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Top Story: SGR deal struck to extend current Medicare reimbursement levels for 10 months
On Tuesday, February 14, 2012, a $20 billion deal on the sustainable growth rate (SGR) was struck, which would protect physicians from the 27.4 percent rate cut to Medicare fee-for-service reimbursement slated to go into effect on March 1, 2012.
Also in this issue:
- CMA lobbies CMS for policy changes; ICD-10 compliance delay announced
- CMA files amicus brief in support of Central Valley whistleblower
- SFMS member selected as 2012 recipient of AAP Martin Gershman Child Advocacy Award
- Obama Administration rejects state's request to impose mandatory Medi-Cal co-pays
- Blue Cross provides clarification on Prudent Buyer amendment
- CMA in Washington to lobby for series of measures that would alter the landscape of medicine in California
- Court awards payments in class action lawsuit against UnitedHealth
- CMA launches new TAC for Medi-Cal and public programs
- Gaining market share of newly insured patients under health reform: a guide for solo and small practices
- Breathing air pollutants raises the risk of having a heart attack
- No whooping cough deaths in 2011 for first time in 20 years
- February is American Heart Month
- Early registration deadline extended for highly acclaimed physician staff leadership program
- Legislative rural caucus to hold informational briefing on the Medi-Cal experience
- Follow the money...register now for the California Health Care Leadership Academy
- Blue Shield launches recontracting initiative
- Upcoming webinars:
Featured member benefit:
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1. SGR deal struck to extend current Medicare reimbursement levels for 10 months
On Tuesday, February 14, 2012, a $20 billion deal on the sustainable growth rate (SGR) was struck, which would protect physicians from the 27.4 percent rate cut to Medicare fee-for-service reimbursement slated to go into effect on March 1, 2012.
Instead of basing the cut on military offset funds available with the drawdown of troops in Iraq and Afghanistan, funds would come from cuts to a prevention program ($5 billion) established under the Affordable Care Act, combined with reducing funding for hospitals with bad debt and reduced Hurricane Katrina Medicaid funding.
Physicians groups have criticized the deal, and the California Medical Association (CMA) was no exception.
“Congress had the opportunity to end the SGR and bring stability to Medicare. Instead they kicked the can down the road,” said James T. Hay, M.D., CMA President, “leaving seniors and member of the military to face serious access problems until after the general elections in the fall.”
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2. CMA lobbies CMS for policy changes; ICD-10 compliance delay announced
Last week, the California Medical Association (CMA) leadership group spoke with Acting Administrator and Chief Operating Officer of the Centers for Medicare & Medicaid (CMS), Marilyn Tavenner, in Washington, D.C., about a number of issues important to California physicians. The discussion included implementation of the International Classification of Diseases Tenth Edition (ICD-10) coding system, scheduled to go into effect in fall 2013. CMA urged CMS to delay the compliance implementation deadline because of the “enormous cost and hassle” for physicians.
It was very gratifying, then, for the delegation to learn that Health and Human Services (HHS) Secretary Kathleen Sebelius announced on February 15 that HHS will postpone the date for ICD-10 compliance.
“We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead,” said Sebelius. “We are committed to working with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”
HHS has not yet announced a new compliance date.
Contact: Elizabeth McNeil, (415) 310-2877 or emcneil@cmanet.org.
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3. CMA files amicus brief in support of Central Valley whistleblower
On February 1, 2012, the California Medical Association (CMA) filed an amicus curiae brief in the California Court of Appeal in support of Mark T. Fahlen, M.D., a Modesto nephrologist who is suing Sutter Central Valley Hospitals, the entity that manages Modesto Memorial Medical Center (where he had staff privileges).
Dr. Fahlen’s case focuses on his rights as a whistleblower under Health & Safety Code section 1278.5, following an established history of reporting nursing errors and insubordination at Modesto Memorial. His observations of patient safety violations were recorded from 2003 to 2008.
As a result of these reports, Dr. Fahlen alleges in his lawsuit, the hospital waged a campaign of retaliation against him culminating in the medical executive committee recommending that he lose staff privileges due to purported "disruptive behavior." After exercising his right to peer review, a joint review committee (JRC) panel consisting of his peers determined that there was no evidence of disruptive behavior that jeopardized Dr. Fahlen's ability to render safe care to patients. Accordingly, the JRC recommended that Dr. Fahlen keep his privileges.
