ACCMA Bulletin Jan-Feb 2022 by ACCMA

BULLETIN ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION

Serving East Bay physicians since 1860

January/February 2022

Fact Sheet Here’s why CMA and a broad coalition of physicians, dentists, nurses, hospitals, safety net clinics and other health care providers are committed to vigorously fighting this initiative. + Effectively eliminates MICRA’s cap on non-economic damages Proponents of this measure say it will simply index for inflation the state’s current cap on non-economic damages. However, the lawyer who drafted and funded this measure has included deceptive and cynical language that creates a broadly-defined category of lawsuits not subject to the cap on non-economic damages, effectively eliminating any limits on non-economic damages for any medical malpractice case and undermining a system that has held medical costs in check for more than 40 years.

+ Costly for consumers and taxpayers According to the California independent Legislative Analyst’s Office, this measure would lead to “annual government costs likely ranging from the low tens of millions of dollars to the high hundreds of millions of dollars,” placing the burden of this additional cost on all of us, while reducing access for those who need it most, including those who use Medi-Cal, county programs, safety net providers and school-based health centers. This measure will vastly increase the number of lawsuits filed in California, and further divert resources for patient care to the legal system.

+ A misleading measure intended to fool the voters This measure was written by an out-of-state trial attorney who is looking to cash in with California cases. Our health laws should protect access to care and control costs for everyone, not increase lawsuits and payouts for lawyers. This is not an adjustment of the MICRA cap; it is a virtual elimination. It would also eliminate the state’s current cap on attorney’s fees in medical malpractice cases, allowing lawyers to take a much higher portion of a patient’s jury award in malpractice cases.

+ Jeopardizes patient access to quality health care This measure would have a particularly adverse impact on community health clinics, which are a vital part of California’s health care safety net. This measure will raise insurance costs, causing physicians in high-risk specialties like OB/GYN to reduce or eliminate patient services. There are, regrettably, individual tragic cases of medical negligence. However, under current law, patients receive unlimited awards for past and future health care costs, as well as lost wages and lost earning capacity and, where warranted, punitive damages. This ballot measure is simply a cynical effort by a wealthy, out-of-state trial lawyer looking to increase lawyers’ share of medical malpractice awards and line his own pockets while driving up health care costs for all Californians.

Protect Access to Quality Health Care | 2

ACCMA EXECUTIVE COMMITTEE Robert Edelman, MD, President Edmon Soliman, MD, President Elect Albert Brooks, MD, SecretaryTreasurer Suparna Dutta, MD, Immediate Past President COUNCILORS & CMA DELEGATES Eric Chen, MD Rollington Ferguson, MD Harshkumar Gohil, MD James Hanson, MD Terry Hill, MD Shakir Hyder, MD Alexander Kao, MD Irina Kolomey, MD Arden Kwan, MD Terence Lin, MD Lilia Lizano, MD Irene Lo, MD Kristin Lum, MD Ross Pirkle, MD Jeffrey Poage, MD Stephen Post, MD Thomas Powers, MD Richard Rabens, MD Steven Rosenthal, MD Suresh Sachdeva, MD Jonathan Savell, MD Judith Stanton, MD Sonia Sutherland, MD Clifford Wong, MD CMA & AMA REPRESENTATIVES Patricia L. Austin, MD, AMA Delegate Mark Kogan, MD, CMA Trustee, AMA Alternate-Delegate Suparna Dutta, MD, CMA Trustee Katrina Peters, MD, CMA Trustee MEMBERSHIP & COMMUNICATIONS COMMITTEE Mark Kogan, MD, Chair Patricia Austin, MD Robert Edelman, MD James Hanson, MD Jeffrey Klingman, MD Stephen Larmore, MD Terence Lin, MD Irene Lo, MD Michael McGlynn, MD Lamont Paxton, MD Katrina Peters, MD Bindoo Rellan, MD Frank Staggers, Jr., MD Ronald Wyatt, MD

Serving East Bay physicians since 1860

News & Comments

PRESIDENT’S PAGE Preserving MICRA for Our Patients and Our Profession By Robert Edelman, MD

YOUR ADVOCACY 9 Where Would We Be Without MICRA?

January/February 2022 | Vol. LXXVIII, No. 1

IN YOUR PRACTICE 15

New Health Care Laws By the California Medical Association

Medicare Final Rule Points Important to Your Practice By Mary Jean Sage, CMAAC, Sage Associates

LEADERSHIP 20 2022 ACCMA Council

After 47 Years, MICRA Is Still Good Public Policy

Advancing CalAIM, Implementing Medi-Cal Rx, and Increasing Vaccine Rates By Scott Coffin, CEO, Alameda Alliance for Health

Council Report

In Memoriam

New Members

Volunteer Opportunity

Talking Points for Protecting MICRA

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ACCMA STAFF Joseph Greaves, Executive Director Mae Lum, Deputy Director Griffin Rogers, Director, Napa & Solano County Medical Societies David Lopez, Assoc. Director of Advocacy and Strategic Initiatives Jennifer Mullins, Assoc. Director of Education and Events Essence Hickman, Operations Associate Alejandra Hinojosa, Communications Associate

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION 6230 Claremont Avenue, Oakland, CA 94618 Tel: 510/654-5383 Fax: 510/654-8959 www.accma.org

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ACCMA BULLETIN | JANUARY/FEBRUARY 2022

NEWS & COMMENTS

E-PRESCRIBING GUIDANCE ON WRITTEN PRESCRIPTIONS

The ACCMA has received reports of pharmacists refusing to fill prescriptions not transmitted electronically since the electronic prescribing mandate took effect January 1, 2022. The Board of Pharmacy (BOP) has clarified that pharmacists are not required to verify that a written, oral, or faxed prescription falls under one of the exceptions of the e-prescription law. In addition, pharmacists may fill a legally valid written, oral or faxed prescription if the only issue is that the prescription was not received electronically. Go to accma.org/News/e-prescribingrequirement to learn more and to find a copy of BOP’s notice, which can be provided to pharmacies if you believe a refusal is unjustified.

GUIDANCE TO THE NO SURPRISES ACT

The American Medical Association has published a free toolkit on the No Surprises Act at ama-assn.org/system/files/amansa-toolkit.pdf. The toolkit focuses on three operational challenges that physicians will need to address immediately to be compliant with the new requirements that have in place since January 1: • Disclosures for when care is provided by out-of-network clinicians at in-network facilities • Rules pertaining to emergency services and post-stabilization care at hospitals and free-standing emergency departments • Obligations to provide good faith estimates for self-pay and uninsured patients. An on-demand webinar is also available from the California Medical Association, free to members. Go to cmadocs.org/ webinars.

TELEHEALTH POLICY UPDATE

Telehealth policies remain in effect until COVID-19 is no longer considered a public health emergency. CMA has published a telehealth policy update summarizing what has been done up to this point and next steps that physicians can watch for in 2022. The update can be downloaded from bit.ly/3s7xuzr.

MEDI-CAL RX IS LIVE

As of January 1, all Medi-Cal pharmacy services has transitioned from managed care to fee-for-service (FFS). Providers will use the Medi-Cal Rx portal to access prior authorizations, beneficiary eligibility lookup, web and batch claims submission, and training. The portal can be accessed at medi-calrx. dhcs.ca.gov/provider. A free on-demand webinar on the transition recorded by CMA and DHCS can be found at cmadocs. org/webinars.

UPDATE ON AB 1400 (SINGLE PAYER)

Assemblymember Ash Kalra pulled his single-payer health care bill (AB 1400) before the Assembly vote took place, recognizing that the bill would not receive the necessary votes for passage. ACCMA members had been asked to call or email their Assemblymembers to oppose AB 1400 as introduced. The ACCMA also contacted local Assemblymembers to ask them 4

to oppose the measure. The bill is now dead for this legislative session. Attention now shifts to the Healthy California for All Commission, which is expected to present a pathway to singlepayer, universal health care in April.

ACCMA MEMBER PUBLISHES DATA ON ALAMEDA COUNTY LTC FACILITIES

Long-standing ACCMA member Terry Hill, MD routinely presented COVID-19 data from the Alameda County long-term care facilities in his role as ACCMA COVID-19 medical director at regular 2021 meetings of the African American Response Circle. The AARC is a collaborative of Black-led organizations and Black community leaders whose mission is to advocate for rapid action to address the disparate impact of the COVID19 pandemic on Black Oakland residents. His data collection has been published in an article in Gerontology and Geriatric Medicine, “COVID-19 Across the Landscape of Long-Term Care in Alameda County: Heterogeneity and Disparities,” available at bit.ly/3gr1b9e. He is currently working on a paper on surveillance methodology.

MEDI-CAL MANAGED CARE PLANS INAPPROPRIATELY DENYING CLAIMS FOR PHYSICIAN-ADMINISTERED DRUGS

The Department of Health Care Services has received reports of denial or impeded access to physician-administered or infused drugs (including chemotherapeutic agents, anti-rejection medications for organ transplants, and long-acting contraceptives) since the transition to Medi-Cal Rx on January 1. Physician-administered or infused drugs billed on a CMS 1500 form are not part of the Medi-Cal Rx transition. Read more at bit.ly/34l10JV. If your practice is experiencing problems billing for physician-administered drugs under the Medi-Cal managed care program, contact ACCMA at (510) 654-5383 or accma@accma.org.

2022 MEDICARE PHYSICIAN FEE SCHEDULE

Congress recently passed a law that stopped all but 0.75% of the 9.75% Medicare payment cuts that would have otherwise occurred in 2022. Find the updated 2022 Medicare Physician Fee schedule at Noridian’s website at bit.ly/3nXvrwz. To learn more about Medicare changes in 2022, an on-demand webinar is available from the ACCMA, free to members. Go to learning. accma.org/recordings.

