NOVEMBER / DECEMBER 2015
Also Inside: MEMBER BENEFITS AND SERVICES
VOLUME 21 | NUMBER 6
CMA's 2015 LEGISLATIVE WRAP UP AND HOUSE OF DELEGATES
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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 Billing/Collections CME Tracking Discounted Insurance
Feature Articles 12 2015 House of Delegates 38 CMA’s 2015 Legislative Wrap Up
Financial Services
Departments
Health Information Technology
5 From the Editor’s Desk
Resources House of Delegates
6 Message From the SCCMA President
Representation
8 Message From the MCMS President
Human Resources Services
22 CMA Member Benefits and Services
Legal Services/On-Call Library
24 SCCMA-MCMS Member Benefits and Services
Legislative Advocacy/MICRA Membership Directory iAPP for the iPhone
30 Trouble Getting Paid? SCCMA-MCMS-CMA Can Help! 32 CMA ON-CALL Online Health Law Library
Physicians’ Confidential Line
34 SCCMA Award Nominations
Practice Management
36 Medical Times From the Past
Resources and Education Professional Development Publications Referral Services With Membership Directory/Website
44 MEDICO News 48 Classified Ads 50 In Memoriam 51 Practice Management Tools and Resources
Reimbursement Advocacy/ Coding Services Verizon Discount NOVEMBER / DECEMBER 2015 | THE BULLETIN | 3
THE SANTA CLARA COUNTY MEDICAL ASSOCIATION OFFICERS
CHIEF EXECUTIVE OFFICER
COUNCILORS
William C. Parrish, Jr.
El Camino Hospital of Los Gatos: Ryan Basham, MD El Camino Hospital: Vacant Good Samaritan Hospital: David Feldman, MD Kaiser Foundation Hospital - San Jose: Hemali Sudhalkar, MD Kaiser Permanente Hospital: Martin Wong, MD O’Connor Hospital: Michael Charney, MD Regional Medical Center: Erica McEnery, MD Saint Louise Regional Hospital: Diane Sanchez, MD Stanford/Lucile Packard Children's Hospital: John Brock-Utne, MD Santa Clara Valley Medical Center: Clifford Wang, MD
President Eleanor Martinez, MD President-Elect Scott Benninghoven, MD Past President James Crotty, MD VP-Community Health Cindy Russell, MD VP-External Affairs Kenneth Blumenfeld, MD VP-Member Services Anh Nguyen, MD VP-Professional Conduct Vanila Singh, MD Secretary Seema Sidhu, MD Treasurer Seham El-Diwany, MD
CMA TRUSTEES - SCCMA Thomas M. Dailey, MD (District VII) Tanya Spirtos, MD (District VII)
BULLETIN
THE MONTEREY COUNTY MEDICAL SOCIETY
Editor
OFFICERS
THE
Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society
Printed in U.S.A.
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. The Bulletin and SCCMA/MCMS reserve the right to reject any advertising. 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 2015 by the Santa Clara County Medical Association.
4 | THE BULLETIN | NOVEMBER / DECEMBER 2015
President James Hlavacek, MD President-Elect Vacant Past-President Jeffrey Keating, MD Secretary Edward Moreno, MD Treasurer Cary Yeh, MD
CHIEF EXECUTIVE OFFICER William C. Parrish, Jr.
DIRECTORS Paul Anderson, MD Valerie Barnes, MD Ronald Fuerstner, MD Gary Gray, DO Steven Harrison, MD David Holley, MD
John Jameson, MD William Khieu, MD Eliot Light, MD James Ramseur, MD Marc Tunzi, MD Craig Walls, MD
Our Honorable Profession — Healers During the Darkest Moments By Joseph Andresen, MD
Editor, The Bulletin
JOSEPH S. ANDRESEN, MD
FROM THE
A chilly wind follows the recent and much needed rain that fell in Northern California. Bundled pedestrians in winter coats and sweaters wait impatiently for the traffic crosswalk light to blink “walk” so they can quickly seek indoor shelter. Just a few orange, red, and bronze leaves remain on bare tree limbs. It’s just a brisk 52 degrees but for us temperate Californians, it still feels like the dead of winter. A cold and chilling shudder has been felt worldwide. Our thoughts, prayers, and heart-filled sympathy is with the victims, families, and friends of those who have died in the recent terrorist Artist credit: Jean Jullien attacks in Paris, Lebanon, and throughout the Middle East. As I write this, 132 have died, 352 others wounded, 99 of them critically, in Paris. Images from St. Louis Hospital in Paris show doctors, nurses, and staff crammed into a ward trying to save the injured. Hundreds of doctors and nurses worked around the clock to care for the injured. Philippe Juvin, head of emergency services at the Georges Pompidou Hospital in Paris has worked in conflict zones, including Afghanistan. He described how the gunshot victims had to be rushed to surgery or intensive care after arriving with injuries that he has only seen in war zones. Dr. Jean-Paul Fontaine, head of the emergency department at the Saint Louis Hospital explained that their hospital sees patients injured in the occasional car crash and possibly just one gunshot injury per year. Suddenly, they received 27 gunshot victims. Catherine, a nurse at Saint Louis Hospital was overwhelmed with the wave of solidarity among the staff, “I prefer to remember this incredible wave of solidarity. All the staff, the doctors, surgeons, nurses who spontaneously phoned to offer their support and come in the middle of the night … That night I was proud of my profession, my colleagues, and my hospital.” Dr. Jean-Paul Fontaine was asked whether this would change the way that he would think about everyday life in Paris? “No, no. And I hope that it will be the same for the Parisian people. Paris is a living city. You can’t imagine there were no football game, no movies, no concerts, no music, no bars. That’s impossible. And you have to keep on having this atmosphere. So we are not afraid.” We are healers. May we continue our important work even under the most difficult circumstances and during the darkest moments.
EDITOR'S DESK
Physician Editor, The Bulletin
Joseph S. Andresen, MD, is the editor of The Bulletin. He is board certified in anesthesiology and is currently practicing in the Santa Clara Valley area.
NOVEMBER / DECEMBER 2015 | THE BULLETIN | 5
House of Delegates Highlights President, Santa Clara County Medical Association
ELEANOR MARTINEZ, MD
MESSAGE FROM THE
SCCMA PRESIDENT
By Eleanor Martinez, MD
Eleanor Martinez, MD is the 2015-2016 president of the Santa Clara County Medical Association. She has a solo obstetrics and gynecology practice in Los Gatos.
President, Santa Clara County Medical Association One of this year’s highlights in my role as President of Santa Clara County Medical Association was the House of Delegates meeting held at the Disneyland Hotel in October. It was another successful convention. I just wish more of my colleagues would get involved and attend it. The House of Delegates develops policies for the CMA. It is during this meeting that we elect CMA Officers. Any physician who is a member of the CMA and their local county medical association can volunteer to serve either as a delegate or an alternate delegate. These physicians represent their constituents when participating in the various caucus meetings. During the HOD convention, all the resolutions are debated (exhaustively at times), to create new policies which are key issues in the practice of medicine. There were several physicians from District VII who were invited to serve on one of the six reference committees this year. Each year I have observed one or two key issues that stand out, like the marijuana policy, immunization, scope of practice, Medicare reimbursements, and access to medical care. This year it is the endof-life issue. Regardless, all resolutions and reports center on medical practices, public health, and governance. Thus, I consider this the highlight of our SCCMA/CMA organization. It is our chance to have a voice and, in my opinion, a very effective one. The HOD is the CMA’s legislative body and the policies and reports for national action established during this meeting is our governance. It is our venue to protect our profession. Which brings me to another point – being a delegate and an alternate delegate is an honor and a commitment. Our involvement is the key to preserving our medical practice. Through this venue we exercise our obligation of being a patient advocate, no matter what mode of practice we are involved
6 | THE BULLETIN | NOVEMBER / DECEMBER 2015
with. We are the Doctor caring for the patient. This is organized medicine in action. Hospitals, large corporations, medical insurance companies, and even the legislature, will not do so. Thus is the necessity for each of us to participate in organized medicine. This is the first year that we have implemented the virtual committees references process. Resolutions and reports were presented by way of the CMA websites and comments/testimonies were posted as well. The various reference committees studied these resolutions and modified them after exhaustive discussions. Thus, the HOD meeting was shortened to two days. In my opinion, this change has accomplished a more efficient use of our time and brought more productive results. The CMA is now open to accepting resolutions for 2016. All of these will be forwarded to various appropriate committees and discussed, then the final report presented to the HOD in October 2016. Some of us were fortunate to be elected to serve in one of those committees. Webinars are being scheduled so that various reference committees can begin to meet virtually. In summary, here are my highlights of the 2015 HOD convention. 1. Meeting candidate Dr. Joaquin Arambulo, a practicing ER Physician from Fresno, seeking our support as he runs for State Assembly in the 31st District. Here is another physician we need in legislature. He is walking our walk and talking our talk. 2. Recognizing our fellow physicians who have made us proud to be among them. To mention a couple: ȧȧ Dr. Richard Pan was recognized for his indefatigable drive towards the full realization for the need for mandatory vaccination. He still needs our support, as there is a growing move by the opposition to remove him from office. We heard how hard a battle was fought by him in seeing this bill through.
5. The involvement of the medical students in mapping out their medical education, their concerns about the debts they incur, and narrowed exposure to all aspects in the medical fields during medical school years; and their sympathy towards the plight of their fellow students who are undocumented is admirable. They took time from their classes to be among us during the HOD convention. The HOD was a platform for them to propose resolutions that will have an impact on them, as well as the future patients they will be caring for. It was very reassuring to see that there is a future in medicine when we experience first hand their passion to preserve their love for medicine. 6. The opportunity to cast our votes for the incoming CMA President Ruth Haskins, MD, from EI Dorado Hills, to reelect Theodore Mazer, MD, from San Diego, to the CMA Speaker of the House and Lee Snook, Jr., MD, as Vice-Speaker of the House. Our own colleague, Tanya Spirtos, MD, has been nominated to be the Vice-Speaker of the House for 2017. I personally enjoy how Dr. Mazer has conducted all the HOD conventions I have attended. He does add levity to these events. The latest is wearing a whimsical hat, with red wig on, in the true Disney spirit. Dr Snook did likewise. When the 2015 HOD convention was adjourned, I realized that we are indeed in a very honorable profession. The passion that exudes from us regarding the preservation of what we believe in, the deep-seated concern for quality and compassionate care for our patients, and our willingness to work collaboratively for the common good is admirable. There is no other profession that compares, except perhaps being a missionary or a martyr!
ȧȧ Dr. Barbara Arnold received CMA’s 2015 Inaugural Compassionate Service Award for her commitment to the health of the community, particularly the aged and the disabled. Her innovative ideas are exemplary. She used painting as a medium for healing and empowerment. 3. Hearing various resolutions being discussed and policies being voted on, to be adopted to our CMA governance or referred for national action – discussions on mode of practice, health care and public health concerns like sugar sweetened beverages, sales and marketing of powdered alcohol, evidence-based education on nutrition and exercise, tobacco products and E-cigarettes, encouraging use of foodstuff without the use of medically important antibiotics, to name a few. In listening and reading all of the testimonies, I was provided with a wealth of medical knowledge that I, as an OB/GYN, could not have possibly encountered in my specialty. 4. Observing our colleagues discuss, debate, and vote on issues regarding physician re-entry into the workforce and maintenance of certification alternative definitions of Board Certification. Assessment of late career physicians is an example of how our fellow doctors are our voice in these legitimate concerns. I would be negligent in not mentioning that the highlight of the debate centered on end-of-life and physicianassisted suicide. These exhibited the realization that we physicians are not going to allow an agency like the California Medical Board, insurance companies, or hospitals to take the lead in deciding on requirements or policies that impact the physicians and our patients. We want to be involved in all of these discussions.
Value of Membership
Why PHYSICIANS practicing in Santa Clara County should be SCCMA/CMA members:
No other organization commands the level of respect in the state Capitol that CMA does. In the world of politics, having a seat at the table makes all the difference.
1. Speaking with a united voice, physicians exert a powerful influence on the political process. Organized medicine is the ”one voice” that legislators and government hear.
Eleanor Martinez, MD SCCMA President
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2. Free one-on-one small practice resources including regulation compliance,contract analysis and billing, payment problems. and more with CMA’s professional economic advocates and practice management experts at 800-786-4262. 3. SCCMA/CMA worked diligently to protect MICRA (Medical Injury Compensation Reform Act), spearheading a successful campaign to defeat Prop.46 in the 2014 election.
4. Free medical-legal information on contracts, subpoenas, employee relations, record retention, collections and more through CMA On-Call, a 24-hour online health law library.
5. Grow your professional network and referral list by networking with peers, established physicians, and heatlhcare leaders and legislators at SCCMA/CMA events.