Despite the JRC recommendation, Sutter followed through with the termination in January 2010. Dr. Fahlen’s lawsuit claims that the action took place without proper cause and was retaliation for his raising concerns about patient safety.
The amicus curiae brief
CMA’s brief states that Sutter has chosen to disregard two distinct rules of law in Dr. Fahlen’s case.
First, the brief claims, is the question of whether or not a hospital can ignore a medical staff peer review body’s findings and arbitrarily terminate a physician. Second is the question of whether a whistleblower physician who suffers retaliation must be subjected to the “exhaustion of remedies” requirement before bringing a claim forward under Health & Safety Code section 1278.5. Section 1278.5 protects whistleblowers who raise concerns about, or cooperate in an investigation into, patient safety and conditions at hospitals; it is distinct from Business & Professions Code section 2056, which prohibits retaliation against physicians who advocate for the care of their patients.
In response to the first question, Sutter claims that the committee’s recommendation that Dr. Fahlen retain his privileges, while also acknowledging that some conduct was inappropriate, presents a technical “deficiency” that justifies their rejection of the findings.
In CMA’s opinion, this understanding is incorrect, and Sutter’s decision was conducted “arbitrarily and capriciously,” as findings of inappropriate behavior by a physician standing alone cannot justify termination of privileges. Rather, termination of privileges based on disruptive behavior must be based on a nexus between the behavior and the physician's ability to render care safely.
CMA's amicus brief also takes issue with the position asserted by Sutter that Dr. Fahlen's whistleblower claim is subject to a requirement that he first try to overturn the hospital's decision through a writ of mandate proceeding as if it were any peer review decision. Section 1278.5 provides that a physician can recover for any damages and obtain reinstatement of privileges as remedies against whistleblower retaliation. It is not necessary, CMA argues, that the physician first try to obtain reinstatement in a separate lawsuit because that remedy is specifically provided for in section 1278.5. CMA’s position, which is rooted in a section of the state’s Health and Safety Code section 1278.5, claims that an exemption to the exhaustion of remedies is in order because Dr. Fahlen’s complaint had to do with patient safety, making him a whistleblower.
The court is expected to rule on this case by the end of the year.
Contact: Samantha Pellon, (916) 444-5532 or spellon@cmanet.org.
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4. SFMS member selected as 2012 recipient of AAP Martin Gershman Child Advocacy Award
Shannon Udovic-Constant, M.D., San Francisco Medical Society (SFMS) President-Elect and a pediatrician at Kaiser Permanente San Francisco, was selected as the recipient of the 2012 Martin Gershman, M.D., FAAP Child Advocacy Award. This prestigious award is given annually by District IX (California) of the American Academy of Pediatrics (AAP) to honor a California pediatrician whose long-established commitment to advocacy for children has been demonstrated through community, state or private-sector activities.
Dr. Udovic-Constant is the co-chair of the AAP California Chapter 1 Advocacy Committee. She co-authored SFMS’s “Minor Consent for Prevention of STIs” resolution that was approved by the California Medical Association House of Delegates, American Association of Family Practitioners and American Medical Association, and adopted as AB 499 signed by Governor Jerry Brown in October 2011. The new law allows children ages 12 and older to obtain preventive treatment for sexually transmitted infections (STI) without parental consent.
Dr. Udovic-Constant will be presented with the award at the annual AAP Joint District Meeting in June 2012.
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5. Obama Administration rejects state's request to impose mandatory Medi-Cal co-pays
On February 6, 2012, the Centers for Medicare & Medicaid Services (CMS) rejected California’s request to impose mandatory co-payments for Medi-Cal patients. This attempt by the state to save $511 million in last year’s state budget by slashing Medi-Cal costs featured a $5 copay for physician office and clinic visits, a $50 copay for emergency room (ER) visits and a $100 copay per day for inpatient hospital stays (up to a $200 maximum).
“The Obama Administration has made the right decision. By federal law and our own ethics, physicians must treat patients who come to the ER, regardless of ability to pay. Imposing a mandatory co-payment would have done nothing to address costs or improve patient care. We are pleased that CMS understands that and has rejected the proposal,” said James T. Hay, M.D., California Medical Association (CMA) President.