UNITEDHEALTH TO ADJUST COVID VACCINE UNDERPAYMENT

UnitedHealthcare is reprocessing claims for COVID vaccine administration after federal investigators found the insurer had underpaid millions of providers, paying 40% less than the Medicare rate. Providers do not need to take any action for the adjustments to be processed. SB 510, sponsored by CMA, went into effect January 1, 2022 and requires that health plans and insurers cover COVID testing and vaccinations during the pandemic without barriers like patient cost-sharing or prior authorizations. The law is retroactive to March 4, 2020, when a public health emergency was declared.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

NEWS & COMMENTS

HEALTH CARE STAFF VACCINATION REQUIREMENTS

The California Department of Public Health (CDPH) announced in January that individuals working in health care facilities now have until March 1, 2022, to get their COVID-19 booster shot. If they are not eligible for a booster by March 1, they must get their booster shot within 15 days of becoming eligible. Go to bit.ly/3GmPtqI to read the CDPH announcement. CMS will begin enforcement of their Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule on February 28. The emergency regulation requires vaccinations for eligible staff at health care facilities participating in the Medicare and Medicaid programs. Facilities covered by this regulation must establish a policy ensuring all eligible staff have received the necessary shots to be fully vaccinated by February 28. FAQs can be accessed at go.cms.gov/3GiTgp7.

ON-DEMAND WEBINAR: DIABETES PREVENTION

From 2019 to 2020, diabetes-related deaths increased by 17.7%, with differences in death rates within each race and ethnic group increased for all race and ethnic groups, and disparities in rates between groups increased. It is vital that health care providers understand the systemic barriers that may prevent certain groups from receiving the care they need to prevent diabetes. A free on-demand webinar from the California Department of Public Health and California Medical Association, “Break the Bias: Health Equity and the Important of Screening and Referring for Diabetes Prevention,” features experts sharing how screening for prediabetes, referring them

UPCOMING EVENTS LEADERSHIP READING AND DISCUSSION GROUP

Wednesday, April 6 | 6:00 to 7:30 pm Free | CME Available | Online Physicians are free to join any meeting of the Leadership Reading and Discussion Group; reading the book is not required. Doctor Hilary Worthen, course director of the Physician Leadership Program, facilitates the discussion group that is held on Zoom. Our next group meets on April 6 to talk about “The Art of Possibility: Transforming Professional and Personal Life,” by Rosamund Stone Zander and Benjamin Zander. This book, published in 2000, is by a family therapist and her husband, a noted orchestral conductor and professor at the New England Conservatory of Music. It is an exuberant guide to a set of practices they feel can make life and relationships bloom. Email Mae Lum, Deputy Director, at mlum@ accma.org to get the Zoom link.

to the National Diabetes Prevention Program, and identifying and overcoming barriers to screening and referral can advance health equity. CME is available. Go to bit.ly/3slgEgP to access the webinar.

MBC LICENSURE FEE INCREASES AND ENFORCEMENT CHANGES

Beginning January 1, all Medical Board applicants and licensees will be impacted by increases in application, initial licensure, and renewal fees. Enforcement changes include cost recovery for investigation and prosecution costs, and malpractice settlement disclosures in cases with judgments greater than $30,000. Read more at mbc.ca.gov/About/Laws/SB806. aspx. The Medical Board has also temporarily waived continuing education requirements AND renewal/delinquent fees for reactivating licenses. These waivers apply only to an individual’s license that: (1) is in a retired, inactive, or canceled status, and (2) has been in such status no longer than five years. Read more at dca.ca.gov/licensees/dca_21_200.pdf.

STAY UP-TO-DATE ON MANAGING COVID INFECTIONS

On January 21, the CDC updated its interim guidance for managing health care workers (HCW) with an infection or exposure to COVID-19 at bit.ly/3AOAWCY. The guidance includes updates on when an HCW can return to work following an infection. Additionally, the California Department of Public Health provides up-to-date guidance to local health jurisdictions on isolation and quarantine recommendations for the general public at bit.ly/3ogAV61.

BUILDING CLINICIAN WELLNESS TOGETHER

Thursdays, April 21 and 28 | 9 am to noon Free | CME Available | Online Wellness leaders from physician organizations are invited to join the Bay Area Clinician Wellness Collaborative, a roundtable for structured guidance and support, collaborating on program development, and identifying policy needs. There is no cost to participate. Join your wellness colleagues in this collaborative to fight physician burnout at the regional level and to improve the health and resiliency of clinicians. The collaborative launches with a free online conference on April 21 and 28 that will promote evidence-based research, real-life experiences, and practical strategies for creating a healthier practice environment. Each 3-hour day will feature a plenary session followed by two panel discussions. CME is available. Collaborative will meet quarterly for deepdive sessions led by wellness experts for 90 minutes in the evenings. Contact Mae Lum at mlum@accma.org or (510) 654-5383, ext. 6307 for more information.

ACCMA BULLETIN | JANUARY/FEBRUARY 2022

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PRESIDENT'S PAGE

Preserving MICRA for Our Patients and Our Profession By Robert Edelman, MD, ACCMA President

his year will be a pivotal year for ACCMA physicians as we work together on many critical issues that impact our profession and the patients we serve. As we enter the third year of the pandemic, efforts continue to get as many patients vaccinated as possible, so that all of our lives may return to normal. In addition to the pandemic, foremost among the challenges we face this year is a looming threat to MICRA. In November, California voters will be asked to vote on a new anti-MICRA (Medical Injury Compensation Reform Act) ballot measure that, along with other concerns, will raise the $250,000 cap on non-economic damages for individuals who have experienced medical malpractice. Physicians fought this battle before when voters rejected Proposition 46 in 2014, but we must fight it again – and even harder this time, as the current ballot measure goes beyond the damage that Prop 46 would have caused, with the cost to patients and taxpayers this time being far greater. (For a background on MICRA, see article on p. 9.) This ballot measure would also create a new category of “catastrophic injury” under which most malpractice claims would fall and which would be entirely exempt from MICRA protections. If approved by voters, the initiative would reduce Californians’ access to quality health care in three ways: by increasing the costs of health care and health insurance; by reducing the number of physicians, particularly in rural, minority, and low-income areas; and by discouraging physicians from performing high-risk procedures and surgeries, even when they may be lifesaving.

MICRA was put in place to ensure that injured patients can recoup unlimited damages for medical expenses and lost wages, as well as in cases of gross medical negligence. The law also protects doctors, hospitals, and other health care providers from frivolous, punitive lawsuits. This new anti-MICRA ballot initiative seeks to eliminate this protection, and even goes so far as to hold physicians personally liable to pay medical malpractice awards, putting at risk our personal assets. (See p. 12 for why MICRA continues to be good health care policy.) If this anti-MICRA initiative passes, the medical profession would lose its safeguards, and the patients and taxpayers will suffer as well. This Bulletin issue focuses on protecting MICRA and what physicians can do to take action to fight back. It also explains in depth about what MICRA is, how it works, and how it came to be. It is important for us as physicians to understand this issue, and to talk to our patients, families, friends, and neighbors about why this ballot measure is bad for California. (For MICRA talking points, see p. 14.) I also urge you to support the ACCMA and CMA in our efforts to preserve MICRA by renewing your membership and encouraging your non-member colleagues to join. If MICRA is weakened, the increased cost of professional liability insurance will far outstrip the cost of membership in organized medicine. We need to act as a profession to educate voters about how MICRA continues to serve their interests, so as to ensure that this ballot measure does not become law.

To place a classified ad, go to www.accma.org > About Us > Advertise with ACCMA, or call our office at (510) 654-5383. ACCMA members can place a classified ad for four months online and in two issues of the ACCMA Bulletin at NO CHARGE.

ACCMA BULLETIN | JANUARY/FEBRUARY 2022

BECOME A PHYSICIAN ADVOCATE

The California Medical Association (CMA) has joined a broad coalition of health care providers, community clinics, advocates, labor groups and others to protect access to care for all California patients and oppose a dangerous ballot measure that will appear on the November 2022 ballot. The measure before voters this year is far more draconian than the Medical Injury Compensation Reform Act (MICRA) measure on the November 2014 ballot (Proposition 46) that was rejected by two-thirds of California voters. We are confident that our 2014 coalition of physicians, community health clinics, hospitals, local governments, public safety, business and labor groups will once again band together to defeat this new measure, which would make it easier and more profitable to sue doctors, nurses and hospitals. We must also understand that this is a very different measure than Prop. 46, in a very different political environment, with very different financial backers. We cannot assume that victory in 2014 will guarantee victory in November 2022. This new measure would effectively eliminate the MICRA cap on non-economic damages for medical malpractice awards altogether and seeks to hold physicians and other health care providers personally liable to pay medical malpractice awards. This measure would have a chilling effect on the entire health care system and have a trickle-down effect that would be borne primarily by low-income patients, who would face higher costs and restricted access to care. The out-of-state attorney driving this initiative has vowed to spend up to $40 million of his own money to get this measure passed. We must do everything we can to educate physicians and communities about the disastrous effects it would have on California’s health care system. The non-partisan California Legislative Analyst’s Office (LAO) has said this measure would increase public health care costs by “hundreds of millions” of dollars every year. It would have particularly devastating effects in rural and other low-income areas. Community health care clinics like the Central Valley Health Network say this measure will cause physicians in high-risk specialties like OB/GYN to reduce or eliminate patient services. Our state is in the midst of an affordability crisis. Housing, education, transportation and health care costs are already difficult for many California families to keep up with. This measure would only put California more out of reach for the working families already struggling to get by. We must all do our part to let the public know what this deceptive measure is really about. The information in this packet is intended to be useful for county medical societies, physicians, health care stakeholder groups and patients who want to participate in the campaign to defeat this measure. You can also visit cmadocs.org/micra for more information. Thank you for your continuing service to your patients and your communities, and for the hard work we will all be doing in the months ahead to advocate for our patients to help keep health care accessible and affordable for all Californians.