Encourage your colleagues to join SCCMA/CMA Now: www.sccma-mcms.org or (408) 998-8850 NOVEMBER / DECEMBER 2015 | THE BULLETIN | 7
Value of Membership By James M. Hlavacek, MD President, Monterey County Medical Society
JAMES M. HLAVACEK, MD
MESSAGE FROM THE
MCMS PRESIDENT
President, Monterey County Medical Society
James Hlavacek, MD, is the 2015-2016 president of the Monterey County Medical Society. He is an Anesthesiologist and is currently practicing Chief-of-Staff with Natividad Medical Center, in Monterey, and also practices at George L. Mee Memorial Hospital.
Today is November 11, Veteran’s Day, the day to remember the “War to end all wars.” Twenty-one years later World War Two began. We continue to be at war. Now ISIS and Syria are the opponents. Medicine is also at war with constant battling with federal and state governments, and the insurance carriers. The electronic health record, meaningful use, ever increasing regulations, decreasing reimbursement, and ever expanding scope of practice for non-physicians, these are challenging times for us all. With your membership in the Monterey County Medical Society (MCMS) and California Medical Association (CMA) you can make sense out of chaos and succeed in these tough conditions. I recently attended the CMA House of Delegates Convention in Anaheim. It was an eye-opening and informative conference. I was so impressed with the staff that we have at CMA. These hard working professionals are watching out for us to insure that we have the best possible practice environment. I met Dustin Corcoran, CEO of CMA. Dustin is an energetic and very dynamic person. He has a deep knowledge of the issues and the tools to get things done. His message was to look at the success we had to defeat Proposition 46 last November. Prop. 46 was mentioned again and again during the HOD meeting. CMA spent $59 million to defeat this terrible bill. To me, it was and remains the rallying cry of why membership in CMA is so important. Remember 46! Dustin was in Monterey this rainy Monday evening. The CMA’s sponsorship this year is the bill to increase the tax on tobacco. California has one of the lowest taxes on cigarettes. SB 591 sponsored by Dr. Richard Pan, would add a $2 tax per pack of cigarettes. The current state tax per pack is 87 cents. The estimated $1.4 – $2 Billion (yes Billion – with a B) dollars raised would go to increase Medi-Cal funding and in-state medical research.
8 | THE BULLETIN | NOVEMBER / DECEMBER 2015
I also met Janus Norman, Chief Lobbyist of CMA. This is one impressive person. Janus has great skills and energy to inform our legislators about the issues that affect all of our practices. Another person I met was Francisco Silva. He is the chief counsel of CMA. He is from Salinas! We had quite a conversation about the new Trauma Center at Natividad. In the small world department, I mentioned this meeting to Supervisor Simon Salinas, and he told me Francisco was his student when he taught at Barden Elementary School! Joaquin Arambula, MD, an emergency room physician, is a candidate for the 31st Assembly seat. I met him after seeing an announcement about his candidacy. He is a young and very earnest person who wants to make a difference for his area of the central valley. He told me there are not enough doctors, too little reimbursement, and not enough being done to improve the health of his community. I asked him if he was still working in the ER. “No,” he said, he is taking a year leave of absence to run his campaign. The cost? $1 million dollars! Help me support Dr. Arambula: joaquinarambula.com. Dr. Richard Pan, or Senator Pan was another interesting person I met. It was fitting that the Disneyland Hotel was the site for the HOD convention. The measles outbreak happened at Disneyland, and here we were to celebrate the most comprehensive and strict immunization bill SB 277. Dr Pan, a pediatrician from Davis, was the bill’s author and champion. Dr. Pan is under the very real threat of a recall until the end of the year. Help support him: drrichardpan. com. The HOD meetings were an impressive display of the passion our members have for the issues. There were heated debates on a wide range of issues and diverse points of view across the spectrum. Our delegates are not a shy bunch! Politics was the theme for the position of the president-elect. Our delegation was visited by both candidates, Drs. Ruth Haskins and Peter Betran. Both are very impressive doctors who have amazing
careers and now want to lead CMA. Dr. Haskins, an OB/GYN from the Sacramento area, was chosen as President Elect for 2015-16. Back home in Salinas I continue in my role as Chief-of-Staff at Natividad. The good news is that the hospital continues to do well with the Level II Trauma Center. The financial picture is positive with the hospital in the black every month. Gary Gray, DO, the chief medical officer and MCMS Board Member, has been appointed CEO of Natividad. Congratulations Gary! Peter Chandler, MD, MPH, Service Director of OB/GYN, and a recently renewed member of MCMS, is serving as the interim chief medical officer. The hospital continues to add new services, most recently Tele-neurology, and Tele-dermatology. I am waiting for Tele-anesthesiology! I was also working in King City this week. I attended the CEO message delivered by Susan Childers. Mee Memorial is in the black for 2015. They are recruiting physicians and continuing to provide services in South County. Like other hospitals in Monterey County, Mee is challenged in recruiting doctors. The same issues are prevalent throughout the state, not enough doctors, low reimbursement, and ever more regulations and restrictions on how we take care of patients. Now, more than ever, your membership in CMA and MCMS is so important. CMA is our advocate and leader in maintaining and improving our practices and the care of our patients. Please encourage your fellow doctors to join us. There is strength in numbers. We need everyone to come together and continue our mission.
Drs. James Hlavacek and Joaquin Arambula
Value of Membership
Why PHYSICIANS practicing in Santa Clara County should be MCMS/CMA members:
No other organization commands the level of respect in the state Capitol that CMA does. In the world of politics, having a seat at the table makes all the difference.
1. Speaking with a united voice, physicians exert a powerful influence on the political process. Organized medicine is the ”one voice” that legislators and government hear.
James Hlavacek, MD MCMS President
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2. Free one-on-one small practice resources including regulation compliance,contract analysis and billing, payment problems. and more with CMA’s professional economic advocates and practice management experts at 800-786-4262. 3. MCMS/CMA worked diligently to protect MICRA (Medical Injury Compensation Reform Act), spearheading a successful campaign to defeat Prop.46 in the 2014 election.
4. Free medical-legal information on contracts, subpoenas, employee relations, record retention, collections and more through CMA On-Call, a 24-hour online health law library.
5. Grow your professional network and referral list by networking with peers, established physicians, and heatlhcare leaders and legislators at MCMS/CMA events.
Encourage your colleagues to join MCMS/CMA Now: www.sccma-mcms.org or (831) 455-1008 NOVEMBER / DECEMBER 2015 | THE BULLETIN | 9
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NOVEMBER / DECEMBER 2015 | THE BULLETIN | 11
12 | THE BULLETIN | NOVEMBER / DECEMBER 2015
2015 House of
Delegates California Medical Association
delegates set policy and
elect officers at annual meeting More than 500 California physicians, residents and medical students convened in Anaheim October 16-18, 2015, for the California Medical Association’s (CMA) annual House of Delegates (HOD). On the following pages are highlights of the actions taken at this year’s meeting. >> STORY BY ELIZABETH ZIMA l PHOTOGRAPHY BY JEFF WALTERS
NOVEMBER / DECEMBER 2015 | THE BULLETIN | 13
2015 This year saw an expanded “virtual” reference committee process, with all reference committee testimony conducted online. The reference committee members met via conference call in advance of HOD to develop recommendations that were presented to the House for f loor debate. This was the final year that the HOD will meet in its current format, with the new governance reforms approved at last year’s meeting taking effect at the close of the 2015 meeting.
The House also installed a new president, Riverside infectious disease specialist Steven E. Larson, M.D., M.P.H., and Folsom OB/GYN Ruth Haskins, M.D., was tapped as president-elect. THE FULL 2015-2016 CMA EXECUTIVE COMMITTEE INCLUDES: • President Steven E. Larson, M.D., M.P.H., Riverside • President-Elect Ruth Haskins, M.D., Folsom • Speaker of the House Theodore M. Mazer, M.D., San Diego • Vice-Speaker of the House Lee T. Snook, Jr., M.D., Sacramento • Chair of the Board of Trustees David Aizuss, M.D., Los Angeles • Vice-Chair of the Board of Trustees Robert E. Wailes, M.D., Encinitas • Immediate Past President Luther F. Cobb, M.D., Eureka
14 | THE BULLETIN | NOVEMBER / DECEMBER 2015
Reports and Resolutions Below are a sampling of the resolutions adopted as policy. (The full actions of the HOD are available for members only at www.cmanet.org/hod. Click on “Annual Meeting Resolutions” then on the “Documents” tab.) TOBACCO (RES. 107-15): CMA reinforced its long-established
stance against tobacco use, with the passage of a resolution that strongly objects to pro-tobacco efforts by the U.S. Chamber of Commerce in other parts of the world. CMA calls on the Chamber to immediately halt all advocacy efforts on behalf of tobacco companies and urges all conscientious companies that are members of the Chamber to either take similar action or quit their membership to protest such anti-health efforts. PUBLIC HEALTH FUNDING (RES. 112-15): The delegates voted
unanimously to urge the State of California to restore public health funding. The resolution calls on CMA to work with state health and legislative officials, through the state budget process, to develop a plan to repair California’s public health infrastructure and funding for vital prevention services. BIOMEDICAL CAREERS (RES. 609-15): The delegates directed
CMA to support pipeline programs targeting underrepresented minority and disadvantaged students, to help increase ethnic minority physicians in medically underserved areas. IMPLICIT BIAS TRAINING (RES. 610-15): Acknowledging
their impact on patient care, the delegates urged CMA to support studies of the impact on patient care of “implicit bias” – defined as the positive or negative perceptions, feelings and stereotypes that impact our comprehension and behaviors in an unconscious way. The resolution also called on CMA to support the inclusion of implicit bias training in medical school curriculums and continuing medical education programs. HSA LIMITS (RES. 411-15): The delegates passed a resolution
directing the association to support increasing the dollar amounts eligible for tax-free deposit into a health savings account (HSA) to cover a greater proportion of an enrollee’s potential out-of-pocket costs in a high-deductible health plan.
NOVEMBER / DECEMBER 2015 | THE BULLETIN | 15
HOSPITAL AFFILIATION REQUIREMENTS (RES. 402-15): The delegates passed a resolution opposing
the health plan practice of requiring physicians to maintain a hospital affiliation in order to contract with the plan. Many physicians, for a variety of reasons, no longer physically practice in a hospital setting. As such, requiring physicians to have hospital privileges at an in-network facility in order to contract with a health plan unfairly penalizes physicians. ADMINISTRATIVE BURDENS (RES. 404-15): In
an effort to reduce the administrative burdens on physicians, the delegates passed a resolution that supports a requirement that each health plan provide a single comprehensive information resource (telephone or online) that can address all inquiries related to benefit eligibility, provider plan participation and service pre-certification.
16 | THE BULLETIN | NOVEMBER / DECEMBER 2015
POWDERED ALCOHOL (RES. 104-15): The
delegates passed a resolution directing CMA to encourage an established health research entity to evaluate powdered alcohol products for potential health and societal impacts. The resolution also calls on CMA to advocate for the development of regulatory controls for powdered alcohol products similar to those for liquid alcohol products. This resolution was referred for national action. MEDICAL LOAN FOR UNDOCUMENTED MEDICAL STUDENTS (RES. 602-15): The resolution directs
CMA to work with the state to create and fund a loan program for undocumented medical students, including public service loan forgiveness for this loan program.
CMA ELECTS SACRAMENTO OB/ GYN RUTH HASKINS, M.D., AS 2015-16 PRESIDENT-ELECT
Awards and Elections CMA INSTALLS RIVERSIDE INFECTIOUS DISEASE SPECIALIST AS 2015-16 PRESIDENT
Riverside infectious disease specialist Steven E. Larson, M.D., M.P.H., was installed as CMA’s 2015-16 president. “It is an enormous honor to serve the 40,000 plus members of CMA as their president,” said Dr. Larson, speaking to the more than 500 delegates in attendance. “As we face some of the most rapidly changing times in health care that this country has ever seen, I look forward to working with the county medical societies and my colleagues across the state in unifying together as one voice to tackle whatever obstacles lie ahead.” Dr. Larson practices in both Riverside and San Bernardino counties. He is currently the Chief Executive Officer and Chairman of the Board of Riverside Medical Clinic and serves as a clinical professor of biomedical sciences at the University of California, Riverside, School of Medicine. Dr. Larson earned his medical degree from the Medical College of Wisconsin and completed his residency in internal medicine and a fellowship in infectious diseases. He earned a Masters in Public Health from Loma Linda University and is board certified in both internal medicine and infectious diseases. In addition to his experience with CMA, Dr. Larson also serves as a delegate to the American Medical Association, is a member of the Medical Group Management Association, the Infectious Disease Society of America, Southern California Infectious Disease Society and the American College of Physicians. “California will be faced with many exciting changes to health care in the coming year, including a ballot measure to increase the state’s tobacco tax, which will help to save lives and reduce teen smoking,” said Dr. Larson. “With a vested interest in public health and a commitment to serve my colleagues and my patients, I’m looking forward to what the year will bring.”
