retention periods in its medical-legal document #1160, "Retention of Medical Records."
Document #1160 also includes recommendations for physicians who may be retiring or closing their practice, appropriate protocols to follow when destroying medical records, and the proper safeguards that should be implemented to comply with HIPAA and California law.
Medical-legal document #1160, "Retention of Medical Records," as well as the rest of the CMA medical-legal library (formerly CMA On-Call), 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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4. U.S. Supreme Court hears oral arguments in Medi-Cal lawsuit
Today, the United States Supreme Court will hear oral arguments in a case that could have huge implications for the more than 10 million patients currently enrolled in California's Medicaid program, and for the physicians who treat them. The California Medical Association (CMA) is a party in the case.
At issue in this case, Douglas v. Independent Living Center of Southern California, is whether patients, physicians and other providers have the right to file suit against government officials for failing to comply with federal Medicaid law. The court is currently reviewing a lower court ruling that blocked the State of California from cutting Medi-Cal physician payments by 10 percent in 2008.
CMA believes the proposed cuts are illegal because, among other reasons, they violate federal access-to-care standards. States are required by law to set provider payment rates at a level that ensures Medi-Cal patients have the same access to physicians and other health care providers as the general insured public.
The 9th Circuit Court of Appeals previously upheld a federal trial court's July 2009 injunction, which found that the cuts would irreparably harm access to health care for the most vulnerable Californians and were enacted in violation of federal Medicaid laws.
California's Medi-Cal rates are already nearly the lowest in the nation. Currently, half the doctors in California cannot afford to participate in the program and 56 percent of Medi-Cal patients can't find a doctor.
Unable to find a physician, many Medi-Cal patients are forced to seek care in already overcrowded and increasingly scarce hospital emergency departments, where the cost of care is much higher. By the time patients end up in the ER, their health conditions have deteriorated and are much more costly to treat.
"The issue before the U.S. Supreme Court is crucial to the future of how patient advocacy will unfold," says San Diego physician Theodore Mazer, M.D. "If patients can't fight for themselves, and as physicians, we can't either— then who is left to stand up for the group of people that needs our help the most?"
Dr. Mazer, an ear, nose and throat physician, treated Medi-Cal enrollees for over 20 years until the state began seeking reimbursement cuts. Eighteen months ago, he stopped accepting new Medi-Cal patients. He is an individual party in the lawsuit. "It's unfortunate that the state has made us choose between accepting new Medi-Cal patients and keeping our practices viable," he says.
The gaping hole in California's safety net will be further exacerbated as there will be 3 million uninsured who will be newly eligible for Medi-Cal in 2014 under the federal health reform legislation. If the state is allowed to cut Medi-Cal rates, California will not have the provider capacity to care for the influx of new Medi-Cal patients.
As the Supreme Court hears this case, the Centers for Medicare & Medicaid Services (CMS) is also considering a number of state plan amendments submitted by the State of California. The state is asking for permission to implement drastic cuts to the Medi-Cal program, including a 10 percent provider rate cut, mandatory patient copayments, and a cap of seven physician office visits per year for beneficiaries.
Although CMS was due to make a decision on the state's requests last week, the agency on Wednesday submitted an official request to the state of California for underlying documentation to support its position that the cuts will not negatively affect access to care for Medi-Cal beneficiaries. CMA has also repeatedly requested this information from the California Department of Health Care Services (DHCS), which administers the Medi-Cal program. DHCS has thus far been unwilling or unable to provide the requested data, prompting CMA and other provider groups to take legal action under the California Public Requests Act.
CMA has been in close communication with CMS on these issues and will continue to work hard to ensure that all Californians have access to quality care when they need it.
Contact: Francisco Silva, (916) 444-5532 or fsilva@cmanet.org.
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5. MedPac mulls SGR repeal with 10-year payment freeze
The Medicare Payment Advisory Commission (MedPAC) recently issued a draft proposal that would repeal the Medicare sustainable growth rate (SGR) and pay for it by freezing or cutting physician reimbursement for the next 10 years. Under the proposal, primary care physicians would see their payments frozen at current levels for 10 years, while specialists would have their pay cut by 5.9 percent a year for the next three years, followed by a seven year freeze. These cuts and freezes are part of a proposal to eliminate the SGR and avert the 29.5 percent physician pay cut that the formula mandates on January 1, 2011.