The proposed copayments exceeded the limits allowed by federal law for Medicaid cost sharing.
“These co-payments would for all intents and purposes be uncollectable, and would have made it even harder for Medi-Cal patients to gain access to the care and medication they need,” Dr. Hay added. “Copayments discourage low-income families from filling prescriptions because they can’t afford it. When patients fail to take their prescription medications correctly, or stop taking their medications altogether, this seriously undermines their quality of life, quality of care, health care outcomes and the value of health care dollars spent.”
The rejection comes just days after Federal Judge Christina Snyder issued her final ruling in CMA et al. v. Douglas.
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6. Blue Cross provides clarification on Prudent Buyer amendment
As previously reported in CMA Alert, Anthem Blue Cross notified contracting physicians of impending changes to its Prudent Buyer Participating Physician Agreement, which become effective April 1, 2012.
The notice, mailed to physicians on December 2011, contains several changes including an expanded confidentiality provision and several changes to Exhibit F, which pertains to the Blue Cross Medicare Advantage PPO product.
The California Medical Association (CMA) had expressed concerns with some of the changes in Exhibit F. In response, Blue Cross has provided the following clarification:
- Section 3.1 holds physicians accountable for audits of “first tier, downstream and related entities.” Blue Cross has clarified that they employ the Centers for Medicare & Medicaid Services definition of these terms.
- Section 3.1 also imposes a hefty financial penalty for failure to allow Health and Human Services, the Comptroller General or their designees the right to timely access to certain books/records. Blue Cross has clarified that this provision was modified pursuant to the Patient Protection and Affordable Care Act, which does include a civil monetary penalty of $15,000/day for each day the organization fails to grant access.
- Section 4.6 requires primary care providers and OB-GYNs to provide or make arrangements for services to Blue Cross Medicare Advantage enrollees on a 24-hour, seven-day-a-week basis. Blue Cross has clarified that after-hours answering service staff and answering machine instructions that direct patients in the event of an emergency to call 911 or proceed to the emergency room are sufficient.
- Section 7.1 requires physicians to comply with Medicare Risk Adjustment Audit record requests within 14 calendar days. Blue Cross has clarified for CMA that they are willing to work with physicians and, upon request, extensions are considered on a case by case basis.
- Section 7.2 imposes penalties resulting from the submission of false data. Blue Cross has clarified that this provision was modified as the result of federal regulations requiring complete and accurate submission of risk adjustment data and a financial penalty for failure to do so.
Physicians are urged to carefully review and assess the impact the contract changes will have on their practices. Questions and concerns about the Prudent Buyer contract amendments should be directed to the Blue Cross provider care department at (800) 677-6669.
Physicians should also be aware that they have the right to opt out of the Blue Cross Medicare Advantage PPO product. If you do not wish to participate in this product, you can opt out by providing 180 days written notice, which should be sent via certified mail with return receipt to Anthem Blue Cross Prudent Buyer Plan Contract Processing, Mail Station 8A, P.O. Box 4330, Woodland Hills, CA, 91365-4330.
To help physicians understand their rights when it comes to health plan contract amendments, CMA has published "Contract Amendments: An Action Guide for Physicians." Additional guidance on negotiating and managing complex third-party payor agreements is also available in CMA’s contracting toolkit, "Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations – A Focus on Payor Contracting." Both resources are available free to members in the CMA Resource Library. Nonmembers can purchase the contracting toolkit for $100 in the CMA Resource Library.
Contact: CMA reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org.
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7. CMA in Washington to lobby for series of measures that would alter the landscape of medicine in California
California Medical Association (CMA) physician leaders were in Washington, D.C., from February 13-15 to lobby Congress and the Centers for Medicare & Medicaid Services (CMS).
