late-breaking news from your medical association volume XXI / no. 3 MAY 2014
local State Senator Leland Yee Suspended from State Senate Position The California State Senate voted on March 28, 2014 to suspend State Senator Leland Yee (D-San Francisco) following Yee’s March 26 arrest by the FBI on charges related to public corruption and gun trafficking. The FBI’s 137-page affidavit charges Lee with buying automatic firearms and shoulder-launched missiles from the Moro Islamic Liberation Front, an Islamist extremist group located in the southern Philippines, and attempting to re-sell those weapons to an undercover FBI agent. Yee, who represents part of San Francisco and most of San Mateo County, withdrew his candidacy for California Secretary of State after his arrest, but not in time to omit his name and candidate statement from the Voter Information Guide for the June Primary Election. Ironically, his statement boasts: “Under the Constitution, the Secretary of State’s job is to empower Californians to govern California, to guarantee fair elections, expose special interests, and prevent corruption. I am the Democrat who will represent everyone.” The California State Senate voted 28-1 to suspend Yee with pay. Senate President Pro Tem Darrell Steinberg (D-Sacramento) stated that the California Legislature has no authority to suspend a member without pay, but he vowed to introduce a constitutional amendment to go on the November ballot that would give future legislatures the option of suspending a member without pay under similar circumstances.
Aetna Launches Northern California ACO Initiative The Santa Clara Valley IPA (SCCIPA) has formed an accountable care collaborative with Aetna. The new ACO will commence next month and will include more coordinated management of SCCIPIA’s Aetna enrolled patients with chronic conditions such as diabetes and asthma. The ACO will be added to Aetna’s Whole Health product line for small and medium-sized employer groups. SCCIPA has about 800 physicians, including more than 550 specialists, providing care for 100,000 lives, and contracts for care with eight hospitals in Santa Clara County.
Measles Alert Confirms No New Measles Since March The county public health system has reported three additional cases of measles the last week of March in San Mateo County residents, for a total of four cases in the county since January 1. The index case in the new cluster had recently traveled internationally. The two secondary cases are epidemiologically linked to the Index. As of March 28, 49 cases of measles had been reported to the CDPH for 2014.
state MICRA Update On March 24 the trial lawyers and their front group, Consumer Watchdog, filed more than 800,000 signatures to qualify a measure on the November ballot that seeks to eliminate the $250,000 cap on noneconomic (pain and suffering) damages currently contained in the Medical Injury Compensation Reform Act (MICRA). Eliminating the cap is expected to quadruple the cost of medical liability premiums if adopted by the voters. The initiative also contains provisions regarding drug testing of physicians, which proponents of the initiative have said was only added because the idea of drug testing “polled well. ” The third part of the initiative requires physicians to check the CURES database before prescribing Schedule II and III drugs. A physician would be guilty of malpractice if the database was not checked. Unfortunately, CURES is currently not able to handle the amount of searches that would be initiated. The initiative will not receive a Proposition number until June. Doctors need to start talking to their patients now to urge a no vote on this initiative. Call SMCMA for background material and fact sheets.
state (continued) AMA Releases 2014 Economic Impact Study of Physicians The AMA released its 2014 Economic Impact Study, prepared by IMS Health, which tracks the reach of jobs output, wages and benefits and tax revenues generated by physicians. The report provides estimates in each of the 50 states, the District of Columbia, and nationally on four key economic indicators. In California total direct jobs supported by the physician industry amounts to 398,273, with indirect jobs amounting to 585,717, for a total of 983,990 jobs supported by the physician industry. Total sales revenue generated by the physician industry in California amounts to $162.6 billion. To review the report, go to the AMA website at www.ama-assn.org/go/EIS.
UC Pays Whistleblower Surgeon $10 Million In a whistleblower-retaliation case, the University of California Regents agreed to pay the former chairman of UCLA’s orthopedic surgery department, Robert Pedowitz, who had alleged that the medical school allowed doctors to take industry payments, $10 million. In 2012, the surgeon sued UCLA, the UC regents, fellow surgeons and senior university officials, alleging they failed to act on his complaints about widespread conflicts of interest and later retaliated against him for speaking up. The matter went to trial and the defendants settled shortly before the matter went to the jury.
