MARCH / APRIL 2012 | Volume 18 | Number 2
Take Advantage of Your Member Benefits and Services!
2012
You still need to make important decisions now about rising health insurance premiums. So what can you do? • Enroll in a qualified High-Deductible Health Plan and open a Health Savings Account. This provides significant premium savings that can help fund your HSA account. With individualonly coverage, you are eligible to contribute up to $3,100 to your account or $6,250 with family coverage, on a tax-deductible* basis (members age 55–64 are eligible to contribute another $1,000). • Investigate RAF Sales Health plans offer incentives through discounts off their risk adjustment factors (RAFs) for you to change health
plans. Instead of your medical rates increasing this year, we might be able to help you offset some of that increase. • Mercer Select HRKnowHow If you play a role in your medical group’s health care and benefit plan decisions, stay current on challenging issues. Access is included at no charge for all members who purchase group health insurance through Marsh. Includes: • News and analysis of important benefit issues. • Compliance Link tool to assist with health care and group benefit plan administration.
* Marsh and the Association/Society do not provide tax, investment or legal advice. Please consult with your professional advisors for guidance on these issues.
Please call Marsh at 800-842-3761.
We serve members who want assistance in evaluating the medical insurance choices before them. We can assist you with the information you need to make the critical choices on the road ahead.
Sponsored by:
Administered by:
56569 (3/12) ©Seabury & Smith, Inc. 2012
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d/b/a in CA Seabury & Smith Insurance Program Management • 777 South Figueroa Street, Los Angeles, CA 90017 800-842-3761 • CMACounty.Insurance@marsh.com • www.MarshAffinity.com • CA Ins. Lic. #0633005 • AR Ins. Lic. #245544 2 | THE BULLETIN | MARCH / APRIL 2012
BULLETIN THE
Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society
700 Empey Way • San Jose, CA 95128 • 408/998-8850 • www.sccma-mcms.org
MEMBER BENEFITS Legal Services/On-Call Library Reimbursement Advocacy/ Coding Services Billing/Collections Discounted Insurance Referral Services With
the iPhone Legislative Advocacy/MICRA House of Delegates Representation Practice Management Resources and Education Financial Services Professional Development Health Information Technology
From the Editor’s Desk
7
Message From the SCCMA President
Joseph Andresen, MD William S. Lewis, MD
8 It Pays to Be a Member 12 DocBookMD 14 Member Benefit: Health Resource Services, LLC 16 New NORCAL Member Advantage 17 See What You Could Be Saving on Workers’
Compensation Insurance!
Membership Directory/Website Membership Directory iAPP for
6
Marsh
19 Member Benefit: Discount Ticket Program
20 The Good, the Bad…and the Really Painful…
Tanya Spirtos, MD
22 Save These Dates
24 CMA ON-CALL Medical Legal Library
32 Member Benefit: Reimbursement Advocacy Program 36 SCCMA Alliance News
37 South Bay American Medical Women’s Association
Anlin Xu, MD
Resources
38 Medical Times From the Past: The Cory Brothers Modernized Medicine in Santa Clara County
Publications
CME Tracking
40 MEDICO NEWS
Physicians’ Confidential Line
Elizabeth Ahrens-Kley
44 Classified Ads
Verizon Discount
47 CMA CEO Update: Preparing for the Future of Medicine
Human Resources Services
48 CMA's CES Resources MARCH / APRIL 2012 | THE BULLETIN | 3
The Santa Clara County Medical Association Officers President William Lewis, MD President-Elect Rives Chalmers, MD Past President Thomas Dailey, MD VP-Community Health Cindy Russell, MD VP-External Affairs Howard Sutkin, MD VP-Member Services Scott Benninghoven, MD VP-Professional Conduct Eleanor Martinez, MD Secretary Sameer Awsare, MD Treasurer James Crotty, MD
Chief Executive Officer
Councilors
William C. Parrish, Jr.
El Camino Hospital of Los Gatos: Arthur Basham, MD El Camino Hospital: Lynn Gretkowski, MD Good Samaritan Hospital: Jeff Kaplan, MD Kaiser Foundation Hospital - San Jose: Seham El-Diwany, MD Kaiser Permanente Hospital: Anh Nguyen, MD O’Connor Hospital: Michael Charney, MD Regional Med. Center of San Jose: Richard Kline, MD Saint Louise Regional Hospital: Diane Sanchez, MD Stanford Hospital & Clinics: Peter Cassini, MD Santa Clara Valley Medical Center: John Siegel, MD
AMA Trustee - SCCMA James G. Hinsdale, MD Tanya W. Spirtos, MD (Alternate)
CMA Trustees - SCCMA Martin L. Fishman, MD (District VII) Susan R. Hansen, MD (Solo/Small Group Physician) James G. Hinsdale, MD (Past-President) Randal Pham, MD (Ethnic Member Organization Societies) Tanya Spirtos, MD (District VII)
BULLETIN THE
Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society
Printed in U.S.A.
Editor
Joseph S. Andresen, MD
Managing Editor Pam Jensen
Opinions expressed by authors are their own, and not necessarily those of The Bulletin, SCCMA, or MCMS. The Bulletin reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted in whole or in part. Acceptance of advertising in The Bulletin in no way constitutes approval or endorsement by SCCMA/MCMS of products or services advertised. Address all editorial communication, reprint requests, and advertising to: Pam Jensen, Managing Editor 700 Empey Way San Jose, CA 95128 408/998-8850, ext. 3012 Fax: 408/289-1064 pjensen@sccma.org © Copyright 2012 by the Santa Clara County Medical Association.
4 | THE BULLETIN | MARCH / APRIL 2012
THE MONTEREY COUNTY MEDICAL SOCIETY OFFICERS President James Ramseur, Jr, MD President-Elect John Clark, MD Past President John Jameson, MD Secretary Eliot Light, MD Treasurer Steven Vetter, MD
CHIEF EXECUTIVE OFFICER William C. Parrish, Jr.
DIRECTORS Paul Anderson, MD
R. Kurt Lofgren, MD
Valerie Barnes, MD
Jeff Keating, MD
Ronald Fuerstner, MD
Kelly O'Keefe, MD
David Holley, MD
Patricia Ruckle, MD
AMA Trustee - mcms David Holley, MD
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FROM THE EDITOR’S DESK
Joseph Andresen, MD Editor, The Bulletin
Potentially Significant Impacts on Out-of-Network Billings By Joseph Andresen, MD
Joseph Andresen, MD, is the editor of The Bulletin. He is board certified in anesthesiology and is currently practicing in the Santa Clara Valley area.
Editor, The Bulletin A February 6th article in Bloomberg Newsweek highlights an issue that may have a significant impact on outof-network billing for outpatient surgical care. The lawsuit, Aetna Life Insurance Co. v. Bay Area Surgical Management LLC, case no. 112CV217943, filed on February 2, 2012 in Santa Clara County Superior Court, alleges that the surgery centers illegally induced its physician investors, who are in-network with Aetna, to refer their patients to the surgery centers with promises that the patients would not have any financial responsibility to the surgery centers for their out-of-network coinsurance and deductibles. Aetna claims that the surgery centers then turned around and submitted charges for reimbursement that were “artificially inflated,” because “they are much greater than the amount the facility expects to be paid which is reflected by the fact that the facility does not collect those charges from the member.” One example cited by Bloomberg Newsweek was a $66,100 charge for bunion surgery. Aetna alleges that this type of billing scheme drives up the cost of health insurance coverage because, by not having any “skin in the game,” patients have no incentive to become better educated about the true costs of their health care. According to a press release from BASM, insurance giant Aetna Inc. is using aggressive litigation tactics to strong-arm family-run Bay Area Surgical Management (BASM) into making patients of their affiliated surgery centers use only Aetna-affiliated facilities. With legal action and threats, the billion-dollar insurance company is trying to get away with not paying providers fairly and taking away patients’ right to use a provider of their choice. “This is a calculated move by Aetna to steer patients to contracted facilities,” said attorney Daron Tooch, partner at Hooper Lundy & Bookman, P.C., who is representing BASM in the case. 6 | THE BULLETIN | MARCH / APRIL 2012
“By attacking out-of-network providers who are simply trying to deliver the best care, “patients’ right to choose is being threatened,” he added. Aetna’s lawsuit raises the stakes considerably because it alleges that providers are liable for engaging in a fraudulent and illegal kickback scheme whenever they forgive a patient’s coinsurance and deductible amounts, even if the provider bills the patient, but ultimately does not collect from the patient. The outcome of this lawsuit will have significant implications in the future and has already created nationwide attention. “That is why providers must listen and watch timely and closely, when the out-of-network health care earthquake is already here,” states Dr. Jin Zhou, regarded as the “Godfather of PPACA and ERISA Claims” for providers by the health care provider community.
References:
1. http://www.businessweek.com/news/2012-02-06/bunionrepair-at-66- 100-spurs-aetna-lawsuit-against-clinics.html 2. http://oig.hhs.gov/compliance/provider-compliance-training/ index.asp 3. http://www.prnewswire.com/news-releases/classic-david-vsgoliath-case-aetna-bullies-surgical-group-threatens-patientschoice-lawsuit-according-to-basm-140278263.html 4. http://www.fentonnelson.com/news/industry-insights/news99. htm
MESSAGE FROM THE SCCMA PRESIDENT
william s. lewis, MD President, Santa Clara County Medical Association
A Reality Check By William S. Lewis, MD President, Santa Clara County Medical Association We do it all the time. We examine a patient and offer a diagnosis, followed by a reminder that it could be a lot worse. But do we ever apply that perspective to ourselves and our profession? I hear the moaning all the time, often from myself. The cost of practicing medicine is up, but reimbursement is down. If you are in a solo or small group, it seems the government is intent on your extinction. If you are with a large group, it appears that politicians are bent on overregulating managed care insurance. We rant about the ever-expanding scope of practice and independence of allied health providers. We resist emergency call because it interferes with our practices and our lives. We shun sacrifice and responsibility for care that goes unreimbursed. We fear health care reform. And of course, in light of it all, what good is the CMA or the AMA anyway? So we drop out and disengage. Sometimes we need a reality check. There is a crisis in medicine, but if you think it’s here, then you need to read about your colleagues in Syria. Buried in the news of the uprising are the plight of the wounded and the medical personnel who treat them. In case you missed it, a group of Syrian doctors met last month in Washington to report that medical treatment for anti-government protesters has gone underground. Even in war, there are rules. The Geneva Conventions declare: • All wounded and sick shall be respected and protected. • They shall be treated humanely and receive medical care and attention required by their condition.
• The physical or mental health and integrity of persons interned, detained, or otherwise deprived of liberty by any party shall not be endangered by any unjustified act or omission. • Medical units shall be respected and protected at all times and shall not be the object of attack. War zones are dangerous, but we have come to expect that unarmed physicians will not be targeted for providing care to the sick and injured, regardless of their politics. Then there’s Syria. Last October, Amnesty International accused the government of targeting the
wrote Physicians for Human Rights in their December report. As a result, doctors and nurses have established an underground health network in the most violent neighborhoods. Supplies are smuggled in and blood products are procured through a black market of local and foreign donors. Then in February, Doctors Without Borders claimed Syria is using medicine as a weapon of persecution. Interviews with Syrian doctors provided chilling details of desperate conditions. Wounded civilians are transported in private vehicles, since ambulances are under governmental control. Mobile emergency clinics move from one safe house to another to avoid detection. Volunteer doctors and nurses staff these clinics, at great personal risk, in harsh conditions with rudimentary equipment. Have you heard of the Doctors Coordinate of Damascus, a group of physicians dedicated to the clandestine medical care of civilian protestors? They report that over 300 medical personnel have been arrested and 37 killed in Syria for treating injured protestors. In March, they were awarded for their courageous effort by the humanitarian organization People in Need. The award recognized all underground Syrian doctors who imperil their own lives to save others. These doctors nobly represent the highest ideals of medicine and raise the level of respect for our profession worldwide. Now, you know. And if you are like me, your perspective just changed. Problems? Sacrifice? Well, at least you’re not sneaking your way to work because you’re carrying a pocketful of bandages and antiseptic, or dodging bullets while operating because someone tipped off the authorities. Your worries just got smaller and your burdens lighter. And though you’re no less perturbed by proposed government rules and regulations, maybe, just maybe, you are resolved to do something productive about it.
Sometimes we need a reality check. There is a crisis in medicine, but if you think it’s here, then you need to read about your colleagues in Syria. wounded and health workers. According to their report, state-run hospitals are used to identify, arrest, and remove protesters without treatment. Protesters are forced to avoid public hospitals and turn to private hospitals for treatment. But when these private hospitals request blood from the central blood bank, they provoke official suspicions. Doctors face the dilemma of furtively treating these patients or forking them over to security officials. “Health workers suspected of trying to treat the wounded are reportedly detained, interrogated, and tortured. Further, doctors who treated wounded protestors in their hospitals have been discharged simply for providing medical care to opponents of the regime,”
William S. Lewis, MD, is the 2011-2012 President of the Santa Clara County Medical Association. He is a board certified ENT physician and is currently practicing in the Los Gatos area.