Sacramento OB/GYN Ruth Haskins, M.D., was selected as the association’s president-elect. She will serve in this capacity for one year and will be installed as president at the conclusion of next year’s HOD. “I am thrilled to have been elected to become CMA president and cannot wait to positively contribute to ensure this wonderful organization, and the doctors it represents, continues to move closer to achieving its full potential,” said Dr. Haskins. As one of her main goals, Dr. Haskins plans during her term to encourage the active participation of all CMA members by optimizing the year-round process of policy-making. “I encourage all physicians to incorporate health advocacy as an integral part of the practice of medicine,” said Dr. Haskins. “I encourage doctors to look at health advocacy as an outlet for enhancing their passion for practicing medicine by the empowerment gained by speaking out in the political arena.” Dr. Haskins attended the University of Pittsburgh School of Medicine. She was selected in 1980 for a Health Professions Scholarship Program position and while in medical school began active duty in the U.S. Air Force (USAF) with the rank of Second Lieutenant. Upon graduation, she reported to the David Grant USAF Medical Center at Travis Air Force Base, for training in Obstetrics and Gynecology, at the rank of Captain. Dr. Haskins completed her four-year
NOVEMBER / DECEMBER 2015 | THE BULLETIN | 17
IMPERIAL VALLEY PHYSICIAN RECEIVES CMA’S 2015 “COUNTRY DOCTOR” AWARD
residency and was transferred to Scott Air Force Base Medical Center in Illinois. She was promoted to Major in 1991, and was involved in the military’s readiness campaign during Desert Storm and Desert Shield. In 1992 she was appointed Chairman of the Department of Obstetrics and Gynecology at Scott Air Force Base. From 1997 through 2008, Dr. Haskins was an Associate Professor at the University of California, Davis. There, she initiated a course in legislative advocacy that grew into an annual lobby day for OB/GYN residents, which just celebrated its 10th anniversary. Today, Dr. Haskins has a very busy solo practice in the Sacramento area. She has been a member of CMA and the Sierra Sacramento Valley Medical Society for 22 years, serving as CMA trustee from 2013 to 2015 and as chair of the CMA Council on Legislation from 2010 to 2013. She has also been an active delegate representing the voice of the American College of Obstetricians and Gynecologists in the House of Delegates for over 20 years. “Now I look forward to being the voice for all doctors and an advocate for all patients of California,” she said.
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George Carr Fareed, M.D., was awarded CMA’s Frederick K.M. Plessner Memorial Award, which honors the California physician who best exemplifies the ethics and practice of a rural country practitioner. Dr. Fareed has been described by patients as an empathetic doctor and has become a friend to many patients. Before he moved to the Imperial Valley in 1991, he had a distinguished history as a clinical researcher, worked as the team doctor for the U.S. tennis team and established three HIV specialty care clinics for underserved patients in the Imperial Valley, which borders Mexico. From 1970 until 1991, Dr. Fareed was a successful clinical researcher as an assistant professor of medicine at Harvard Medical School and then an associate professor at the University of California, Los Angeles Geffen School of Medicine. He continues there today as an adjunct associate professor. After his years in academic research, he moved into public and private biotech work as the director of cancer biotherapy at INGENER, director of new product development for XOMA Corp. and as president of Advanced Antigens, Inc. He developed processes that led to three U.S. patents in the biotech field. After two decades spent in research, he decided that he wanted to use to put his clinical skills into action and headed out to the Imperial Valley to establish his practice in the town of Brawley. He started by establishing three HIV clinics through a partnership with Clinicas De Salud Del Pueblo, because there was little treatment available in the area for those with the infection. These clinics were the first in the area to serve patients on both sides of the border. Dr. Fareed has an active interest in sports medicine and was able to put this interest into practice as the team physician for the U.S. Davis Cup tennis team, working with such tennis greats as Michael Chang, Jim Courier, Andre Agassi, John McEnroe and Pete Sampras from 1991 to 2003.
SACRAMENTO PHYSICIAN RECEIVES CMA’S INAUGURAL COMPASSIONATE SERVICE AWARD
Sacramento ophthalmologist Barbara Arnold, M.D., was awarded the first annual Compassionate Service Award, which honors the California physician who best illustrates the association’s commitment to community and charity care. In addition to being a skilled and compassionate physician, Dr. Arnold is a gifted artist who teaches art classes through the Crocker Art Museum for visually impaired and legally blind individuals. Since the program’s inception in 2012, her efforts have helped
Other News
ANNUAL GALA RAISES IN EXCESS OF $60,000 FOR PUBLIC HEALTH PROGRAMS
The CMA Foundation hosted the 19th Annual President’s Reception and Awards Gala at Disney’s Grand Californian Hotel and Spa in Anaheim during CMA’s annual House of Delegates meeting. The event raised in excess of $60,000, including $32,500 for medical student grants— thanks to the generosity of our sponsors and donors. Honored at the event were new CMA President Steven E. Larson, M.D.; the 2015 Robert D. Sparks, M.D., Leadership Achievement Award winner, San Diego physician David Folsom, M.D.; and the 2015 Adarsh Mahal, M.D., award winner, San Francisco physician Michael LeNoir, M.D. After a cocktail reception and dinner, guests were treated to the music of the band Power Mix, a 17-piece orchestra with a full horn section, three strings and eight lead vocalists. The band covered old favorite dance hits from yesterday and today.
visually impaired individuals develop creative and meaningful hobbies with rewards far beyond the students’ hopes and expectations. Currently, there is a waiting list for Dr. Arnold’s classes. Many of her students come from out of the Sacramento area, some travelling with their guide dogs via Amtrak to take her classes. Dr. Arnold has been teaching ophthalmology to residents at the University of California Davis Eye Center for more than 20 years. She is an Emeritus Chair in the UC Davis Department of Ophthalmology and was the department chair for 26 years.
Among the big ticket items auctioned off were an evening of good food and political insight with CMA’s CEO, Dustin Corcoran – also known as the defender of MICRA and the destroyer of Proposition 46; a chance to see golf ’s most talented players at Augusta Masters Golf Tournament in Georgia; and a San Francisco 49er weekend package featuring Club Level seats in the new Levi’s Stadium to watch the team play. To view more photos from the event, visit CMA’s Flickr page at www.flickr.com/californiamedicalassociation. CALPAC FUNDRAISING RECORD SHATTERED AT HOUSE OF DELEGATES
CMA’s Political Action Committee, CALPAC, shattered all previous fundraising records in the history of the PAC by raising roughly $173,000 during CMA’s annual meeting. In a record-setting show of support for CALPAC, CMA members bested last year’s mark of $119,000 while also exceeding the $140,000 goal established at the opening of the House of Delegates meeting. The donations collected over the weekend, as well as all contributions made to CALPAC, will be used to support candidates who share medicine’s agenda and priorities and will work to affect policies beneficial to the House of Medicine. For more information about CALPAC, visit www.calpac.org.
NOVEMBER / DECEMBER 2015 | THE BULLETIN | 19
2010
2011
2012
2013
2014
New governance rules go into effect for CMA
WITH THE CLOSE OF THE CMA’S 144TH HOUSE OF DELEGATES (HOD) ON OCTOBER 17, NEW GOVERNANCE REFORMS TAKE EFFECT. THESE REFORMS WILL ALLOW CMA TO BE MORE NIMBLE AND EFFECTIVE IN MAKING DECISIONS ON CRITICAL ISSUES THAT ARE IMPORTANT TO PHYSICIANS.
In 2013, CMA’s Governance Technical Assistance Committee (GTAC) recommended, and the HOD adopted, a proposal to create a more modern, efficient system of governance and enable more focused and effective advocacy programs. In 2014, HOD approved updates to CMA’s bylaws that enabled these changes. CMA’s long-standing traditions of democratic participation and representative governance will continue, but HOD will focus on the most pressing matters facing physicians and the practice of medicine. A new HOD structure will focus on a limited number of current major issues—the most important matters facing physicians and the practice of medicine each year, while the Board of Trustees will assume responsibility for policy-making on all other matters. The new bylaws will also
accommodate the submission of resolutions from individuals throughout the year, rather than just once a year, allowing CMA to react quickly—via its democraticallyelected Board of Trustees—to critical issues in real time. Any CMA member may author a resolution and have it submitted to the Board of Trustees using the year-round process. This approach preserves the ability of individual members to participate in and inf luence CMA policy-making in a more timely way, rather than waiting for a once-a-year opportunity at HOD, which had been CMA’s tradition. In 1856, CMA was established with a mission very similar to the one followed today—promoting the science and art of medicine, the care and well-being of patients, the protection of the public health and the betterment of the medical profession. The new governance
20 | THE BULLETIN | NOVEMBER / DECEMBER 2015
structure will allow the membership to maintain its position as a nimble, proactive organization ready to lead the practice of medicine for another 150 years. In 2016, HOD will become a two-day meeting, during which delegates will discuss and vote on the most important issues facing CMA members and the practice of medicine, including any items that the Board refers to the House. Delegates will also elect officers, receive annual reports on the actions of the standing councils and committees during the previous year, and attend educational sessions on key issues. CMA would like to thank those members who participated in this three-year process, particularly the GTAC members who worked so hard on this proposal and the trustees and delegates who debated the issues.
More Photos From the 2015 House of Delegates Annual Session
CMA Past Presidents and CEO pose for a photo at the House of Delegates annual session.
Some of our District VII Delegates and SCCMA Members at the President’s Reception and Awards Gala during CMA’s HOD meeting.
CMA Past President Luther Cobb, MD, presents SCCMA/ CMA Member Sharon Levine, MD, with a proclamation from the state assembly for her outstanding contributions in leadership to the CMA.
Some of our District VII Delegates and SCCMA Members at the President’s Reception and Awards Gala during CMA’s HOD meeting.
SCCMA/CMA Delegate and CMA Trustee Dr. Thomas Dailey gives his comments on a resolution being discussed.
CMA Past President Luther Cobb, MD, presents SCCMA/ CMA Member Sharon Levine, MD, with a proclamation from the state assembly for her outstanding contributions in leadership to the CMA. NOVEMBER / DECEMBER 2015 | THE BULLETIN | 21
CALIFORNIA MEDICAL ASSOCIATION
MEMBER BENEFITS Contact CMA Today!
When you join CMA, you hire a powerful professional staff to protect the viability of your practice. By protecting your practice from legal, legislative, and regulatory intrusions, your CMA membership lets you focus on what’s really important: your patients.
1-800-786-4262 www.cmanet.org/ groupdiscounts
Members can offset the price of their annual dues when using CMA membership services and discounts. Thanks to CMA’s group buying power, members receive deep discounts on everything from magazines to office supplies to insurance products. From auto insurance to retirement plans, CMA’s discount programs will save you time and money. Many CMA members save more than their annual dues!
Legal Services CMA On-Call: CMA’s health law library, CMA On-Call, has over 5,400 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/cma-on-call or by calling 800.786.4262. Legal Services: CMA’s legal department provides members with information and resources about laws and regulations that impact the practice of medicine. While CMA staff cannot provide physicians with individual legal advice, our health law information specialists, with the support of CMA legal counsel, will help you find legal information and resources on a multitude of health-law related issues. Call 800.786.4262.
Professional Development CME Tracking/Credentialing: CMA’s Institute for Medical Quality 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 $33 a year for CMA members, $57 for nonmembers. IMQ, 415.882.5151 or www. imq.org. CMA Webinar Series: CMA’s webinar series gives physicians the opportunity to watch online 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. All of our webinars are also archived for on-demand viewing at any time in our resource library. There are currently more than 100 archived webinars on topics ranging from HIPAA, to health reform, to coding, billing, and compliance. www.cmanet.org/webinars. CMA Seminar Series: Experts from CMA’s various centers travel to local county medical socities throughout the state, holding live seminars for members and their staff on a variety of issues. Contact your local county medical society for more information. ICD-10 Resources & Training: In an effort to help practices navigate the transition to ICD-10, CMA has developed several resources, including a robust FAQ document and tip sheet. Additionally, CMA has partnered with the largest and most respected coding organization, AAPC, to provide our members with a complete suite of ICD-10 solutions at steeply discounted rates. Visit www.cmanet.org/icd10 for more information.
22 | THE BULLETIN | NOVEMBER / DECEMBER 2015
Certified Professional Coder Program: CMA members and their staff receive big discounts on Certified Professional Coder (CPC) training and certificates from AAPC. AAPC’s CPC credential is the gold standard for medical coding in physician office settings. Contact your local county medical society for more information.
Practice Management CMA Reimbursement Help Center: Trouble getting paid? In the past five years, CMA’s practice management experts recouped over $10 million from payors on behalf of physician members. CMA provides members and their staff with FREE one-on-one assistance with individual practice management, reimbursement, and contracting related issues. Reach CMA’s practice management experts at 888.401.5911. CMA Payor Contract Analysis: CMA members have free access to objective written analyses of major health plan contracts at www.cmanet.org/ces. Each analysis is designed to help physicians understand their rights and options when contracting with a third party payor, as well as which contract provisions are prohibited by California law.