While CMA leadership was in town, they spoke with Members of Congress about support for a series of measures that would alter the landscape of medicine for California physicians. These included:
- Alternative Medicare health care delivery and payment models that CMA is asking CMS to pilot test
- An update to Medicare physician payment regions for California with a four-year hold harmless for California’s rural physicians
- An increase in Medi-Cal reimbursement rates to encourage more doctors to participate in the program before 2014, when 3 million uninsured Californians will enroll
- Support for the first Consumer Operated and Oriented Plan (CO-OP) in California’s Health Insurance Exchange under the Affordable Care Act – the Pacific COOP for Health, which is being organized by the Inland Empire Medical Foundation through the Riverside County Medical Association
- Increase in the freedom of seniors to see physicians who are outside of the Medicare program
To learn more, read CMA’s federal Congressional talking points.
Contact: Elizabeth McNeil, (415) 310-2877 or emcneil@cmanet.org.
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8. Court awards payments in class action lawsuit against UnitedHealth
A federal court judge has cleared the way for nearly $200 million in awards to be disbursed to physicians through a settlement against UnitedHealth Group. This disbursement would settle claims from physicians for 15 years of artificially low payments the insurer paid for out-of-network health services.
Spearheaded by the Litigation Center of the American Medical Association (AMA), the California Medical Association and other state medical societies, this decade-long legal battle exposed a fundamental conflict of interest at UnitedHealth. The Litigation Center’s work with organized medicine, state regulators and U.S. senators succeeded in calling into question the system for paying out-of-network medical bills, which has been controlled completely by insurers.
Disbursements are to come as follows:
Claims sent direct to Claims Administrator
Most physicians will receive checks from Berdon Claims, LLC in the next couple of months, but if you have not received your check by April 15 and filed a claim directly to the Claims Administrator, contact Berdon Claims, LLC, by:
- Toll-free phone: (800) 443-1073
- Fax: (516) 222-0271
- E-mail: unitedhealthcare@berdonclaimsllc.com
Claims sent through the Managed Care Advisory Group
Most physicians will receive checks from the Managed Care Advisory Group (MCAG) in the next couple of months, but if you have not received your check by April 15, 2012 and filed through MCAG, you should contact MCAG to inquire about the status of your settlement check by:
- Toll-free phone: (800) 355-0466 - press option 4
- E-mail: physicianservices@mcaginc.com
Visit the AMA Practice Management Center to learn more about the settlement, including updated FAQs, and to access the full press release.
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9. CMA launches new TAC for Medi-Cal and public programs
Earlier this month, a group of 11 physicians came together to examine issues relating to Medi-Cal and other public programs in the state of California, forming the California Medical Association’s (CMA) newest technical advisory committee (TAC).
Chaired by CMA Vice Speaker Theodore M. Mazer, M.D., the new Medi-Cal TAC will be charged with discussing potential reforms and improvements to various public programs. While Medi-Cal will make up the bulk of the group’s focus, programs such as Healthy Families and aspects of the federal Affordable Care Act will also fall into the committee’s purview.
The committee’s membership is made up of physicians from across the state, practicing a wide array of specialties.
In addition to Dr. Mazer, the TAC will include Douglas Brosnan, M.D. (Placer-Nevada, emergency medicine); Toni Chavis-Johnson, M.D. (Los Angeles, pediatrics); Stuart Cohen, M.D. (San Diego, pediatrics); William Henning, D.O. (San Bernardino, family practice); Richard Rabens, M.D. (Alameda-Contra Costa, pediatrics); Oscar Sablan, M.D. (Fresno-Madera, family practice); Gilbert Simon, M.D. (Sierra-Sacramento, pediatrics); Melvyn Sterling, M.D. (Orange, internal medicine); Douglas Tolley, M.D. (Yuba-Sutter-Colusa, obstetrics/gynecology); and medical resident Charlene Hauser, M.D., (Sierra-Sacramento, family medicine).
During their inaugural teleconference, topics of discussion included potential ways of reforming the Medi-Cal fee-for-service system, methods of improving care for so-called “dual-eligibles” and the future of the state’s Healthy Families program.
The group’s initial teleconference was held February 9, and regular in-person meetings are set to begin in late March.
Contact: David Ford, (916) 551-2554 or dford@cmanet.org.
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10. Gaining market share of newly insured patients under health reform: a guide for solo and small practices
With the influx of approximately 6.5 million newly insured patients in California in 2014 when health reform takes effect, many physicians will want to compete for access to these patients. But how do small and solo practices compete with large health care systems?