Robert E. Wailes, M.D. President, California Medical Association

MICRA IMPROVES ACCESS TO CARE

Where Would We Be Without MICRA? BY LOWERING HEALTH CARE COSTS, MICRA IMPROVES CALIFORNIANS’ ACCESS TO CARE

his November, California voters will be asked to vote on a new ballot measure that renews an attack on the Medical Injury Compensation Reform Act of 1975 (MICRA). This initiative, bankrolled with millions of dollars from an out-of-state trial attorney, would effectively eliminate the cap on non-medical damage awards in malpractice cases, substantially raising health care costs for all Californians and putting at risk California’s fragile safety net to ensure patient access to health care. Yet MICRA’s attributes as a well-reasoned public policy and the model for national medical liability tort reform remain as compelling today as they were when it was enacted in 1975. During the early and mid-1970s the number of extremely large medical malpractice awards prompted nearly all commercial malpractice insurance companies to leave California. The two remaining companies increased the cost of malpractice coverage so significantly that few doctors could afford it. In a period of just a few months, 60% of all doctors in California were operating without malpractice coverage. After the temporary closure of many physician offices and clinics, and a physician ‘sit-in’ at the Governor’s office, the Legislature called a special session to address the malpractice insurance crisis. As a result, MICRA was born. The ACCMA kept their membership informed that year of the demise of the ACCMA’s commercially underwritten professional liability group coverage, provided legislative updates, and reported on the ACCMA’s creation of Medical Insurance Exchange of California (MIEC), the first doctor-owned professional liability insurer in California. An assessment of $300.00 was levied by the California Medical Association House of Delegates on the CMA membership to fund their efforts to solve the crisis. MICRA is the centerpiece of affordable and accessible, high quality medical care in California and is an enduring public policy success. It ensures that patients suffering malpractice shall receive full and unlimited compensation for actual damages and, at maximum, an additional quarter-million dollars for non-economic damages and “pain and suffering.” It contains meaningful and reasonable tort reform to reduce litigation and moderate its costs, including: • Placing reasonable limitations on personal injury lawyers’ contingency fees to reduce the tremendous financial incentive personal injury lawyers had (up to 50% of awards)

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to pursue frivolous cases Allowing periodic payment of awards in excess of $50,000, giving insurers a more affordable means to pay large awards and ensuring that money will be available to the injured patient over time Allowing disclosure of collateral sources of recovery received by the injured patient from Workers’ Compensation, disability or health insurance or other sources, to prevent double recovery of those losses Establishing a statute of limitations What is considered by experts to be the most effective provision of MICRA, a $250,000 cap on subjective, non-quantifiable, damages for mental anguish, or what is termed “pain and suffering.” It also increased the state licensing agency’s ability to monitor the competence of physicians and established arbitration as an alternative dispute resolution process (see sidebar, “MICRA’s Basic Provisions” on page 10).

The personal injury lawyers’ main strategy against MICRA is to argue that its quarter-million dollar “cap” on pain and suffering has, over time, kept awards low and thus, restricted access to the courts for aggrieved patients. Consequently, they call for a significant increase in the cap and the establishment of an annual cost-of-living adjustment. But factual analysis shows that awards have grown in size at a much faster rate than the cost of living, despite having in place a cap on “pain and suffering” damages. This is because nothing in MICRA limits an injured patient’s ability to recover all objective, quantifiable present and future losses, a fact that personal injury lawyers often obscure. The law also allows for assessment of “punitive damages” when a physician’s conduct is deemed egregious or intentionally harmful. The California Legislature purposely established this cap to address an overriding societal concern: preservation of accessible and affordable health care. In 1975, then Assemblymember Barry Keene aptly described the legislature’s thinking when it capped pain and suffering damages at $250,000 and chose not to include a cost-of-living index: Patients’ rights to recover for non-economic losses, chiefly ‘pain and suffering,’ were severely limited in the belief that there are limits to what society can afford in an area of great subjectivity in which it is not always possible to compensate with dollars. continued on page 10 ACCMA BULLETIN | JANUARY/FEBRUARY 2022

MICRA IMPROVES ACCESS TO CARE

(continued from page 9)

MICRA’S BASIC PROVISIONS Limits on Non-Economic Damages Non-economic damages in a claim against a health care provider for medical negligence are limited to $250,000. Economic damages, such as lost earnings, medical care, and rehabilitation costs, are not limited by statute. California Civil Code Section 3333.2.

a claimant to give a 90-day notice of an intention to bring a suit for alleged professional negligence. If the notice is given within 90 days of the expiration of the statute of limitations, the statute is extended 90 days from the date of the notice. California Code of Civil Procedure Sections 364 and 365.

Evidence of Collateral Source Payments A defendant in a medical liability action may introduce evidence of collateral source payments (such as from personal health insurance) as they relate to damages sought by the claimant. If a defendant introduces such evidence, the claimant may also introduce evidence of the cost of the premiums for such personal insurance. Civil Code Section 3333.1.

Statute of Limitations In California, a claim for alleged medical negligence must be brought within one year from the discovery of an injury and its negligent cause, or within three years from injury. Code of Civil Procedure Section 340.5.

Limits on Attorney Contingency Fees In an action against a health care provider for professional negligence, an attorney’s contingency fee is limited to 40% of the first $50,000 recovered; 33% of the next $50,000; 25% of the next $500,000, and 15% of any amount exceeding $600,000. California Business and Professions Code Section 6146. Advance Notice of a Claim To further the public policy of resolving meritorious claims outside of the court system, MICRA requires

An increase in the MICRA cap on non-economic damages has been rejected in California again and again: 10 times in court, five times in the Legislature, and by voters in 2014, when voters said No by a vote of 57% to 33% to the trial lawyers’ attempt to quadruple the cap on non-economic damages (Proposition 46). The measure that will be on the ballot in November 2022 goes well beyond what Prop 46 would have done. The available data indicates that an increase in the MICRA cap would lead to an increase in medical liability insurance premiums ranging from 21 to 93 percent. That’s because an increase in the cap would not only raise awards and settlements, it would also encourage more lawsuits, especially non-meritorious lawsuits. Health care providers will then pass along the higher premium costs to the people who pay for health care in California: health care consumers, workers covered by employer-subsidized health

Periodic Payments of Future Damages A health care professional may elect to pay a claimant’s future economic damages, if over $50,000, in periodic amounts. This avoids a claimant’s wasting of an award prior to actual need. Code of Civil Procedure Section 667.7. Binding Arbitration of Disputes Patients and their health care providers may agree that any future dispute may be resolved through binding arbitration. California statute requires specific language for such contracts and provides that all such contracts be revocable within 30 days. Code of Civil Procedure Section 1295.

insurance, and taxpayers. According to the California independent Legislative Analyst’s Office, this anti-MICRA measure would lead to “annual government costs likely ranging from the low tens of millions of dollars to the high hundreds of millions of dollars.” For safety-net hospitals (UC teaching hospitals, public hospitals, children’s hospitals), which are mostly self-insured, scarce funding would be taken away from direct patient care to cover these added litigation and health care costs. And if the MICRA cap is raised, the bulk of the costs would be borne by high-risk physician specialties (OB/GYN, surgery) and these safety-net institutions, reducing both access and services for California’s uninsured and most vulnerable patients. The argument that the MICRA cap should be adjusted after “all these years” pales when considering that eliminating the cap would divert resources for patient care to the legal system.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

MICRA IMPROVES ACCESS TO CARE

MICRA HAS MODERATED MALPRACTICE INSURANCE COSTS AND PRESERVED ACCESS TO CARE Prior to the MICRA reforms in 1975, the cost of malpractice insurance in California was exceeded only by the cost for physicians practicing in New York City. Since MICRA’s passage, the average national cost of malpractice coverage has increased by 854%, while California’s costs have risen only 287%. Current California malpractice insurance costs are in the lower half of rates among all states, and rates in Northern California are in the lower third among all states. This has resulted in substantial savings in malpractice insurance costs for physicians. And as noted previously, this moderation in the cost of malpractice coverage has significantly benefitted self-insured institutions that play a huge role in the safety net for low-income and uninsured patients. THE POLITICAL BATTLE TO PRESERVE MICRA Personal injury and trial lawyers intend to once again obfuscate the issues and minimize the detrimental impact that weakening MICRA would have on patients and our health care system. They will trot out the well-worn argument that it is reasonable to increase the cap on “pain and suffering” because it hasn’t been updated, and failure to do so is robbing patients of their right to justice. But the November initiative is not an adjustment of the MICRA cap; it is a virtual elimination. It would also eliminate the state’s current cap on attorney’s fees in medical malpractice cases, allowing lawyers to take a much higher portion of a patient’s jury award in malpractice cases. They will also prey on public animosity toward the insurance industry by claiming that preserving MICRA simply allows greedy insurance companies to rack up more profits, ignoring the fact that roughly 50% of malpractice coverage in California is self-insured and only 10% of coverage is provided by traditional commercial insurance carriers. The remainder is underwritten by organizations that have no commercial profit motive, including physician-owned malpractice insurers sponsored by medical societies and other “co-op” type coverage of various types, such as MIEC. The personal injury and trial lawyers are also reviving scurrilous attacks on the medical profession, claiming physicians either

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overtreat or withhold treatment from patients for profit. But as discussed in greater detail on page 12, MICRA continues to be good public policy worth preserving. WHAT PHYSICIANS CAN DO TO PRESERVE MICRA To counter the trial lawyers’ strategy, organized medicine will once again need your help to educate the public about how MICRA serves the public and patients’ interests. We must get the word out about this latest scheme to end California’s long-standing liability reform law and exploit patients for profit. ACCMA members can support this effort by taking the following actions. Go to page 14 to read more about talking points and social media messages when discussing MICRA. • Join the campaign at cmadocs.org/micra/commit and list yourself and/or your organization as an official opponent of the ballot measure. • Contribute to the CMA Education Fund at cmadocs. org/micra/Take-Action/CMA-Education-Fund. Ask your hospital medical staff or group practice to support the fund used to educate physicians, the public, and the legislature regarding the importance of MICRA. • Donate as an individual physician to the Campaign to Protect MICRA at efundraisingconnections.com/c/MICRA. • Sign up for text updates by texting “CMA MICRA” to 52886. • Follow ACCMA and CMA on Twitter and share our posts: twitter.com/eastbaydocs and twitter.com/cmadocs. • When they become available this summer, you can help distribute educational materials (cmadocs.org/micra/ resources) to your patients, colleagues, friends, and family. Physicians’ greatest asset is the esteem in which they are held by their patients. If you are comfortable doing so, share your thoughts about MICRA with your patients, and encourage them to vote No on the ballot initiative this November. • By being an ACCMA/CMA member, you are already helping support our efforts to defeat this dangerous initiative. Encourage your nonmember colleagues to do their part and join the ACCMA/CMA. Joining is easy: go to accma.org/ join or ask them to contact the ACCMA at (510) 654-5383 or accma@accma.org.

Put Your ACCMA Membership to Work! Go to www.accma.org > Membership, or call ACCMA at (510) 654-5383 for help.

