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SDCMS "News You Can Use" (2012.01.09)

by: San Diego County Medical Society
Published January 9, 2012

SDCMS “News You Can Use”
— January 9, 2012

Governor’s Proposed 2012–13 Budget
The budget aims to fill a projected shortfall of $9.2 billion dollars ($4.1 billion in the current budget year and $5.1 billion in 2012–13) and create a $1 billion reserve, for a total of $10.1 billion in “solutions.” The governor proposes to close the deficit through a combination of $4.1 billion in cuts to public programs coupled with $5.1 billion in new revenues from a proposed tax initiative that will appear on the November 2012 ballot, and approximately $1 billion in borrowing and fund shifts. If the governor’s tax initiative is unsuccessful, the budget outlines cuts totaling $5.39 billion, which fall primarily on education programs such as Proposition 98 (K–14 spending), the University of California, and the California State University.

Issues of Concern to Physicians
Of concern to physicians, included in the 2012–13 budget proposal are the following:

  • Elimination of the Healthy Families Program and Transition of Enrollees Into Medi-Cal: This proposal, which was debated but not adopted last year, would transition all 900,000 Healthy Families children into Medi-Cal. While the governor claims that this proposal would “prepare the state for health reform,” federal reform would only move about one-quarter of the children from one program to another. This proposal moves well beyond this, and may have the effect of straining the already overburdened Medi-Cal delivery system. Estimated savings: $64.4 million (2012–13) and $91.5 million (2013–14).
  • Mandatory Enrollment of Medi-Cal / Medicare Dual Eligibles Into Medi-Cal Managed Care: Under this proposal, all 1.2 million dual eligibles would be required to join a managed care plan, which would coordinate benefits from both programs. Recently adopted CMA policy (HOD 203-11) specifically opposes this move due to concerns about continuity of care and access to specialists. Estimated savings: $678.8 million (2012–13) and $1 billion (2013–14).
  • Medi-Cal Managed Care Expansion Into Rural Counties: The governor proposes to expand the Medi-Cal Managed Care program into rural counties that do not currently have managed care infrastructure. This transition would happen gradually over time. It is unclear whether all rural counties would have the physician networks and healthcare infrastructure to support managed care. Estimated savings: $2.7 million (2012–13) and $8.8 million (2013–14).
  • The FamilyPACT Program, the Every Woman Counts Program, and the Prostate Cancer Treatment Program Moved to Department of Health Care Services (DHCS): Unlike previous years, none of these programs is proposed to be cut, but administration of them will be moved to a new department.
  • Securing 'Operational Flexibilities' in the Medi-Cal Program (benefit design, service delivery, etc.): This proposal is largely undefined, but could include reducing benefits or changing care delivery models. Estimated savings: $75 million (2012–13).

Now that the governor has released his proposal, the Budget Committees in both houses of the Legislature will begin considering it in the next few weeks. CMA will be actively lobbying against reductions to healthcare programs and will inform members and staff as appropriate. The Legislature and the governor may move quickly on the state budget this year in order to leave time to campaign for the tax initiative in fall 2012.

SGR Can Kicked Down the Road for Two Months to the End of February 2012
The bill signed by the president on Dec. 23 delayed the 27.4% Medicare pay cut due to the SGR formula for two months. It also extended the floor on the work geographic practice cost index (GPCI) and certain other policies. All of the other changes that were included in the Medicare physician payment final rule for 2012 will still take effect. Physicians should not expect that payment rates will remain unchanged. As detailed in this AMA memo from Nov. 4 following the release of the final rule, numerous changes are being made in the relative value units, GPCIs, electronic prescribing and quality reporting programs, and multiple procedure payment rules for 2012. All of these changes will take effect as scheduled for dates of service beginning Jan. 1, 2012. In addition, although P.L. 112-078 provided for a 0% update to the Medicare conversion factor, the final rule indicated that there would be a 0.18% increase in the conversion factor for budget neutrality, and this change will also be effective Jan. 1, 2012. Click here for further details.