Do You Have Concerns about Covered California’s Network Adequacy in our County? If you do, take action and send your specific complaints, with as much detail as possible, to all of the following organizations: Department of Managed Health Care (DMHC) - http://wpso.dmhc.ca.gov/contactform/ Covered CA - consumerprotection@covered.ca.gov Office of Patient Advocate (OPA) - contactopa@opa.ca.gov
2013 Medi-Cal EHR Incentive Payments Extended The deadline for providers to apply for Medi-Cal electronic health records (EHR) incentive payments for the 2013 program year has been extended by one month, to April 30, 2014. For more information and updates go to: www.medi-cal.ehr.ca.gov.
national Healthcare Spending Growth Highest in Decade According to the U.S. Department of Commerce, healthcare spending grew at a 5.6 percent annual rate in the fourth quarter of 2013. The growth, a ten-year high, is driven in large part by $8 billion more in hospital revenue, which according to USA Today was more than the prior four quarters combined. The healthcare spending makeup has changed in past decades. According to The Wall Street Journal, nursing care accounted for only 5 percent of health spending in 1960, but represented 13 percent in 2012. Hospital spending, however, is down, accounting for about 30 percent of spending in 2012 compared to 40 percent in 1980. Spending on physician services also declined, accounting for 23 percent of spending in 2012 compared to 25 percent in 1990. Medical devices declined sharply, 3.5 percent of health spending in 2012, compared to 8.5 percent in 1960.
Simple Test May Rule Out Heart Attack in ER According to the lead researcher in a Swedish study (Karoinska University Hospital) published in the Journal of the American College of Cardiology, a simple test in the emergency department may prevent at least 20 percent of hospital admissions for chest pain. The study showed that a blood test, combined with the usual electrocardiogram of the heartbeat, had a 99 percent accuracy rate, which allowed the emergency room physician to discharge patients rather than admit them to the hospital for observation. Of the 9,000 patients studied, only 15 suffered a heart attack the following month, and not one patient died.
Frequency of Diagnostic Errors in the U.S. According to the BMJ Quality and Safety Abstract published on April 17, the frequency of diagnostic errors in outpatient care in the U.S. adult population is 5.08 percent, or roughly 12 million persons annually. This analysis was an estimation compiled from three large observational studies on U.S. outpatients. The researchers defined misdiagnoses as “missed opportunities to make a timely or correct diagnosis based on the available evidence.” See www.qualitysafety.bmj.com.
U.S. Top 30 Accountable Care Organizations SK&A, a Cegedim Company, has identified 537 ACOs, with the number of physicians, nurse practitioners and physician assistants participating in ACOs exceeding 190,000. An ACO is the equivalent of a joint venture between physicians, medical groups, clinics, 2
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health systems, hospitals, and in many cases insurance companies. There are five types of ACO categories: 1) Medicare Shared Savings (MSS) Programs designed to coordinate care for Medicare fee-for-service beneficiaries; 2) Commercial ACOs, distinct from Medicare ACOs in that a commercial payer, rather than Medicare, is the entity providing the financial incentives for quality and cost performance to provider organizations; 3) Look-Alike ACOs, which contract with commercial plans in a similar model to other ACOs but do not contract with Medicare; 4) Medicaid ACOs, which is a fee-for-service program through Medicaid, also known as an Accountable Care Collaborative; and 5) Pioneer ACO, designed for early adopters of coordinated care that take on more risk than the MSS model. SK&A have identified the top 30 ACOs, ranked in terms of total number of physician affiliations. The number one ranked ACO is Partners Healthcare in Boston, which is a Pioneer model. The third, fifth, and seventh ranked ACOs are Hill Physician Commercial Models, with third-ranked Hill affiliation with Dignity/UCSF and Healthnet. Fifth ranked is Hill Physicians with Dignity Health and CalPERS ACO; and seventh ranked is Hill Physicians with St. Marys Medical Center, Saint Francis Memorial Hospital, UCSF Medical Center and Blue Shield. The only other northern California ACO ranked in the top thirty is Brown & Toland, which also has three separate programs: Brown & Toland Physicians ACO (a Pioneer model), ranked 21; Brown & Toland Physicians and CIGNA, ranked 25; and Brown & Toland Physicians and Blue Shield, ranked 26, both of which are Commercial models. There are two southern California ACOs in the ranking, Heritage California ACO, a Pioneer Model, and Heritage Provider Network & Blue Cross, a Look-Alike Model, both out of Northridge.
Some Interesting Facts About Epic Epic is a large, privately held health IT company best known for its EHR system. As most of you know, Epic has an impressive customers list including Kaiser-Permanente, Cleveland Clinic, Johns Hopkins Medicine, UCLA Health, Tex Health Resources, Massachusetts General, Mount Sinai and Duke. In total Epic has 297 customers, wth 70 percent of HIMSS Analytics Stage 7 hospitals using the EpicCare inpatient EHR system. CVS Caremark is switching from its proprietary System to Epic. When transition is complete, 51 percent of Americans will have an Epic record. Did you know that Epic was founded in 1979 by a woman, computer scientist Judy Faulkner, who coded the original Epic software? She remains the company’s CEO. All Epic systems are developed, implemented and supported in-house. Epic is the only major EHR vendor that is not a member of Commonwealth Health Alliance, an industry coalition aimed at increasing interoperability between EHR platforms. Epic is known for spending little money on sales and marketing efforts. The company has about one-quarter the sales staff of competitor Cerner. Epic systems are one of the most expensive on the market. Kaiser, for example, spent $4 billion.