ACCMA BULLETIN | JANUARY/FEBRUARY 2022

WHY MICRA IS GOOD PUBLIC POLICY

After 47 Years, MICRA Is Still Good Public Policy

ballot initiative that would substantially raise health care costs for all Californians, reduce access to health care and harm patients most in need is heading to the November 2022 ballot. The measure would effectively eliminate California’s medical lawsuit limits; create a new, broadly defined and dangerous category of malpractice lawsuits; and enable new financial windfalls for California’s trial lawyers. This article summarizes why physicians, hospitals, and safety-net clinics want to protect MICRA and are opposed to this ballot initiative. MICRA MODERATES THE COST OF MALPRACTICE COVERAGE TO PRESERVE ACCESS TO CARE MICRA’s reasonable provisions (limits on attorneys’ fees and “pain and suffering” damages, periodic payment of awards over time instead of in a lump sum, etc.) have reduced California’s malpractice coverage costs and thus kept more scarce health care dollars available to provide direct patient care. When physicians and hospitals qualify for the lower insurance premiums made possible by MICRA, they do not have to increase their fees to remain economically viable. On the other hand, increasing the MICRA cap would leave more California families unable to afford care. Most dramatically, increased health care expenditures will directly affect care for our most vulnerable and uninsured patients who receive care from county and state health systems, University of California’s health system, obstetricians, emergency physicians and hospital emergency departments, community clinics, Planned Parenthood, highly specialized surgeons, and others. And it will ultimately affect all providers of care, particularly our fragile network of primary care physicians, who are finding it increasingly difficult to maintain a viable medical practice—a problem that has been further exacerbated during the current COVID-19 pandemic. In the other four states with the largest share of the medical liability insurance market (New York, Florida, Illinois, Pennsylvania) but with no strong MICRA-type reforms, internists, general surgeons, and obstetricians pay from 150 to 220 percent more than their counterparts in California. The effectiveness of the MICRA cap in holding down medical liability insurance premiums can also be seen after the Oregon Supreme Court, in 1999, removed the state’s $500,000 cap on non-economic damages: by 2017, the

medical liability insurance premiums paid by internal medicine specialists in that state had increased by nearly 40 percent. MICRA’S CAP PROPERLY BALANCES A SOCIETAL GOAL TO PRESERVE ACCESS TO CARE In 1975, the California Legislature consciously chose not to index the MICRA cap to inflation. Its reasoning was that putting a limit on awards for non-quantifiable “pain and suffering” serves society’s greater need to make more scarce health care dollars available for patient care. The Legislature noted that MICRA places no limit on quantifiable economic losses, and these losses are calculated at current and future values as appropriate. It also noted that MICRA places no limit on punitive damages, which may be assessed in cases where egregious behavior and intentional harm can be proven. An increase in the cap would exponentially increase malpractice insurance rates because higher awards would also stimulate more lawsuits, particularly non-meritorious litigation. This was borne out in Oregon after the state Supreme Court invalidated their $500,000 non-economic damage awards cap in 1999; the number of malpractice claims per capita increased by 10 percent afterwards. On the other hand, after Texas imposed a $250,000 cap in 2003, the number of medical liability claims declined by about 46 percent. A higher cap on non-economic damages would also drive up health insurance premiums, reducing the willingness and ability of California residents to obtain health insurance and thus making it more difficult for them to get the medical care they need. Many may decide to go without coverage. A study by the Kaiser Family Foundation estimates that a 10 percent increase in the price of health insurance could reduce the number of Californians covered by private insurance by up to 4.2 million people. A higher MICRA cap would discourage physicians from setting up their practices in California or cause them to move their practices to other states. This was the case in Texas: after 2003, when Texas capped their non-economic damages awards at $250,000, the physician supply in that state increased by an average of 87 percent from 2006 to 2013, as reported by the Texas Medical Board. It is also anticipated that a higher MICRA cap would encourage early retirements by physicians, discourage

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WHY MICRA IS GOOD PUBLIC POLICY

physicians from continuing to practice in high-risk specialties, and cause medical students who eventually want to practice in California from entering certain specialties. The state’s physician workforce shortfall would thus be exacerbated and would have a disproportionate impact on California’s social safety net. MICRA ENSURES THAT INJURED PATIENTS ARE ADEQUATELY COMPENSATED AND RECEIVE THE HIGHEST POSSIBLE PERCENTAGE OF THE AWARD MICRA places no limit on payment of actual losses, such as medical bills, lost wages, future earnings, custodial care and rehabilitation, etc. As a result, over the years malpractice awards in California have far exceeded increases in the rate of inflation. Since 1976 the average size of paid medical liability claims in California has increased at an average annual rate that is 2.77 times the average annual rate of inflation, even with the $250,000 MICRA cap. The result of this trend is that the average payment per claim in 2017 ($263,881) was about nine times what the average would have been if it had kept pace with the inflation rate ($29,510). Additionally, MICRA ensures that a higher percentage of awards go to injured patients instead of attorneys. An annual analysis of malpractice awards by the Medical Underwriters of California found that of the 248 cases from 2002–2008, injured patients received a total of $180,138,659 more because of MICRA’s limits on attorneys’ fees. MICRA HAS NOT STIFLED PATIENTS’ ACCESS TO THE COURTS Notwithstanding the cap, Californians who believe they have experienced medical malpractice continue to find attorneys willing to take their cases. The incidence of medical liability claims in California remains significantly greater than the corresponding rate outside California. In 2017, the claims frequency rate in California was 6.2 percent, which is 56 percent higher than the average rate for the other 49 states. Further corroboration that attorneys are still taking on malpractice claims can be found in the 2010 report on Kaiser-Permanente’s arbitration system, which notes that 77% of the cases closed in 2009 involved legal representation for the claimants (plaintiffs). This percentage is consistent with previous reports on the system. DEFENDERS OF MICRA ARE LARGELY PHYSICIANS AND OTHER PROVIDERS, NOT A PROFIT-MINDED INSURANCE INDUSTRY In the last legislative battle challenging MICRA, physicians and

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other providers were MICRA’s front-line defenders. This included county health systems, University of California Medical Centers and other teaching hospitals, Planned Parenthood, community clinics, Kaiser Permanente, large multi-specialty groups, and professional associations representing physicians and other health care professionals. Many of these providers are self-insured and represent about 50% of the total malpractice coverage in California. Only about 10% of liability coverage is provided by traditional commercial insurers, and the balance is provided by “co-op” type organizations formed by various groups to protect themselves. This includes California’s physician-owned professional liability insurers (such as MIEC), which are the ultimate consumer-driven insurance company in which the insureds are also the owners of the company; captive insurers created specifically to insure one group or organization; and cooperatives that pool contributions from health care providers to cover losses. OTHER STATES HAVE FOLLOWED CALIFORNIA’S LEAD Virtually every state and the District of Columbia have adopted some form of medical liability tort reform, following California’s lead. More than half of the states—31 states—have placed some limit on awards for damages. MALPRACTICE INSURANCE RATE REDUCTIONS ARE NOT ATTRIBUTABLE TO PROP. 103 Some critics of MICRA make baseless assertions that professional liability rate reductions are attributable to passage of Proposition 103, the Insurance Rate Reduction and Reform Act, an initiative enacted in 1989 to reform automobile insurance rates. Controlling insurance rates do nothing to limit insurance costs, which are a function of the losses incurred and the true determinants of insurance rates. If malpractice awards increase in frequency and amount, insurance costs will go up, which will be passed on to physicians and other providers, and ultimately passed on to patients. More importantly, when Proposition 103 was enacted, professional liability insurance rates were already declining because MICRA’s cap on non-economic damages was finally influencing malpractice awards after being upheld by the California Supreme Court in 1985. Malpractice rates continued to decline through the first half of the 1990s, and no challenge to malpractice insurance rates was even asserted by regulators using the provisions of Proposition 103 until 2003. We must work to defeat the anti-MICRA initiative on the November 2022 ballot.

ACCMA BULLETIN | JANUARY/FEBRUARY 2022

MICRA TALKING POINTS

Talking Points for Protecting MICRA

n order to defeat the MICRA ballot initiative, the so-called “Fairness for Injured Patients Act,” we must get the word out about this latest scheme to end California’s long-standing liability reform law and exploit patients for profit. Here are some highlights to share with your colleagues about why it’s important to protect MICRA. MICRA caps non-economic damages to ensure injured patients receive fair compensation while preserving access to health care by keeping doctors and other health care providers in practice, and hospitals and clinics open. Currently, injured patients can receive unlimited payments for economic losses and past and future medical expenses. Nothing in this new initiative would change those payouts. The November 2022 ballot initiative would: • Undermine safeguards on non-economic damages by removing the MICRA cap in cases of broadly defined “catastrophic injury,” which could be something as simple as a scar. • Completely eliminate statutory limits on trial attorney fees. • Allow attorneys to be paid more money up front, while forcing injured patients to take a lump sum payment. • Create a new sham process that effectively prohibits a judge from independently verifying the veracity of lawsuit claims, allowing our courts to be clogged with frivolous lawsuits.

SAMPLE CONTENT FOR FACEBOOK AND TWITTER Avoid using the hashtag #MICRA; instead, use #ProtectMICRA and #ProtectPatients.

WHO BENEFITS FROM THIS PROPOSAL? • This initiative was written and is being funded by a wealthy out-of-state trial lawyer, who has publicly said he’s willing to spend $40 million of his own money to pass it. • According to California’s nonpartisan Legislative Analyst’s Office (LAO), this initiative will drive up health care costs for all Californians. It will reduce access for those who need it most, including those who use Medi-Cal, county programs, safety net providers, and school-based health centers. • The LAO projects this initiative will cost California taxpayers tens of millions “to high hundreds of millions of dollars annually” in health care costs. • Raising the cap on non-economic damages – just a small portion of this ballot measure – would result in a $1,100 annual increase in health care costs for a family of four. • In 2014, voters rejected Prop. 46, which would have quadrupled the cap on non-economic damages. This measure goes well beyond what Prop. 46 would have done and the cost to taxpayers would be far greater.