Executive Director Comment: This (directly below) is a billing gotcha — please check to make sure your office staff have the answers to the obvious questions!

HIPAA 5010 Compliance Deadline Has Passed
January 1, 2012, marks the compliance deadline for use of the new version of the standard electronic HIPAA transactions. Version 4010 has been in use since 2003, and CMS is requiring all HIPAA "covered entities," which includes physicians who conduct any of the transactions named in HIPAA electronically (i.e., claims or remittance advice), to begin using Version 5010 starting on January 1, 2012. Click here for details.

Click Here to Read "Encinitas Doctor Heads California Medical Association" from the Jan. 2 Union-Tribune

CONTENTS

  • January Is Cervical Health Awareness Month
  • 2012 Medicare Quality Reporting Program
  • Smartphones Blamed for Increasing Risk of Health Data Breaches
  • Medicare Opens Physician Claims to Researchers
  • Supreme Court Hears Arguments in Drug Patent Cases
  • Blue Cross Announced Changes to Prudent Buyer Contract
  • A Wave of New Changes to California Employment Laws for 2012
  • SDCMS' Brief EHR Implementation Survey
  • Receive Free EHR Implementation Assistance
  • SDCMS-CMA Seminars / Webinars / Events
  • San Diego County Healthcare Events

MEDICAL …

January Is Cervical Health Awareness Month
The CMA Foundation is part of the national Cervical Cancer-Free Campaign, engaged in efforts to reduce the prevalence of cervical cancer through increased screening and vaccination. For more information, click here.

FEDERAL …

2012 Medicare Quality Reporting Program
Several important changes in the Medicare quality reporting program for physicians take effect in 2012. Physicians who participate between 2011 and 2014 are eligible for incentive payments. Those who do not participate in 2013 and beyond will face a penalty beginning in 2015. Click here to read the complete article.

Smartphones Blamed for Increasing Risk of Health Data Breaches
Click here to read the complete article.

Medicare Opens Physician Claims to Researchers
A new regulation will allow the release of Medicare claims data for developing doctor quality scores starting in 2012. On Dec. 5, CMS finalized a regulation granting access to physician billing data to qualified organizations, including consumer groups and employers. Doctors' claims from 2009, 2010, and the first two quarters of 2011 will be available for analysis starting next year, according to the final rule. Click here to read the complete article.

Supreme Court Hears Arguments in Drug Patent Cases
U.S. Supreme Court justices in December heard oral arguments in two high-profile patent cases that could have widespread effects on patients who need certain drugs. Click here to read the complete article.

STATE …

Executive Director Comment: Another gotcha (directly below) — please don't do the usual "sure, I'll do anything"!!!

Blue Cross Announced Changes to Prudent Buyer Contract (from Dec. 12 NYCU)
Anthem Blue Cross notified its contracting physicians of changes to its Prudent Buyer Participating Physician Agreement effective April 1, 2012. The amendment includes SEVERAL changes, including an expanded confidentiality provision and several modifications to Exhibit F, which pertains to the Blue Cross Medicare Advantage PPO product. CMA has several concerns with the changes to Exhibit F, has expressed those concerns to Blue Cross, and is awaiting their response. Physicians are urged to carefully review and assess the impact the contract changes will have on their practices. Questions and concerns about the Prudent Buyer contract amendments should be directed to the Blue Cross provider care department at (800) 677-6669. Click here for details and resources.

A Wave of New Changes to California Employment Laws for 2012 • Click Here

  • New Mandatory Employee Notification Requirements
  • California Employers May be Required to Pay for Health Insurance for up to Seven Months
  • Commission Plans Must be in Writing by 2013
  • Restrictions on the Use of Consumer Credit Reports in Employment
  • New Independent Contractor Misclassification Liability
  • Human Trafficking Bill Requires Disclosure
  • Coverage of California Domestic Partners Under Health Insurance Plans Issues to Out-of-state Employers
  • Discrimination Based on Genetic Information
  • California's Organ Donation Leave Law Clarified
  • California's Antidiscrimination Laws are Broadened to Expressly Prohibit Discrimination Based on "Gender Identity" and "Gender Expression"
  • Medical Debts Exempt from Wage Garnishment
  • Increased Potential Liability for Minimum Wage Violations
  • Employment Acceleration Act Prevents State and Local Government from Requiring Employers to Use E-Verify Program
  • NLRB Notice Requirements