MARCH / APRIL 2012 | THE BULLETIN | 7
member benefits
It Pays to Be a Member Take Advantage of Your Member Benefits and Services! Practice Management CMA’s Reimbursement Help Center: Trouble getting paid? Call CMA’s reimbursement experts for personal assistance with contracting or reimbursement issues. Only available to CMA members. 888/401-5911. Amerinet: A Group Purchasing Organization (GPO) whose primary focus is negotiating discounts on many of the products and services that you use every day. This includes a 22% discount on Verizon Wireless for your business and employees’ personal lines. As a member, you will have access to contracts that will help you reduce your overhead without changing how you are currently doing business. All this is available at no cost to you. For more information, just complete the request form at http:// amerinet-hrs.com/santaclara or call them direct at 800/842-6663 and one of their non-commissioned regional managers will contact you. DocBookMD: Connect, Communicate, and Collaborate With DocBookMD for Free: DocBookMD gives you the entire Santa Clara or Monterey County member physicians database on your mobile devices. Bonus: You can HIPAA-compliantly, bi-directionally communicate with photos with other members who have signed up for the system. You can use any two devices per DocBookMD account, including any combination of Android or Apple device. Go to the App Store or the Android Market now to download DocBookMD today. To register for free, all you need is your CMA I.D. number. To obtain your CMA I.D. number, call SCCMA at 408/998-8850 or MCMS at 831/4551008. Practice & Liability Consultants LLC: Members receive $10 off the regular hourly consulting fees. Since 1985, Practice & Liability Consultants have worked with over 1,500 practices as practice management and malpractice prevention specialists. Services include practice assessments, valuations, benchmarking, mergers, operations/personnel issues, partnership/ group formation/improvements and seminars. Benefits include greater productivity, increased gross and net income, greater patient satisfaction, and a more pleasant work environment. Fees are based on either a flat fee or hourly basis and, where possible, a minimum and maximum fee is quoted. Please call 415/764-4800, or contact csm@practiceconsultants.net. EnviroMerica, Inc. is a Bay Area-based compliance consulting firm specializing in OSHA, HIPAA, AAAASF, AAAHC, JCAHO, CAP, IMQ, CLIA, and other regulatory agencies and accreditation requirements. They 8 | THE BULLETIN | MARCH / APRIL 2012
have assisted thousands of medical and dental facilities in California with all of their regulatory compliance needs for the past 14 years. They assure their clients are up to all standards, keeping their offices, patients, and staff safe and keeping them clear from hefty fines that are often levied by the regulatory agencies – such as CAL/OSHA, the Department of Health, the EPA, as well as the Medical Board of California. Services include annual training, up-to-date and customized safety manuals, all appropriate office documentation including complete and compliant MSDS books, plus complete physical compliance of the office. Via an insurance policy, EnviroMerica guarantees all their clients against any and all fines they may receive from any of the regulatory agencies. EnviroSafe Medical Services, LLC (Subsidiary of EnviroMerica) is a Licensed Medical Waste Transporter, specializing in transporting contaminated sharps, bio-hazardous waste including pathological/microbiological material (red bags), pharmaceuticals, chemo, radioactive material, hazardous chemicals (i.e. glutaraldehyde, formaldehyde, lead, mercury, x-ray solutions, etc.), alkaline batteries, fluorescent bulbs, electronic waste, and expired pressurized tanks, etc. SCCMA/MCMS members receive a Complimentary Compliance Review from EnviroMerica (valued at $275) and receive a 20% discount off their already low prices for compliance and waste management services. Call 650/655-2045 or toll free 888/323-0583 for more details. TPO Human Resource Management: TPO is an award-winning HRconsulting firm serving primarily the Bay Area. Typical services include, general HR consulting, employee handbook development, neutral third-party investigations into employment matters including harassment, managerial training on HR regulatory and leadership skill-building, and helping employers maintain current best HR practices. How we work with SCCMA and MCMS members: Over the past 17 years, TPO has provided HR support to SCCMA, as well as the members of SCCMA and MCMS. TPO has facilitated numerous HR training programs for members to attend and has provided many articles throughout the years. MCMS/SCCMA members receive a free initial consulting call ($50 Savings) and then 10% off the initial work, products, and services with TPO. Contact Melissa Irwin, SPHR-CA, Sr. Consultant: 831/647-7292 or melissai@tpohr.com. OfficeWorksRX: Members receive preferred pricing and FREE working interview. When your office is short staffed, are you getting the help you really need? OfficeWorksRX is your employment remedy! They specialize in placing medical assistants, receptionists, transcriptionists, and records clerks, as well as biller/collectors, coders, and office managers. Whether you require full- or part-time employees, permanent or tem-
porary placement, vacation or maternity leave coverage – THEY CAN HELP! OfficeWorksRX provides: pre-screened candidates that have a health care background within 24-48 hours. Call Kristen Biernat at 877/463-3123 for more information.
Legal Services Medical Legal Library (Formerly CMA On-Call): This online library contains over 4,500 pages of up-to-date legal information on a variety of subjects of everyday importance to practicing physicians. Accessible to members at www.cmanet.org/resource-library or by calling 800/7864262. Legal Services: CMA legal experts provide immediate member assistance for HR, medical regulatory or legal questions. Call 800/786-4262. PrivaPlan: Receive $170 discount…from $495 retail down to $325 on a do-it-yourself On-line HIPAA Privacy & Security Compliance Toolkit and/or On-line HIPAA Training (toolkit code): sccma325toolmcms. Also available: Remote & On-Site Security Risk Analysis, a required Core Meaningful Use measure. Visit www. PrivaPlan.com. For a special CMA toolkit price of $325 (retail $495) use Coupon Code: sccma325toolmcms or Code: sccma129trainmcms for $129 training (retail $169). Email support@privaplan.com for more info on a Security Risk Analysis for your practice.
Financial Services CMA Credit Card: Physicians can show their CMA pride with CMA-branded credit cards from Bank of America. Call Bank of America at 866/598-4970. Practice Financing: Members get reduced loan administration fees from Banc of America Practice Solutions (a subsidiary of Bank of America) for software upgrades, practice expansion, and equipment purchasing. A members-only coupon code is required to access this benefit. Get your code at www.cmanet.org/membership/membership-benefits or call 800/786-4262. Merchant Services/ Payroll Services/ Check Management: CMA members receive exclusive discounts and a three-year rate guarantee on Heartland Payment System’s suite ma na gement . Heartland offers a full suite of services to meet the needs of the health care market, including ConfirmPay, a PC-based tool that processes credit card and ACH transactions with real time insurance verification and patient responsibility estimator for over 400 insurance carriers. Heartland Payment Systems also has local sales and service professionals who specialize in the health care industry and a 24/7/365 live customer service team. Contact Heartland Payment Systems at 866/941-1477 or www. heartlandpaymentsystems.com. Comerica Bank: Comerica has supported the SCCMA’s offices and members’ banking needs for over 20 years and now
supports the MCMS. Comerica provides a wide range of financial services for businesses, individuals, and wealth management. For information, please contact Jo Matheson, Senior Vice President, at 408/556-5261 or email her at jamatheson@comerica.com. Legacy Wealth Advisors, LLC: Provides financial planning, retirement planning, professional money management, and more! Members receive a one-hour complimentary consultation (over a $300 savings). For more information, call Michelle Hamilton at 408/452-7700. Bureau of Medical Economics (BME): Receive a 5% discount off the basic rate for collections. (Rate based on volume –you only pay if they collect.) For more information regarding BME’s collection services, call Karen Jorgenson at 408/286-6219. Coding and Reimbursement Hotline: Access a wealth of coding and billing information by calling Sandie Becker, CMC, MCMS/SCCMA’s coding/reimbursement specialist at 831/455-1008 or 408/998-8850 Ext. 3007 or email: sandie@sccma.org. This service is FREE-of-charge to our members and their staff.
Insurance Medical, Workers’ Comp, Life, Disability, Long-Term Care, and More: Marsh serves as the insurance advisor for the Santa Clara County Medical Association, Monterey County Medical Society and their members. They design, develop, and implement insurance plans available only to members – with discounted pricing, enhanced coverage, or both. They assist members and their office managers by providing information, programs, and guidance to assist with insurance buying decisions. CONTACT: Call 800/842-3761; e-mail: member.insurance@marsh.com; website: www.marshaffinity.com. Auto and Homeowners Insurance: Discounted auto and homeowners insurance for CMA members. Contact Mercury Insurance Group at 888/637-2431 or www.mercuryinsurance.com/cma. NORCAL Mutual Insurance Company: Formed by physicians in 1975 to provide the highest quality medical professional liability insurance products and services to its policyholder-owners. NORCAL Mutual insures nearly 20,000 physicians and other health care professionals in solo practice, medical groups, hospitals, clinics, and allied health care facilities in California, Alaska, and Rhode Island. More than three-quarters of NORCAL Mutual policyholders have been with the company longer than five years. They stay with NORCAL Mutual because it stands with them, providing vigorous defense to the standard of care, unparalleled risk management, and personalized local service. In 1984, NORCAL received their first “A+” rating from A.M. Best. They have maintained an “A” or better rating every single year since then. NORCAL offers a variety of FREE on-line CME courses for members of NORCAL. For more information, visit www. norcalmutual.com or call Jeanne Zosky at 800/652-1051.
Continued on page 10
MARCH / APRIL 2012 | THE BULLETIN | 9
Professional Development CME Tracking/ Credentialing: CMA’s Institute for Medical Quality (IMQ) certifies CME activity for credentialing purposes to the Medical Board of California, as well as to hospitals, health plans, specialty societies, and others. CME certification is $29 a year for CMA members, $49 for non-members. Contact IMQ at 415/882-5151 or www.imq.org. CMA Webinar Series: CMA’s webinar series gives physicians the opportunity to watch on-line presentations on important topics of interest and interact with legal and financial experts from the comfort of their homes or offices. The webinars are free to CMA members and their staff at www.cmanet.org/events. MCMS/SCCMA Seminar/Webinar Series: Member physicians and their office staff often attend FREE-of-charge seminars (including Office Managers) covering legal issues, HIPAA, risk management issues, contract negotiations, reimbursement, billing, OSHA compliance, how to open/close/how to determine the value of a medical practice, HR requirements/guidelines, and much more. Check out www.sccma-mcms. org/TheBulletin for more information.
Health Information Technology (HIT) gloStream: gloStream will pay nonmembers first year dues or members receive 25% off of their electronic medical record software purchase! gloStream provides doctors with certified, voice-enabled electronic medical record and practice management solutions delivered and supported through a nationwide community of local technology partners. gloStream products are secure, easy-to-use applications, and the only solutions on the market with Microsoft Office built right in. gloStream partners leverage gloDNA (“Detailed Needs Analysis”), a proprietary implementation process that has given gloStream a 100% success rate. For more information, call gloWest at 866/456-7995, visit www.proficientEMR.com, or email info@proficientEMR.com. HIT Resource Center: CMA is closely monitoring the electronic standards development process, and will be updating this resource center as new information becomes available at www.cmanet.org/hit. EHR Webinar Series: 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. Maxwell IT is a national education consulting program endorsed by state medical associations to help physician practices learn how to assess, select, and implement EHRs. A members-only coupon code is required to access this benefit. Get your code at www.cmanet. org/benefits or call CMA’s Member Help Center, 800/786-4262. Epocrates: CMA members get a discount on all Epocrates mobile and online products. Save 30% on subscriptions to Epocrates products such as the #1 rated Epocrates Essentials. Epocrates provides point-of-care access (via mobile devices and the web) to information on drugs, diseases, and 10 | THE BULLETIN | MARCH / APRIL 2012
diagnostics. For more information, visit www.cmanet.org/benefits.
Publications CMA produces a number of publications to keep members up to date on the latest health care news and information affecting the practice of medicine in California. Members and registered website users can subscribe to any of these publications by visiting www.cmanet.org/newsletters. CMA Alert: CMA publishes a biweekly e-newsletter, CMA Alert, to keep its members up to date on critical issues affecting the practice of medicine in California. CMA Capitol Insight: CMA Capitol Insight is a biweekly column by veteran journalist Greg Lucas, reporting on the inner workings of the state Legislature. CMA Practice Resources: CMA Practice Resources (CPR) is a monthly bulletin from the Center for Economic Services. This bulletin is full of tips and tools to assist physicians and their office staff in improving practice efficiency and viability. CMA Press Clips: Get daily reports on health care policy and medicine from newspapers and magazines throughout California and around the nation delivered to you by e-mail. Legal Case List: CMA’s Center for Legal Affairs publishes the Legal Case List once a month. The Case List provides a summary and the current status of litigation in which CMA is a party or has filed a brief as amicus curiae. Legislative Hot List: CMA’s Center for Government Relations publishes the Legislative Hot List weekly during the legislative session. The Hot List provides a summary and the current status of CMA-sponsored bills, as well as the progress of other significant legislation. Regulations Quick List: CMA’s Center for Medical and Regulatory Policy publishes the Regulations Quick List once a month. The Quick List provides summaries and status updates on various regulations being tracked by CMA. OMSS Advocate: CMA’s Organized Medical Staff Section publishes the OMSS Advocate, a quarterly newsletter that provides CMA-OMSS member medical staffs with updates on current events and issues. You must be an OMSS member to receive this newsletter. Email medstaffhelp@cmanet.org for more information. For more information about advertising in any of CMA’s publications, email to: advertising@cmanet. org. The Bulletin: Members receive a FREE subscription to the voice of Monterey and Santa Clara County physicians. This bimonthly publication includes medical articles, classifieds, new member benefits, coding/billing/collection advice, CME classes and webinars, seminars, new members listing, and more! MCMS/SCCMA Pictorial Membership Directory: Appear in MCMS/SCCMA’s annual pictorial membership directory! Receive a FREE directory each year ($60.00 value) and receive a 50% discount
off each additional directory purchase by member. Contact Maureen Yrigoyen at 831/455-1008 or 408/998-8850 Ext. 3001 for details.
AUTOMOTIVE SERVICES Autobahn Los Gatos: Members, their families, and staff receive a 10% discount on labor. Specializing in BMW and Mercedes Benz repair. Call Dave or Gary at 408/356-5985, to set up your appointment today. Car Rentals: Save up to 25% on car rentals for business or personal travel. Members-only coupon codes are required to access this benefit. Get your code at www.cmanet.org/benefits or call 800/786-4262. Call Avis at 800/331-1212 or Hertz at 800/654-2200.
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Mailing Lists/Labels: To send new practice announcements, inform your colleagues of a particular legislation or upcoming event. Members can order mailing labels by specialty, zip code, or total membership. Members receive a 50% discount by calling Pam Jensen, MCMS/SCCMA, at 831/455-1008 or 408/998-8850 Ext. 3012.
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MEMBER SUPPLIES
C AL
IF O R N IA
Physician Referral Service: Our physician referral service provides 1200 referrals on-line and handles around 1200 calls per month. Patients can select a physician by city, specialty, language, Medicare, or Medi-Cal, and gender. Call Jean Cassetta, MCMS/SCCMA, at 831/4551008 or 408/998-8850 Ext. 3010 for a “Physician Referral Service Participation Agreement” or to sign up today. Discounted Tickets & See’s Candies Certificates: Discounted tickets available for members, their staff, and families to: California’s Great America, Gilroy Gardens, Disney’s Theme Park, Monterey Bay Aquarium, Raging Waters, and Six Flags Discovery Kingdom. Gift certificates also available for See’s Candies. For more information, call Sharon Jensen, MCMS/SCCMA, at 831/455-1008 or 408/998-8850 Ext. 3008. The Alliance: Members of the Alliance work together to promote quality health in Santa Clara and Monterey Counties through education, community service programs, and legislative advocacy. Benefits of membership include advocacy for quality health care, legislative awareness and action, lifelong friendships, active local, state, and national projects, close support for the medical family. For more information, call Suzanne Jackson (SCCMA Alliance) at 408/354-3447, or Patricia O’Keefe (MCMS Alliance) at 831/ 657-1600, or visit www.sccmaa. org.
Other Supplies and Resources
florist.com and enter discount code SCCMA. 20% discount available at the following locations: Santa Clara Citti’s Florist, 800 Scott Blvd, Santa Clara – 408/246-7272; San Jose Citti’s Florist, 3100 Stevens Creek, San Jose – 408/984-8900; or Campbell Citti’s Florist, 990 E. Hamilton Ave, Campbell – 408/371-7000. Classic Car Wash: The Santa Clara County Medical Association has partnered with the premier car wash company in Santa Clara County, Classic Car Wash, to provide a valuable new member benefit. Now as a valued member of SCCMA, you will receive a $5.00 discount on a car wash! This represents an 18% - 28% savings, depending on which car wash you select! In addition, we wanted to thank each member by providing a benefit you can extend to your staff and family members. Therefore, under the terms of our agreement, you may share this exclusive member benefit with your family and staff as well. Classic Car Wash has four locations in Santa Clara County to serve you. Details and locations are listed in the coupon (one must present a coupon to receive this discount). Discount coupons are available on SCCMA/MCMS’s website at www.sccma-mcms.org under the “Membership” tab, so you can print additional coupons as needed. There are no restrictions on the number of coupons you can use for yourself, your family, or your staff. For more information and offers regarding Classic Car Wash, please visit their website at www.classiccarwash.com. Staples: Save up to 80% on office supplies and equipment from Staples, Inc. Visit www.cmanet.org/ benefits to access the members-only discount link. 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. Security Prescriptions: Get 15% off tamper-resistant security prescription pads and printer paper. Visit the RX Security website, www.rxsecurity.com/cma.php. Magazine Subscriptions: 50% off subscriptions to hundreds of popular magazines, with a best price match guarantee. Contact Subscription Services Inc. at www.buymags.com/cma or 800/289-6247. Copyland/Zip 2 Print: Members receive excellent quality customer service with a 10% discount on all printing, from prescription pads, new practice announcements, brochures etc. FREE shipping or delivery depending on your office location. More information call or email Frank Ettefagh at 408/9712722 or frank@zip2print.com. Or, visit their new location at: 2342 Steven’s Creek Blvd., San Jose, CA 95128.