For Twitter

For Facebook • Health care providers, community clinics, advocates, labor groups and others oppose the costly MICRA measure that would make it easier and more profitable to sue health care providers. Join the campaign today at protectmicra.org. • An out-of-state trial lawyer wants to increase state and local government malpractice and health care costs by “hundreds of millions of dollars annually.” Learn the facts now at cmadocs.org/micra. • The anti-MICRA measure targets physicians and will cause health care providers to leave the state – and physicians in high-risk specialties like OB/GYN to reduce or eliminate services. Share this post so we can defeat this initiative in November! • Don’t be deceived by the so-called Fairness for Injured Patients ballot measure – it’s a ploy to make it easier and more profitable to sue doctors, clinics, and hospitals. Join the fight to oppose the MICRA measure at protectmicra.org!

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Health care providers, community clinics & labor groups all oppose costly MICRA ballot measure that would make it easier & more profitable to sue health care providers & clinics. Join us at protectmicra.org. #ProtectMICRA An out-of-state trial lawyer wants to increase state & local gov’t health care costs by “hundreds of millions of dollars annually,” placing the burden directly on CA taxpayers. Join us to #ProtectPatients at protectmicra.org. #ProtectMICRA. Anti-MICRA ballot measure would reduce #AccessToCare for those who need it most, patients who use Medi-Cal, safety net providers, and health centers. Join us to #ProtectPatients at protectmicra.org. #ProtectMICRA

NEW HEALTH CARE LAWS

New Health Care Laws By the California Medical Association

hile the number of new laws overall is significantly reduced as compared to past years, many new and significant laws were enacted. Below is an abbreviated list of new laws of interest to physicians. For a more complete list, go to bit.ly/3KSYknG. AB 80 (Burke) – Taxation: Coronavirus Aid, Relief, and Economic Security Act: Federal Consolidated Appropriations Act 2021 CMA Position: Support Excludes, for taxable years beginning on or after January 1, 2019, from gross income any advance grant amount, as defined, issued pursuant to specified provisions of the CARES Act or the Consolidated Appropriations Act 2021, and covered loan amounts forgiven pursuant to the Consolidated Appropriations Act 2021. AB 263 (Arambula) – Private detention facilities and public health orders CMA Position: Support Current law requires the operator of a private detention facility, as defined, to comply with, and adhere to, the detention standards of care and confinement agreed upon in the facility’s contract for operations, as specified. This bill would require a private detention facility operator to comply with, and adhere to, all local and state public health orders and occupational safety and health regulations. The bill would state that its provisions are declaratory of existing law. AB 856 (Maienschein) – Pupil health: COVID-19 Youth Health Information Act CMA Position: Support The act requires the State Department of Education to post on its website information related to the safe return of pupils to exercise and physical activity, as defined, after exhibiting signs or symptoms of, or testing positive for, COVID-19, and would specify that the information include current guidelines issued by the American Academy of Pediatrics. The bill also requires the department to include on its website current guidelines of the American Academy of Pediatrics for pupils to obtain medical clearance before returning to exercise and physical activity after exhibiting signs or symptoms of, or testing positive for, COVID19, as specified.

SB 242 (Newman) – Health care provider reimbursements CMA Position: Support Requires a health care service plan or health insurer, but not a Medi-Cal managed care plan, to reimburse contracting health care providers for their business expenses to prevent the spread of respiratory-transmitted infectious diseases causing public health emergencies declared on or after January 1, 2022. SB 336 (Ochoa Bogh) – Public health: COVID-19 CMA Position: Neutral Requires, when the State Department of Public Health issues a statewide order or mandatory guidance, or when a local health officer issues an order, related to preventing the spread of COVID19, as defined, or protecting public health against a threat of COVID-19, that they publish on their website the order or guidance and the date that the order or guidance takes effect. The bill also requires the department or local health officer to create an opportunity for local communities, businesses, nonprofit organizations, individuals, and others to sign up for an email distribution list relative to changes to the order or guidance. SB 510 (Pan) – Health care coverage: COVID-19 cost sharing CMA Position: Sponsor Requires a health care service plan contract or a disability insurance policy that provides coverage for hospital, medical, or surgical benefits to cover the costs for COVID-19 diagnostic and screening testing and health care services related to the testing for COVID-19, or a future disease when declared a public health emergency by the Governor of the State of California, and would prohibit that contract or policy from imposing cost sharing or prior authorization requirements for that coverage. The bill also requires a contract or policy to cover without cost sharing or prior authorization an item, service, or immunization intended to prevent or mitigate COVID-19, or a future disease when declared a public health emergency by the Governor of the State of California, that is recommended by the United States Preventive Services Task Force or the federal Centers for Disease Control and Prevention, as specified. SB 221 (Wiener) – Health care coverage: timely access to care Codifies the regulations adopted by the Department of continued on page 16 ACCMA BULLETIN | JANUARY/FEBRUARY 2022

NEW HEALTH CARE LAWS

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Managed Health Care and the Department of Insurance to provide timely access standards for health care service plans and insurers for nonemergency health care services. The bill requires both a health care service plan and a health insurer, including a Medi-Cal Managed Care Plan, to ensure that appointments with nonphysician mental health and substance use disorder providers are subject to the timely access requirements, as specified. SB 428 (Hurtado) – Health care coverage: adverse childhood experiences screenings CMA Position: Sponsor Requires a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2022, that provides coverage for pediatric services and preventive care to additionally include coverage for adverse childhood experiences screenings. The bill authorizes each department to adopt guidance to implement this provision. Because a willful violation of these provisions by a health care service plan would be a crime, the bill imposes a state-mandated local program. AB 359 (Cooper) – Physicians and surgeons: licensure and CME CMA Position: Co-Sponsor This bill expands the exception for a 4-attempt requirement to obtain a passing score on all parts of Step 3 of the United States Medical Licensing Examination to include an applicant who meets certain requirements, including holding an unlimited license as a physician and surgeon in another state, or in a Canadian province, issued as provided, holding an unrestricted license to practice medicine in a state, in a Canadian province, or as a member of the active military, United States Public Health Services, or other federal program for a period of at least 4 years, having satisfactorily completed specified postgraduate training, certification, and examination requirements, and not having been subject to specified licensure denials or disciplinary action. This bill also loosens restrictions on continuing medical education to allow for courses that include practice and office management, coding, reimbursement, and education methodology. SB 806 (Roth) – Healing arts CMA Position: Oppose Unless Amended This bill extends the sunset dates for the Medical Board of California (MBC), the Osteopathic Medical Board of California (OMBC), the Podiatric Medical Board of California (PMBC), and the Physician Assistant Board (PAB), and makes additional technical changes, statutory improvements, and policy reforms stemming from the joint sunset review oversight of the programs. Current law authorizes an administrative law judge, in an 16

order issued in resolution of a disciplinary proceeding before a board within the Department of Consumer Affairs or before the Osteopathic Medical Board of California, upon request of the entity bringing the proceeding, to direct a licensee found to have committed a violation of the licensing act to pay a sum that does not exceed the reasonable costs of the investigation and enforcement of the case. Under current law, the Medical Board of California is prohibited from requesting or obtaining from a physician and surgeon investigation and prosecution costs for a disciplinary proceeding against the licensee. This bill would repeal the above-described provision that prohibits the board from requesting or obtaining investigation and prosecution costs for a disciplinary proceeding against a licensee. SB 447 (Laird) – Civil actions: decedent’s cause of action CMA Position: Oppose Current law provides that a cause of action that survives the death of the person entitled to commence an action or proceeding passes to the decedent’s successor in interest and an action may be commenced by the decedent’s personal representative or, if none, by the decedent’s successor in interest. Current law limits the damages recoverable in that action or proceeding to the loss or damage that the decedent sustained or incurred before death, including any penalties or punitive or exemplary damages that the decedent would have been entitled to recover had the decedent lived. Current law prohibits the recovery of damages for the decedent’s pain, suffering, or disfigurement in that action or proceeding. This bill permits damages for a decedent’s pain, suffering, or disfigurement to be recovered in an action brought by the decedent’s personal representative or successor in interest if the action or proceeding was granted a specified preference before January 1, 2022, or was filed on or after January 1, 2022, and before January 1, 2026. AB 457 (Santiago) – Protection of Patient Choice in Telehealth Provider Act CMA Position: Sponsor Under current law, it is unlawful for healing arts licensees to offer, deliver, receive, or accept any kickbacks, in the form of money or otherwise, as compensation or incentives for referring patients, clients, or customers to any person, subject to certain exceptions. This bill provides that payment to an internet-based service provider that offers information and resources to prospective patients of licensees does not constitute the information provided as a referral as long as the internet-based service provider does not recommend of endorse a specific licensee to a prospective patient.

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MEDICARE UPDATES

Medicare Final Rule Points Important to Your Practice By Mary-Jean Sage, CMA-AC

he published Medicare Physician Final Rule deemed most elements effective on January 1, 2022. While there are no changes that one might consider major, there are opportunities for some new services to be reimbursed and there are some significant changes to existing services with which providers should become familiar when providing those services. Here is a summary of some of the important changes.