The California Medical Association (CMA) has created a new medical-legal document, #0206 "Accessing Patients: Marketing and Other Steps Physicians Can Take," to help physicians develop a marking strategy to gain market share of these newly insured patients.
The document will help access the environment or culture of the area where you practice and identify your target audience. The document also takes physicians through the legalities of advertising and how to correctly advertise to a new patient base.
This information is part of the CMA medical-legal library and is free to members. Nonmembers can purchase medical-legal documents for $2 per page.
Contact: Samantha Pellon, (916) 551-2872 or spellon@cmanet.org.
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11. Breathing air pollutants raises the risk of having a heart attack
In the February 15, 2012, issue of the Journal of the American Medical Association, researchers published a review of literature showing a link between breathing pollutants from traffic, such as carbon monoxide, nitrogen dioxide, sulphur dioxide and tiny soot-like particles, and an increased risk for heart attacks.
The study also found that poor air quality could also increase the heart rate, speed up atherosclerosis (hardening of the arteries), and make the blood more likely to form potentially dangerous clots.
The effects of pollution are particularly tough on people with diabetes and cardiovascular disease. In light of this new study, the California Medical Association Foundation encourages physicians to access the Diabetes and Cardiovascular Disease Reference Guide 2nd ed. (PRG).
This reference guide provides health care providers with current clinical guidelines; evidenced based best practices; and patient self management resources to assess, manage and address diabetes as cardiovascular disease complication.
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12. No whooping cough deaths in 2011 for first time in 20 years
The California Department of Public Health (CDPH) announced in January 2012 that it had no recorded deaths in the state from pertussis last year. This is the first time since 1991 that there were no fatalities. The number of diagnosed whooping cough cases fell from 9,154 in 2010 to 2,795 in 2011.
According to CDPH, the factors affecting the lower death rate include AB 354, a law passed in 2011 requiring pertussis booster shots for middle and high school students; more awareness of the disease; quicker diagnosis by physicians; and wider vaccine availability.
Despite the reduction in deaths, physicians should remember that all students entering seventh grade will need a pertussis vaccine booster (Tdap) before starting school in fall 2012.
According to the state, patients may be exposed to pertussis and other diseases before the back-to-school rush this summer. Now would be a good time to protect them now through immunization!
Physicians can:
- Send a reminder and make phone calls and send notices NOW to your patients who have not yet received a Tdap booster, including those who have received a dose of Td but not Tdap.
- Immunize with Tdap NOW at every opportunity, including sports physicals and visits for mild illness or injury, and give other recommended immunizations: meningococcal conjugate, HPV, influenza, and any catch-up doses of varicella, MMR and hepatitis B.
- Provide clear and accurate documentation about Tdap immunization for your patients and their schools. Vaccines have similar names and abbreviations, e.g. Tdap, DTaP, Td, DT, etc., which can be confusing to the school staff who will be keeping records for the new law. If you use the California Immunization Registry, consider printing out a copy of the “Blue Card” after Tdap has been given for the student to take to school.
- Post downloadable electronic banners on your practice’s website and in electronic newsletters to help notify your patients.
- Order enough Tdap vaccine to immunize your patients affected by the new law. Before ordering, ensure you have adequate storage in your vaccine refrigerator for your orders – in many clinics, multiple orders will be indicated.
For additional guidance, visit www.shotsforschool.org.
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13. February is American Heart Month
Cardiovascular disease is the leading cause of death in the United States. One in every three deaths is from heart disease and stroke, equal to 2,200 deaths per day. For both men and women, it has become the leading cause of death.
Cardiovascular disease and diabetes have a strong relationship, with two out of three people diagnosed with diabetes dying from heart disease or stroke. To increase awareness of the effects heart disease might have for diabetics, the American Diabetes Association and the American Heart Association have introduced a campaign called “Do You Know Your ABCs” to raise awareness.
These ABCs are an easy way to review some of the most important health issues related to diabetes. Use these to help your patients lower their risk for diabetes, heart disease and stroke.
A is for A1C
A1C (glycosylated hemoglobin) reflects an individual’s average blood glucose level for the two-to-three month period before the test. Explain that health care providers use it to determine how well they are managing your blood sugar. Emphasize that a goal of less than 7 percent is desirable, which corresponds to an average blood glucose level of 150 mg/dL.