MedPAC, which advises Congress on Medicare payment policy, estimates that its SGR repeal would cost about $200 billion. The cost would be offset by cuts to physicians, Medicare Part D drug plans, post-acute care facilities, hospitals, laboratories, durable medical equipment, Medicare Advantage, and others. Medicare patients would also see their benefits cut by 14 percent.
This is the first time in a decade that MedPAC is not recommending a payment increase for physicians. The California Medical Association (CMA) is extremely concerned about this sudden departure from past MedPAC policy, which demonstrates the difficult fiscal environment that we are facing as we fight to once and for all repeal the SGR. Although there seems to be the political will to repeal the fatally flawed formula, the enormous price tag will make any proposal controversial.
CMA, AMA, and others in organized medicine strongly oppose the MedPAC proposal. A long-term payment freeze in an era of 6 percent average annual practice cost increases essentially equates to a significant payment cut. The freeze, plus the 5.9 percent cuts to specialists, will be devastating for seniors trying to find a physician in California.
MedPac is scheduled to vote on this proposal, which is expected to be fleshed out in more detail in the coming weeks, when it meets again in early October. Stay tuned for more details.
Contact: Elizabeth McNeil, (415) 882-3376 or emcneil@cmanet.org.
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6. Last chance to stop Medicare cuts: Tell Congress that repealing the SGR makes economic sense
The California Medical Association (CMA) is joining the American Medical Association, state medical associations and national medical specialty societies in a united campaign to get a permanent repeal of the flawed Medicare sustainable growth rate (SGR) formula included in the deficit reduction package that is currently being developed by Congress’ Joint Select Committee on Deficit Reduction.
CMA is urging physicians to join us in this effort and tell Congress that repealing the SGR not only ensures patients can see a doctor when they need one, but that it also makes economic sense.
CMA believes that this could be the last realistic opportunity to repeal the SGR because of the huge price tag. “It’s now or never,” says CMA President James G. Hinsdale, M.D. “We are in the last sprint of the SGR marathon, and physicians need to engage to make this happen.”
CMA is asking Congress to repeal the SGR and work with us over the next few years to test and develop alternative payment models and health care delivery systems that ensure access to efficient, appropriate, high-quality, coordinated care.
CMA and the rest of the coalition believe that any effort to stabilize our nation’s finances must be based on a true assessment of future expenditures. The current budget baseline, however, assumes that massive physician payment cuts will be implemented, even though Congress has rejected such cuts 12 times over the past decade. What initially were annual cuts of just a few percent have ballooned into a 30 percent across-the-board payment cut to physician reimbursement, scheduled for January 1, 2012.
There is unanimous agreement that cuts of this magnitude would result in serious disruptions in care for the nation’s elderly and disabled populations, and cannot be allowed to occur. Bypassing this issue or passing another short-term fix simply drives up the cost of a long-term solution.
The cost of physician payment reform has been growing over the years as Congress enacted frequent short-term fixes. As recently as 2005, the cost of permanent reform would have been $48 billion, but today it is estimated to be nearly $300 billion over the next 10 years. If action is not taken now, the cost will continue to escalate to nearly $600 billion in only a few short years.
The deficit reduction committee is also considering proposals that would reduce federal matching funds for California’s Medi-Cal and Healthy Families programs. These reduced federal expenditures would force California to further reduce physician payment rates and increase patient copayments. CMA and the physicians of California are extremely concerned that additional cuts to already low payment rates will exacerbate the current access to care problems and cause irreparable harm to patients.
Congress needs to realize that physicians are not only vital to the health and well-being of patients, but they are also crucial to the California economy. Physicians in California employ more than 500,000 people and are substantial contributors to the state and federal tax base. Maintaining stable Medicare and Medi-Cal payment rates keeps physicians in practice and prevents further unemployment and economic erosion.