Citti’s Florist: SCCMA members receive a 20% discount on flowers, plants, or gifts. (Locally delivered or picked up orders only.) $10.00 off wire orders world-wide. No other discounts apply. Go to www.cittisMARCH / APRIL 2012 | THE BULLETIN | 11
DocBookMD is provided FREE to SCCMA DocBookMD is provided FREE and MCMS members thanks NORCAL. to SCCMA and MCMStomembers thanks to NORCAL.
communicate collaborate coordinate
Mobilize your practice with
DocBookMD FAST • E ASY • S E CURE
• HIPAA-compliant • On-demand messaging • Share images of X-rays, EKGs, wounds • Fast look-up of physicians and pharmacies
12 | THE BULLETIN | MARCH / APRIL 2012
Features include...
1 DocBookMD is designed by physicians for physicians and provides an exclusive HIPAA-compliant professional network to communicate collaborate and coordinate with your medical society colleagues
On-Demand Messaging
• HIPAA-compliant • Send instant messages • Set message priority: Get a 5 min, 15 min or normal response time
2 Multi-Media Collaboration Securely send high resolution images, e.g. of X-rays, EKGs or wounds
3 Fast Look-Up A directory of county Medical Society colleagues
4 Quick Pharmacy Search It’s easy to get started:
5
Use on Multiple devices
Switch easily and seamlessly between up to two devices: iPhone or Android, and an iPad or iPod touch.
• First download DocBookMD from the iTunes App Store or Google play • Open up the app on your device to begin the registration process. You will need your Medical Society ID number. If you do not have it, contact your medical society for assistance.
• Start using DocBookMD to communicate collaborate and coordinate! For more details go to:
communicate collaborate coordinate
DocBookMD.com MARCH / APRIL 2012 | THE BULLETIN | 13
Member benefit
Who We Are
HRS/Amerinet is a group purchasing organization (GPO) founded in 1980 as a marketing affiliate of Amerinet. HRS/ Amerinet membership includes health care organizations as well as dental and veterinary facilities. We are owned by a non-profit organization which allows us to concentrate on our members, not the bottom line. HRS/Amerinet’s core values and business approach reflect our health care heritage. We treat our members and vendors with the same considerations as health care providers view their patients. We are friendly, professional, data driven, responsive, conservative, ethical, and actively seek long-term healthy outcomes. With hundreds of thousands of member organizations representing millions of Americans, HRS/Amerinet is one of the largest GPOs in the nation. As of 2009, we have saved our members over $992 million. Our owner, Virginia Mason Medical Center (www. virginiamason. org), was recently named the nation’s top hospital of the decade by Leapfrog, an independent health care association of large employers whose mission is to make health care delivery safer and affordable.
Our Business
TA CLARA SAN
•
Health Resource Services
IAT SSOC ION • LA
Fact Sheet
Y MEDIC UNT A CO
C AL
IF O R N IA
Our Vendors
HRS/Amerinet offers its members access to over 800 agreements that include over 1,000,000 SKUs. Here are some of the product groups HRS/Amerinet contracts cover: Construction Diagnostic Imaging Energy Solutions Environmental Services Executive Resources Food Service Information Technologies Laboratory Medical and Surgical Supplies Office Solutions Pharmaceuticals Plant Engineering
How to Join HRS/Amerinet
If you are interested in joining HRS, or simply learning more about the program, please contact Evan and mention you are a part of SCCMA or MCMS:
HRS/Amerinet negotiates discounted rates on products and services driven by the industry needs of our members. These savings are passed along to our members. Essentially, HRS/ Amerinet leverages the purchasing volume of its membership to obtain favorable pricing from preferred manufacturers and service providers.
Evan Stoll (800) 842-6663 toll free (206) 583-6516 local (801) 478-5772 fax Evan.stoll@amerinet-gpo.com
HRS/Amerinet membership is free and voluntary. And we make it easy to register and access the vendor discounts. HRS/Amerinet has an active customer service team to answer member questions and direct members to particular vendor representatives.
Health Resource Services 1100 Olive Way, Suite 1030 Seattle, WA 98101 (800) 842-6663 www.amerinet-hrs.com www.amerinet-gpo.com customerservice@amerinet-gpo.com
For Our Members
HRS/Amerinet is committed to helping our members achieve new levels of success now and years from now. Every day, our clinical and supply chain experts are hard at work developing solutions that deliver real benefits to our members and those they serve. HRS/Amerinet is the GPO that helps members lower costs, enhance revenue, and improve quality of care by customizing a set of performance solutions that delivers quantifiable savings, actionable data, and guidance members can trust.
14 | THE BULLETIN | MARCH / APRIL 2012
Expanding your expertise with ours.
When you refer your patients to John Muir Health, you can be confident they will receive exceptional care from a dedicated team of experts. Our highly experienced medical specialists provide a comprehensive, multidisciplinary approach that offers a continuum of clinical expertise across a full range of services. • Behavioral Health Center • Cancer Institute • Cardiovascular Institute • High-Risk OB • Inpatient Rehabilitation Services • Level III NICU
John Muir Medical Centers, Concord and Walnut Creek, California
• Level II Trauma Center • Neurosciences Institute • Orthopedics Institute • Pediatrics • Surgical Services • Weight-Loss Surgery
johnmuirhealth.com MARCH / APRIL 2012 | THE BULLETIN | 15
member benefit
NORCAL Member Advantage Look What's New In Membership! RISK MANAGEMENT DISCOUNT DETAILS:
NORCAL Mutual’s 5% discount for completing two risk management CME credits is now 7% for policyholders who complete a third CME credit and remain a member of the Monterey County Medical Society/Santa Clara County Medical Association. Risk management CME activities are available to NORCAL policyholders free of charge. CME credits can be earned conveniently on-line at MyNORCAL, the policyholder login area of the NORCAL Mutual website, www.norcalmutual. com. If you don’t currently have a MyNORCAL account, call NORCAL’s Policyholder Services at 877/443-7232, Monday through Friday from 8:00 a.m. – 5:00 p.m. This expanded Risk Management Discount for MCMS/SCCMA members is applicable to policies renewing January 1, 2012 or later. Policyholders must have earned the three CME credits and have been active members of MCMS/SCCMA 90 days prior to their policy renewal in order to receive the 7 % discount in 2012. Remember to keep your MCMS/SCCMA membership current in order to get the full 7% discount for 2013. Please invite your colleagues to join MCMS/SCCMA and to apply to NORCAL to become eligible for the seven percent discount.
ber of factors such as the area of the state where they practice and their medical specialty. This overall rate reduction will take effect retroactively to January 1, so that the majority of NORCAL’s policyholders, who renew on January 1 or later, will benefit from the rate decrease. NORCAL will re-rate all policies that were either written or renewed in 2012 and apply the new rates. Policyholders can expect to see their rate adjustment reflected in an upcoming, scheduled billing statement, no later than July 1.
For most physicians in a solo practice of 1 - 4 physicians, you may now qualify for a 7% reduction on your NORCAL Mutual premiums!*
AN OVERALL RATE DECREASE FROM NORCAL MUTUAL:
In addition to offering this extra savings to MCMS/SCCMA members, NORCAL Mutual is also reducing California rates an overall 7.07%. The rate reduction impact per policyholder will vary depending on a num-
16 | THE BULLETIN | MARCH / APRIL 2012
OTHER BENEFITS:
NORCAL has also eliminated the age requirement for the retirement tail premium waiver. Policyholders can retire completely and permanently from their practice of medicine at any age, and receive a free tail, as long as they have been a policyholder for the previous five years and remain retired. All other provisions allowing limited work remain unchanged, including, for example, the ability for a physician to work on a limited basis for remuneration, or on a charitable basis, without jeopardizing their free tail. If you have any questions about the Risk Management Discount or the overall rate decrease, please call NORCAL’s Policyholder Services at 877/443-7232, Monday through Friday from 8:00 a.m. – 5:00 p.m. *If you are currently part of NORCAL Mutual’s surcharge program, you are not eligible for the Risk Management Discount Program. Remember… Think MCMS/SCCMA! 831/455-1008 or 408/998-885
MEMBER BENEFIT
See What You Could Be Saving on Workers’ Compensation Insurance! “My premium savings was over $1,900! What a great member benefit. All Society members with employees should get a quote. It was so easy to do.” – Philip R. Delio, MD Neurology Associates of Santa Barbara Did you know that CMA/Association/Society members can save 5% on their workers’ compensation insurance? And, they may save even more than that, up to 15%, depending upon their group medical carrier. It’s true. CMA/SCCMA/MCMS members receive a 5% discount on workers’ compensation insurance policies provided through Employers Compensation Insurance Company. This discount is available exclusively through Marsh, the CMA/SCCMA/MCMS-sponsored broker and administrator. And, EMPLOYERS provides you with the loss control tools, such as Loss Control ConnectionSM, that can help you manage the long-term costs associated with workers’ compensation. Because safer workplaces contribute to lower workers’ compensation premiums and less lost time for employees, the importance of effectively preventing injuries and managing claim costs is clear. • EMPLOYERS Loss Control ConnectionSM is an easy-to-use, online risk management database that provides policyholders with unlimited access to a comprehensive library of loss prevention tools, OSHA log software, safety posters, and other valuable resources—at no charge. Should you have a claim, experienced professionals at EMPLOYERS work to deliver prompt, efficient, knowledgeable service to resolve claims quickly and fairly while helping employees get back to work. Don’t wait until the last minute. Contact Marsh today to get a workers’ compensation premium quote, so you’ll be prepared in the event your rate increases on renewal. If you have any questions, or would like to get an immediate indication of your potential savings, please call a Marsh Client Service Representative at 800/842-3761 or e-mail CMACounty.Insurance@marsh. com.
MARCH / APRIL 2012 | THE BULLETIN | 17
TuRN INTO
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Your time is valuable. Would you rather be spending it with patients or answering messages, playing phone tag, and chasing critical information from the lab, radiology, pharmacy or specialist? evigils™ offers everything you need to turn spent time into time well spent. It dramatically increases the efficiency, effectiveness and productivity of your medical practice and helps enhance your quality of patient care.
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eVigils.com
evigils™ is a private, closed loop, secure communication service designed to address the shortcomings of e-mail and texting as applied to the collaborative nature of healthcare. evigils™ security • There is no data stored on a personal device, iPhone®, iPad®, computer, etc. • All data is stored in our data center in encrypted data bases. • Our data center is a very high security, Class III data center. • All communication traffic is encrypted using modern SSL technology
18 | THE BULLETIN | MARCH / APRIL 2012
member benefit
2012 Discount Ticket Program CALIFORNIA’S GREAT AMERICA Online only:http://www.cagreatamerica.com Adult Admission Season Pass (includes Parking Pass and Gilroy Garden admission only)
Gilroy Gardens Adult Admission Child/Senior Admission (3-6 years or over 64)
Regular Price
Discounted Price
$56.00
$32.00
$80.99
$71.00
Online Only: www.gilroygardens.org
$44.99 $34.99
$22.00 $22.00
DI S NE Y T h eme Pa rk (contact the Membership office) Corporate Discount Ticket Program Order Tickets online – Information on the MCMS/SCCMA website Save $40, $50, $60 per ticket (based on various ticket packages) Monterey Bay Aquarium ONLINE ONLY; HTTP://AFFILIATE.MONTEREYBAYAQUARIUM.ORG Adult (18-64 years) Child (3-12 years) Student (13-17 years) Senior (65+ years)
Raging Waters
$32.95 $19.95 $29.95 $29.95
$28.95 $15.95 $25.95 $25.95
ONLINE ONLY: WWW.rwsplash.com
Adult Admission Season Pass Under 3 years FREE!