PAYMENT POLICIES AND CONVERSION FACTOR When the Final Rule was released on November 2, CMS stuck to their proposed conversion factor of $33.5983, which was a 3.75% decrease from last year for the physician fee schedule and $20.9343 for the anesthesia fee schedule, which is a decrease of 2.39% for that fee schedule. However, Congress stepped in during December 2021 and boosted the conversion factor through passage of the Protecting Medicare and American Farmers from Sequester Cuts Act. In addition to mitigating the cut to the Medicare conversion factor, this legislation staved off other Medicare cuts, including a phased-in delay of the Medicare and “pay as you go” sequestration cuts that impact all Medicare payments. These fixes are in effect only for 2022 and, in the case of Medicare sequestration, will be phased out starting April 1, 2022. Summary of the elements are: • Delays 2% cuts to Medicare through March 2022 • Delays sequestration 4% cuts to 2023 • 3.75% reduction in MPFS changed to a 0.75% reduction

The various Medicare Administrative Contractors (MAC) have updated the Physician Schedule reflecting the adjusted conversion; visit the MAC for California at med.noridianmedicare. com. The Medicare Part B deductible for beneficiaries is $170.10 for 2022 and every practice should begin collecting toward this deductible from their patients who do not have a Medicare secondary insurance that will cover this deductible. Other highlights of the Final Rule include: • E/M Visits – shared visits, critical care, and telehealth, including new modifiers • Telehealth • Telehealth and Behavioral Health • Vaccine Administration rates • Remote Therapeutic Monitoring (RTM) services - new • MIPS changes E/M VISITS – SPLIT (OR SHARED) VISITS What is a split or shared E/M service? Per CMS, they are E/M services performed jointly by a physician and non-physician in a facility setting (outpatient department, inpatient, emergency, department, skilled nursing facility). The clinicians sharing the E/M must be in the same group and the same specialty. Also remember there is a Medicare payment differential for services billed by physicians and nonphysician practitioners (NPPs). Prior to 2021, the concept of shared services was only used in continued on next page

Phase 1 Jan–March 2022

Phase 2 April–June 2022

Phase 3 July–Dec 2022

0.82%

Medicare Sequestration

PAYGO Sequestration

0.82%

1.82%

2.82%

Cuts Medicare Physician CF Reduction

Total Cuts Across the Board

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MEDICARE UPDATES

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Medicare and not recognized by CPT codes and/or other payers. In 2021, the AMA added the concept of shared services between a physician and a qualified health care professional (QHP). While CMS uses the term nonphysician practitioner (NPP), both QHP and NPP mean someone who has E/M in their scope of practice. The concept allows for E/M services to be jointly performed by a physician and NPP/QHP. In May 2021, CMS removed instructions for shared services, critical care, and nursing home services from the Medicare Claims Processing Manual, saying they would address the issue in rulemaking, which they have done! Split/shared services in 2022 per the Final Rule are: • Allowed: In facility settings – inpatient, outpatient including observation and emergency department • Allowed: In nursing facilities for visits that are not mandated to be done by a physician • Allowed: For critical care • Removed: Allowed in office setting if incident-to requirements are met CMS believes the E/M services performed split/shared should be reported by the clinician who does a “substantive portion” of the visit. In 2023 this will be based on time spent with the patient (both face-to-face and non-face-to-face). However, 2022 will be a transitional year and the substantive portion may be determined based either on time or performance of key components. CMS is also allowing prolonged care to be reported as split/shared – again in the facility setting. There is a new HCPCS II (National Code) modifier that is required by Medicare to identify split/shared services. That modifier is FS – Split (or shared) evaluation and management service. Beware of the definition of this modifier. While it does not specifically state in the definition of the modifier that it is to be used with facility-only services, that is CMS’s intent and they have addressed that in the Final Rule documentation. Modifier FS should not be used with any service reported in the physician’s office – place of service (POS) 11 (office). Documentation for this type of service, as with all types of service, is important. The documentation must identify the two clinicians who shared the visits. The individual who performs the substantive portion of the visit (and bills for it) must sign and date the encounter. The clinician who bills for the service is identified as the rendering/performing provider on the Medicare claim via his/her type 1 NPI. Remember, the services may include both face-to-face and non-face-to-face activities. Access the on-demand webinar on Medicare 2022 at pathlms.com/medical-society for examples of documentation that is compliant with the requirements for shared/split services. 18

E/M SERVICES: CRITICAL CARE For 2022, CMS will be adopting the CPT descriptions, parentheticals, and prefatory language for critical care services (CPT 99291 and 99292). Additionally, they will be allowing concurrent care in the same time period by practitioners of different specialties to provide medically necessary, non-duplicative care. Shared/split services may be provided for critical care as long as the physician and NPP are in the same group and same specialty. The time of these clinicians may be combined to meet the first hour of critical care and subsequent 30-minute increments. CMS will also allow an E/M service on the same day as critical care if the E/M service took place prior to the patient becoming critical care is reported for an additional service later in the day. This means the status of the patient changes and there are two distinct episodes of care. Again, documentation of both diagnosis and service becomes very important when submitting claims for these services. Further, CMS will continue to allow critical care to be paid when done by a surgeon in the post-operative period of a 10- or 90-day global period. However, remember the critical care must be unrelated to the anatomic site or general surgery procedure that was performed. In these scenarios, one will use the new HCPCS Level II modifier FT, and not CPT modifier 24 for reporting purposes. A note about the modifier FT – unrelated evaluation and management (E/M) visit during a postoperative, or on the same day as a procedure or another E/M visit. (Report when an E/M visit is furnished within the global period but is unrelated or when one or more additional E/M visits furnished on the same day are unrelated.) Do not use FT except in this situation even though the definition of the modifier does not say “critical care.” TELEHEALTH CMS notes that the term is used broadly to refer to medical services furnished via telecommunications technology. CMS uses the phrase “Medicare Telehealth Services” to refer to a subset of services that are on its list, and may be billed via interactive, audio, and visual communication. The CMS list of covered telehealth services during the PHE may be accessed at cms.gov/Medicare/ Medicare-General-Information/Telehealth/Telehealth-Codes. CMS continues to believe the waivers that allowed practices to have telehealth visits when the patient was at home, regardless of geography, will expire when the PHE ends. Many groups are lobbying Congress for action on telehealth. In the meantime, CMS did finalize any service(s) added under Category 3 of the telehealth services to remain on the list until December 1, 2023. These are primarily therapy-related services.

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MEDICARE UPDATES

TELEHEALTH AND BEHAVIORAL HEALTH The Consolidated Appropriations Act of 2021 allows telehealth for behavioral health services after the PHE ends. A face-to-face visit within 6 months prior to the telehealth visit is required and it also requires an in-person visit once every 12 months thereafter unless that would be “inadvisable or impractical” for the beneficiary. There are limited exceptions to this, so make sure any exceptions are well documented in the medical record. Phone-only will be allowed only if the provider has the capacity for real-time, audiovisual communication, but the patient is unable or unwilling. Again, make sure this is well documented in the record. Audio-only Modifier – FQ. The long description for this modifier is: The service was furnished using audio-only communication technology. This quote is from the final rule: “In the interests of monitoring utilization and program integrity concerns for audio-only telehealth services furnished under the terms of this exception, we proposed to create a service-level modifier that would identify these mental health telehealth services furnished to a beneficiary in their home using audio-only communication technology.” CMS is using this modifier to identify mental health services furnished to a beneficiary in their home, phone only. DO NOT use the new FQ modifier for non-mental health E/M services performed audio only. Telephone Calls (Clinicians with E/M Scope of Practice) – CPT 99441-99443. After the PHE, CMS is not proposing to continue payment for these codes because they are unable to waive the requirement that telehealth services be furnished via interactive, audiovisual communication. At that time, these services (and codes) will return to a non-covered status and

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will have decreased RVUs. ADMINISTRATION OF PREVENTIVE VACCINES Rate setting for these vaccines was addressed in the 2022 Final Rule: • Will continue to pay $30 per dose for administration of influenza, pneumococcal, and hepatitis virus vaccines • Will maintain the current rate of $40 per dose for the administration of COVID-19 vaccines through the end of the calendar year in which the ongoing PHE ends. Effective January 1 following the year in which the PHE ends, the payment rate for COVID-19 vaccine administration will be set at a rate to align with the payment rate for the administration of other Part B preventive vaccines. REMOTE THERAPEUTIC MONITORING (RTM) SERVICES There are two sets of new codes in the medicine section of CPT for Remote Therapeutic Monitoring services and Medicare will begin to cover these services in 2022. The code structure corresponds to codes in the Remote Physiologic Monitoring (RPM) subsection of E/M and mirror those services, while having some differences. The first set of codes is for the set-up of equipment and education and also for the device supply and monitoring for a 30-day period. These services will typically be done by clinical staff. The second set of codes is for professional management in a calendar month. continued on page 22

Comparison: Remote Physiologic Management & Remote Therapeutic Monitoring

Remote physiologic monitoring (RPM)

Remote therapeutic monitoring (RTM)

99453, 99454 for device, set up, and education and monitoring

98975, 98976, 98977 for device, set up, and education and monitoring

99457, 99458 for treatment management services

98980, 98981 for treatment management services

Physiologic measures

Non-physiologic measures

Considered E/M services, may be reported by physicians, May be reported by physicians, NPs, Pas, physical therapists, NPs, and PAs and others Clinical staff may bill incident to physician and NPP services Services may not be billed incident to a physical therapist; for codes that are not physician/NPP treatment work may be billed by a PT/OT or PT or OT assistant, supervised by PT/OT Data must be digitally uploaded

Date may be patient reported or digitally uploaded ACCMA BULLETIN | JANUARY/FEBRUARY 2022

2022 ACCMA COUNCIL

2022 ACCMA Council

Edmon Soliman, MD President-Elect

Albert Brooks, MD Secretary-Treasurer

Suparna Dutta, MD Immediate Past-President

DA–CON TR AME AL

Irene Lo, MD District 4-A

ASSOCIATION

Sonia Sutherland, MD District 2

A COS1T8 6 0MEDIC

INC

Lilia Lizano, MD District 1

Robert Edelman, MD President

R AT E D JA N

Ross Pirkle, MD District 3-A

Kristin Lum, MD District 3-B

Eric Chen, MD District 3-C

Arden Kwan, MD District 3-D

Jeﬀrey Poage, MD District 3-E

Irina Kolomey, MD District 4-B

VACANT District 5-A

Shakir Hyder, MD District 5-B

Terence Lin, MD District 5-C

Cliﬀord Wong, MD District 6

Thomas Powers, MD District 7-A

Steven Rosenthal, MD District 7-B

Stephen Post, MD District 8

Suresh Sachdeva, MD District 9

James Hanson, MD District 10-A

Terry Hill, MD District 10-B

Judith Stanton District 10-C

Richard Rabens, MD District 10-D

Rollington Ferguson, MD District 10-E

Alexander Kao, MD District 11

Jonathan Savell, MD District 12-A

Harshkumar Gohil, MD District 12-B

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

2022 ACCMA COUNCIL

2022 ACCMA Council

Kiran Narsinh, MD District 1 - Alternate

Eric Alexander, MD District 2 - Alternate

Michael Stein, MD District 3 - Alternate A

VACANT District 3 - Alternate B

Colin Manseld, MD District 3 - Alternate C

Joshua Perlroth, MD District 3 - Alternate D

Kenneth Grullon, MD District 3 - Alternate E

VACANT District 4 - Alternate A

Nimisha Mishra-Shukla, MD District 4 - Alternate B

Jeﬀrey Stuart, MD District 5 - Alternate A

Gautam Pareek, MD District 5 - Alternate B

Basil Besh, MD District 5 - Alternate C

Qaiser Niaz, MD District 6 - Alternate

Chao Ho, MD District 7- Alternate A

Renee Wachtel, MD District 7 - Alternate B

Robert Deutsch, MD District 8 - Alternate

Paul Wotowic, MD District 9 - Alternate

Katrina Saba, MD District 10 - Alternate A

Warren Strudwick, Jr., MD District 10 - Alternate B

Gary Goldman, MD District 10 - Alternate C

Sijie Zheng, MD District 10 - Alternate D

Renee Fogelberg, MD District 10 - Alternate E

Rohini Noronha, MD District 11 - Alternate

Leena Mehandru, MD District 12 - Alternate A District 1: Crockett, El Sobrante, Hercules, Pinole, Richmond, Rodeo, San Pablo District 2: Concord, Martinez, Pleasant Hill District 3: Alamo, Lafayette, Moraga, Orinda, Walnut Creek