Please contact your local congressional representative, Congressman Xavier Becerra (the only Californian on the 12-member committee), and California Senators Barbara Boxer and Dianne Feinstein today and tell them that physicians are vital to the health and economic well-being of Californians.
For additional background on these issues, including talking points, sample letter and contact information for your Members of Congress, see CMA’s SGR advocacy campaign kit. CMA has also prepared a poster for you to place in your office and a flyer that you can copy and give to your patients, asking them to urge their Member of Congress to stop the Medicare cuts and protect their access to doctors.
Contact: Elizabeth McNeil, (415) 882-3376 or emcneil@cmanet.org.
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7. IOM offers additional ideas for revamping Medicare geographic payment formula
The Institute of Medicine (IOM) last week released the second edition of its study on the Medicare geographic payment formula. The latest report includes additional ideas for overhauling Medicare’s geographic payment system, which is used to adjust for geographic variation in costs when calculating payments for physicians and hospitals. The new recommendations, intended to supplement but not replace those released in June, focus on methods for setting the work adjustment, calculating the labor portion of the practice expense and using cost-share weights. The California Medical Association (CMA) thanks IOM for their rigorous analysis of these complex issues.
For years, CMA has been urging Congress to reform the flawed and outdated geographic payment regions. CMA testified before the IOM on this issue last fall. The costs of running a physician's practice differ substantially across the country, and failing to take that into account in Medicare payments is a big mistake that harms senior citizens' access to care, CMA said in its testimony. CMA applauds the IOM for recognizing those differences and developing thoughtful recommendations that factor in the variations.
“The current system is outdated and not distributing payments accurately,” says CMA President James G. Hinsdale, M.D. “A great example is San Diego—a county that is still designated as rural and clearly is not. Our belief at CMA is that payment accuracy will help to improve seniors’ access to care in these underpaid regions. Therefore, we urge the Centers for Medicare and Medicaid Services (CMS) and Congress to adopt the IOM’s recommendation to consolidate the physician and hospital payments regions into Metropolitan Statistical Areas.”
During the health care reform debate, IOM was asked by the U.S. House of Representatives and the U.S. Department of Health and Human Services (HHS) to make recommendations on how to improve the accuracy of the Geographic Practice Cost Index (GPCI), which is used to determine Medicare payments.
The IOM committee has concluded that the rationale for fine-tuning Medicare payments based on geographic variations in expenses is sound and should be continued. However, the report urges fundamental changes to the data sources and methods used to calculate the adjustments and increase payment accuracy.
One such change recommended by the committee would be to place physicians and hospitals into the same Metropolitan Statistical Areas, which reflect regional costs more accurately than the outdated payment localities that are currently used to determine reimbursement. In California, for example, the physician payment localities haven't been updated in more than 12 years, leaving many recently urbanized counties inappropriately grouped into payment localities with lower-cost (mostly rural) counties.
Additionally, the committee recommended that Congress standardize the labor markets and the wage and benefits indexes used to adjust Medicare payments for hospitals and physicians. CMA agrees with IOM that the Bureau of Labor Statistics is the appropriate source for this data, and that it should be broadened to include the full range of occupations employed in physician offices today, such as health information technology experts.
IOM also recommended that a new source of data be developed to more accurately determine the price of commercial office rent for physicians. CMA is, however, urging CMS to continue using existing HUD data until a better data source can be developed.
Importantly, IOM recommended that public policy goals, such as improving access to care in rural physician shortage areas, should be addressed, but not through the Medicare geographic payment formula.
“CMA looks forward to a continued working relationship with IOM on these difficult and technical Medicare payment issues,” says Dr. Hinsdale. “We share IOM’s goal to base Medicare payments on accurate data that is applied fairly in all regions of the country.”
IOM is expected to release a final report in the spring that will present the committee's evaluation of the effects of the adjustment factors on health care quality, population health and the distribution of the health care workforce.
Contact: Elizabeth McNeil, (415) 882-3376 or emcneil@cmanet.org.
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8. There's still time to RSVP for the 15th Annual President's Reception and Awards Crystal Gala
The California Medical Association (CMA) and the CMA Foundation invite you to attend the 15th annual President's Reception and Awards Crystal Gala, Sunday, October 16, at the Marriott Hotel in Anaheim. The gala will take place during CMA's annual House of Delegates meeting.