Six Flags Discovery Kingdom
$33.99 $52.99
$23.00 $43.00
online only:
https://shopsixflags.accesso.com/clients/sixflags/affiliate/index.php?m=15780 USERNAme - SantaClaraDK
General Admission Season Passes Meal Voucher
See’s Candies
1 lb. Gift Certificate
$54.99 $64.99 $12.00
$16.40
$32.00 $50.00 $11.00
$13.70
CALL THE MEMBERSHIP OFFICE AT SCCMA/MCMS FOR DISCOUNT CODES 408-998-8850, OR LOOK ONLINE AT sccma-mcms.org MARCH / APRIL 2012 | THE BULLETIN | 19
By Tanya Spirtos, MD Those of you already using electronic health records (EHR) can skip this article, for fear of post-traumatic stress disorder remembering their own experiences. For the rest of you just starting the transition, I would hope that my experiences of 2011 will assist you in your journey forward. The moral of this story is: think positive, expect negative, and don’t settle for “good enough!” During the past year, my work at the SCCMA, the CMA, and the AMA suffered, as did my family, due to what became an all-consuming transition at the Women’s Care Medical Group comprised of eight physicians, two nurse practitioners, numerous medical assistants, and an in-office billing team. As one of the first at our hospital to make the transition, we received extra IT help, but we also stumbled upon landmines that those following in our path will hopefully avoid. The major lessons we learned were: 1. It will take longer to adapt than the IT “experts” warned you. You will be told to close the office except emergencies for one week, and then have minimal number of patients for two weeks, before slowly getting back up to “full steam.” The truth is that no one will really be helping you navigate the first few patients, you will make mistakes you have to redo (painfully), and you will spend hours every evening and every weekend trying to catch up on unfinished charts, lab results and documents (remember: medical assistants will no longer be filtering the “paper” flowing electronically directly to you!), and phone messages (in the beginning, you will still need to chase down the paper chart to answer the call – or, if you made the mistake of scanning the ENTIRE chart into the computer, you will have to scroll through many pages to find a simple answer). 2. You will spend an exorbitant amount of money before you ever see any time or office savings. No one can accurately predict for you the initial cost of the electronic medical record program and licenses, computer work stations, and scanners for EACH employee — not to mention overtime hours for the office managers and medical assistants, as well as the consultant IT help on an almost daily basis. What you may save in fewer filing clerks is surpassed by the pay of new employees with EHR-related duties. 3. Morale and well-being of physicians and employees will take a severe blow. Anxiety, depression, irritability, sleep disturbances, and frustration are all common; the pressure of learning new technology and then rapidly adapting from comfortable work patterns to an entirely new format can be overwhelming to both novice as well as tech-savvy employees. Physicians tend to be very skillful, conscientious, and goaloriented: these traits can make them too critical of their own ineptitude, perceived slowness in adapting, and inability to “complete the task” in a self-imposed time frame. The relationship between the physicians and the employees may be rocky as each adapts to the others’ work styles and perceived patient needs. The best analogy I can think of for this first year of EHR is: being diagnosed with cancer (not terminal, thank God!). You receive the diagnosis and presumed “cost of care,” you undergo the surgery (switching on the EHR) and various adjuvant treatments (eradicating the paper flow, adding new touches and talents, recognizing mistakes, and having
to redo them). Over it all hangs a feeling of disbelief, depression, anger, bargaining, acceptance, and finally looking ahead (now it sounds like Elizabeth Kubler-Ross!). All of this takes a toll on the health of those around you: your spouse, your children, your health (think you have time to go to the gym? prepare healthy meals? sleep peacefully without dreaming of the computer?) — not to mention the low back pain, carpal tunnel, and strained paraspinous and eye muscles from staring at the computer screen for hours-on-end. Activities that bring you joy (the arts, community groups, hobbies) and participation in professional activities (organized medicine, charities and free clinics, specialty societies) are sidelined, until you reach the “recovery phase” as a survivor of EHR implementation. Let me end with some simple advice to you who are contemplating the start of your own transition. 1. Keep focused on the bottom line. There is no choice but to accept and excel at the technology in order to maximize effectiveness and remuneration, as a physician in the future health care system. But try not to lose touch with the delivery of quality health care to a person depending on you (i.e., refer back to the Hippocratic oath: still recited by tech-savvy and idealistic medical students). There may come a day when each person’s entire collection of notes and records from all sources of health care is seamlessly interwoven into one usable, coherent form. 2. Don’t give up partway through this transition. Practices that start and then put aside implementation, or only accept certain pieces of the EHR, may not avail themselves all of the benefits to compensate for the costs incurred. Understandably, some practices may choose the wrong electronic health record and be forced to start all over or convert along the way. 3. Do your research ahead of time. Find a same-specialty practice locally using that electronic health record and spend a few hours learning from their mistakes. Why reinvent the wheel? Also, decide ahead of time what you are going to do with the paper charts. Of course, you can pay a company to come in and scan every page of every chart into the documents section, but then who will distill and type that medical information into the format? Most likely your paper chart in no way resembles the software clinical record purchased, as constructed by the “experts.” 4. Hold regular meeting of physicians and office personnel. Initial weekly, and then monthly, meetings of all physicians and office personnel are essential to analyze errors and mistakes, share “best practice” patterns, and maintain the morale and comraderie of all involved. Keep reminding everyone of the goal: better patient care, less paper, less chance for errors, and, eventually, greater work satisfaction. Yes, implementing EHR has been a tremendous storm, but we have no choice but to weather it and survive — detritus swept away, a new horizon of infinite possibilities ahead of us, hopefully still the same dedicated physician, but with new talents and life experiences. Accepting, adapting, and excelling in the technology of health care delivery should maximize our clinical effectiveness and financial remuneration in the future health care system. By our natures and our education, physicians can become even more compassionate, communicative, and effective in the future coordinated health care team. MARCH / APRIL 2012 | THE BULLETIN | 21
SCCMA Annual Awards Banquet and Installation Tuesday, June 5, 2012 • 6:15 pm Social 7:00 pm Dinner & Program • The Fairmont Hotel, San Jose
Installation: Rives C. Chalmers, MD, SCCMA President 2012-13 Honoring: William S. Lewis, MD, SCCMA President 2011-12 Award Honorees Robert M. Pearl, MD – Robert D. Burnett, MD Legacy Award Steve Fountain, MD – Benjamin J. Cory, MD Award Eleanor Levin, MD – Outstanding Achievement in Medicine William Jensen, MD – Contribution in Medical Education Robert M. Gould, MD – Contribution to the Medical Association David Quincy, MD – Contribution to the Community Assemblymember Jim Beall – Citizen’s Award Donna Spagna – Dedicated County Alliance Member Award Formal invitations will be mailed end of April
MCMS Annual lnstallation Dinner
Tuesday, June 12, 2012 • 6:15 pm Social 7:00 pm Dinner & Program • Del Monte Beach House, Monterey Installation: John Clark, MD, MCMS President 2012-13 Honoring: James Ramseur, MD, MCMS President 2011-12 Formal invitations will be mailed in May
Billing Collections Consulting
Honest Fair Accountable
Accurate Consistent Knowledgeable
The Bureau of Medical Economics (BME) is a full service medical billing and collection agency exclusively sponsored by the Santa Clara County Medical Association since 1947
Competitive pricing and superior service for your Billing, Collection, and Consulting needs.
Committed to providing superior billing and collection services to physicians and other professional providers of health services while upholding the professional integrity of those we represent.
BME Headquarters 700 Empey Way, San Jose, CA. 95128 (408) 998-5811 Fax(408) 998-5850 WWW.BMESC.COM
A rate of recovery over twice the national average. A direct line to Customer Service is available to all clients Monday through Friday from 9am -5pm For Customer Service: Karen Jorgenson (408) 998-5811 X3034 karen@bmesc.com
CLARA CO TA
N TIO
SAN
PH: (408) 452-7700 FAX: (408) 452-7470 Email: michelle@lwallc.com
ASSOCIA AL
Y MEDIC UNT
As a proud sponsor of the Santa Clara County Medical Association’s Annual Awards Banquet, Legacy Wealth Advisors would like to congratulate the recipients of this year’s awards.
The LWA team includes Michelle Hamilton, MBA as a specialist in financial planning and portfolio administration.
member benefit: practice resources
CMA MEDICAL-LEGAL LIBRARY The California Medical Association’s FREE Information-on-Demand Service Access the answers to your medical-legal questions — free of charge — with CMA’s ON-CALL documents. CMA ON-CALL is the California Medical Association’s 24-hour online medical-legal library and is the most comprehensive health law and medical practice resource for California physicians. The medical-legal library and its ON-CALL documents includes most of the Center for Legal Affairs’ California Physician’s Legal Handbook (CPLH), as well as more specialized information on peer review and other subjects. In many cases, the documents also include do-it-yourself sample letters and forms. These documents are available free to members at www.cmanet.org or by calling the member help center at 800/786-4262. The document number follows the title. ADA/DISCRIMINATION
AIDS AND HIV
ANTITRUST
ADA and rehabilitation acts: Requirements and defenses (0806)
Confidentiality of AIDS/HIV information (1112)
The antitrust laws: What physicians can do (0210)
Disabled physicians and employees (0812)
Consent for HIV test (0414)
The antitrust laws: Physician group mergers (0211)
Discrimination: HIV-infected patients (0817)
Physicians and unions (0212)
Disabled patients: Provision of health care services (0814) Language interpreters (0813) Patient access to physician offices / facilities (0811) Sign language interpreters (0802)
ADVERSE EVENTS Medical error and adverse events: Voluntary systems and reporting (1530) Medical error and adverse events: Mandatory systems and reporting (1540) Vaccines, drugs and devices: Reporting adverse events (1507) Medical error and adverse events: Transformation through a fair and just culture (1535)
ADVERTISING Advertising by AHPS (0203) Physician advertising (0205) Medical referral services (0240) Workers’ compensation advertising (1905) Accessing patients: Marketing and other steps physicians can take (0206)
24 | THE BULLETIN | MARCH / APRIL 2012
HIV-infected physicians (1312)
ALLIED HEALTH PROFESSIONALS
BUSINESS PROHIBITIONS / DISCLOSURE REQUIREMENTS Corporate practice of medicine bar (0280)
AHP relationships: Business issues (0245)
Disclosure requirements: State and federal (0220)
AHP relationships: Liability issues (0801)
Decision-making authority for integrated entities (0226)
Alternative and complimentary health care practitioners (1630) Medical assistants (1605) Naturopathic doctors (1616) Nurses (1615)
Physician ownership and employment prohibitions (0215)
CLINICAL LABORATORIES
Optometrists (1617)
Certification, licensure and registration (0310)
Physician assistants (1620)
Disclosure, payment, billing, record retention and storage (0305)
Speech-language pathologists and audiologists (1610)
ANCILLARY SERVICES Clinical trials (0255) Cosmetic procedures (1625) Liposuction (1352) Physicians selling vitamins and dietary supplements (0258) Tissue banks (1340)
Self-referral and fee-splitting prohibitions (0315)
CONSENT Blood transfusions (Paul Gann blood safety act) (0407) Cancer information requirements (0410) Dimethyl sulfoxide (DMSO) (0413) Exposed health care workers: Testing patients’ blood (0432) Incompetent patients: Patients lack capacity to consent (0418)
Informed consent (0415)
Controlled substances: Prescribing (0509)
Informed consent exceptions (0417)
Drug dispensing (not schedule ii-v drugs) (0505)
Physician websites, internet advice and e-mail (0823)
Informed consent: Inpatient procedures (0430)
Drug formularies, prescription drug benefit plans, and pharmacy benefit managers (0507)
Electronic funds transfer (1609)
Informed consent: choosing surrogates (0422)
Telemedicine (0435)
Informed consent: Long term care facilities (0421)
Drug prescribing: Drugs from other countries (0511)
Mental health: ยง5150 holds/72-hour detention (0405)
Drug prescribing: Unauthorized (0515)
Payment to secure availability of on-call coverage (1214)
Pain management (0513)
Emergency transfer laws (1215)
Medical marijuana initiative (1315)
Medical staff and on-call coverage requirements (1216)
Informed consent forms format (0420)
Minor consent (0425) Vaccine administration: Mandated information (0440) Use of restraints and seclusion (0419)
Drug prescribing (not schedule II-V drugs) (0510)
DRUG TESTING
DEATH / ORGAN DONATION
Employer obligations regarding drug use in workplace (0523)
Autopsies (1301)
Medical staff testing programs (0522)
Diagnosis of death by neurological criteria (1302) Pronouncement of death and death certification (1305) Organ and tissue donation (1307)
Physician obligations regarding drug testing (0525)
EMEDICINE
EMERGENCY TRANSFER
Reducing/restructuring on-call coverage requirements (1217)
EXPERT WITNESS ISSUES Expert witness guidelines (0909) Expert witness issues (0910)
FRAUD AND ABUSE
Electronic health records (1132)
Advice of counsel defense (0601)
Electronic health records: Federal initiative program (1133)
Criminal convictions of physicians (0605)
Responding to requests for non-beneficial treatment (0403)
Meaningful use of electronic health information (1136)
Fraud and abuse prohibitions (0610)
Deciding to forgo treatment: Advance directives and POLST (0445)
Online consumer review and rating sites (0822)
DECISIONS REGARDING LIFESUSTAINING TREATMENT
Electronic signatures (1138)
Criminal investigations (0703) Identity theft (0608)
Continued on page 26
Deciding to forgo treatment: Without advance directive or POLST (0408) DNR requests and orders and CPR (0409) Documenting decisions to forgo treatment (0411) Patient self-determination act and Joint Commission standards (0412) Physician-assisted suicide (1325) CMA model policy: Responding to requests for non-beneficial treatment (0404)
DRUG PRESCRIBING / DISPENSING Controlled substances: Dispensing (0508)
MARCH / APRIL 2012 | THE BULLETIN | 25
CMA Medical-Legal Library, from page 25 Medicare OIG investigations (0710) The Medicare contract recovery audit contractor program (0629)
FRAUD AND ABUSE: REFERRAL ISSUES Anti-kickback prosecution (0627) Gifts and free services to patients (0612) Kickbacks and fee-splitting: prohibitions (0620) Kickbacks and fee-splitting: other laws (0621) Professional courtesy (0624) Safe harbors (Medicare) (0630) Self-referral: California and federal (Stark) (0636) Self-referral: Federal (Stark ii) (0648)
MANAGED CARE: OVERVIEW Adding new doctor to panel (1010) Coverage requirements/pre-existing conditions (1071) Disclosure by managed care plans (1020) Managed care glossary (1023) Managed care: Health plan liability (0830) Managed care: Physician malpractice liability (1043) Office audits: managed care (1047) Patient complaints about managed care plans (1049)
Physician complaints about managed care plans (1051) Point-of-service plans (1048) Retaliation by managed care plans or others (1050)
MANAGED CARE: CONTRACT TERMINATION / EXCLUSION
MANAGED CARE: UTILIZATION REVIEW AND MANAGEMENT Access to physicians (1005) Clinical guidelines (0835) Denials of necessary medical services (1025) Disease management organizations (1033) Formation and use of utilization profiles (1060)
All products/affiliates clauses (1075)
Hospital stay and discharge requirements (1039)
CMA contract analysis service (free item) (1705)
Independent external medical review (1007)
Contract termination by physicians (1055)
Medical directors: Utilization review and medical practice (1045)
Contract termination or exclusion: Action plan (1099)
Pay for performance (1027)
Contract termination/exclusion: Legal challenges (1041)
Penalties for failure to follow UR procedures (1065)
Exclusion/termination of physicians: Antitrust challenges (1035)
Physician specific outcome reporting (0899)
Exclusivity provisions in contracts (1040)
Primary care physicians and access to ob/gyns (1046)
Failure to receive plan referrals (1053)
Second opinions (1080)
Prohibited managed care contract clauses (1070)
Telephone medical advice (1085)
MANAGED CARE: RISK ARRANGEMENTS
MEDICAL BOARD: DISCIPLINE AND LICENSING
Capitation, including risk adjustment (1016)
Grounds for MBC discipline (0790)
Financial incentive arrangements (1036)