VACANT District 12 - Alternate B

Patricia Austin, MD AMA Delegate

Mark Kogan, MD AMA Alternate Delegate

Katrina Peters, MD CMA Trustee

Suparna Dutta, MD CMA Trustee

District 4: Antioch, Brentwood, Byron, Clayton, Oakley, Pittsburg District 5: Fremont, Newark, Union City District 6: Castro Valley, Dublin, Hayward District 7: San Leandro, San Lorenzo District 8: Alameda District 9: Danville, Diablo, San Ramon District 10: Oakland, Piedmont, Emeryville District 11: Albany, Berkeley, El Cerrito, Kensington District 12: Livermore, Pleasanton

ACCMA BULLETIN | JANUARY/FEBRUARY 2022

MEDICARE UPDATES

(continued from page 19)

RTM is the review and monitoring of data related to signs, symptoms, and functions of a therapeutic response. Data may be objective device generated, integrated data, or subjective inputs by patients (this element differs from RPM). The data must be reflective of a therapeutic response that provides a functionally integrative representation of patient response. Things one needs to remember about RTM: • Services must be ordered by a physician/NPP. • A physician or other qualified health care professional uses the results. • Do not use these codes if a more specific CPT code exists for the service. • Do not double count time when billing for these services. • 98980 and 98981 require at least one interactive communication with patient or caregiver, which contributes to the time. • CPT book has a long list of codes “do not count time on date when” another service is done – review it carefully! OTHER PROVISIONS OF THE FINAL RULE • The penalty phase for Appropriate Use Criteria (AUC) will not take effect until 1/1/23 or on January 1 following the end of the PHE, whichever is later. • Co-insurance for planned colorectal screening services that become diagnostic or therapeutic will be phased out to 0 between 2023 and 2030; it remains at 20% for 2022. • A patient who is enrolling in hospice may now elect a physician/NP/PA from an RHC or FQHC beginning in 2022.

Performance Category Weights: For 2022 performance year/2024 payment year, the performance category weights are 30% for quality, 30% for cost, 15% for improvement activities, and 25% for promoting interoperability. • Promoting Interoperability: Revises reporting requirements for promoting interoperability. • Cost Performance Category: Adds five new episode cost-measures to the cost category. • Performance Threshold: Establishes a performance threshold of 75 points, an increase of 15 points from last year. The MIPS changes are discussed in more detail in the Medicare 2022 on-demand webinar at pathlms.com/ medical-society. The New Year has begun; it is the time of year to start using new CPT and HCPCS codes, billing Medicare for new services allowed, and time to update your systems to start gathering MIPS data. Please remember your ACCMA team has a number of member resources to help you with any of these issues. Contact the ACCMA by emailing accma@accma.org or calling 510-6545383. •

QUALITY PAYMENT PROGRAM In the Quality Payment Program section of the Final Rule, CMS finalized changes to reporting and participation options for providers in the program. There are several new policies designed to offer additional assistance and flexibilities to small practices. Access the Medicare 2022 on- demand webinar at pathlms.com/ medical-society to review these policies. In 2023 the MIPS Value Pathways (MVPs) will go into effect, beginning with seven measure options. The rule establishes scoring policies for MVPs and subgroups. Beginning in the 2026 performance year, multispecialty groups must form subgroups if they report MVPs. Subgroup reporting enables reporting of information about performance at a more granular level and would be limited only to clinicians reporting through MVPs or Alternative Payment Mode Performance Pathway. To allow for a transition, subgroup reporting would be voluntary for the 2023, 2024, and 2025 performance years. The rule also makes the following notable changes to MIPS for the 2022 performance year (2024 payment year): 22

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REGISTRY

PLACEMENT

FIRM

Physicians

Nurse Practitioners Physician Assistants

Locum Tenens Permanent Placement Voice: 800- 919- 9141 or 805-641 -9141 FAX : 805- 641 -9143 jnguyen@ t r acyzw eig.com w w w.t r acyzweig.com

ALAMEDA ALLIANCE

Advancing CalAIM, Implementing Medi-Cal Rx, and Increasing Vaccine Rates By Scott Coffin, Alliance CEO

lameda Alliance for Health (the Alliance) is proud to serve over 297,000 children and adults in Alameda County. In this article, you will read about the launch of Enhanced Care Management, Community Supports, and the transition of major organ transplants into Medi-Cal managed care, all major components of the California Department of Health Care Services’ (DHCS) program California Advancing & Innovating Medi-Cal, better known as CalAIM. You will also learn the latest updates on the implementation of Medi-Cal Rx. Lastly, you will learn about our ongoing efforts to increase COVID-19 vaccination rates among our members, and about the importance of our work with community partners during this critical time. As part of the long-awaited multi-year initiative CalAIM, on January 1st, the Alliance launched Enhanced Care Management (ECM), Community Supports (previously known as In Lieu of Services or ILOS), and transitioned all major organ transplants—three major CalAIM components that will help us improve care for some of our most vulnerable members. These key CalAIM initiatives will assist us in addressing social determinants of health, leading to the improved physical health of our members, and helping us better support children with complex medical conditions, coordinate re-entry services for justice-involved individuals, and deliver a broader range of services to aging adults. Building on the successes of the Health Homes Program (HHP) and Whole Person Care (WPC) pilots that the Alliance previously implemented, we have successfully launched the ECM benefit and transitioned approximately 1,000 members who were previously enrolled in the HHP and WPC care management programs, and who will continue to be engaged and connected to clinical and nonclinical services to meet their health care goals. ECM is a member-centered benefit that provides services to help individuals manage and improve their health. These services include outreach and engaging members in their care, comprehensive assessments of the member and development of a care plan to manage their care and meet their goals, enhanced coordination of care, and providing support to ensure that

the member can monitor and manage their health. Additional services include helping members safely transition out of the hospital or other treatment facilities, supporting the member or their family by educating them about health issues and options to improve treatment adherence, and finally connecting the member to community and social services. In addition to the launch of the ECM benefit, the Alliance has successfully introduced the Community Supports services, which are social determinants of health services delivered through our community-based provider network to eligible members. The addition of social determinants of health is expected to help our members avoid hospital stays, to reduce visits to the emergency department, and to improve their overall wellbeing. The following Community Supports services are now available to eligible members: • Housing Transition Navigation Services to assist members with obtaining housing • Housing Deposits to help members identify, secure, and coordinate funding necessary to enable them to establish basic housing • Housing Tenancy and Sustaining Services with the goal of providing safe and stable tenancy once housing is secured for members • Recuperative Care to provide short-term integrated and clinical care for individuals who no longer require hospitalization but still need to heal from an injury or illness • Asthma Remediation to provide physical modifications to a member’s home environment to help ensure their health, welfare and safety and reduce acute asthma episodes • Medically Tailored Meals/Medically Supportive Food and Nutrition to help members achieve their nutrition goals of regaining and maintaining their health In order to better prepare us for the launch of these services, the Alliance conducted community listening sessions and hosted provider trainings to help our provider partners understand the ECM benefit and Community Supports, who it serves, as well continued on page 24 ACCMA BULLETIN | JANUARY/FEBRUARY 2022

ALAMEDA ALLIANCE

(continued from page 23)

as other important details about the program. Our teams are prepared to continue to offer guidance to providers about ECM and Community Supports and assist with future referrals to these important services. We encourage our provider partners to contact us with questions or concerns about these programs by calling our Case Management Department at (510) 7474512 or by emailing our team at ecm@alamedaalliance.org. Additionally, the DHCS has developed a Provider Tool Kit on ECM that can be found at bit.ly/32J0Co6 and an explanation of Community Supports at bit.ly/3rWoDAI. Lastly, as part of CalAIM, we are happy to report that we have successfully transitioned the major organ transplant benefits into Medi-Cal managed care. The Alliance previously administered kidney and corneal transplants for our members, and as of January 1st, we are now administering all major organs, including bone marrow, heart, liver, lung, combined liver and kidney, and combined liver and small bowel transplants. While much work lies ahead, we are encouraged by the CalAIM initiatives and the immense opportunity it provides us with to offer higher quality care and more equitable health outcomes to Alliance members and to the entire Medi-Cal population. MEDI-CAL RX Another major recent statewide change includes the implementation of Medi-Cal Rx, which was completed on January 1st. Medi-Cal Pharmacy Benefits are now being administered through the fee-for-service delivery system and our Medi-Cal members are now receiving prescriptions through the state-wide administrator Magellan Medicaid Administration Inc. (Magellan). The Alliance continues to support physician-administered drug treatments for Medi-Cal members, and we fully maintain administrative responsibilities for members enrolled in Alliance Group Care. Following the January 1st implementation, Medi-Cal beneficiaries and pharmacies are reporting issues across the state, including excessive wait times for Medi-Cal members, pharmacists, and physicians to reach Magellan’s Call Center. Additionally, authorization denials for prescriptions submitted by pharmacies are being reported, as well as eligibility errors, causing delays for our members to access their medications. The Alliance’s Pharmacy team has been assisting our members, contracted pharmacies, and physicians by escalating issues to Magellan and DHCS. Providers can reach out to the Medi-Cal Rx Call Center at (800) 977-2273 or visit www.medi-calrx.dhcs.ca.gov to speak to a call center representative. For general Medi-Cal Rx questions, please email rxcarveout@dhcs.ca.gov.