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. Subscribe to any of these newsletters online at www.cmanet.org/ newsletters. CMA Alert: CMA’s bi-weekly e-newsletter provides up-todate information on many issues of critical importance to California physicians. CMA Practice Resources (CPR): CMA’s free monthly e-mail bulletin from CMA’s practice management experts that focuses on critical payor and health care industry changes and how they directly impact the business of a physician practice. Each issue includes tips on reimbursement and contracting related issues along with information on the latest practice management news. CMA’s Press Clips: CMA’s daily news roundup, provides a quick but meaningful overview of the day’s health care news.
Insurance Mercer Insurance Services: As the primary insurance advisor for CMA and its affiliated county societies, Mercer offers a wide variety of sponsored insurance plans and services for members. With health care reform impacting members as employers, you need to be speaking with a knowledgeable advisor to consider your medical plan offerings, in or out of the health exchange, for yourself, your employees and your dependents in the months and years ahead. Designed to cover a multitude practice and personal insurance needs the CMA-sponsored insurance plans include disability, group life, workers’ compensation, employment practices liability (with access to employment counsel included), and dental. Members also have access to personal insurance concierge services to help with your insurance planning. More information on Mercer’s sponsored benefit program can be found at www.countyCMAmemberinsurance.com or by calling 800.842.3761.
Auto and Homeowners Insurance: Discounted auto and homeowners insurance for CMA members. Mercury Insurance Group, 888.637.2431 or visit www.mercuryinsurance.com/cma.
Other Supplies and Resources Medical Waste Disposal and Regulatory Compliance: EnviroMerica offers CMA members heavily discounted medical waste removal and regulatory compliance services. Through EnviroMerica, CMA members can protect themselves from regulatory fines, receive compliance consultations and properly dispose of medical waste at a fraction of the cost charged by competitors. Find out more at www.enviromerica.com or by calling 650.655.2045. DocBookMD: CMA members are eligible for a free download of the DocBookMD smart phone app, which allows them to securely send messages directly from their iPad, iPhone and Android devices. Find out more at www.docbookmd.com or by contacting your county society. Physician Practice Websites: Mayaco Design and Marketing offers CMA members deeply-discounted website design services for their practices starting at $1,250. Contact Mayaco at 209.957.8629 or visit www.mayaco.com for more information. HIPAA Compliance: PrivaPlan offers CMA members discounted rates on HIPAA privacy and security compliance resource kits custom tailored to California’s regulations. Find out more at www.privaplan.com. StaplesAdvantage: Save up to 80% on office supplies and equipment from Staples, Inc. Visit www.cmanet.org/ groupdiscounts to access the members-only discount link. COLA: COLA is a physician-directed organization whose purpose is to promote excellence in laboratory medicine and patient care through a program of voluntary education, consultation and accreditation. This member benefit provides a 15% savings on COLA’s Laboratory Accreditation Program and its educational products and services. CMA members also receive free online support and a complimentary basic quality lab course and may be eligible for a discount on AAFP and ACP proficiency testing programs. Visit www.cmanet.org/groupdiscounts to access the members-only discount code. 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. www.medicalert.org/cma or 800.253.7880. Security Prescriptions: Get 15% off tamper-resistant security prescription pads and printer paper. www.rxsecurity.com/ cma.php. Magazine Subscriptions: 50% off subscriptions to hundreds of popular magazines, with a best price match guarantee. Visit Subscription Services Inc. at www.buymags.com/cma or call 800.289.6247. 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/ groupdiscounts or call 800.786.4262.
NOVEMBER / DECEMBER 2015 | THE BULLETIN | 23
1/800/842-6663 Recieve FREE access to contracts that will help you reduce your overhead without changing how you are currently doing business, including a 22% discount on Verizon Wireless.
Practice & Liability Consultants, LLC Debra Phairas, 415/764-4800, or email csm@practiceconsultants. net. Medical Office Consultants Receive a discount off hourly consulting fees. Services include: Practice assessments, valuations, benchmarking, mergers, operations/personnel issues, Partnership/group formation improvements, and seminars.
TPO Human Resource Management Melissa Irwin at 831/647-7292 or melissai@tpohr.com. Members receive a free initial consultation ($50 Savings) & 10% off initial products and services with TPO. Services include HR consulting, employee handbook development, third-party investigations into employment matters including harassment & managerial training.
CREDIT CARD PROCESSING/FINANCIAL SERVICES
PRACTICE MANAGEMENT ASSISTANCE
BENEFITS/SERVICES
SCCMA/MCMS MEMBER
Amerinet Health Resource Services (HRS)
360 Payment Solutions Jesse Meddaugh at 408/637-1160. Offers credit card processing that is guaranteed to match or beat your current processing fees as well as provide on-site local support.
Legacy Wealth Advisors, LLC: Ed Ryu at 408/452-7700. Provides financial and retirement planning, professional money management, and more! Members receive a complimentary 1-hour consultation ($300+ savings).
Bureau of Medical Economics (BME) For more information regarding BME’s collection services and rates, call Karen Jorgenson at 408/286-6219. Receive a 5% discount on the basic rate for collections (based on volume – you only pay if they collect).
The Bulletin
Members receive a FREE subscription to SCCMA/MCMS’s bimonthly publication, which includes medical articles, classifieds, member benefits, coding/billing/collection advice, CME classes, seminars, and webinars, and information on our upcoming events!
SCCMA/MCMS Membership Directory Call our office at 408/998-8850 or 831/455-1008 for details or to place an order.
Autobahn Los Gatos Dave Lee or Gary Cassetta at 408/356-5985 to set up your appointment today. Members, family, and or staff receive a 10% discount on labor. Specializing in BMW and Mercedes Benz repair for 25 years.
OFFICE SUPPLIES/PRINTING
AUTOMOBILE REPAIR
Appear in SCCMA/MCMS’s annual pictorial membership directory! Receive a complimentary copy of our directory each year ($65.00 value) and 50% discount off each additional directory purchase.
MEMBER RESOURCES
Physician members and their office staff may attend FREE seminars covering legal issues, HIPAA, risk management, contract negotiations, reimbursement, billing, CALOSHA compliance, how to open/ close a medical practice, & more.
SCCMA/MCMS PUBLICATIONS
PROFESSIONAL DEVELOPMENT
SCCMA/MCMS Seminar/ Webinar Series
Mailing Lists/Labels Pam Jensen, SCCMA/MCMS, at 408/998-8850 or 831/455-1008 ext. 3012. 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.
Physician Referral Service Jean Cassetta, SCCMA/MCMS, at 408/998-8850 or 831/455-1008 ext. 3010 for a “Physician Referral Service Participation Agreement” or to sign up today. Our physician referral service provides 1,200 referrals online and handles around 1,200 calls per month. Patients can select a physician by city, specialty, language, Medicare, or Medi-Cal, and or gender.
Discounted Tickets & See’s Candies Certificates Copyland/Zip 2 Print Frank Ettefagh: 408/971-2722 or frank@zip2print.com. 2342 Stevens Creek Blvd., San Jose, CA 95128 Receive a 10% discount on all printing, including prescription pads, new practice announcements, brochures, etc. FREE shipping or delivery depending on your office location.
Leslie Sorensen at 408/998-8850 or 831/455-1008 ext. 3008. 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.
NOVEMBER / DECEMBER 2015 | THE BULLETIN | 25
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Do you have an office EMERGENCY? Call us at (408) 217-6000 26 | THE BULLETIN | NOVEMBER / DECEMBER 2015
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CALIFORNIA MEDICAL ASSOCIATION
SEE JANE SAVE WITH CMA Purchased health insurance for her
Purchased workers’ comp insurance
8-person staff through Mercer.
through the Mercer/Preferred
SAVED: $12,120
Employers program.
SAVE: $750
Called CMA’s legal information line and accessed documents from CMA’s online
Earned 16 CME by attending
health law library, instead of calling an
CMA’s Western Health Care
attorney for that same information.
Leadership Academy.
SAVED: $2,660
SAVED: $400
Used EnviroMerica to manage
Participated in 3 online webinars.
her practice’s medical waste and
SAVED: $297
regulatory compliance.
SAVED: $1,200
Used CMA’s magazine discount program to subscribe to 10 magazines
Hired CMA partner Mayaco Internet
for her waiting room and exam rooms.
and Marketing to design a new
SAVED: $250
mobile-friendly website.
SAVED: $1,000
Bundled her auto and home insurance through Mercury Insurance.
Called CMA’s reimbursement helpline.
RECOVERED: $800
SAVED: $230 Kept track of her CME credits through
Sent her billing staff to CMA’s
IMQ’s online CME certification portal.
ICD-10 boot camp.
SAVED: $24
SAVED: $800
Bought security prescription EMR Purchased office supplies through
sheets from RxSecurity.
CMA’s Staples Advantage program.
SAVED: $10
SAVED: $750
TOTAL SAVINGS: $21,291 Saving money, having access to unique services, knowing her dues support the California Medical Association’s efforts to protect the viability of her practice, so she can focus on providing her patients with excellent care: PRICELESS 28 | THE BULLETIN | NOVEMBER / DECEMBER 2015
CALIFORNIA MEDICAL ASSOCIATION
YOUR CMA MEMBERSHIP: PRICELESS When you join CMA, you hire a powerful professional staff to protect the viability of your practice. By protecting your practice from legal, legislative and regulatory intrusions, your membership lets you focus on what’s really important: your patients. Here are a few examples:
PROPOSITION 46: California’s Medical Injury Compensation Reform Act (MICRA) has kept access to affordable health care a reality for patients across the state. CMA stalwartly defends this landmark law year after year. In 2014, the trial lawyers mounted an all out attack on the law, seeking to overturn it at the ballot box. But CMA led the fight against the trial lawyers’ Proposition 46, in what turned out to be one of the most contentious and high-stakes ballot fights in California history. The voters of California ultimately spoke loudly and definitively, sending Prop. 46 to defeat by a vote of 67 percent to 33 percent. The message was clear – Californians simply don’t want to increase health care costs and reduce health access so trial attorneys can file more lawsuits.
MEDICARE SGR: CMA was integral in the passage of the The Medicare Access and CHIP Reauthorization Act,” which will eliminate the badly broken Medicare sustainable growth rate (SGR) physician payment system. In the decade leading up to the passage of this monumental legislation, physicians faced double-digit payment cuts year after year. With the threat of devastating cuts eliminated and a stable payment system going forward, physicians will be able to maintain their practices and meet the growing health care needs of the nation’s seniors. This legislation is worth hundreds of millions of dollars to physicians nationwide over the coming decade.
ACA PRIMARY CARE RATE INCREASE: CMA has worked tirelessly to ensure physicians are paid correctly under the Affordable Care Act’s (ACA) primary care rate increase. CMA’s intervention directly resulted in changes worth $13.7 million to the physicians of California.
DIRECT PAYOR ASSISTANCE: In addition to advocacy that benefits every physician in California, CMA members also benefit from one-on-one assistance from the practice management experts in CMA’s Center for Economic Services (CES). CES has recouped $10 million from payors on behalf of CMA member physicians in the past five years. These monies represent actual physician reimbursements that would have likely gone unpaid without the intervention of the CES team.
Can you afford NOT to be a member? www.cmanet.org/join For more information, call the CMA member help line, (800) 786-4262. NOVEMBER / DECEMBER 2015 | THE BULLETIN | 29
TROUBLE GETTING PAID? $
I’VE RECOVERED
Your CMA & County Medical Associations Can Help!
70,000
from my payors using our Centers for Economic Services
In the past five years, our Centers for Economic Services have recovered over $10 million from payors on behalf of our members. Our Centers for Economic Services are staffed by pratice management experts with a combined experience of over 125 years in medical practice operations. Our goal is to empower physician practices by providing resources and guidance to improve the success of your practice. Assistance ranges from coaching and education to direct intervention with payors or regulators.
Members can call on our practice management experts for one-on-one help with payment, billing and contracting issues. If you answer “yes” to any of the following questions, it might be time to call for help. • Do you have any questions about Covered California?
• Do you need help with Medicare related issues?
• Are your claims not being paid in a timely manner?
• Are your claims being denied after obtaining prior authorization?
• Are you not being paid according to your contract? • Are you receiving unreasonable requests for medical records? • Are you receiving untimely requests for refunds or is a payor recouping money from your check without first notifying you in writing of a refund request?
• Have you been presented with a managed care contract and you’re not sure if the terms are consistent with California law? • Have you done everything you can to resolve an issue with a payor, but have hit a brick wall?
Access to our Centers for Economic Services experts is a FREE, members-only benefit. Need help?
Call Sandie at (408) 998-8850 or email: sandie@sccma.org 30 | THE BULLETIN | NOVEMBER / DECEMBER 2015
TROUBLE GETTING PAID? SCCMA-MCMS-CMA Can Help!