MBC enforcement authority (0708)
Risk bearing med groups and IPAs: Regulation of solvency (0223)
MBC public disclosure program (0717) MBC investigations (0705) Sexual relations with patients; sexual misconduct (0838) U.S. Medical licensing agencies (0720)
MEDICAL BOARD: REPORTING TO MBC and NPDB: Reporting disciplinary actions (1415) MBC and NPDB: Reporting malpractice payments (1414) MBC and NPDB-HIPDB reports: Self-query (1406) MBC: Other reporting requirements (1408) NPDB and HIPDB overview (1405)
MEDICAL PRACTICE: EMPLOYMENT ISSUES CMA model employment contract (0213) Covering physicians (locum tenens) (0107) Employer poster requirements (1308) Ethical guidelines for employer/employee physicians (0224) 26 | THE BULLETIN | MARCH / APRIL 2012
Family and medical leave (0216) Independent contractors (0225) New-hire reporting requirement (0232) Overview of select physician practice employment issues (0217) Pre-employment inquiries (0233) Wage and hour laws (0235) Retirement notice (0250) Whistleblower protections for employees (0229)
MEDICAL PRACTICE: GROUPS, IPAS, MSOS Legal and practical considerations concerning accountable care organizations (0201) ADR in physician contracts (0207) Applicability of use tax on physicians (0208)
Security breach of health information (1144)
MEDICAL RECORDS: REQUESTS FOR ACCESS Attorney pre-litigation request for medical information (1127) Request by other third parties: CMIA, IIPPA, and the HIPAA privacy rules (1101) Employer access/employment physicals (1145)
MEDICARE AND MEDI-CAL Medi-Cal audits (0626) Medicare audits (0625) Medicare participation (and non-participation) options (0151) Medicare reassignment rules (0147) Reasonable and necessary services under Medicare (0640)
Health plan access to medical records (1170)
Resource guide on Medicare/Medi-Cal (0600)
Medi-Cal and Medicare investigators’ access (1148)
Denials under Medicare managed care (1026) Side agreements with Medi-Cal patients (0150)
Patient access to medical records (1150)
Medicare managed care/Medicare Advantage (0152)
QIO access to physician office charts (1155) Requests by law enforcement/search warrants (1147)
Medicare drug benefit (Medicare RX) (0516)
OSHA/OFFICE SAFETY
Capital resources for physicians (0209)
Subpoenas: guide for responding (1180)
MSOs and PPMs (physician practice management cos.) (0231)
MEDICAL RECORDS: SPECIAL CONFIDENTIALITY RULES
Accidents: Investigating and documenting (1841)
Confidentiality of sensitive medical information (1110)
Ergonomics (1827)
Medical group: How to form (0228) Medical partnerships and corporations (0230) Medical practice options: Overview (0200) Legal and practical considerations concerning medical foundations (0218) Physician rights: Medical groups and IPAs (0219) Practice consultant: How to hire (0221) Practice consultant: Sample agreement and RFP (0222) Governance issues for physician organizations (0239) Selling your practice to an integrated delivery system (0256) “Specialty IPA”: How to form (0227)
MEDICAL RECORDS: HIPAA Overview (1600) Business associate agreements (1602) Electronic transaction rule (1606) Privacy rule (1603) National provider identification numbers (1608) Security rule (1607) Spanish notice of privacy practices (1604)
Special confidentiality requests (1175) Disclosure of immunization information (1187)
MEDICAL STAFFS
Bloodborne pathogens (1805) Cal-OSHA compliance and inspections (1810) Hazardous substances: Communication in workplace (1815) Hazardous waste (1820) Injury and illness prevention programs (1825) Medical waste (1830)
Allied health practitioners (AHPs) in the hospital (1201)
Occupational injury and illness records: Log 300 (1828)
Bylaws analysis service (free item) (1703)
Sharps and safety needles (1807)
Disruptive behavior involving medical staff members (1241)
Tuberculosis transmission (1835)
Economic credentialing and exclusive contracts (1212)
Aerosol transmissible diseases (1842)
Exclusive contracts (1211) Guidelines for physician well-being committees (1240) Hospital medical staff incorporation (1219) Hospital accreditation organization standards (1248) Ten strategies to protect quality through medical staff self-governance (1250) Medical staff relationship with hospital board (1279)
Workplace violence (1840) Guide to CMA sample exposure control documents (1845)
OUTPATIENT FACILITIES Ambulatory care accreditation program (1326) Mammography facilities and x-rays (1335) Surgicenters and other outpatient facilities (0202) Hospital outpatient clinics (0214)
PEER REVIEW
Legal counsel for the medical staff (1281)
Assisting physicians with substance abuse (1403)
Med staff membership for Medicare-excluded physician (1207)
Board certification as a requirement of medical staff privileges (1205)
Medical records: Most commonly asked questions (1100)
Medical staff self-governance: policy and law (1280)
Credentialing: Liability releases, indemnification (1430)
Accounting of disclosures (1122)
Sexual harassment in the medical staff context (0837)
Credentialing: Malpractice claims (1431)
Medical staff bylaws: A binding agreement to protect patient care (1206)
External peer review (1417)
MEDICAL RECORDS: MANAGEMENT
Allowable copying charges (1125) Contents of medical records (1135) Fax machines and the medical office (1146) Retention of medical records (1160)
Documentation of peer review activities (1407) Ongoing professional practice evaluation (1498)
Continued on page 30 MARCH / APRIL 2012 | THE BULLETIN | 27
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CMA Medical-Legal Library, from page 27 Fair hearing requirements (1410)
Late payment by plan/IPA (0124)
Guide to peer review hearings (1411)
Fee schedules (0129)
Administrator and board access to peer review files (1420)
Non-contracting physicians/implied contract (0130)
Proctoring (1422)
Insolvency of plan or IPA (pre-bankruptcy) (0131)
Peer review protections – executive summary (1425)
Payment denial after authorization/verification of eligibility (0145)
Privileging low volume practitioners (1429)
Payment denials by managed care plans and IPAs (0146)
Reporting incompetent/impaired/unethical colleagues (1435) Sharing peer review information (1440) State agency request for peer review info (1443) Summary suspension (1445)
PHYSICIAN/PATIENT RELATIONSHIP
Plan requests for refunds from physicians (0135) Reimbursement for immunizations and other injections (0185) Silent PPO action guide (1907) Health plan special claims review (0180)
REIMBURSEMENT: FROM PATIENTS
Establishment of physician/patient relationship (0818)
Billing patients (0110)
Patient retention/restrictive covenants (0275)
Collecting from deceased patient’s estate (0120)
Physician/patient communication (0819)
Collecting from patients/extending credit (0112)
Termination of physician/patient relationship (0805)
Concierge (boutique) practices (0117)
PROFESSIONAL LIABILITY Commonly asked questions (0800) Arbitration of medical injury claims (0807) Countersuits (malicious prosecution) (0808)
Health savings accounts (0118) Waiver of copayment (0115) Red flags rule (1119)
REIMBURSEMENT: OTHER ISSUES
Communicable diseases, tuberculosis, bioterrorism (1506) DMV reports: Epilepsy/lapses of consciousness (1525) Neonatal and pediatric disorders (1527) Occupational illness and injury (1528) Psychiatric inpatients: Reporting firearms prohibition (1515) Vital statistics: Birth or marriage (1503)
REPRODUCTIVE ISSUES Abortion issues (0401) Tests of pregnant women, newborns and young children (1303) Infertility treatment: Consent requirements (0406) Infertility treatment: Licensing and screening requirements (1313) Informed consent for sterilization (+ hysterectomies) (0416)
WARNING OBLIGATIONS Physician’s duty to warn (0815) Proposition 65 warnings (0816)
WORKERS’ COMPENSATION Basics of the Workers’ Comp system (1911)
Criminal prosecution of physicians (0809)
Charging for form completion (0113)
Health care organizations (HCOs) (1915)
Elder and dependent adult abuse liability (0895)
Emergency medical services fund and federal funds for Undocumented alien emergency care (0119)
Identifying fraud (1922)
Hiring a billing company (0111)
Medical provider networks (1932)
Medical liens (0125)
MPN independent medical review (1955)
Physician access to hospital, lab and pharmacy charges (0123)
Qualified medical examiners (QMEs) (1945)
Small claims action to recover payment (0155)
Subpoenas (1940)
Good Samaritan and other immunities (0820) Malpractice insurance issues (0804) MICRA information (0825) Punitive damages (0836) Resolution of claims with Medicare-eligible claimants (0832) Sexual harassment of patients or employees (0870) Unanticipated outcomes in patient care (0824) What happens when you’re sued (0803)
REIMBURSEMENT: FROM HMOS AND OTHER PRIVATE PAYORS RICO settlements (0108) Assignment of benefits (0105) Bankruptcy of IPA or health plan (0106) Coordination of benefits (0114) Coordination of benefits: Payment below Medicare (0116) Emergency services (0121) ERISA plans (0122) 30 | THE BULLETIN | MARCH / APRIL 2012
Treatment of relatives (or oneself) (0160)
REPORTING ABUSE/ VIOLENCE Child abuse or neglect (1505) Elder/dependent adult abuse (1510) Domestic violence (1511) Injury by deadly weapon/criminal act (1520)
REPORTING DISEASES, CONDITIONS, AND EVENTS Pandemic and emergency health preparedness act (0845) Cancer and Parkinson’s disease cases (1501)
Medical-legal evaluations, reports, and payment (1925)
Spinal surgery: Second opinion process (1951) Treating physicians: Obligations and reports (1930) Treating physicians: Payment (OMFS) (1929) Utilization review (1950)
MISCELLANEOUS ISSUES Asking for CMA legal assistance (free item) (1701) Disability parking certification (0810) False and misleading advertising: how to report fraud (1318) IMQ CME-certification program for physicians (1707) Driving laws: Emergency exemptions (1350)
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Member Benefit
Reimbursement Advocacy Another benefit for SCCMA/MCMS members For coding questions and reimbursement issues, contact Sandie at 408/998-8850 or MCMS 831/455-1008 or email sandie@sccma.org. Also, contact Sandie if you would like to receive the Economic Advocacy newsletter by email.
Reimbursement Advocacy Program (RAP) is a benefit available only to members of the Monterey County Medical Society and Santa Clara County Medical Association. Through RAP, association members gain leverage in collecting payments from managed care plans (and other payers) slow in honoring claims. The RAP program also provides physicians, their office managers, and/or billing staff with coding and billing guidance.
Contact RAP for Assistance With:
Carrier Failure to Process “Clean Claims” in Accordance With State Law (30 days for PPO plans and 45 days for HMOs) • Habitual Downcoding • Treatment Authorization and Subsequent Denial • Payment Inconsistent With the Physician’s Contract and CPT Guidelines • Coding Guidance
Follow These Steps To Expedite In-Office Collection: Step #1: Collect Accurate Data Remember—collection of accurate data is vital to your practice. Verify the information below at every patient encounter: • HMO or IPA affiliation • Name of insurance company • Name of Primary Care Physician (PCP)—with some plans this information can change monthly • Patient’s home address. Do not accept a P.O. Box, in lieu of a home address • Patient’s phone number • Address and phone number of patient’s current employer • If the patient visit requires a referral from a PCP, secure the referral number prior to the patient visit Step #2: Discuss Fees and Billing Procedures With Your Patients It is very important to inform new patients 32 | THE BULLETIN | MARCH / APRIL 2012
about billing policies, when they call for an appointment. Place a sign at the check-in area advising patients that co-pays and deductibles are due at the time of service. Also, incorporate these policies in your patient registration form. Collect any applicable co-pays and/or unmet deductibles at patient checkout. Strict adherence to the foregoing will eliminate the additional expense of follow-up billing. Consistent observance of the “pay at time of service” policy not only reduces overhead, but reinforces the custom with patients, resulting in their readiness to pay prior to leaving the office.
Step #3: Electronic Billing Claims should be filed electronically, whenever possible. This practice will significantly expedite payments and save resources, i.e. staff time, supplies, postage. In order to ensure timely reimbursement, whether billing electronically or via submission of paper claims, it is imperative that claims are “clean” and accurate, i.e. employ proper use of CPT procedure codes, modifiers, and ICD-9 diagnosis codes. The availability of up-to-date coding manuals, familiarity with current coding literature, augmented with attendance at billing-related seminars, are essential tools for precise billing.
Step #4: Obtain “Physician Claims Inquiry” Forms From MCMS/SCCMA These bright green forms, identified with the MCMS/SCCMA logo, garner excellent results when affixed to claims that seem to be “hung-up” in the system. Attach this attentiongetting form to a copy of the original claim(s) and resubmit to the carrier—30 days after the first submission for PPOs and 45 days for HMOs. Step #5: Request Help From MCMS/ SCCMA RAP After 30-45 days, if there is no response to the “Physician Claims Inquiry,” complete and sign an RAP form, and attach a copy of the claim, the patient’s insurance card, along with any related correspondence, and mail to: Monterey County Medical Society or Santa Clara County Medical Association 700 Empey Way San Jose, CA 95128 To request “Claims Inquiry” & “Reimbursement Advocacy” forms, Please contact one of the following: Fax 408/289-1064 Call 408/998-8850 Ext. 3007 Web www.sccma-mcms.org Mail See above address
•
TA CLARA SAN
C AL
IAT SSOC ION • LA
Y MEDIC UNT A O C
IF O R N IA Serving Physicians Since 1876
“My Membership provides me a Voice in Sacramento and Washington DC.” William S. Lewis, MD
Santa Clara County Medical Association, Monterey County Medical Society, and CMA Members Enjoy: Vast CMA Resources: • • • • • • •
Contract Analysis Reimbursement Hotline Legal Hotline Legislative Hotline HIPAA Compliance Free Monthly Webinars on various topics Extensive Online Resources including over 200 letters, agreements, forms, etc. • Plus - Free Legal Advice with CMA ON-CALL Documents!
Santa Clara County Medical Association and Monterey County Medical Society Resources: • • • • • • • • • • • •
Annual Directory CMA Member Seminars Cost-Saving Benefits Bi-Monthly Publication Website/Online Resources Insurance Savings Alliance Membership Annual Social Events Patient Referrals Practice Resources Reimbursement Advocacy DocBookMD phone app
Federal, State, and Local Advocacy:
Your dues are an investment which supports our efforts in protecting your rights.
If We Don’t Fight for You… Who Will?
Phone: (408) 998-8850 or (831) 455-1008 www.sccma-mcms.org MARCH / APRIL 2012 | THE BULLETIN | 33
Santa Clara County Medical Association Town Hall Meeting Tuesday, May 1, 2012 Presents:
Paul Phinney, MD, CMA President-Elect “The Direction of Organized Medicine: Where We’ve Been, Where We’re Going, and Why We Are Relevant” Santa Clara County Medical Association Headquarters 700 Empey Way, San Jose - 2nd Floor Conference Rooms
All SCCMA physician, resident, student, and Alliance members are invited (Non-members are welcome, too!)
Paul Phinney, MD, Biography
Paul Phinney, MD, is President-Elect of the California Medical Association and has been a practicing general pediatrician with The Permanente Medical Group since 1984. He served in a number of clinical leadership roles at Kaiser Permanente in south Sacramento, including Chief of Pediatrics (1988-94), Chief of Pediatrics (19942002), and Chair of the Permanente Regional Pediatric Chiefs (1992-95). Doctor Phinney has been a member of CMA since 1988, and is Chair of the CMA Board of Trustees in what is now his sixth year as a CMA Trustee. He was the 2003 President of SSVMS (Sierra Sacramento Valley Medical Society), served on its board of directors, 2000-2004, and was a delegate to the CMA House of Delegates, 20022004. Doctor Phinney has also served on the CALPAC Board of Directors (2003 to 2010), CMA Council on Legislation, and on CMA committees including Finance, Nominations, Medical Board, and MICRA Education Fund.
6:00 PM – Heavy Hors d’oeuvres and Libation 6:30 PM – Presentation/Annual Business Meeting/Council
-------------------------------------------------------------------------------------------To reserve a seat, please fax-back your RSVP ASAP to Jean Cassetta at 408/289-1064. Name(s): Questions: 34 | THE BULLETIN | MARCH / APRIL 2012
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MARCH / APRIL 2012 | THE BULLETIN | 35
sccma alliance news
The SCCMA Alliance Honored at the Celebrating Families Program Pat Heller and Kathleen Miller of the SCCMA Alliance attended the reception held at the EMQ Community Center in Campbell. The recognition event, held on February 2, honored agencies which provided financial and personal support of “Celebrating Families!” The Alliance provided a grant to help translate the existing curriculum into Spanish to facilitate recovery for parents and children impacted by alcohol or drug dependence. The curriculum consists of sixteen sessions – each is comprised of a meal, skill building instruction, and a family activity. Rosemary Tisch (pictured on the right), director of Prevention Partnership International, presented the certificate to Kathleen Miller (on the left), representing the Alliance.