INCREASING VACCINATION RATES With the highly contagious Omicron variant circulating in our communities, the Alliance continues to prioritize efforts to increase the number of Alliance members who are vaccinated with lifesaving COVID-19 vaccines. Currently, 70.1% of our Medi-Cal members 12 years and older have received at least one dose of the COVID-19 vaccine, an 8% increase from the baseline rate that we reported to the DHCS when we first began our Vaccination Incentive Program. In addition to mailing Gap-In-Care reports to our contracted physicians with information on which of their patients are not yet vaccinated, the Alliance continues to offer our Physician Incentive Program, which compensates providers and their staff for increasing vaccination rates among our members. Solo practitioners and multi-provider practices participating in this program will receive $50 for each of their assigned patients who receives a COVID-19 vaccine from October 1, 2021 to February 28, 2022. If you have any questions, call our Provider Services team at (510) 747-4510. In addition to ongoing collaborations with our provider partners, we continue to work with the Alameda County Health Care Services Agency (HCSA) on vaccination and health education efforts at Santa Rita Jail and in the community through the DOOR program, which provides door-to-door outreach involving neighbor-to-neighbor conversations about the safety and effectiveness of the vaccines. We have also launched our hyperlocal media campaign which includes ongoing social media engagement as well as ads on the BART system and AC Transit buses that will run through March. Live after-hours outbound calls to unvaccinated members with information and resources about the COVID-19 vaccines began in mid-December, and lastly the Alliance continues to offer our members with information and resources to ensure that those most at risk for severe disease are best protected, and to encourage safer choices this winter to the entire community. ABOUT ALAMEDA ALLIANCE FOR HEALTH Alameda Alliance for Health (Alliance) is a local, public, not-forprofit managed care health plan committed to making high-quality health care services accessible and affordable to Alameda County residents. Established in 1996, the Alliance was created by and for Alameda County residents. The Alliance Board of Governors, leadership, staff, and provider network reflect the county’s cultural and linguistic diversity. The Alliance provides health care coverage to over 294,000 low-income children and adults through National Committee for Quality Assurance (NCQA) accredited Medi-Cal and Alliance Group Care products.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

COUNCIL REPORT

OCTOBER 14, 2021

The Council meeting was called to order by Doctor Suparna Dutta, President. Mr. Greaves gave an update on staffing changes, stating that Ms. Perez is no longer with ACCMA. Mr. Greaves discussed Ms. Mullins’ promotion to Associate Director of Education and Events and expanded roles for Ms. Lum and Mr. Lopez. Jyothi Marbin, MD, Director, UCSF/UCB Joint Medical Program, gave a brief description of the Program’s mission and an overview of its partnership with ACCMA. The program will celebrate its 50th anniversary in 2022. Doctor Marbin discussed the 2021 scholarship recipients, who were Nate Bohm-Levine, Camila Hurtado, and Mekhala Hoskote. She asked Council members to reach out regarding preceptorships. Doctor Dutta asked the Council for nominations for Alternate Councilors in the following vacant positions: District 3, District 4, and District 12. The Council approved the ACCMA Success Plan, which outlines core focuses and strategies for continuing to strengthen the organization over the next 3 to 5 years. The plan was presented at length at the previous meeting and was modified slightly in response to feedback from the Council. The Council accepted a report from the Executive Committee regarding an interim action taken by the Executive Committee in support of a Contra Costa County Board of Supervisors resolution declaring COVID-19 misinformation a public health emergency. Mr. Greaves noted that ACCMA advocacy resulted in some earned media, including an interview on Telemundo. The Council approved the nomination of Doctor Lubna Hasanain to the DHMC Health Equity Committee. The DMHC Health Equity and Quality Committee will provide initial recommendations to the DMHC Director for standard health equity and quality measures, including annual benchmark standards for assessing equity and quality in health care delivery. The AMA Delegates reported that the Special Meeting of the AMA House of Delegates (HOD) will be held virtually November 12–16, 2021. The CMA Trustees reported that the CMA Board of Trustees has not met recently, and that CMA is currently preparing for the virtual House of Delegates meeting later in October. The Council discussed the No Surprises Act, which takes effect on January 1, 2022. The new rule focuses on the independent dispute resolution process for insurers and physicians to resolve their payment disputes, as well as the provisions relating to good faith estimates for uninsured individuals, and the patient-provider dispute resolution process. The CMA, AMA, and specialty societies and the national hospital associations have all expressed serious concern with the new rule. CMA believes the rule is inconsistent with the No Surprises

Act statute and Congressional intent to establish a balanced independent dispute resolution process (IDR). Mr. Greaves reported that the CMA Board of Trustees would be taking a position on the Outpatient Dialysis Initiative at its meeting later this month. This initiative would require at least one licensed physician, nurse practitioner, or physician assistant to be on site during treatment at outpatient kidney dialysis clinics. The Council was provided information about a request to members of Congress asking that they cosign two highpriority “Dear Colleague” letters for physicians and their patients regarding the Public Service Loan Forgiveness and Medicare Payment Cuts. The Council also discussed CMA urging Congress to address two of our nation’s highest health care priorities in President Biden’s Build Back Better social programs infrastructure legislation—permanent access to more affordable health insurance through the Affordable Care Act (ACA) and lowering the cost of prescription drugs. Mr. Greaves gave an update on MICRA and noted that there is increased activity and that fundraising efforts are underway. Members of the Council reported on efforts to elicit support from local hospital medical staffs. The Council was provided a copy of the ACCMA Open Letter from hundreds of East Bay physicians urging their patients to get vaccinated. Mr. Greaves noted that the letter generated some earned media for the ACCMA and acknowledged Doctor Albert Brooks, who represented ACCMA in an interview with KRON4. Mr. Greaves reported that at this time, the Alameda County Health Officer is not interested in issuing a Health Officer Order requiring patrons to show proof of vaccination or a pre-entry negative test for certain businesses like indoor dining, bars, and gyms. The County has other strategies it is currently employing to encourage people to get vaccinated such as the Vaccine Incentives Program. Mr. Greaves noted that this item would be considered by the Community Health Committee at its meeting later in the month. The Council discussed Bay Area Health Officers issuing criteria for lifting COVID-19 indoor masking requirements. The counties of Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, Sonoma, and the City of Berkeley will lift the indoor masking requirement in public spaces not subject to state and federal masking rules when the criteria are met. Ms. Lum discussed the ACCMA history book written by Mr. Donald Waters and informed the Council about the author’s presentation on November 17, 2021. Ms. Lum gave an update on membership stating that membership is down compared to last year, as well as an update on upcoming webinars and events. There being no further business, the meeting was adjourned.

Join the ACCMA at www.accma.org/membership/join-now ACCMA BULLETIN | JANUARY/FEBRUARY 2022

CLASSIFIEDS

The Joint Medical Program is seeking physicians to host student preceptorships! The Joint Medical Program (JMP) is a joint program between UC Berkeley and UCSF. Over the first two and half years of medical school, our students concurrently learn about foundational sciences, clinical medicine, and complete a master’s in science, all on the UC Berkeley campus. They then complete the remainder of their medical degree at UCSF. The goal of the JMP is to train anti-racist physician change-makers committed to health equity and social justice. JMP students participate in clinical preceptorships as part of their preclinical education. These sessions provide them an opportunity to practice clinical skills and to observe medicine in action. Preceptorship sessions may be held in-person and/ or via telehealth. Preceptors can schedule these sessions

directly with their assigned student(s) on a flexible schedule. Students are required to complete a total of 3–4 half-days (or a total of 12–16 hours) over the academic year (September– July). During these sessions, students are expected to have the opportunity to practice and receive observation and feedback on patient histories, and physical exams (to the extent possible, if precepting via telemedicine visits), oral presentation, and notes. Our students consistently describe these experiences as among the most meaningful learning opportunities of their preclinical years. We are looking for physicians able to precept one or more medical students for 3–4 half day sessions over the coming academic year. If you are interested, please contact Jessie Heminway at jmp_programs@berkeley.edu.

IN MEMORIAM George W. Bauer, MD (1933–2021) passed away in Castro Valley on November 13. He graduated valedictorian at Grant Union High School in North Sacramento in 1951. He attended UC Berkeley, where he fast tracked his pre-med courses to get into George Washington Medical school. Dr. Bauer spent two years as a medical doctor in the US Army, where he served stateside. In 1964, he began his internal medicine practice at Doctors Hospital (now San Leandro Hospital). He was an exceptional physician, making rounds to his patients in the hospital 7 days a week to ensure their needs were attended to. In 2003, at the age of 70, Dr. Bauer retired from medicine. He was a father of 5, grandfather of 12, and great-grandfather of 5. He was a member of the ACCMA for 53 years.

by a fellowship in Nephrology at San Francisco General Hospital (UCSF). He joined what became the Oakland Medical Group in 1969, and in 1970 started the Chronic Hemodialysis Program at Providence Hospital in Oakland, making him the first physician to provide dialysis services in the East Bay. He later worked with the East Bay Nephrology Group and the Santa Rosa Medical Clinic. A generous volunteer, Doctor Weaver traveled extensively to bring his medical skills to underserved areas around the world (Thailand, American Samoa, Cambodia, Malawi, and Peru) and community and rural clinics in California. He was also heavily involved in local community activities. He is survived by his son and two sisters. He was a member of the ACCMA for 48 years.

John Carrel Weaver, Jr., MD (1936–2021) passed away at Highland Hospital, where he once served his medical residency, on November 12. He was an Oakland native who graduated from Piedmont High School, Stanford University, and Northwestern University School of Medicine. He served his internship at Highland Hospital from 1962 to 1963. Following that, Dr. Weaver served active duty as a US Navy doctor with the Marine Corps in Japan. He returned to a medical residency at Highland Hospital, followed

NEW & RETURNING MEMBERS Omar M. Murad, MD Endocrinology, Diabetes and Metabolism Berkeley Endocrine Clinic Sukwinder S. Sandhu, MD Gastroenterology

Explore ACCMA Volunteer Opportunities! Visit ACCMA.org/Volunteer, or call ACCMA at (510) 654-5383 to find out more.

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COUNCIL REPORTS

we are still in this

TOGETHER and We Are Here for You Serving our Community Since 1996

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