Health Care Reform Triggers Benefits Action Among Employers Employers are reporting the increased impact of health care reform on various aspects of employee benefits. According to Health Care Reform: Full Steam Ahead, the first in a series of five research briefs based on The Prudential Insurance Company of America’s Eighth Annual Study of Employee Benefits: Today & Beyond, nearly half (49%) of employers report they are extremely or very likely to make a high-deductible health plan their only health insurance option.
FDA Approval Expected For User-Friendly Overdose Antidote The FDA approved a user-friendly opioid overdose antidote to help curb the growing public health crisis of U.S. overdose deaths. The new handheld device Evzio delivers a single dose of naloxone, a receptor antagonist that can quickly reverse the effects of opioid overdose via a small automatic injector. Many in organized medicine favor the availability of naloxone for patients, first responders and bystanders who can help save lives. California along with many other states have made it easier for health professionals to prescribe, dispense and distribute naloxone.
ICD-10 Delay a Costly Disappointment for Many Health Systems and Vendors Many provider organizations expressed frustration, disappointment, and concern over the one-year delay for ICD-10 implementation. The general view is that health systems will experience increased costs. Many facilities already added staff in anticipation of going live in October, and had entered into contracts with outside vendors who must now go back and see whether there are opportunities for delay. Another executive states that the delay will also prevent provider organizations from benefitting from the greater specificity that ICD-10 promises to deliver, which could be used to identify clinical outliers in order to improve care and bring down costs.
Private Equity Firms Investing in International Hospital Chains TPG, a private equity firm with many U.S. healthcare investments along with a pharmaceutical group, has agreed to acquire Chindex International for $461 million. Chindex is an American healthcare company but it operates and manages several hospitals and ambulatory clinics throughout China. Private equity firms have become mainstays among U.S.-based hospital operators, including Nashville-based Hospital Corporation of America (HCA). But the firms have also made a bigger push into international hospitals during the past several years. As an example, Sequoia Capital and Kohlberg Kravis Roberts have both invested in Apollo Hospitals, a major hospital chain based in India. Turkey’s largest hospital company, Medical Park, has also exchanged hands with several private equity firms. According to KPMG, global healthcare private equity deals have doubled from 2010 to 2011, with interest growing most in India, China, Brazil and Eastern European countries. MAY 2014
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medicare Breakdown of Top Fifteen Medical Specialties Ranked by Average Paid to Individual Billers On April 8, CMS released searchable, physician-specific Medicare claims data on its website. The spreadsheet files show for each physician his or her NPI, name, address, average charge and Medicare payment amounts, unique beneficiary counts, and other information. This action as taken after Freedom of Information Act requests were submitted, following a recent court decision that reversed an injunction that previously prevented CMS from making the data available to the public. More than one provider may submit bills under a physician’s NP,I so these figures, in many cases, distort extraordinarily high service volume. The top ten medical specialties ranked by average paid to individual billers are: Hematology/Oncology, Radiation Oncology;, Ophthalmology, Medical Oncology, Portable X-Ray, Rheumatology, Nephrology, Cardiology, Dermatology, and Interventional Pain Management. To view the CMS dataset go to: http://www.cms.gov and click Research, Statistics, Data and Systems in the top menu. Then scroll down to Statistic Trends and Reports and click Medicare Provider Utilization and Payment Data.
upcoming events Save the Date: SMCMA Annual Meeting Is Thursday, June 19 The SMCMA Annual Meeting of Members will take place on Thursday evening, June 19, at San Mateo’s Peninsula Golf and Country Club. Keynote speaker will be Zubin Damania, MD (aka ZDoggMD), hospitalist, CEO, and internet celebrity. Dr. Damania is CEO of Turntable Health, a membership-based direct primary care clinic in Downtown Las Vegas, and since 2010 has been writing and performing as ZDoggMD, known for his comedic raps and comedy sketches about medical issues and working in the medical field. Our Distinguished Service Award will be presented to Dirk Baumann, MD, vascular surgeon at Palo Alto Medical Foundation-PMC. Tickets will be available at $60 for SMCMA members and their guests, and $90 for all others. Invitations will be mailed to members in early May.
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