Alliance Attends American Cancer Society Wig Room Ribbon Cutting Ceremonies Many cancer patients undergo extensive chemotherapy and, as a result, have had the devastating complication of hair loss. Donna Spagna, an Alliance member, is an active volunteer at American Cancer Society (ACS) and has been instrumental in equipping a place for patients to feel comfortable in finding the appropriate head coverings during their time in treatment. Besides organizing community volunteers to help wash the wigs, Donna has spearheaded the effort to outfit a comfortable and stylish room at the ACS. On February 15, a banner day at the ACS offices in Campbell, special guest, Rose Simmons (pictured on the left), chief operating officer of the American Cancer Society San Francisco Bay Area, and Donna (on the right) attended the ribbon cutting ceremony in Campbell at the newly refurbished Wig Bank. Alliance members attending the ceremony were Mary Hayashi, Suzanne Jackson, Carolyn Miller, Kathleen Miller, Sally Normington, and Marita Trobough of Next Step Boutique. The SCCMA Alliance underwrote the installation of the large full wall mirror. Special kudos to Cambrian Mirror and Glass for donating the beveled mirror and all the volunteers who made this special room a reality.
L to R: Donna Spagna and Marita Trobough 36 | THE BULLETIN | MARCH / APRIL 2012
South Bay American Medical Women’s Association Meeting By Anlin Xu, MD AMWA Co-President On December, 7, 2011, the South Bay American Medical Women’s Association (South Bay AMWA) held their first ever Holiday Celebration Gala at the Dynasty Seafood Restaurant in Cupertino. Over 150 women physicians, and their family and friends, came and celebrated the holiday season at this festive event. The National American Medical Women’s Association (AMWA) was established in 1915. It is the only national medical organization solely dedicated to women physicians. Through the years, National AMWA and its local branches have provided fellowship and education to women physicians throughout the United States. National AMWA has also supported meaningful organizations, such as the American Women Hospital Services, and given women physicians a voice with legislators at the state and national levels. The South Bay AMWA is a local branch of the National AMWA, with members from Santa Clara County and other adjacent counties. Its 501c(3) status denotes it as a nonprofit charitable organization. Our previous president, Dr. Sian Lindsay, brought this organization to a new level, with quarterly educational meetings focusing on topics that are important to women physicians, such as asthma, hypertension, and domestic abuse. In 2011, under the leadership of co-presidents, Dr. Gloria Wu and Dr. Durga Madala, and board members Drs. Anlin Xu, Maureen Khoo, Sheri Bortz, and Laurel Waters, the South Bay AMWA continued with its tradition of quarterly educational events, but also started membership surveys and spearheaded the development of special interest groups to further serve the needs of its members. Dr. Susan Hansen, past Chief of Staff of El Camino Hospital (2001), and current trustee to the California Medical Association (CMA), was the keynote speaker at the event. She reiterated the CMA’s continuing
AMWA board members effort to protect the sacred patient-physician relationship, and its firm stance on prohibiting corporate practice of medicine in California. Dr. Hansen also addressed the issue of our country’s increasing Medicare cost, and the difficulty Medicare has in withholding pay cuts to physicians in 2012. The South Bay AMWA’s first Holiday Celebration Gala was a great success. The members enjoyed great food, fellowship, and a very informative talk by Dr. Hansen. If you are interested in joining South Bay AMWA, please email our incoming 2012 co-presidents, Dr. Anlin Xu at anlin.xu@gmail.com, Dr. Maureen Khoo at mokhoo@gmail.com, or treasurer, Dr. Laurel Waters at lwatersmd@yahoo.com.
A great time was had by all at the South Bay AMWA’s first ever Holiday Celebration Gala. Dr. Susan Hansen was the keynote speaker. MARCH / APRIL 2012 | THE BULLETIN | 37
MEDICAL TIMES FROM THE PAST
The Cory Brothers Modernized Medicine in Santa Clara County By Elizabeth Ahrens-Kley Leon P. Fox Medical History Committee Arriving in San Jose in December of 1847, Dr. Benjamin Cory was the first American-trained physician to hang his shingle in the pueblo. Ben’s tales of mining for gold, being an effective California state legislator, and the fight for improved sanitation and health service for the poor were enough to provide the necessary encouragement for his younger brother, Dr. Andrew Jackson (Jack) Cory, to also leave Ohio to join forces with his brother in the field of medicine in Santa Clara County. Between these two physicians, health care in San Jose was forever changed. Both received their medical degrees from the Medical College of Ohio in Cincinnati, Ben in 1845 and Jack in 1860. Ben practiced alongside his father, Dr. J. M. Cory, in Ohio, for two years before crossing the plains by foot and oxen; Jack, upon receiving his medical degree, promptly sailed from the city of New York to San Francisco, and came directly to San Jose. In those crucial early years, these two brother physicians made their mark on medicine.
THE HOSPITAL ON BASCOM AVENUE
In the first half of the 1850s, as a member of the San Jose Common Council, Dr. Ben Cory helped to lay the basic groundwork for care of the indigent sick in Santa Clara County. In these early years, sanitation was a serious problem. Epidemics of cholera, small pox, diphtheria, and
Dr. A. Jack Cory
other infectious diseases would strike regularly. There was no hospital; medicines and medical supplies were difficult to obtain. The doctor worked on sanitation ordinances and campaigned tirelessly for improvement in the city’s health services. He surely was ecstatic to learn of Jack’s interest in medicine, and his willingness to come to California to help in the vital struggle for better health care. In 1860, the county hospital was relocated to South Street, west of Los Gatos Creek, but the city was growing rapidly, and the citizens objected to the “pest house” being in such close proximity. It again became necessary to move the hospital to a new location. Through the concerted efforts and leadership of Drs. Ben and Jack Cory, the county was able to purchase property for a hospital on Bascom Avenue, in 1871, and construction of the new Santa Clara County Infirmary (presently Santa Clara Valley Medical Center) was completed in 1875. Full operations began the next year, with six wards to accommodate 65 patients. Dr. Jack Cory was the first physician director of the hospital. He remained in charge of the county hospital for 11 years (1865-1876) and was the county coroner for a total of nine years. Dr. Ben Cory was the medical director of the hospital from 1880-1882.
CIVIC LEADERSHIP
The new Santa Clara County Infirmary (Bascom Avenue is in the foreground) 38 | THE BULLETIN | MARCH / APRIL 2012
Dr. Benjamin Cory
By the death of Dr. Benjamin Cory in 1896, he had been practicing medicine in San Jose for nearly 50 years, longer than any other physican on the Pacific Coast, up until that time. Dr. Benjamin Cory and his brother, Dr. A. J. Cory, were motivated civic leaders, inspired by notions of public service to fellow citizens, the community, and the state. Through their combined efforts and effective leadership, the foundations for modern medicine were solidly planted in Santa Clara County.
In a Victory for Patients, Judge Rules State Violated Disclosure Law A Sacramento Superior Court judge ruled on March 19, 2012, that the California Department of Health Care Services (DHCS) violated the California Public Records Act by refusing to provide public documents related to DHCS’s proposed Medi-Cal cuts. The California Medical Association (CMA), along with the California Hospital Association and the California Pharmacists Association, filed the lawsuit in October 2011, after DHCS repeatedly denied CMA’s requests for information that purported to support the state plan amendment that was submitted to the Centers for Medicare & Medicaid Services (CMS) in June 2011.
“This is a victory for patients in California,” said James T. Hay, MD, CMA President. “Data shows that access to care would be substantially impacted by cuts to California’s Medicaid program (Medi-Cal). Our request of the state was simple – we wanted to see information they claimed to have showing the contrary. Clearly, it didn’t exist.” Judge Connelly ordered the state to provide the documents it gave to CMS. The state has 20 days to appeal or seek additional time to explain why it believes the documents should not be revealed. (CMA Alert, April 2, 2012 issue)
The state of California was seeking permission to implement drastic cuts to the Medi-Cal program, including a 10% provider rate cut, mandatory patient copayments, and a cap of seven physician office visits per year for beneficiaries. CMA requested public records that DHCS relied on when drafting the state plan amendment. In his final order, Judge Lloyd Connelly stated the documents requested by CMA were not “not subject to the deliberative process privilege claimed by DHCS.”
MARCH / APRIL 2012 | THE BULLETIN | 39
medico news
CMA recommits to patient safety despite court ruling favoring nurse anesthetists A state court of appeal has ruled that nothing in California law requires nurse anesthetists to be supervised by physicians when administering anesthesia to patients. The ruling came without regard for the numerous concerns and objections raised by the California Medical Association (CMA) and the California Society of Anesthesiologists (CSA). The court’s ruling lets stand a 2009 decision by former Governor Arnold Schwarzenegger to exempt California from federal rules requiring physician supervision of nurse anesthetists in Medicare participating hospitals. According to the court, any concerns “that a physician’s practical, ethical, and legal responsibilities for his or her patient’s care will be jeopardized by the use of unsupervised certified registered nurse anesthetists to administer anesthesia” should be resolved “with the Legislature, not this court.” CMA and CSA challenged Schwarzenegger’s decision in court because they believe it is inconsistent with California law, which requires that a physician always retain responsibility and control over the medical care of his or her patient. Physician supervision over nurse anesthetists is
necessary within this framework, according to CMA, to ensure that the medical professional with the best training and the most clinical experience remain involved through all aspects of anesthesia care. Although nurse anesthetists can and do administer anesthesia, physicians are the most qualified to monitor the effects of the anesthesia, and to react immediately when medically necessary. Despite the recent court ruling and Schwarzenegger’s opt-out decision, hospitals in California still have the authority to require physician supervision of nurse anesthetists at their facilities. Furthermore, medical staffs at hospitals may also be able to implement a supervision requirement within the scope of their self-governance rights over the professional work in a hospital. While disappointed with the decision, CMA remains undeterred and committed to protecting the quality and safety of all medical care provided to Californians. CMA is analyzing the opinion and exploring all legal, regulatory, and legislative options. (CMA Alert, March 19, 2012 issue)
CMA announces sponsored bill package February 24, 2012, was the last day to introduce legislation for this year’s session. While the California Medical Association (CMA) will take a position on hundreds of bills in the coming weeks and months, there are also nine new sponsored bills that were subject to the February deadline, a few of which are listed below. A full summary of CMA-sponsored bills, including legislation on a physician health program in California, will be forthcoming. SB 1318 (Wolk) Health facilities: influenza vaccinations – This bill would require all health care workers in health care facilities, including physicians, to either receive the influenza vaccination or wear a mask to help prevent the spread of influenza. AB 1742 (Pan) Health care coverage: payment for benefits – Requires Knox-Keene regulated PPO products to authorize and permit assignment of an enrollee’s or subscriber’s right to reimbursement for covered services to
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the provider furnishing those services. The bill provides for the direct payment of individual insurance medical benefits by a health insurer to the person who provided the hospitalization or medical or surgical aid, and limits the amount of the reimbursement to the amount of the benefit covered by the policy. AB 1746 (Williams) Schools: nutrition: beverages – This bill would ban the sale of sugary sports drinks during school hours at middle and high school campuses throughout California. AB 2109 (Pan) Communicable disease: immunization exemption – This bill would require a parent or guardian seeking a personal belief exemption for their child to obtain a document signed by themselves and a licensed health care practitioner saying they have been informed of the risks and benefits of the immunizations, as well as the public health risks of the specified communicable diseases. This
bill preserves a parent’s option to exempt their child from immunizations, but also ensures that such a decision is an informed one. AB 2063 (V. Manuel Perez) Immunizations for children: reimbursement of physicians – Requires a health care service plan or health insurer that provides coverage for childhood and adolescent immunization to reimburse a physician or physician group in an amount not less than the actual cost of acquiring the vaccine plus the cost of administration of the vaccine. The bill would prohibit the imposition of deductibles, coinsurance, or other cost-sharing mechanism for the administration of childhood or adolescent immunizations or for related procedures. The bill also prohibits the plan from requiring a physician or physician group to assume financial risk for immunizations, whether or not those immunizations are part of the current contract. (CMA Alert, March 5, 2012 issue)
medico news
CMS releases draft notice for Stage 2 of EHR meaningful use Last month, the Centers for Medicare & Medicaid Services (CMS) released a draft notice of proposed rule making (NPRM) defining Stage 2 of meaningful use for electronic health records (EHR). Like Stage 1, this new definition of meaningful use contains a set of mandatory measures that physicians must report, as well as a series of clinical quality measures from which physicians must select. In addition to the proposed definition of Stage 2, CMS also proposed changes to the existing Stage 1 of meaningful use. The California Medical Association (CMA) has prepared a document that will brief physicians on proposed changes. These changes would take place in 2013 and 2014 for physicians demonstrating Stage 1 meaningful use during those calendar years. CMA has prepared a document that will brief physicians on proposed changes to both Stage 1 and Stage 2. On December 1, 2011, U.S. Health and Human Services Secretary Kathleen Sebelius announced that HHS would delay implementation of Stage 2 of meaningful use of EHR until 2014. Under previous rules, physicians who achieved meaningful use in 2011 would have had to move to the higher Stage 2 standard in 2013. The NPRM would codify this delay.
On January 1, 2015, the federal government will begin reducing Medicare payments for physicians who don’t meet meaningful use. The rule provides clarification on the basics of the incentive program, including how physicians can comply with meaningful use in time to avoid payment reductions in Medicare. This summary of the NPRM is intended to help physicians understand what is currently being proposed. This rule is not final; it will be subject to a 60-day comment period once it has been officially published in the Federal Register. CMA will be filing formal comments once the comment period opens. Under the Medicare EHR Incentive Program, physicians can receive incentive payments as high as $44,000. Meaningful use is the necessary foundation for all impending payment changes involving patientcentered medical homes, accountable care organizations, bundled payments, and value-based purchasing. For more information about the proposed changes go to http:// www.cmanet.org/files/assets/news/2012/03/nprm-stage-2-summary.pdf. (CMA Alert, March 5, 2012 issue)
CMA requests amendments to medical liability reform On March 15, the California Medical Association (CMA) sent a letter to the U.S. House of Representatives leadership opposing H.R. 5, a medical liability reform bill that now includes language to CMA-supported repeal of the Independent Payment Advisory Board (IPAB). “While we strongly support the repeal of the Medicare Independent Payment Advisory Board and appreciate the state preemption of medical liability laws that will preserve California’s successful MICRA law,” stated the letter, “we have serious concerns with two additional medical liability provisions that will expose California physicians to even greater liability
despite the bill’s stated legislative intent to reduce health care costs and insurance premiums.” These provisions include: 1) the fair share rule; and 2) the no punitive damages for medical products and devices that comply with FDA standards. The fair share rule would preempt California’s joint and several liability law and would “dramatically increase the potential for physicians to face enforcement proceedings against their personal assets.” The law would make it necessary for physicians to purchase “increased medical professional liability insurance coverage,” and would increase physician
liability premiums in California. CMA requested two amendments to the law that would recognize state laws already in place, including “any state law that governs the allocation or recovery of damages among tort feasors.” In the second instance, the letter also expressed concerns with granting complete immunity from punitive damages to medical product and device manufacturers, distributors, and suppliers, and not physicians. CMA is seeking to fix the provisions so it can support the other favorable parts of the bill. (CMA Alert, March 19, 2012 issue)
MARCH / APRIL 2012 | THE BULLETIN | 41
medico news
Supreme Court sends Medi-Cal case back to California court of appeals On February 22, 2012, the United States Supreme Court sent the Douglas v. Independent Living Center of Southern California and other related cases back to the Ninth Circuit Court of Appeals. That court has previously sided with physicians and other providers, agreeing that interested parties should have the ability to sue in order to block cuts to California’s Medicaid program, Medi-Cal. The federal Medicaid Act requires that government-insured and privately insured patients have equal access to medical care. If the state and federal government continue to cut these programs, physicians will be forced to stop taking new patients, meaning that access to care will be greatly impacted. “This is a win for physicians and their patients in California,” said Dustin Corcoran, CEO, California Medical Association (CMA). “The lower court has previously ruled that interested parties indeed have the right to sue the state if the federal Medicaid Act is being violated. They will have the opportunity to decide that once again.”