B is for blood pressure
Explain to your patients that high blood pressure makes their heart work harder than it should. Patients with diabetes should aim for a blood pressure level below 130/80 mm Hg.
C is for cholesterol
Finally, explain that cholesterol numbers tell physicians about the amount of fat in your blood. Inform patients that some kinds, like HDL cholesterol, help protect their hearts. Others, like LDL cholesterol, can clog their arteries. High triglycerides raise the risk for a heart attack or a stroke.
For more information on American Heart Month or California Medical Association Foundation Resources, please visit the links below:
- California Medical Association Foundation
- American Heart Association
- Do You Know Your ABCs
- American Heart Month
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14. Early registration deadline extended for highly acclaimed physician staff leadership program
Three-day leadership program: March 8-10, 2012, Coronado Island (San Diego)
Hotel accommodations: Special rate at the Coronado Island Marriot Resort & Spa
Register early: Save $100. Early registration ends February 24, 2012 (new extended date!)
The acclaimed 2nd Annual Stepping Up to Leadership – IMQ/PACE Platinum Training Program for Physician Leaders will provide physicians with the skill sets they need to effectively lead their medical staffs. It will feature dynamic speakers ranging from Diane Kenny, a recognized leader in helping companies effect behavioral change, to nationally recognized facilitators and medical staff leaders with extensive leadership experience.
The program addresses the most challenging decisions facing medical staff leaders, such as rehabilitating an impaired or disruptive physician; conducting effective meetings; improving communication; and using data to support better decision-making about quality, patient safety and privileges.
Keynote speaker spent 10 years as senior advisor to Tom Peters Company
The keynote speaker, Dianne Kenny, is a recognized leader in helping companies effect behavioral change. She has spent over 10 years as a senior consultant at Tom Peters Company and Blue Point Leadership Corporation. She will talk about how to identify the skills most essential to medical staff leaders. This three-day program uses an interactive learning environment to engage participants through self-assessments, Q&A, role-playing and case studies.
The Institute for Medical Quality (IMQ) is offering this program in conjunction with the University of California, San Diego Physician Assessment and Clinical Education (PACE) program, with support in part by a grant from The Physicians Foundation. It will take place in San Diego at the Coronado Island Marriott Resort and Spa from March 8-10, 2012. Early registration discount ends on February 15, 2012.
Details and registration information are available on the IMQ website – www.imq.org or by contacting Lisa San Gabriel, (415) 882-3314 or lsangabriel@imq.org. You can also download the brochure here.
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15. Legislative rural caucus to hold informational briefing on the Medi-Cal experience
The California State Legislative Rural Caucus is holding an informational briefing to learn about the experiences of physicians and their patients in rural areas, particularly in regard to Medi-Cal.
The California Medical Association (CMA) would like to encourage rural physicians and their patients to come out, attend and speak about their experiences with Medi-Cal. In particular, CMA encourages physicians to share how they would have been affected by the 10 percent reimbursement rate cuts approved by the Centers for Medicare & Medicaid Service, but recently enjoined by a U.S. District Court judge. As recent data shows, Medi-Cal patients already have a harder time getting access to health care than privately insured patients. These new cuts would have had drastic impacts on both providers and patients.
Friday, February 24, 2012
10 a.m. to 12 p.m.
UC Merced – Fresno Center
550 East Shaw Ave
Fresno, CA 95929
The Rural Caucus, chaired by Assemblymember Linda Halderman, M.D., (R-Fresno), is composed of members of the Senate and Assembly from both parties who represent rural California districts. The committee explores issues affecting residents of these areas.
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16. Follow the money...register now for the California Health Care Leadership Academy
Registration is now open for the 15th Annual California Health Care Leadership Academy, scheduled for April 27-29, 2012, at Disneyland Hotel in Anaheim.
With federal health reform fast becoming not just fodder for debate, but a concrete reality, a transformation of the health care marketplace already is under way. The closer collaboration and increased quality and cost accountability demanded by the Affordable Care Act are accelerating a trend of decline in under-resourced independent medical practices, many of which are being acquired by hospital-dominated integrated systems. Health plans also have been on the move to gain control of physician practices, and thereby a larger piece of a shrinking pie. Who will survive, who will control and who will prosper in the realignment of the health care delivery system?