Honored at the dinner will be incoming CMA President James T. Hay, M.D., and the recipients of the CMA Foundation Leadership Awards.
Attendees will be treated to a special show by renowned performance painter David Garibaldi, followed by a private concert from big-band legends Big Bad Voodoo Daddy. Complimentary childcare and shuttle to and from the event will be available.
Tickets are on sale now for $125 per person, or $1,000 for a table of 10. Proceeds will support the CMA Foundation's work linking physicians and their communities to raise awareness about important public health issues.
The deadline to RSVP has been extended to October 7.
For more information or to RSVP, visit the CMA Foundation website.
Contact: Shelley Tirsbek, (916) 779-6662 or stirsbeck@thecmafoundation.org.
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9. Expecting a CALS survey in 2012? Register today for IMQ's PreCALS conference
The Institute for Medical Quality's 2012 PreCALS Conference will be October 27-28, 2011, at the Hilton Orange County in Costa Mesa.
The conference is a must for medical staff leadership and hospital personnel preparing for the 2012 California accreditation and licensure survey (CALS). Medical staff teams (chiefs of staff, committee chairs, quality-management personnel, and medical staff directors and coordinators) are encouraged to attend.
This conference provides essential information for medical staff leadership and hospital personnel responsible for:
- Implementing new or revised accreditation and licensing requirements in clinical departments;
- Granting privileges for telemedicine providers, aging physicians or physicians with low volume or no admissions;
- Applying leadership standards to their medical staff self-governance;
- Complying with the standards most frequently cited in California as noncompliant; and
- Preparing a medical staff for an unannounced survey.
For more information, visit the IMQ website.
Contact: Leslie Anne Iacopi, (415) 882-5167 or liacopi@imq.org.
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10. Earn free CME at CollaborativeCARE Conference, November 15-20 in Long Beach
The California Medical Association (CMA) has partnered with the CollaborativeCARE
Conference (C3) to provide CMA members with free access to world class continuing medical education.
Join us for the inaugural C3 conference, November 15-20, 2011, at the Long Beach Convention Center and earn up to 24 AMA Category 1 Credits™ – free of charge. And be sure to visit the CMA booth on the exhibit floor.
C3 delivers an integrated curriculum designed to enhance care coordination and improve patient health. You will have the opportunity to attend live education sessions that not only are unbiased, evidence based and expertly informed, but also will foster coordinated care leading to better outcomes for your patients.
As a valued CMA physician, you can attend the Long Beach event free of charge and your registration fee for all future C3 events will be waived.
For more information, including speakers, topics and registration, visit www.ccconference.com.
Contact: C3, (877) 303-0719 or c3lb11@compusystems.com.
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11. Upcoming webinars
10/5: Providing Extraordinary Customer Service: Participants will learn how to use form letters, scripts and other easy-to-use tools to help break through the limits of ordinary communication and outdated work habits and improve overall customer service and personal fulfillment.
The one-hour webinar will be October 5 at 12:15 p.m..
10/6 and 10/11: Estate Planning Series: What will happen to your practice and your family upon your death or disability? This two-part webinar series will cover the various aspects of estate planning, with particular attention to the specific needs of physicians.
Part one of the series will be October 6 at 12:15 p.m., and part two is October 11 at 12:15 p.m.
10/12: ICD-10: This webinar will cover what you need to do now to prepare for the ICD-10 transition, which will introduce more than 200,000 new diagnosis codes effective in 2013. The new codes will be much more descriptive, requiring a good understanding of both anatomy and medical terminology.
This program will give you a jump start by explaining the new characteristics and how they differ from today’s ICD-9 coding system.
The one-hour webinar will be presented twice on October 12, at 12:15 p.m. and again at 6:15 p.m.
To register for either of these webinars, visit the CMA event calendar.
Contact: CMA's member help center, (800) 786-4262 or memberservice@cmanet.org.
12. 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 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 CMA's website 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 www.buymags.com/cma for details.
Contact: CMA member help center, (800) 786-4262 or memberservice@cmanet.org.