The Supreme Court’s decision will have huge implications for the more than 10 million patients who are currently enrolled in California’s Medicaid program. “The state cannot continue to propose sweeping cuts to programs for California’s poorest and most vulnerable patients,” Corcoran added. “Our hope is that they get the message loud and clear with the U.S. Supreme Court’s decision today.” Through Medi-Cal, physicians, dentists, pharmacists, adult day health care providers, clinics, and hospitals provide health care services to low-income seniors, families, children, and people with disabilities. By providing these primary and preventive care services, the state ensures these Californians have access to health care, while at the same time saving money by lowering the chances they will be forced to seek more costly health care, such as emergency rooms or hospital admissions. CMA is a party in the case. (CMA Alert, March 5, 2012 issue)
CMA urges Congressional committees to repeal IPAB In early March, both the House Energy and Commerce Health Subcommittee and full committee voted to approve legislation (H.R. 452) to repeal the Medicare Independent Payment Advisory Board (IPAB), a panel established by the Affordable Care Act that would begin making annual recommendations to Congress in 2014 to achieve specified levels of Medicare savings. In late February, the California Medical Association (CMA) and 24 other organizations representing 350,000 doctors signed a letter asking the committee to repeal IPAB. CMA is gratified that the committees moved quickly on this issue. The letter to the committee chairs stated: “Major health policy decisions will rest in the hands of 15 unelected and largely unaccountable individuals.” Fewer than half of the IPAB members can be health care providers, and none are permitted to be practicing physicians. “Even worse,” the letter said, “if IPAB fails to report recommendations or never becomes operational, this power will rest solely in the hands of a single individual – the Secretary of the Department of Health and Human Services. Not only does the creation of IPAB severely limit
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congressional authority, it essentially eliminates the transparency of hearings, debate, and a meaningful opportunity for critical stakeholder input.” Comparing the IPAB to the sustainable growth rate (SGR) formula, the letter said that the IPAB will be required to recommend cuts “based on unrealistic spending targets in 2014. American’s physicians are concerned that strict budgetary targets and other limitations imposed on the panel will ultimately threaten the ability of the nation’s seniors and disabled to obtain health care,” because the cuts directed by the IPAB may disproportionally fall on physicians. The House Ways and Means Committee is expected to mark up the bill and then pass it out to the House floor sometime in June. Despite the momentum in the House, the Medicare IPAB enjoys bipartisan support in the Senate, and it is unlikely to be overturned. However, CMA will continue to push for its ultimate repeal. (CMA Alert, March 19, 2012 issue)
medico news
Medicare announces another extension of HIPAA 5010 enforcement On March 15, 2012, the Centers for Medicare & Medicaid Services (CMS) announced they would again extend the enforcement discretionary period, allowing practices an additional 90 days to become fully compliant with the use of HIPAA 5010 transaction standards. What this means for physicians is that while the implementation date of January 1, 2012, is still in effect, contractors will not reject claims submitted in the 4010 electronic formats until July 1, 2012. The California Medical Association (CMA) has also surveyed the major payors in
California to understand whether they will require claims to be submitted in 5010 format on April 1. While some did require 5010 on January 1, others were allowing for contingencies until April 1. For information on which major payors will require 5010 transactions on April 1, CMA has created a quick reference guide, available on CMA’s website at www.cmanet. org/ces. Several other resources to assist with the transition are available from CMA, the American Medical Association, and CMS. These resources are spelled out in our publication, Pre-
paring for the New HIPAA 5010 Standards: A Guide for Physicians, available in CMA’s online resource library at http://www.cmanet.org/resource-library/detail/?item=preparing-for-thenew-hipaa-5010-standards-a. CMA encourages all physicians to continue working with their vendors, clearinghouses, and billing services to transition to the 5010 format as soon as possible. Offices that transmit directly must ensure their software is updated. (CMA Alert, March 19, 2012 issue)
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San Jose | San Francisco | Hayward | Sacramento MARCH / APRIL 2012 | THE BULLETIN | 43
Classifieds office space for rent/ lease MEDICAL COMPLEX FOR LEASE • MORGAN HILL Available now, 1,200 sq. ft. Well-partitioned, excellent location. Next to lab and family practice offices. New carpet and paint. Flexible term. Call 408/666-4308. MEDICAL SUITES • LOS GATOS – SARATOGA Two suites, ranging from 1,000 to 1,645 sq. ft., at gross lease cost. Excellent parking. Located next door to Los Gatos Community Hospital. Both units currently available. Call 408/355-1519. OFFICE SUITE AVAILABLE Location is highway 85 at De Anza. One suite available. Currently configured with six Tx rooms/offices, entry, large master office with balcony. Street signage to 100,000 cars a day. Marble entry. Zoned medical/office. No variance required. Looking for established business/practice that values prime location in beautiful building. Please be qualified. No start ups. Contact Dr. Newman at 408/9968717. Brokers welcome if you have a client. $2.00 per sq. ft. plus 3N. Located at 1196 South De Anza at Rainbow. MEDICAL OFFICE SPACE FOR LEASE • SANTA CLARA Medical space available in medical building. Most rooms have water and waste. Reception, exam rooms, office, and lab. X-ray available in building. Billing available. 2,500– 4,000 sq. ft. Call Rick at 408/228-0454. NEWLY UPDATED 1,508 SQ. FT. MEDICAL SUITE Available now, in all-medical building next to Regional Medical Center. Four exam rooms, two offices, reception, ADA restroom, galley kitchen, storage, sound speakers in all rooms. Some furniture, exam tables included. Great space, available now. $3,770 gross. Call or email Liz Walker at 408/436-8386 or lizwalker@reliablepropertymanagement.net. ELEGANT AND SPACIOUS LOS GATOS MEDICAL OFFICE Available to share with prominent aesthetic dermatologist. This upscale office has seven exam rooms, a lab, two large administrative 44 | THE BULLETIN | MARCH / APRIL 2012
offices, and a marble and granite waiting room with comfortable seating for eight patients. Call Irene at 408/358-5757 to schedule your private showing. Price is negotiable. MEDICAL SUITES • GILROY First class medical suites available next to Saint Louise Hospital in Gilroy, CA. Sizes available from 1,000 to 2,500+ sq. ft. Timeshare also available. Call Betty at 408/8482525. DOWNTOWN MONTEREY OFFICE FOR SUBLEASE Spacious, recently remodeled, excellent parking, flexible terms. Call Molly at 831/6449800. MEDICAL/PROFESSIONAL OFFICE FOR LEASE Medical/Professional office 2,600 sq. ft, ground floor near Santana Row. $2.00 sq. ft. Available now. Email at sksiddiqui@yahoo. com. PRIME MEDICAL OFFICE FOR LEASE • SAN JOSE Excellent location. Westgate area. 1,584 sq. ft. West Valley Professional Center, 5150 Graves Ave. Suite 2/stand-alone unit. Private office, reception area, exam rooms with sinks. Available 2/1/11. Call owner at 408/8671815 or 408/221-7821. SANTA CLARA OFFICE • HOMESTEAD AND JACKSON Plumbed for Dental/Medical, or other use. 1,200 sq. ft. Downtown across from post office and weekly farmers market. Excellent Location! Dentist on site, please do not disturb. Don’t miss! Come see! Call 408/838-8191 or 408/741-1956.
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PRIVATE PRACTICE/OFFICE for sale PRIVATE PRACTICE FOR SALE IM/FP/GP. Primary care practice for sale, including inventory and equipment. Close to O’Connor Hospital. If interested, please call Stacy at 408/297-2910.
EMPLOYMENT OPPORTUNITY OCCUPATIONAL MEDICINE PHYSICIANS • PRIMARY CARE, ORTHOPEDICS, & PHYSIATRY Our occupational medical facilities offer a challenging environment with minimal stress, without weekend, evening, or “on call” coverage. We are currently looking for several knowledgeable and progressive primary care and specialty physicians (orthopedist and physiatrist) interested in joining our team of professionals in providing high quality occupational medical services to Silicon Valley firms and their injured employees. We can provide either an employment relationship including full benefits or an independent contractor relationship. Please contact Rick Flovin, CEO, at 408/228-0454 or e-mail riflovin@allianceoccmed.com for additional information. INTERNIST WANTED San Jose Medical Group has an immediate opening for a Board Certified, experienced Internist. One of our busy Internists relocated to Southern California recently, creating an opportunity for the right candidate to step into a successful growing practice. Must have excellent communication, clinical, and interpersonal skills. Excellent salary and benefits with bonus opportunities. Please fax CV to 408/278-3181 or email Tania_mcadams@ sanjosemed.com. EMPLOYMENT OPPORTUNITY Physician/Locum tenens for Family/Internal Medicine. Office based practice only. Coverage mostly needed during vacation. Parttime, must have excellent communication, interpersonal and clinical skills. Please fax CV to 408/356-6676. PRIMARY CARE PHYSICIAN • PART TIME Oceanaire is a residential eating disorder program for adult women with anorexia and
bulimia nervosa, and binge eating disorders. Part time/5-10 hours weekly. The physician is responsible for monitoring medical stability of up to six women in treatment. Responsibilities include reviewing medical records for admission, performing admissions exams, meeting with clients weekly, interfacing with multidisciplinary treatment team, and providing phone support when medical concerns arise. Experience with eating disorders is not required. Send resumes to golee.abrishami@ centerfordiscovery.com. See http://www. centerfordiscovery.com for more information about our programs.
FOR SALE SL65 MERCEDES BENZ V12 Twin Bi Turbo 604 HP. Silver metallic, light grey interior at $13,000 original down. Contact 408/621-4350. $80,000.
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We hate lawsuits. We loathe litigation. We help doctors head off claims at the pass. We track new treatments and analyze medical advances. We are the eyes in the back of your head. We make CME easy, free, and online. We do extra homework. We protect good medicine. We are your guardian angels. We are The Doctors Company. The Doctors Company is devoted to helping doctors avoid potential lawsuits. For us, this starts with patient safety. In fact, we have the largest Department of Patient Safety/Risk Management of any medical malpractice insurer. And, local physician advisory boards across the country. Why do we go this far? Because sometimes the best way to look out for the doctor is to start with the patient. To learn more about our medical professional liability program, call The Doctors Insurance Agency at (415) 506-3030 or (800) 553-9293, or visit us at www.doctorsagency.com.
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When patients and families are coping with serious, life-limiting illness,
they require expert care, compassion and personal attention. Whether it is spending time with loved ones, fulfilling dreams, or simply remaining comfortable and independent for as long as possible, Hospice of the Valley guides patients and their families to meet their goals. • The hallmark of hospice care is that it serves patients wherever they live—be it in their home, nursing home, hospital or assisted-living facility • Hospice of the Valley team members consist of physicians, nurses, social workers, chaplains, hospice aides, volunteers, and grief counselors who are experts in palliative and hospice care and are available to assist in the management S.C.C.M.A. of your patient’s needs Margarita Vizcaya, hospice aide
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• For those dealing with grief and loss, the Community Grief and Counseling Center at Hospice of the Valley provides families and individuals with one-on-one counseling and loss-specific support groups to adults, teens and children • Since 1979, Hospice of the Valley‘s legacy of compassionate palliative and hospice care, community education, advocacy and outreach has set the standard for quality hospice care state wide and nationally, and our organization is a locally-based, operated, and supported non-profit organization Monique Kuo, MD, medical director
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CMA CEO Update
dustin corcoran CMA Chief Executive Officer
Preparing for the Future of Medicine By Dustin Corcoran CMA Chief Executive Officer For more than 150 years, the California Medical Association (CMA) has fought on the frontlines of nearly every major policy, political, budgetary, societal, and legal campaign affecting this state’s physicians. Serving more than 35,000 members, CMA and its staff remain committed to our time-honored mission statement: to promote the science and art of medicine, protection of public health, and the betterment of the medical profession. The shared challenges facing those who practice medicine may never have been more formidable than today. In this uniquely turbulent political and fiscal environment, we have redoubled our efforts to provide the support and services physicians need to be able to focus on their jobs and bring good health and happiness to the lives of millions of Californians. Our legislative session kicked off last year with Governor Jerry Brown and Lt. Governor Gavin Newsom speaking to member physicians about the current state of the state. Health care and the future of medicine in California were top issues in last year’s state budget and in the legislature. On that front, we continue to lead a multi-faceted legislative and legal campaign to protect the landmark malpractice reform law passed in 1975, known as MICRA. In 2011, CMA filed a “friend of the court” brief, defending MICRA’s constitutionality in the California Court of Appeal case Stinnett v. Tam – in a huge victory, the court upheld the existing law. On the national level, CMA’s 2010-11 President, James G. Hinsdale, MD, was elected to represent California physicians by serving on the American Medical Association’s (AMA) esteemed Council on Medical Services. Additionally, CMA’s testimony last year was critical to the Institute of Medicine’s seminal report highlighting geographic differences in medical practice costs, and is sure to impact the way federal health care reform is implemented in the coming years. CMA also took a huge step forward in adopting policy that recommends legalization and decriminalization of medical cannabis – the culmination of years of careful debate and deliberation, and a sciencedriven consensus that the current system is failed public policy. For the second year in a row, CMA’s Center for Economic Services (CES) recouped more than $2.7 million from payors, on behalf of members. The center’s reimbursement help line fielded over 2,600 calls from more than 1,200 different physician practices. In a time when physicians are facing severe cuts, having CES resources available has proven to be more important than ever.
CMA mounted a vigorous effort on behalf of nearly two dozen organizations, leading delegations to Sacramento and Washington, D.C., urging state and national leaders to reject cuts to Medicare and MediCal. Arguing on behalf of physicians and patients in Medi-Cal, CMA representatives also argued before the U.S. Supreme Court. With 2012 upon us, CMA has an opportunity to lead policy development on new models of health care delivery, as well as implementation of federal health reform. We will continue to help shape the development and enforcement of-laws and regulations as they emerge, representing the interests of physicians and their patients along the way. Changes are coming – and CMA is poised and ready to meet the demands of the future.