Consonant with the California Health Care Leadership Academy’s mission of helping physicians and practice managers better understand and manage leading-edge developments in the evolving health care marketplace, this year’s conference has been designed to provide both information and tools to help meet the challenges of this brave new world. Continuing the Academy’s standard of programming excellence, the presentations and workshops will be an invaluable resource in guiding practices as they navigate the new environment.
To see the full agenda and register, visit www.caleadershipacademy.com. Register by March 30 to save $100!
17. Blue Shield launches recontracting initiative
The California Medical Association (CMA) learned that Blue Shield is in the process of recontracting with physicians across the state. Notices to physicians were mailed on January 27. Blue Shield states the reason for the recontracting initiative is twofold: 1) Blue Shield has not done a large scale recontracting with physicians in over a decade, so the new contracts will allow Blue Shield to ensure consistency and compliance with new laws and regulations; and 2) Blue Shield will be offering various tiered networks based on price point in anticipation of California’s health insurance exchange, a key feature of the federal health reform law. Physicians are under no obligation to participate in any of these products. There are no fee schedule changes at this time, other than for Medicare lines of business.
While the new contract will eventually be rolled out statewide, the first phase focuses on the following counties:
| Alameda | Mariposa | San Joaquin |
| Alpine | Mono | San Mateo |
| Amador | Monterey | Santa Barbara |
| Calaveras | Napa | Santa Clara |
| Colusa | Placer | Santa Cruz |
| Contra Costa | Plumas | Solano |
| El Dorado | Riverside | Sutter |
| Lake | San Benito | Tehama |
| Lassen | San Bernardino | Tulare |
| Marin | San Francisco | Yuba |
Physicians in Fresno County received the new contract in July 2011.
The cover letter that accompanied the new contract asks that physicians review, sign and return the new agreement to Blue Shield by February 17. However, Blue Shield has assured CMA that failure to return the new agreement will not affect a physician’s participation status with Blue Shield.
To assist physicians, CMA has completed an analysis of the new Blue Shield contract, which is available to CMA members at www.cmanet.org/ces. Physicians are encouraged to carefully review and understand the vast range of legal and practical implications associated with the execution of any contract for the delivery of medical services or the associated management and administrative services.
For additional information on evaluating and negotiating complex managed care contracts, see CMA’s contracting toolkit, Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations – A Focus on Payor Contracting.
Physicians with concerns about the new contract terms are encouraged to contact Blue Shield Provider Services at (800) 258-3091.
Contact: CMA’s reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org.
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18. Upcoming webinars
2/23: CMS Pioneer ACO Model: Mai Pham, M.D., Director of ACO Activities at the Centers for Medicare & Medicaid Services (CMS) Center for Medicare & Medicaid Innovation, will describe the Center’s Pioneer ACO Model and answer CMA members’ questions about it. The Pioneer ACO Model is designed to support organizations with experience operating as accountable care organizations (ACOs) or in similar arrangements, providing more coordinated care to beneficiaries at a lower cost to Medicare.
3/7: Managing Difficult Employees and Reducing Conflict in the Practice: Very few medical or business schools teach hands-on human resources management skills and techniques. This information-packed workshop will teach you the secrets of how to lead, coach and manage difficult employees; set practice values; and reduce conflict in the practice.
3/21: HIPAA Update 2012: Are you compliant with HIPAA? Many new rules have been put in place including a major update on HIPAA and the HITECH Act. This webinar provides instruction on how to achieve compliance with these new rules as well as compliance with the existing HIPAA Privacy and Security rules and relevant California privacy laws.
Contact: CMA's member help center, (800) 786-4262 or memberservice@cmanet.org.
19. Featured member benefit
MedicAlert: MedicAlert is a nonprofit foundation with over 50 years of lifesaving experience identifying and providing vital medical information to emergency personnel for over 4 million members worldwide. CMA members and their patients save $10 on new adult enrollments and $2.95 on Kid smart enrollments. For more information, visit www.medicalert.org/cma or call (800) 253-7880. You can also contact CMA's member help center at (800) 786-4262 or memberservice@cmanet.org.