Here’s what our members have said: “The value that our medical associations’ reimbursement experts bring to physician practices cannot be understated. In addition to the support we receive resolving payor issues, my staff and I rely on the wide range of member-only tools and services to keep my practice running smoothly. Membership is not a cost to my practice - it’s an investment. I couldn’t run my practice without it.”
“I can point to quite a few claims we had written off as unrecoverable - until our medical associations’ reimbursement experts stepped in and got us payment. They have provided us with an invaluable service: Turning zero payment and no prospects into cash in the bank.”
HOW CAN WE HELP YOU?
CALL (408) 998-8850 TO FIND OUT! Tools and resources to empower physician practices Whether it’s identifying and fighting unfair payment practices, improving the efficiency of your practice or negotiating payor contracts, SCCMA-MCMS and CMA have tools and resources to help. Learn more at www.sccma-mcms.org.
Sandie Moore, CMC
Physician Advocate, Certified Medical Coder and Reimbursement Specialist
NOVEMBER / DECEMBER 2015 | THE BULLETIN | 31
CALIFORNIA MEDICAL ASSOCIATION
CMA ON-CALL ONLINE HEALTH LAW LIBRARY With new laws and regulations passed every year, running a medical practice can be complicated. While the California Medical Association (CMA) works hard every
day to lighten unnecessary burdens and streamline information, we are also your best source of knowledge to effectively answer difficult questions about practicing medicine in California. CMA’s online health law library contains nearly 5,000 pages of CMA On-Call documents and valuable information for physicians and their staff. Access to the library is free to members.
Have you ever asked… What is the process for terminating the physician-patient relationship?
I’m having issues with a member of my staff—what are the legal steps required to terminate employment?
What restrictions apply to electronic prescribing of controlled substances?
What can I do regarding a negative online review about my practice?
How long do I have to retain medical records?
How can I challenge my quality rating in a pay-for-performance program?
I’m looking to grow my practice—are there laws that govern physician advertising?
www.cmanet.org/cma-on-call Access to CMA’s health law experts is a FREE, members-only benefit. Need help? Call (800) 786-4262 or visit cmanet.org.
COMPLETE CMA ON-CALL SUBJECT LIST: ADA/Discrimination
Expert Witness Issues
Medicare and Medi-Cal
Adverse Events
Fraud and Abuse
Miscellaneous Issues
Advertising
Fraud and Abuse: Referral Issues
Office Safety
AIDS/HIV
Managed Care: Contracting
Outpatient Facilities
Allied Health Professionals
Managed Care: Overview
Peer Review
Ancillary Services
Managed Care: Risk Arrangements
Physician-Patient Relationship
Antitrust
Managed Care: Utilization Review and Management
Professional Liability
Business Prohibitions/Disclosure
Medical Board: Discipline and Licensing
Reimbursement: From Patients
Clinical Laboratories
Medical Board: Reports
Reimbursement: From Private and Public Payors
Consent
Medical Practice: Workforce Issues
Reimbursement: Other Issues
Death/Organ Donation
Medical Practice: Physician Practice Models
Reporting Abuse
Drug Prescribing/Dispensing
Medical Records: HIPAA
Reporting Diseases, Conditions, and Events
Drug Testing
Medical Records: Management
Reproductive Issues
eMedicine
Medical Records: Requests for Access
Warning Obligations
Emergency Transfer
Medical Records: Special Confidentiality Requirements
Workers’ Compensation
End of Life Issues
Medical Staffs
Actual On-Call documents:
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Santa Clara County Medical Association 700 Empey Way • San Jose, CA 95128 • 408/998-8850 • FAX 408/289-1064 December 2015 TO:
All Members, Santa Clara County Medical Association (SCCMA)
FROM:
Scott Benninghoven, MD, Chair, 2015-2016 Awards Committee
At the 2016 Medical Association’s annual banquet, the association will honor several individuals with its perpetual awards. These awards are significant honors which reflect the respect, recognition, and appreciation of our membership. The recipients are selected from among our outstanding members who have distinguished themselves with extraordinary service to medicine in general, to the association, to the community, or to medical education. Selections are made by the Awards Committee, with the aid of input from the membership at-large. Your suggestions for recipients for each of the awards, outlined on the next page of this memo, will be appreciated. Please complete the form below to submit suggestions, keeping in mind the requirements for each award as listed on the opposite page. If you would like to nominate more than one person, or for more than one award, please photocopy this form or send a letter. Suggestions must be received by February 16, 2016. Thank you for your recommendations. If you previously suggested a candidate who was not given an award, please feel free to resubmit that name. I THINK ______________________________________________________ WOULD BE A GOOD CANDIDATE FOR THE _____________________________________________________________________________________ . (Name of Award) PLEASE ATTACH ALL SUPPORTING INFORMATION, INCLUDING ACCOMPLISHMENTS AND CONTRIBUTIONS THAT WILL HELP THE AWARDS COMMITTEE EVALUATE THE CANDIDATE FOR THE AWARD SELECTED. YOU MAY MAIL, FAX, OR EMAIL THE INFORMATION TO PAM JENSEN AT SCCMA. SUBMITTED BY: __________________________________________________________________________________ MD (Please print) MAIL FORM TO: SCCMA Attn: Pam Jensen 700 Empey Way San Jose, CA 95128 EMAIL: pjensen@sccma.org FAX: 408/289-1064 DEADLINE: February 16, 2016 34 | THE BULLETIN | NOVEMBER / DECEMBER 2015
Santa Clara County Medical Association
ANNUAL AWARDS
ROBERT D. BURNETT, MD LEGACY AWARD
For a physician member of the Medical Association who has demonstrated extraordinary visionary leadership, tireless effort, selfless long-term commitment, and success in challenging and advancing the health care community, the well-being of patients, and the most exalted goals of the medical profession. The only four recipients of this award are Robert D. Burnett, MD, Philipp Lippe, MD, Robert Pearl, MD, and Sharon Levine, MD.
BENJAMIN J. CORY, MD AWARD
For a physician member of the Medical Association who has displayed forward-looking, pioneering ideas, enterprise, enthusiasm, and prolonged professional stature and ability.
AWARD FOR OUTSTANDING ACHIEVEMENT IN MEDICINE
For a physician member of the Medical Association who, during his/her medical career, has made unique contributions to the betterment of patient care, for which he/she has achieved widespread recognition. Consideration shall be given to research and/or the development of procedures, methods of treatment, pharmaceutical agents, or technological advances in the field of medicine.
AWARD FOR OUTSTANDING CONTRIBUTION TO THE MEDICAL ASSOCIATION
For a physician member of the Medical Association who has exhibited sustained interest and participation in one or more activities of the Association over and above that expected of the membership at-large.
AWARD FOR OUTSTANDING CONTRIBUTION IN MEDICAL EDUCATION
For a physician member of the Medical Association who has exhibited sustained interest and participation in one or more medical education activities over and above that expected of the membership at-large.
AWARD FOR OUTSTANDING CONTRIBUTION IN COMMUNITY SERVICE
For a physician member of the Medical Association who has exhibited sustained interest and participation in one or more activities of the community over and above that expected of the membership at-large.
CITIZEN’S AWARD
For an individual who is not a member of the Medical Association, who has achieved public recognition for a significant contribution in the health field. (This usually will be a non-physician, although physicians are not categorically excluded.)
1994 1995 1996 1997 1998 1999 2000 2001
Benjamin J. Cory, MD Award
Outstanding Outstanding Contribution To The Contribution In Medical Association Medical Education
Outstanding Achievement In Medicine
Robert W. Jamplis
Richard M. O’Neill
John B. Shinn
Thomas J. Fogarty
---
Robert W. Andonian
Ronald L. Kaye
Norman E. Shumway
Christopher C. Chow
David M. Rosenthal
William C. Fowkes
Thomas A. Stamey
Outstanding Contribution In Community Service Arthur A. Basham / Arthur L. Messinger ---
Citizen’s Award Gary W. Steinke, MD / Mrs. Pamela Steinke Mr. Howard W. Pearce
Cindy Lee Russell / Minoru Yamate
Florene Poyadue, RN
---
Bernice S. Comfort
Robert J. Frascino
Michael R. Fischetti
Suzanne Jackson, RN
Mansfield F. W. Smith
Stanley D. Harmon
Howard R. Porter
Burton D. Brent
William A. Johnson
Judge Leonard Edwards
Donald J. Prolo
Steven S. Fountain
C. Michael Knauer
Jack S. Remington
M. Ellen Mahoney
Rigo Chacon
Sharon A. Bogerty
Stephen H. Jackson
Theodore Fainstat
Richard P. Jobe
Barbara C. Erny
Janet Childs
Roger P. Kennedy
Bert Johnson
Nelson B. Powell / Robert W. Riley
Robert Michael Gould
Tony & Brandon Silveria
Elliot C. Lepler
Allen H. Johnson
Bruce A. Reitz
David Morgan
Tom Campbell / Ted Lempert
Joseph E. Mason, Jr.
Anthony S. Felsovanyi
David A. Stevens
Martin D. Fenstersheib
Michael E. & Mary Ellen Fox
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2002 2003
Robert M. Pearl
2004
Robert Wuerflein
Eugene W. Kansky
Barry Miller
D. Craig Miller
Elizabeth Menkin
Jayne Haberman Cohen, DNSc
2005 2006
Harvey J. Cohen
Richard L. Miller
Gus M. Garmel
Rodney Perkins
Elouise Joseph
Doris Hawks, Esq.
Arthur A. Basham
Robert W. R. Archibald
G. David Adamson
Harmeet S. Sachdev
Edward A. Hinshaw, Esq.
2007 2009 2010 2011 2012 2013 2014 2015
Stephen H. Jackson
Cindy L. Russell
Catherine L. Albin
John R. Adler, Jr.
Madhur Bhatnagar
Debbi Ricks
Bernadette Loftus
Martin L. Fishman
George P. Kent
Thomas Krummel
Seham El-Diwany
Peggy Fleming-Jenkins
Melvin Britton
James G. Hinsdale
David Levin
Gary Steinberg
Leo Strutner
Judge Lawrence Terry
Tanya Spirtos
Dennis Siegler
Robert Armstrong
Gary Silver
Kathleen King
Steven S. Fountain
Robert Gould
William Jensen
Eleanor Levin
David Quincy
Assemblymember Jim Beall
James G. Hinsdale
Stephen C. Henry
Rosaline Vasquez
Diane E. Craig
Jeffrey D. Urman
Congresswoman Anna Eshoo
Martin L. Fishman
David H. Campen
Jonathan H. Blum
Gary E. Hartman
Keith A. Fabisiak
Gay Crawford
John P. Sherck
J. Ronald Tacker
James D. Wolfe
Stephen L. Wang
Susan E. Kutner
Senator Jerry Hill
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NOVEMBER / DECEMBER 2015 | THE BULLETIN | 35
Great Moments in Medicine
The Mother Killer By Gerald E. Trobough, MD Leon P. Fox Medical History Committee In the late 18th and early 19th centuries, thousands of mothers died after childbirth from puerperal fever. This disease was first described by Hippocrates in his treatise “Epidemic” about 400 BC. In that pre-bacterial era, puerperal fever, often referred to as childbed fever, was a mysterious disease that swept through maternity wards, killing many women who had given birth. The medical profession was at a loss to explain the cause or develop a method to prevent the disease. It was a young Hungarian born physician, Ignaz Philip Semmelweis (1818-1865) who was given credit for discovering the contagiousness of the disease and how to prevent it. After receiving an MD degree from the University of Vienna, Semmelweis took special classes in Obstetrics, earning a degree in midwifery in 1845. Wanting to further his studies under Karl von Rokitansky, the Pathology Professor at the University of Vienna, he was assigned to the Allgemeines Krankenhaus, Vienna’s charity hospital. His assignment was to determine the etiology of puerperal fever. 36 | THE BULLETIN | NOVEMBER / DECEMBER 2015
In 1840, the hospital’s lying-in department was enlarged, making it the largest maternity hospital in the world. The maternity department was divided into the First and Second Clinics. The First Clinic was for staff physicians, professors, and medical students. The Second Clinic was for midwives, midwifery students, and staff. The midwives emphasized natural childbirth and proper hand hygiene. High risk patients were referred to First Clinic. The number of deaths due to puerperal fever at the charity hospital were so high, it was referred to as a “death house.” It was noted that a delivery at home or in the street on the way to the hospital, resulted in much lower rates of puerperal fever whether delivered by a midwife or physician. When Semmelweis conducted a two-year study of the two clinics, he noted astounding results. The percentage of maternal deaths at the First Clinic was 11.4%, while the Second Clinic had a 2.7% mortality rate during the same months and under similar conditions. Many physicians and professors felt this disease was caused by atmospheric conditions (weather) or miasmas (poisoned air). Semmelweis examined seasonal influences, fear, modesty concerns of seeing a male physician, constipation, and delayed lactation in both clinics, but none of these explained the cause of the
deadly fever. He reasoned both clinics had similar influences on patients. Semmelweis continued to study the two practice models and noted some differences. Midwives delivered patients that were laying on their left side, so the physicians delivered patients on their left side. This had no effect on the mortality rate. He then reduced the size of the student class by 50% and expelled foreign students, since it was believed their pelvic exams were too rough. The mortality rate was unchanged. Not until one of Semmelweis’ friends, who was a professor, died of sepsis identical to puerperal fever after being nicked by a student’s scalpel during an Ignaz Semmelweis autopsy of a dead mother, ver.” His hand washing rules were resented and did he realize the disease was caused by a contaopposed by many of his contemporaries even gion transferred by the scalpel. He immediately though thousands of womens’ lives were saved. went to the autopsy room and asked to smell the The disappointment caused him to become dehands of a student who was working with cadavpressed and occasionally violent. He was comerous tissue. He noted the hands had a putrid mitted to a Sanitarium for the Insane in Vienna. odor. He ordered a chlorinated solution and Semmelweis died at age 47 of sepsis, the same had the student wash his hands in the solution infection he had fought so valiantly to prevent in and the odor disappeared. The following day, he mothers under his care. The cause of his infecposted a sign on the entry door to the delivery tion is disputed, but it probably occurred from room instructing everyone exposed to cadaverthe frequent beatings he received at the asylum. ous tissue to wash their hands before entering the delivery suite. The maternal mortality rate In retrospect, Semmelweis’ doctrine was dropped to 1.5%. When they also washed be- about 20 years ahead of the medical world’s tween examining patients, the maternal death thinking. Thanks to his work and the work of rate dropped to less than 1%. Pasteur and Lister during the last quarter of the Semmelweis repeated these hand washing procedures in other European hospitals with the same results. In 1859, he wrote the “Etiology, the Concept and the Prophylaxis of Childbed Fe-
19th century, pregnant women entering hospitals were no longer condemned to die of puerperal fever.