California Medical Association Political Action Committee
Fighting for you! CALPAC needs your help to support candidates and legislators who understand and embrace medicine’s agenda.
Our top priorities are: 1. Protect MICRA 2. Preserve the ban on the corporate practice of medicine 3. Provide solutions to our physician shortage crisis!
Please visit www.calpac.org for more information MARCH / APRIL 2012 | THE BULLETIN | 47
CMA’s Reimbursement Helpline (888) 401-5911 Through this members’ only service, CES provides one-on-one educational assistance and payor advocacy to physician members and their staff. The helpline is staffed by practice management experts with a combined experience of over 125 years in medical practice operations. Practices can call on CMA’s Center for Economic Services reimbursement experts to discuss economic issues affecting their practice, including but not limited to billing and collections, coding and documentation, and managed care contracts. All resources, with the exception of CPR, listed below can be located on our website at www.cmanet.org/ces.
CMA’s Practice Resources (CPR) Monthly E-Mail Bulletin – 2011/2012 CMA Practice Resources (CPR) is a free monthly e-mail bulletin from CMA's Center for Economic Services. This bulletin is full of tips and tools to help physicians and their office staff improve practice efficiency and viability. Visit www.cmanet.org/news/cpr to sign up or view the current issue. Archived issues of CPR are available via our online resource library.
CMA Hosted Practice Management Webinars CMA hosts a series of live monthly webinars to educate physicians on a range of topics from health information technology to reimbursement issues. CMA members can access archived webinars and the 2012 upcoming webinar calendar on our website at www.cmanet.org/calendar. Webinars are free for CMA members and their staff.
“Know Your Rights” Series of one-page print and post documents that summarize the prompt pay legislation sponsored by CMA (AB 1455). Companion seminar available (Know Your Rights) Know Your Rights: Timely Payment State and federal laws require that most payors pay clean claims within specific time frames. California law further requires health plans and insurers to pay interest on claims that are not paid within the required time frame Know Your Rights: Timeframes to Appeal Practice revenue is lost when claims are underpaid, delayed, or inappropriately denied. When your practice learns that a claim has been denied and the reason for the denial, steps should be taken to appeal the claim as appropriate. Following is a summary of timeframes for appeals. Know Your Rights: Quick Guide for Appeals Payors deny claims for a variety of reasons. This document describes some of the more common types of denials and how to respond to them.
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Know Your Rights: identify and Report Unfair Payment Practices The regulations implementing CMA-sponsored legislation (AB 1455 - Unfair Payment Practices) prohibits health plans and their contracting medical groups/IPAs from engaging in various unfair payment practices. CMA summarizes the unfair payment practices in this one page print and post document. Know Your Rights: Filing a Formal Complaint with the Regulator This is a quick reference guide to assist practices with identifying the appropriate regulator by plan type. The guide includes direct links that can be accessed to file a formal complaint against an HMO, PPO, medical group/IPA or Blue Cross Blue Shield Out-of-State plans.
Practice Empowerment Mini Toolkits/Informational Guides Medicare Part B 2012 Important Changes: What They Mean to Your Practice-2011 The Centers for Medicare & Medicaid Services (CMS) issued a final rule on November 1, 2011, that updates payment policies and Medicare payment rates for physicians’ services furnished in 2012. To assist physician offices in planning for billing changes, CMA has developed this guide to highlight changes that may impact physician billing. Companion seminar available (Medicare Changes for 2012) Medicare Electronic Prescribing Overview: Payment Incentives and Payment Reductions - 2011 Medicare introduced an e-prescribing program in 2009 that encourages physicians to electronically transmit their prescriptions. The e-prescribing program provides incentive payments for physicians who e-prescribe and payment penalties for physicians who do not. Starting in 2012, Medicare will begin 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. Medicare Enrollment Guide for Individual Physicians – Updated June 2011 Medicare enrollment processes have changed considerably over the years, and even more so with the introduction of national provider identifiers. The enrollment application process for individuals can be complex and burdensome. CMA has developed this document to guide new physicians through the enrollment process, and to assist enrolled physicians who are making changes or who must revalidate their enrollment. Preparing for the New HIPAA 5010 Standards: A Guide for Physicians- 2011 (Join Legal/CES publication) Physician practices may need to make adjustments to the patient data they collect and report in order to comply with a new Health Insurance Portability and Accountability Act (HIPAA) requirement that takes effect January 1, 2012. While the changes primarily impact software vendors and billing clearinghouses, compliance may require medical practices to change some business processes as well. The California Medical Association (CMA) is advising members to familiarize themselves with these regulations and be proactive about making the needed changes to comply prior to the January 1 effective date. Are you ready for the transition to HIPAA Version 5010? - 2011 (Joint Legal/CES publication) Beginning January 1, 2012, physicians and others in the health care industry will be required to use the updated 5010 version of the Health Insurance Portability and Accountability Act (HIPAA) transactions standards to
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CMA's CES Resources, from page 49 conduct electronic administrative transactions, such as claims submissions, checking eligibility, claims status, remittance advice, and referral authorizations. This resource sheet assists physicians with preparing for the 5010 transaction. 5010 Quick Reference Guide - 2011 CMA surveyed the major payors in California to find out which of them will allow for an extension on the 5010 enforcement deadline. Results, where available, are below. This guide will be updated regularly as new information becomes available Special Investigations Unit Audit Guide - 2011 The California Medical Association (CMA) has received complaints from physicians who have received refund requests from the Anthem Blue Cross Special Investigations Unit that were outside of the 365-day period allowed by California law. As a result, CMA has filed a formal complaint with the Department of Managed Health Care (DMHC) and asked them to quickly investigate these potential violations. To help physicians understand their rights and responsibilities when it comes to health plan refund requests, CMA has prepared this Special Investigations Unit Audit Guide. LaSalle Medical Associates: Important Changes - 2011 Effective April 1, 2011 LaSalle Medical Associates hired MedPOINT Management, a managed services organization (MSO), to assume full administrative and operational responsibilities. Due to challenges with the former MSO, an immediate change in management was necessary. This affects the following physician services: Claims processing and capitation payments Provider services and contracting Referral authorization and utilization management Eligibility and benefits verification Quality management This change affects physician offices in Los Angeles, San Bernardino, Riverside, Fresno/Madera, Kern, Kings, San Joaquin, Stanislaus, and Tulare counties. CMA has developed the attached summary of the change in LaSalle contact information with links to the LaSalle notices sent to physicians Contract Amendments: An Action Guide for Physicians - 2010 This guide is designed to help physicians understand their rights and options when a health plan notifies them of a material modification to a contract, manual, policy or procedure. Payor Solvency Checklist - 2010 To help physicians monitor the financial health of their contracted payors, CMA has put together a checklist available to members. You can also request a hard copy by contacting CMA using the information below. 2010 Guide for Medicare Consultation Code Reporting - 2010 As a result of Medicare’s decision to no longer recognize and pay consultation code services effective 1/1/10, CMA has published a 6-page billing guide that includes an overview of the issue, a code crosswalk, and links to additional resources.
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CMA Managed Care Consultation Code Quick Reference Guide – Updated October 2011 This is a companion guide to the Medicare Consultation Code Guide (above). CMA surveyed the major managed care payors in California to find out which of them plan to follow Medicare’s lead and eliminate consults. This chart will be updated regularly as new information becomes available. Payor Profiles - 2011 Center for Economic Services has compiled critical information for interacting with the major payors. On each of the payor profiles you will find the important contact numbers, addresses, and links for quick reference for payor interactions. You can use these profiles on-line or print them to keep at your fingertips. These documents are updated annually. Aetna Anthem Blue Cross Blue Shield Cigna Health Net Medicare United Healthcare Timely Access Regulation Guide – 2010 (Joint Policy/Legal/CES publication) The California Department of Managed Health Care (DMHC) recently finalized regulations that require HMO patients to be seen within certain timeframes for various levels of care. The primary intent of these regulations and the underlying legislation is to require HMOs to ensure that their networks of providers have the capacity and availability to provide care to enrollees in a timely manner. Although there will not be a full picture of what physicians need to know regarding contracting or implementation for some time, CMA has published a toolkit to help physicians understand these new regulations and what they could mean for their practices. The toolkit will be regularly updated as new information becomes available.
Practice Empowerment Toolkits Best Practices Toolkit - 2009 This toolkit offers a series of proven steps that solo and small-group practices can take to improve many facets of their practice, including the delivery of better-quality medical care. It is based on an important premise: that in order to provide quality medical care, a physician practice must be efficient and well run. The toolkit is organized into nine chapters that can be read sequentially or on an as-needed basis. Companion seminar available (What Every Physician/Office Manager Should Know about Their Practice) Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations - 2005 Payor contract negotiations can be difficult. This guide is designed to guide the physician through t he contract evaluation and negotiation/renegotiation process. This guide also
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CMA's CES Resources, from page 51 provides the physician and his/her office staff with practical tips and tools to assist with the negotiation, implementation, and on-going management of complex agreements. Companion seminar available (Taking Charge)
Other Educational Tools CMA Sample Letters Sample Termination Letter – Patient If the terms of a proposed contract are not acceptable or sustainable, physicians have the right under California law to terminate their agreement with the payor prior to the effective date of the changes. Physicians who decide to exercise their right to terminate their agreement with a payor are encouraged to communicate their decision to with their patients. Physicians may wish to consider using the sample letter CMA has prepared to notify patients of their decision to terminate their contract. Sample Termination Letter – Material Modification to Contract (Payor) If the terms of the proposed contract are not acceptable or sustainable, physicians have the right under California law to terminate their agreement with the payor prior to the effective date of the changes. Physicians who wish to exercise their right to terminate their contract must do so in writing. Physicians may wish to consider using the sample letter CMA has prepared to notify the payor of their decision to terminate their contract. Sample Letter – Request for Copy of Complete Fee Schedule and Detailed Payment Rules California law requires health plans and their contracting medical groups/IPAs to disclose to contracting physicians the amount of payment for each and every service to be provided under the contract. Plans must also disclose the detailed payment policies and rules used to adjudicate claims. CMA has created a sample letter physicians can use to request this information from the payor. Sample Letter – Request for Copy of Signed and Executed Contract, Complete Fee Schedule and Detailed Payment Rules California’s unfair payment practices regulations require health plans and their contracting medical groups/IPAs to disclose to contracting physicians the amount of payment for each and every service to be provided under the contract. Plans are required to disclose this information initially upon contracting, annually, and upon the physician’s written request. Comparison of Anthem Blue Cross Access Standards - 2010 In October, Blue Cross announced amendments to their Prudent Buyer contract to comply with the new Timely Access regulations that caused concern with physicians. At CMA’s request, Blue Cross issued clarification on the original contract amendments. CMA also highlights that many of the new state-mandated timely access timeframes are less stringent than Blue Cross’s existing requirements and provides a comparison of the existing Blue Cross standards. Managed Care Contracting CMA offers members free access to, objective analyses of several health plan participating provider contracts. While these analyses are not intended to be exhaustive, they are designed to draw a physician's attention to
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issues which may warrant further inquiry or clarification. NOTE: CMA is currently updating contract analyses for each of the major health plans in California. These analyses will be posted on the website when they are available. In the meantime, if you have any questions regarding specific health plans contact the reimbursement helpline at (888) 401-5911 or economicservices@cmanet.org. 1. 2. 3. 4. 5.
Anthem Blue Cross of California Prudent Buyer Plan Blue Shield of California Health Net (includes addendum analysis) United Healthcare Cigna – COMING SOON
CMA Center for Economic Services Upcoming Webinars Please note that this calendar does not include CMA’s ICD-‐10 training courses to be offered in 2012.
March 7: Managing Difficult Employees and Reducing Conflict in the Practice Debra Phairas • 12:15 – 1:15 p.m. March 21: HIPAA Update 2012 David Ginsberg • 12:15 – 1:15 p.m. April 4: A Guide to Managing Upset and/or Difficult Patients Debra Phairas • 12:15 – 1:15 p.m. April 18: Best Practices for Managing Your Accounts Receivable Mary Jean Sage • 12:15 – 1:15 p.m. May 2: Medicare: Top 10 Claim and Documentation Errors That Cost Your Practice Money Kevin Garrick • 12:15 – 1:15 p.m. May 16: Telephone Etiquette for Medical Personnel Mary Jean Sage • 12:15 – 1:15 p.m. June 6: A Manager’s Guide to Lowering Practice Costs Debra Phairas • 12:15 – 1:15 p.m.
June 20: Writing Effective Appeals Mary Jean Sage • 12:15 – 1:15 p.m. July 18: Preparing for a Medicare and/or Medi-‐Cal Audit Mary Jean Sage • 12:15 – 1:15 p.m. Aug. 1: Coding for Medical Necessity Arthur Lurvey, M.D. • 12:15 – 1:15 p.m. Aug. 15: Program Integrity in Medicare and Medi-‐Cal – The Physician’s Role Bruce Tarzy, M.D. • 12:15 – 1:15 p.m. Sept. 5: A Guide to Reviewing Payor Contracts Kris Marck • 12:15 – 1:15 p.m. Sept. 19: Creating and Implementing Financial and Office Policies Debra Phairas • 12:15 – 1:15 p.m. Oct. 3: Protect Your Practice From Payor Abuse Mark Lane • 12:15 – 1:15 p.m. Oct. 17: Establishing Expectations for High Performance From Medical Staff Debra Phairas • 12:15 – 1:15 p.m. MARCHA/RC APRIL | THE BULLETIN Nov. 7: Understanding and 2012 CARC Revenue Codes | 53
See Jane Save Meet Dr. Jane. She is member and and a member is aa California California Medical Medical Association Association member member of her local medical society. society. Dr. Jane takes full advantage of the member discounts available to to her. her. InIn 2010, 2011, she discounts available she saved: saved:$22,476. $22,476. • Purchased four annual magazine subscriptions for her practice. Saved: $67 • Changed medical insurers, modified plan design, added an HSA compatible plan through CMA’s insurance partner, Marsh. Saved: $17,500 • Purchased auto insurance through CMA’s partnership with Mercury Insurance. Saved: $174 • Received 30% off a one-year subscription to Epocrates online clinical reference guide. Saved: $60 • Changed credit card processing to Heartland Payment Systems’ Transparent Cost Plus structure. Saved: $600 • Moved payroll processing for her eight employees to Heartland Payment Systems’ 100% paperless system with direct deposit. Saved: $750 • Attended the California Health Care Leadership Academy. Saved: $300 • Contacted CMA’s Economic Services help line for assistance with a problem payor. Recovered: $500 • Bought security prescription pads from RX Security. Saved: $25 • Called CMA’s Member Help Line and spoke with a health law information specialist about some legal questions. The specialist directed her to several member legal resources. Dr. Jane downloaded 10 medical-legal documents, with sample letters from CMA On-Call, CMA’s medical-legal library and the most comprehensive health law and medical practice resource for California physicians (instead of paying an attorney for the same information). Saved $2,500 Note: Cost savings represents an average savings of a solo physician accessing CMA member benefits. Actual savings may vary.
To learn more about additional member savings visit cmanet.org/benefits or call the CMA Member Services Help Line at 800.786.4262 54 | THE BULLETIN | MARCH / APRIL 2012
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