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T H E C A LI FOR N I A M EDIC A L A SSOCI AT ION
POWERFULLY BENEFITS AND PROTECTS T H E COM M U N IT Y It is difficult to imagine, but the 2015 legislative year was even more challenging than the 2014 legislative year, which included the diversion of staff resources to defeat Proposition 46. With a third of legislators (40 out of 120) serving freshman terms, the California Medical Association’s (CMA) Government Relations staff spent a considerable amount of time during the first quarter educating new legislators and their staff about the mission and policies of CMA. Through our educational efforts, we successfully stopped the introduction of a number of harmful legislative proposals and shifted focus to the passage of CMA’s sponsored bill package.
C M A’ S 2 01 5 L E G I S L A T I V E W R A P U P BY JANUS L. NORMAN, CMA SENIOR VICE PRESIDENT
SCHOOL VACCINES
A majority of our resources this year went to the passage of SB 277 (Pan and Allen), our sponsored bill eliminating the personal belief exemption (PBE) for school vaccination requirements. We faced relentlessly vocal opposition from anti-vaccine activists, who were supported by the California Chiropractic Association and the newly founded Public Health Council. As it moved through the Legislature, SB 277 had four hearings in various committees, each of which was flooded by protesters. Our strategy to overcome this deluge was to counteract on the same grassroots level from which we were attacked. CMA engaged with school districts, county boards of supervisors and all levels of local government to strengthen support for the bill. Through these and our more traditional lobbying efforts, we were able to see the bill passed out of the Legislature and sent to the Governor’s desk. Although the Governor had 12 days to pass or veto the measure, he chose to sign SB 277 into law less than
38 | THE BULLETIN | NOVEMBER / DECEMBER 2015
24 hours after he received it. In his signing naturopathic doctors; and SB 622 (Hernandez), for optometrists. Each of the bills claimed to message, he wrote, “The science is clear that expand the scope of practice for allied health vaccines dramatically protect children against professionals as a means of ameliorating a number of infectious and dangerous diseases. California’s access to care crisis, but, in reality, While it’s true that no medical intervention posed a danger to patients. Through diligent is without risk, the evidence shows that lobbying and with the engagement of our immunization powerfully benefits and protects physician members calling and writing their the community.” legislators, CMA convinced lawmakers of SB 277 also garnered tremendous support in that truth. Each bill was successfully killed in the press and from the physician community at either a policy or fiscal committee, sending an large. All through the year, this bill made state unequivocal rejection of scope expansions as an and even national headlines. The New York answer to access to care issues. Year after year, Times, often regarded as the national “newspaper these expansions are rejected by the Legislature, of record,” even editorialized in support of demonstrating that the physician voice still the bill. After SB 277 became law, Senator “Our strategy to overcome this deluge was to counteract on Richard Pan, M.D., the same grassroots level from which we were attacked.” was lauded by TIME magazine as a “hero of vaccine history,” while holds sway at the Capitol. the Journal of the American Medical Association Scope of practice fights generally play out pointed to SB 277 as a potential catalyst and similarly, except, this year, for one unique model for stricter vaccine requirements across experience. An amicable solution was reached the nation. The New England Journal of Medicine on AB 1306 (Burke), relating to certified nurse chronicled the entire SB 277 story, describing a midwives (CNMs). Negotiations with the sea change in the national politics of vaccination. CNMs were productive and in time we were We continue to regularly field calls from allies able to reach an agreement, moving CMA to a across the country who are seeking to learn more neutral position. Ultimately, however, this bill, about what we accomplished and how we did it. too, died in committee. Unfortunately, our time to celebrate the hardwon victory was not long, as we quickly had to PHYSICIAN AID-IN-DYING turn our attention to new attacks: a referendum Another fruitful negotiation centered on SB 128 to overturn the new law and a recall effort (Wolk and Monning), the physician aid-in-dying against Dr. Pan for his authorship of it. Through bill. This controversial measure demanded a lot CMA’s political action committee, CALPAC, we of attention from CMA. We began the year with will continue to work to defend Dr. Pan and his a longstanding House of Delegates-established important law from this spurious attack. policy of opposition to this subject. It soon
SCOPE OF PR ACTICE
Throughout the year, CMA dedicated a vast amount of resources to the successful defeat of several scope-of-practice expansion attempts that were before the Legislature. These measures were: SB 323 (Hernandez), for nurse practitioners; SB 538 (Block), for
became clear, though, that this was no longer the overwhelming stance of the membership that it once was. CMA’s physician leaders began a conversation with our physician members so that we could update our official policy to reflect the new, nuanced views of our members. CMA became the first medical association in the nation to move from opposition to neutrality
NOVEMBER / DECEMBER 2015 | THE BULLETIN | 39
on physician aid-in-dying. Having received CUR ES permission from our Council on Legislation and In the final days of the session, while almost all from our Board of Trustees to engage with the eyes were watching the major political fights, bill’s proponents in hopes of reaching solutions, CMA staff went to work with Assemblymember CMA’s lobbyists, in conjunction with CMA’s Travis Allen to extend the Controlled Substance Center for Legal Affairs, entered exhaustive Utilization Review and Evaluation System negotiations. Although CMA had become (CURES) registration deadline for all prescribers neutral on the concept of physician aid-in-dying, and furnishers. On Thursday, September 10, there were still concerns to be addressed about CMA and Assemblymember Allen gutted and the bill’s language. Through countless meetings, amended AB 679 to extend the deadline from a final comprehensive solution was reached and CMA officially ”AB 533 would have drastically changed the current health became neutral on the bill. care marketplace by allowing a massive transfer of negotiating The crucial amendments power to the health plans at the expense of physicians.” that were secured to reach that agreement included the strongest statutory immunity protections for physicians, January 1, 2016, to July 1, 2016. This extension voluntary participation protections and mental will allow the Department of Justice to roll out health evaluations. After SB 128 failed in the its automated registration process and protect Assembly Health Committee, its cause was doctors from being disciplined by the Medical revived through a bill, ABX2 15 (Eggman), Board of California during the system roll-out. in the special session on health care called by In two days, the bill was heard in Senate the Governor. This bill ultimately retained our Business and Professions Committee, on the negotiated amendments and our neutrality, and Senate Floor and on the Assembly Floor. AB was passed by the Legislature on its last day in 679, as amended on September 10, passed the session. On October 5, the Governor signed the Legislature without receiving a single “no” vote. bill into law. The measure also included an urgency clause, meaning the bill goes into effect as soon as it is WOR K ERS COMP signed by the Governor. The physician aid-in-dying bill was far from our only instance of exhaustive negotiations “SUR PR ISE” BILLING this year. CMA also took part in extensive Our other focus in the final days was the discussions regarding AB 1124 (Perea), a bill completion of a year-long fight. AB 533, that would require the Division of Workers’ introduced by the Chair of the Assembly Compensation to establish a prescription Health Committee, Rob Bonta, initially seemed formulary. After several months of diligent like a matter of negotiation. We had a good negotiations, we reached an agreement with relationship with the author, and we shared his the author’s office that moved our position to goal of addressing the “surprise billing” problem. neutral. Through negotiations on this bill, CMA Instead, over the course of the year, those solidified its standing as a full stakeholder in negotiations became increasingly hostile until workers’ compensation. they finally deteriorated to an all-out war. Going into the last week of the legislative session, AB 533 would have drastically changed
40 | THE BULLETIN | NOVEMBER / DECEMBER 2015
the current health care marketplace by allowing a massive transfer of negotiating power to the health plans at the expense of physicians. The bill would have required noncontracted physicians and dentists to accept Medicare rates as payment in full when performing services in a contracted or “in-network” facility. In addition, the bill would have implemented barriers for PPO patients seeking to access their out-ofnetwork benefits. Overnight, the bill became essentially a health plan-sponsored bill, with the strong support of consumer groups and organized labor. With myriad resources, the health plans spent tens of thousands of dollars hiring contract lobbying firms to
lobby in favor of AB 533. The California Federation of Labor, the California Firefighters and most of organized labor, who were misinformed about the full contents of the bill, also lent their political muscle to the passage of bill, for they believed it would protect patients from exorbitant, unexpected bills. Finally, the California Chamber of Commerce and consumer groups, led by Health Access, also spent their political resources in favor of the bill. In order to defeat AB 533, it was all hands on deck at CMA and we called upon our Legislative Key Contacts, CMA officers and medical executives, asking them to call their legislators on the last night of session to ask them to vote no on AB 533.
CMA was also able to call upon the specialty societies and two of our closest allies to stand in opposition: the California Dental Association and the California Podiatric Medical Association. After countless hours of lobbying and passionate debate in the halls and on the floors of the State Capitol, CMA and our allies defeated the measure on the floor of the State Assembly. This CMA victory was the final act taken by the Legislature in 2015, solidifying this year as one of the most challenging and one of the most successful. FOR MORE DETAILS ON THE MAJOR BILLS THAT CMA FOLLOWED THIS YEAR, VISIT HTTP:// CAL.M.D./LEG-WRAP-2015.
Don’t let your profession fall into the wrong hands. Contribute to CALPAC today.
First, let’s start with the bad Just this year, more than 25 bills were produced in the state legislature that had the potential to be extremely harmful to California’s physicians and health care system. CMA opposed those measures, but new bills like them pop up every year. Here’s the takeaway: government and special interest groups are constantly trying to take control of your industry. Your clinical autonomy is in jeopardy as a result, but you can do something about it.
Now here’s the good part CMA has a track record of success when it comes to legislative advocacy. Last year, we successfully led the charge against an attack by trial lawyers that would have significantly increased costs for thousands of doctors. We also helped one of our members get elected in the State Senate, who is right now fighting to improve public health as a practicing physician in California. Big changes are happening in your profession.
will you help us win the next battle?
It’s your profession. Take control. Using your contributions, CALPAC backs those running for state and federal office who share our philosophy and vision of the future of health care and medical practice. We use a proven integrated approach, consisting of lobbying, grassroots activity and political action to support hundreds of candidates without bias or favoritism. We are a voluntary political organization, but most importantly we are operated by physicians for physicians.
Contribute online today www.CALPAC.org or mail a check to 1201 J Street Suite 200, Sacramento, CA 95814 Political law and CALPAC policy determines how your contribution to CALPAC is allocated. CMA will not favor or disadvantage anyone based on the amounts of or failure to make PAC contributions, nor will it affect your membership status with CMA. Contributions to PACs are voluntary and not limited to suggested amounts. Contributions are not deductible for state and federal income tax purposes.
NOVEMBER / DECEMBER 2015 | THE BULLETIN | 41
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CMA Alert, October 19, 2015 issue
Governor signs bill to extend CURES registration deadline for prescribers and dispensers In the final days of the legislative session, the California Medical Association (CMA) worked to pass Assembly Bill 679 to extend by six months the registration deadline for the Controlled Substance Utilization Review and Evaluation System (CURES). All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate (DEA Certificate) now have until July 1, 2016, to register to use CURES. In 2013, Senate Bill 809 required the California Department of Justice (DOJ) to identify and implement a streamlined application and approval process for CURES registration. Currently, the registration process re-
mains highly manual, requiring notarization of documents and reportedly six to eight weeks to process applications. A streamlined process was seen as essential to meeting the January 1, 2016, registration deadline. DOJ has not issued a definite date for when streamlined registration will be available, and so CMA pursued an extension. The bill was signed into law on October 11. CMA will continue to monitor the situation, communicate with DOJ and update members on progress. CMA recommends that any physicians who need access to CURES not wait for streamlined registration and begin the process for registration as soon as possible.
CMA Alert, October 19, 2015 issue
Ninety medical associations ask CMS to release MACRA funds for small practices The California Medical Association (CMA) and almost 90 other medical associations have sent a letter to the Centers for Medicare and Medicaid Services (CMS), asking them to expedite the release of $125 million for physician education and technical assistance as prescribed by the Medicare payment reform legislation, the “Medicare Access and CHIP Reauthorization Act of 2015” (MACRA). On April 16, 2015, President Obama signed MACRA into law negating the Medicare sustainable growth rate (SGR) formula and replacing it with new payment systems. After more than a decade of fighting for change by CMA and others in organized medicine, the bill was passed in a monumental bipartisan action taken by Congress. MACRA specifically authorizes a total
$125 million for the education of small medical practices for the fiscal years 2015-2019, to fund the development of physician quality measures for the quality reporting programs, to help physicians report on quality and transition to new payment models. We are approaching the end of 2015 and no funds have been released for educational programs. The letter also asks that these funds go to physician organizations with the knowledge and familiarity with small practices and specialties. The success of MACRA is contingent upon all physician specialties having a sufficient set of actionable and relevant measures that improve patient care and allow physicians to comply with the program. Physician-led organizations are best suited to develop new measures that are useful to their members, harmonize with
44 | THE BULLETIN | NOVEMBER / DECEMBER 2015
specialty societies’ clinical data registry activities, complement specialty developed alternative payment models, and fulfill their long-term goals of improving the profession and patient care. The letter also urges CMS to avoid technical assistance approaches that utilize large, impersonal education and communication initiatives, such as the CMS national provider calls and webinars. Large-scale, generic conference calls held at mid-day when physicians are busy treating patients have had very limited success in educating physicians on complex issues. Technical assistance must be hands-on and tailored to the needs of the individual practice, area or specialty.
Hardship Exemption for Medicare Meaningful Use Program 2015 Because of a delay in the publication of regulations governing the Medicare meaningful use program, physicians are being urged to preemptively file for a 2015 hardship exemption to avoid penalties in 2016. Physicians should apply for an exemption under the “extreme and uncontrollable circumstances” category, even if they are uncertain whether they will meet the program requirements this year. Doing so will not preclude physicians from receiving an incentive if they do meet meaningful use requirements, but applying can serve as a safety net in staving off a penalty. In order to avoid a penalty under the meaningful use program, eligible professionals must attest that they met the requirements for meaningful use stage 2 for a period of 90 consecutive days during calendar year 2015. Unfortunately, however, the Centers for Medicare and Medicaid Services (CMS) did not publish the updated regulations for stage 2 meaningful use until
October 16, 2015. As a result, eligible professionals were not informed of the revised program requirements until fewer than the 90 required days remained in the calendar year. CMS has stated that it will grant hardship exemptions for 2015 if eligible providers are unable to attest due to the late publishing of the rule. However, under current law, CMS can only grant such exemptions on a case-bycase basis. This means that many eligible professions will be required to apply for exemptions and that CMS will have to act on each application individually. CMS has approved over 85 percent of hardship exemptions in the past. Hardship applications will be available in early 2016 at http://www.cms.gov/EHRIncentivePrograms. The California Medical Association (CMA) and the American Medical Association are also supporting new legislation in Congress to streamline the hardship exemption process. The
legislation, H.R. 3940 – the Meaningful Use Hardship Relief Act of 2015 – would grant CMS the authority to grant blanket hardship exceptions to physicians, hospitals and other affected providers for 2015, alleviating burdensome administrative issues for both providers and the agency. CMA will continue to monitor this situation. For more information on the electronic health record (EHR) incentive program, see the CMS tipsheet, "EHR Incentive Programs for Eligible Professionals: What You Need to Know for 2015."
National Health & Nutrition Examination Survey, 2015-16 The National Center for Health Statistics, part of the Centers for Disease Control and Prevention, is conducting a major study of the health of persons living in the United States. Santa Clara County, California has been selected as one of the survey locations during the current National Health and Nutrition Examination Survey (NHANES). The survey will be used to gather information to assess the health and nutrition status of children and adults and their needs for health care. For more information about this survey you may visit the NHANES website at: http://www.cdc.gov/nhanes. Over 55 years similar surveys have been successfully conducted on various segments of the U.S. population. They have provided the National
Center for Health Statistics with important data on health conditions and concerns in this country. Data are collected through household interviews and standardized medical examinations in their mobile examination center. Their personnel will be conducting the survey in Santa Clara County from November 30, 2015 through February 22, 2016. A sample of about 567 people from Santa Clara County will be asked to participate in the survey. Interviewers will be calling on designated households throughout the area. They will obtain the demographic information used to identify and select people for the examination. NOVEMBER / DECEMBER 2015 | THE BULLETIN | 45
CMA Alert, November 16, 2015 issue
Ask the Expert: If an exchange patient fails to pay the premium, is the plan required to pay for services? Maybe. Under the Affordable Care Act, exchange enrollees who receive federal premium subsidies to help pay their premiums are entitled to keep their insurance for three months after they have stopped paying their premiums. Insurance ID cards for exchange enrollees do not indicate whether the enrollee is subsidized, but Covered California recently reported that 90% of California exchange patients are receiving subsidies, so the likelihood of encountering a patient receiving subsidies is very high. In the first month of the grace period, federal law and California regulations require plans to pay for services incurred even if the patient fails to pay the premiums due by day 90 (CCR §1300.65.2(b)(1)(A)). But in months two and three of the grace period, plans can “suspend” coverage and pend or deny claims if the patient doesn’t true up on his or her premiums by day 90. However, in 2014, the California Medical Association (CMA) was successful in advocating that plans be required to clearly communicate through their real time eligibility and verification systems if an enrollee’s coverage is suspended during the second and third months of the grace period. Further, the regulation requires plans to reflect “suspended” coverage on day one of the second month of the grace period, and requires plans to use one of three eligibility status indicators to reflect suspended coverage – “coverage pending,” “coverage suspended”
or “inactive pending investigation” (CCR §1300.65.2(b)(C)). If a plan fails to reflect suspended coverage using one of the above indicators on day one of the second month of the grace period, and a physician provides services to a subsidized enrollee, the plan is financially responsible for the claims incurred (CCR §1300.65.2(d) (5)). However, you need to be able to prove that the plan did not comply with the regulation. For this reason, it is extremely important that practices verify eligibility on all exchange patients, ideally on the date of service, or as near the time of service as possible, and that the practices retain a printout of the eligibility verification and includes it as part of the patient’s chart. If a patient’s eligibility verification comes back indicating his or her coverage is suspended, the practice can treat the situation as it would any other patient who has had a lapse in coverage. For non-emergency services, patients may be given the option to either pay cash at the time of service or reschedule to a later date. If a plan requests a refund for services provided during the first month of the grace period, practices should dispute the request in writing, citing California Code of Regulations section 1300.65.2 (b)(1)(A), which requires plans to pay for services incurred in the first month of the grace period. Practices should also contact CMA so that we can identify any systemic issues with the payor.
If a plan requests a refund on a patient who was in the second or third month of the grace period, but the eligibility verification did not reflect suspended coverage, the plan is not entitled to the refund. The practice should submit a written dispute to the plan citing California Code of Regulations section 1300.65.2(d)(5). Again, please contact CMA if this happens, so we can identify any systemic issues. For more information, visit CMA’s exchange resource center at www.cmanet.org/ exchange. In the resource center, you can download CMA’s Surviving Covered California tip sheets as well as a number of other CMA exchange resources. CMA members and their staff also have FREE access to our reimbursement helpline at 888/401-5911 or economicservices@ cmanet.org.
CMA Alert, November 2, 2015 issue
CMA publishes FAQ on new school vaccination law On June 30, 2015, California Governor Jerry Brown signed into law Senate Bill 277, sponsored by the California Medical Association, which eliminates the personal belief exemption from school vaccination requirements, barring parents from skipping their children’s school-re-
quired immunizations unless they have a medical exemption from a physician. CMA, along with the American Academy of Pediatrics, California, and the California Academy of Family Physicians, has developed an FAQ that provides information on what phy-
46 | THE BULLETIN | NOVEMBER / DECEMBER 2015
sicians need to know about SB 277 and vaccination laws. The FAQ is available free in CMA’s online resource library at http://www.cmanet.org/ resource-library.
CMA Alert, November 2, 2015 issue
CMS issues final 2016 Medicare payment rule; includes reimbursement for end-of-life discussions The Centers for Medicare and Medicaid Services (CMS) released the final 2016 Medicare physician fee schedule. One of the biggest changes in the CMS proposal is the assignment of codes to pay physicians for end-oflife consultations. Key policies finalized in the 2016 payment rule include: Advanced care planning: The final fee schedule includes two CPT codes to reimburse for advance care planning. Compensating health care professionals for time spent with patients discussing treatment wishes and goals of care is a critical step forward in honoring patient treatment preferences, particularly for those nearing the end of life.
Physician payments: The final rule includes a 0.5% overall increase in Medicare reimbursement in 2016 for all providers. Merit-Based Incentive Payment System: In the final rule, CMS has made changes necessary to begin implementation of the new Merit-Based Incentive Payment System for physicians and other practitioners, which will fully take effect in 2019. For more information, see the CMS fact sheets at https://www.cms. gov.
CMA Alert, October 19, 2015 issue
New CMS rule changes meaningful use requirements The Centers for Medicare and Medicaid Services (CMS) published new rules for the current and final stages of the electronic health record (EHR) incentive program. In publishing the rule, CMS acknowledged the difficulties physicians have experienced with meeting meaningful use requirements. The regulations announced are intended to ease the reporting burden for providers, support interoperability, and improve patient outcomes. While the modified rules for years 20152017 are final, the stage 3 portion of the final rules were released with the opportunity for public comment, with the expectation that CMS will revise stage 3 in the coming months. Major provisions of the final rule include: • In 2015-2017, eligible professionals will be responsible for 10 objectives including one public health reporting objective, down from 18 total objectives in prior stages in 2015-2017. • Medicare providers switching EHR vendors or who have other technology difficulties are encouraged to apply for a hardship exception. • The reporting period is reduced from a full calendar year to 90 days for all providers in 2015, for new participants in 2016 and 2017, and for any provider who begins stage 3 in 2017. • While eligible professionals are voluntarily able to begin stage 3 in 2017, CMS emphasizes that all providers will be required to comply with
stage 3 requirements beginning in 2018 using 2015 certified EHR technology. The 60-day public comment period will allow CMS to gather additional feedback about the way these rules will interact with the Medicare payment reform legislation passed earlier this year (the Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA). MACRA, which replaces the sustainable growth rate formula, establishes a merit-based incentive payment system. Achieving meaningful use will be a component of physicians’ compensation under the MACRA payment scheme. The final rule synchronizes reporting under the EHR incentive programs to end the separate stages of meaningful use in order to transition physicians to the new payment scheme under MACRA. While CMS made significant changes to the meaningful use program, the California Medical Association (CMA) continues to advocate for greater reform to make the program less burdensome. For more information on the federal EHR incentive program and meaningful use, see
CMA On-Call documents #4301, “Electronic Health Records: Federal Incentive Program”; #4302, “Meaningful Use of Electronic Health Records”; and #4305 “EHR Meaningful Use: Stage 2.” These and other On-Call documents are available free to members in CMA’s online health law library at www.cmanet.org/cma-oncall. Also available to download is Meaningful Use Modifications: Stage 1, 2 and 3 CMS October 2015 Final Rule.
NOVEMBER / DECEMBER 2015 | THE BULLETIN | 47
Classifieds OFFICE SPACE FOR RENT/LEASE OFFICE SPACE TO SHARE • LOS OFFICE FOR LEASE/SUBLEASE O’Connor Hospital area with office lease/ sublease. Please contact Dr. Maggie Chau at 408/799-7842 for details.
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 408/2280454.
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.
MEDICAL OFFICE SPACE TO SHARE • SUNNYVALE Convenient location. One large private office plus one exam room, shared waiting room and front office. Newly built, total 1,280 sq. ft. Available now. Please call 408/438-1593.
MEDICAL/DENTAL/PROFESSIONAL OFFICE SUITE • SALINAS Second story of professional building across from Salinas Valley Memorial Hospital. Private balcony. Freshly painted and carpeted, ready for occupancy. 1,235 sq. ft. at $0.729/ sq. ft. Rent is $900/month. Contact Steven Gordon at 831/757-5246.
MEDICAL OFFICE SPACE TO SHARE • CAMPBELL Convenient location. 5+ exam rooms M-F. In-office digital x-ray. Two large private offices, shared waiting room and front office. Total office size 3,000 sq. ft. Available now. Call 408/376-3305 or marlene@svspine. com.
GATOS
Located adjacent to El Camino Hospital Los Gatos. Beautiful large office. In-house x-ray, 3 exam rooms available on a daily basis and 7 available 2 days/week. Procedure room. Large open reception area with lovely waiting room. One physician consultation office available. Patient and staff restrooms. Lovely break area with refrigerator, dishwasher, microwave, and adjacent patio. Hi-speed internet, outside and inside storage areas. Ample parking. Cost of sublease proportionate to usage. Call 408/378-7240.
OWN YOUR OWN MEDICAL BUILDING • 1,368 SF Plus income from additional multi-tenants. Professional office building (+/- 3,008 SF). Great freeway access to Hwy 17/880, 85 & 280. Pride of ownership building / well maintained. Call Derik for additional information at 408/436-3670.
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
METRO MEDICAL BILLING, INC. • • • • • •
Full Service Billing 25 years in business Book Keeping ClinixMIS web based software Training and Consulting Client References
Contact Lynn (408) 448-9210 lynn@metromedicalbilling.com Visit our Website: metromedicalbilling.com
48 | THE BULLETIN | NOVEMBER / DECEMBER 2015
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.
INTERNAL MEDICINE PHYSICIAN NEEDED We are looking for an internal medicine physician for our multi-specialty group. Please email your CV to kaajhealthcare@gmail. com.
PRIMARY CARE PHYSICIAN FOR NONPROFIT CLINIC Catholic Charities of Santa Clara County is looking for a Primary Care Physician as a Supervising Physician for a Physician Assistant, Nurse Practitioner, and medical interns on Thursdays. Clients include homeless, mental health, and seniors. Contact jobs@catholiccharitiesscc.org.
STAFF PHYSICIAN • SAN JOSE STATE UNIVERSITY Staff Physician San Jose State University Job ID: 23501 Full/Part Time: Full-Time Regular/Temporary: Regular Job Code: 7737, Range 1 Department: Student Health Center About the Position: *Applicants interested in part-time work (e.g. 0.8 FTE) are encouraged to apply.* The incumbent is expected to support the Director’s and the Medical Chief of Staff’s efforts for effective operation of the Student Health Center. Reporting to the Medical
Chief of Staff, a Physician provides a variety of medical outpatient services in accordance with the overall operation of the SHC. Working independently, the Physician performs medical, diagnostic, treatment, and counseling services. These activities require a licensed physician and are within the scope of the program established by the CSU Board of Trustees. Further, the incumbent has responsibility for providing highly specialized and/or broad clinical duties that include planning, coordinating, and evaluating ongoing medical care of students. Working collaboratively to support student success is the bottom line purpose of this and all SHC positions. Link to apply: http://apptrkr.com/703075
office also performs sleep studies. EMR in place. High profit margin, and seller will stay to train buyer in proprietary systems. Independent appraisal available. Offered at only $682,000. Excellent seller financing terms available with reasonable down payment. Real estate also available. Contact info@ MedicalPracticesUSA.com or 800/5766935. www.MedicalPracticesUSA.com.
SCCMA & MCMS PHYSICIANS RECEIVE
35% OFF ADVERTISING RATES The Membership Directory is the official directory of the Santa Clara County Medical Association and Monterey County Medical Society. It is published annually and distributed to over 4,000 physicians.
NURSE PRACTITIONER • SAN JOSE STATE UNIVERSITY Nurse Practitioner San Jose State University Job ID: 23505 Full/Part Time: Full-Time Regular/Temporary: Regular Job Code: 8166, Range 1 Department: Student Health Center *Applicants interested in part-time work (e.g. 0.8 FTE) are encouraged to apply.* The incumbent is expected to support the Director’s and the Medical Chief of Staff’s efforts for effective operation of the Student Health Center. Reporting to the Medical Chief of Staff, the Nurse Practitioner provides clinical and educational services in support of SHC operation. Working independently and under general supervision, the Nurse Practitioner administers medical care to patients utilizing written protocols as guidelines. The incumbent has the added responsibility of providing highly specialized and/or broad clinical duties that include planning, coordinating, and evaluating ongoing medical care of students. Working collaboratively to support student success is the bottom line purpose of this and all SHC positions. Link to apply: http://apptrkr.com/702904
The deadline to participate is NOW! Space is limited. Contact Pam Jensen today: 408-998-8850 or pjensen@sccma.org
Tracy Zweig Associates INC.
A
REGISTRY
&
PLACEMENT
FIRM
Physicians
Nurse Practitioners ~ Physician Assistants
FOR SALE FAMILY PRACTICE FOR SALE Family Practice for Sale. East San Francisco Bay, CA. Multi-location, multi-discipline practice for the Asian community’s established residents and newcomers. Revenue $1.4 million. Seller works only half-time. The languages spoken by physicians and staff include Cantonese, Mandarin, Punjabi, and Spanish; buyer doctor must be fluent in at least one Chinese dialect. The
Locum Tenens ~ Permanent Placement V oi ce: 800-919-9141 or 805-641-914 1 FA X : 805-641-9143
tzw ei g@ tracyzw ei g. com w w w. tracyzw ei g. com NOVEMBER / DECEMBER 2015 | THE BULLETIN | 49
In Memoriam Aubrey L. Abramson, MD
A. Maynard Guderian, MD
Paul N. Swartz, MD
*Obstetrics and Gynecology 12/25/29 – 8/31/15 SCCMA member since 1960
*Orthopaedic Surgery 1/1/24 – 8/13/15 SCCMA member since 1964
Internal Medicine Hematology 4/15/22 – 2014 SCCMA member since 1949
Takashi Hattori, MD
Harry G. Whelan, MD
Radiology 11/22/21 – 1/11/15 MCMS member since 1964
*General Surgery 6/3/22 – 5/31/15 SCCMA member since 1957
John A. Del Fiugo, MD
Leslie Malkin, MD
Internal Medicine 12/28/25 – 7/14/15 SCCMA member since 1959
William Creger, MD
Pediatrics 10/2/27 – 4/12/15 SCCMA member since 1964
*Obstetrics and Gynecology 7/8/32 – 3/5/15 SCCMA member since 1977
Kenneth V. Dole, MD
John C. Richards, MD
*Family Medicine 1/2/28 – 3/24/14 SCCMA member since 1960
*Pediatrics 5/25/22 – 1/6/15 SCCMA member since 1954
50 | THE BULLETIN | NOVEMBER / DECEMBER 2015
PRACTICE MANAGEMENT
Practice Management Tools and Resources One of CMA’s many goals is to empower physicians by providing resources and guidance to improve the success of your practices. Whether it’s identifying and fighting unfair payment practices, improving the efficiency of your practice, or negotiating payor contracts, we have tools and resources to help. (http://wwwcmanet.org/resources/reimbursementassistance/practice-management-tools-and-resources/)
TOOLKITS • • • • • • • • • • • • • • • • • •
2015 PQRS and Value-Based Modifier Getting Started Guide ICD-10 Transition Guide – What physicians need to know Updating Provider Demographic Information with Payors Surviving Covered California: Preparing for changes in 2015 Medicare Incentive and Penalty Programs: What physicians need to know Cal MediConnect Physician FAQ: What you need to know about keeping your patients and billing for the dual eligible population A Physician’s Guide to Implementation of SB 866: The new standardized prescription drug prior authorization form Medi-Cal Survival Guide: Important Changes and What they Mean to Your Practice Medicare Transition Guide: What physicians need to know Medi-Cal Primary Care Physician Rate Increase FAQs CMA’s Got You Covered: A physician’s guide to Covered California, the state’s health benefit exchange TRICARE Transition Guide: What physicians need to know Aetna Termination Resource Guide Taking Charge: A step by step guide to evaluate and prepare for negotiations with managed care payors Best Practices: A Guide for Improving the Efficiency and Quality of Your Practice CMA Balance Billing Advocacy Tool Kit Medicare Enrollment Guide for Individual Physicians Publications CMA Practice Resources (CPR)
KNOW YOUR RIGHTS
PAYOR CONTRACTING / CONTRACT ANALYSIS BILLING/CODING • New CMS 1500 Implementation Reference Guide • CMA Medicare Consultation Code Billing Guide • CMA Managed Care Consultation Code Quick Reference Guide, Updated October 2011
SAMPLE LETTERS, CHECKLISTS, AND WORKSHEETS • Financial Impact Worksheet • Payor Solvency Checklist • Sample Tracking Sheet: Health Plan Acknowledgement of Receipt of Claim • Sample Termination Letter – Patient • Sample Termination Letter – Material Modification to Contract • Sample Letter – Request for Complete Fee Schedule and Detailed Payment Rules • Sample Letter – Request for Copy of Signed & Executed Contract, Complete Fee Schedule & Detailed Payment Rules • A/R Phone Call Follow up Log Template
OTHER RESOURCES • • • •
Special Investigations Unit Audit Guide CMA Timely Access Guide Medicare Electronic Prescribing (eRx) Overview Medicare Part B 2012 Important Changes: What they Mean to Your Practice • Patient Handout: FAQ About Accountable Care Organizations (ACOs) • Heritage California Accountable Care Organization (ACO) Physician Frequently Asked Questions • Medicare Audit Guide for Physicians
• • • • •
Know Your Rights: Timely Filing Limitations Know Your Rights: Timely Payment Know Your Rights: Timeframes to Appeal Know Your Rights: Quick Guide for Appeals Know Your Rights: Identify and Report Unfair Payment Practices • Know Your Rights: Filing a formal complaint with the regulator
NOVEMBER / DECEMBER 2015 | THE BULLETIN | 51
CMA EDUCATION what people are saying
Webinars offer an expanded knowledge base of important and difficult topics.
Webinar topics include: · Accounts Receivable · Appeals
· Electronic Health Records (EHR) Implementation and Incentives
· Meaningful Use · Medical School Debt Management
· Audits
· Embezzlement
· Medicare Rules
· California’s Health Benefit Exchange
· Employment Practices
· Multicultural Communications
· Coding for Medical Necessity
· Estate Planning
· PECOS and Medicare Provider Enrollment
· Health Care Reform
· Personnel Management
· Collections and Billing
· HIPAA Compliance
· POLST
· Contracting with Payors
· ICD-10
· Strategic Planning
· Customer Service
· Legislative Advocacy Training
· Telephone Etiquette
· Documentation
· Marketing
· Workers’ Compensation
and Quality Care
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NOVEMBER / DECEMBER 2015 | THE BULLETIN | 53
Dear Members: Members: Are you you and andyour yourpractice practice
at risk?
The law requires that all physicians be compliant for: MBC, DOH, OCR, HIPAA/HITECH Act, and CAL-OSHA Regulations The law requires that all employers be compliant for: CAL-OSHA Regulations, EPA, and HIPAA/OCR
These are Not Optional, they are Mandatory and carry Severe Fines for Failure to Comply! How much does it cost to be compliant? Medical compliance (OSHA, BLOOD Borne pathogens, etc.) costs on the average of $200-$400/month. Plus over time, lost practice time of 5-10 hours per year, management, recordkeeping, etc. Employer compliance (sexual harassment, employee rights, mandatory postings, etc) costs on the average of $200-$2,000.00. Plus over time or lost practice time of x5-10 hours per year, management, recordkeeping, etc.
Get Compliant Nowâ&#x20AC;ŚSCCMA/CMA can HELP!
SCCMA/CMA has negotiated a statewide price to get you and keep you in total compliance, both as a physician and as an employer. This is a turnkey program that requires no work or effort on your part.
The member benefit price is only $29 per monthâ&#x20AC;Śa saving of over $200 per month. Please contact us today to begin this member-only benefit and/or get a demonstration.
408-998-8850
54 | THE BULLETIN | NOVEMBER / DECEMBER 2015
Success. It’s what California’s finest physicians strive for... and what CAP can help you achieve. Since 1977, the Cooperative of American Physicians (CAP) has provided superior medical professional liability coverage and valuable risk and practice management programs to California’s finest physicians through its Mutual Protection Trust (MPT). As a physician-directed organization, we understand the realities of running a medical practice, and are committed to supporting you with a range of value-added programs and services. These include a 24-hour adverse outcomes hotline, HR support, EHR consultation, a group purchasing program, and payment and reimbursement education and support, to name a few.
Protect Your Online Reputation With CAP’s Free Physician’s Action Guide! The Physician’s Online Reputation Action Guide can help you build a strong and positive reputation. Learn how to: • Encourage patients to post positive reviews. • Appropriately respond to negative reviews. • Optimize social media to establish your credibility.
Request your free electronic or hard copy today!
800-356-5672 | CAPphysicians.com/ReputationPro
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