MEMBER BENEFITS …

SDCMS' Brief EHR Implementation Survey
Please click here to take SDCMS' brief survey to gauge where San Diego County's physicians stand with respect to the EHR implementation process. The results of the survey will be emailed to those physicians who complete the survey and request the results.

Receive Free EHR Implementation Assistance
Primary care practices of 10 or fewer practitioners can receive assistance in EHR implementation (internal medicine, family, adolescent, pediatrics, OB/GYN, or general practice all qualify through ARRA funding). contact Rob Yeates at Rob.Yeates@SDCMS.org or at (858) 300-2791.

SDCMS-CMA SEMINARS / WEBINARS / EVENTS — MARK YOUR CALENDARS
For further information or to register for any of the following SDCMS seminars, webinars, or events, visit http://SDCMS.org/event or contact Serena Sauerheber at (858) 300-2779 or at Serena.Sauerheber@SDCMS.org.

SAN DIEGO COUNTY HEALTHCARE EVENTS
To submit a community healthcare event for possible publication, email KLewis@SDCMS.org. Events should be physician-focused and should take place in or near San Diego County.

  • JAN 9: East County Oral History • Bully’s East • http://www.bullyseastsd.com/ • Fifth oral history session scheduled for East County at the monthly luncheons of RODEO. Lunch is $13 per person. No reservations are required. Lunch starts at noon and the oral histories will begin at about 12:30 PM and last about 45 to 60 min. • Email Dr. Ralph Ocampo for details: Ralph Ocampo ocamporr@cox.net
  • JAN 19–22: 9th Annual Natural Supplements: An Evidence-based Update • Hilton San Diego Bayfront • http://www.scripps.org/events/natural-supplements-an-evidence-based-update
  • JAN 21: Brain Tumors: 2nd Annual Collaborative Care Conference • Catamaran Resort Hotel, San Diego • Sponsored by UC San Diego School of Medicine • http://cme.ucsd.edu/braintumors
  • FEB 4–5: Bridging the Hearts and Minds of Youth: Mindfulness in Clinical Practice, Education, and Research • Catamaran Hotel, San Diego • http://cme.ucsd.edu/bridging/
  • FEB 9–11, 2012: 18th Annual Network of Oncology Clinicians and Researchers (NOCR) Meeting • Caesars Palace, Las Vegas • http://www.nocrannualmeeting.com/2012/index.asp
  • FEB 16: Introducing New Technologies to Patient Care: The Promise and the Perils • UC San Diego Telemedicine and Medical Education Building, La Jolla • http://www.regonline.com/Register/Checkin.aspx?EventID=1012115
  • FEB: 17–18: Cell Society: 2nd Annual Clinical Meeting • Coronado Island Marriott Resort • https://xmedicacme.com/cell_society
  • MAR 10–17: Timmy Global Health Mission Trip to Ecuador • Clinics seeing approximately 40 patients per provider per day. • http://www.timmyglobalhealth.org
  • MAR 12–16: Topics and Advances in Internal Medicine • Catamaran Resort Hotel, San Diego • http://cme.ucsd.edu/internalmed
  • MAR 15: Prescription Opioid Misuse Academy: The Dark Side of Prescription Opioids • An Educational Program of the American College of Medical Toxicology • Catamaran Resort Hotel, Mission Bay • http://www.acmt.net
  • MAR 17–18: Topics and Advances in Pulmonary and Critical Care Medicine • Catamaran Resort Hotel, San Diego • http://cme.ucsd.edu/internalmed
  • APR 19–22: California Orthopaedic Association Annual Meeting • Park Hyatt Resort in Carlsbad • http://www.coa.org/coa-annual-meeting.html
  • APR 25: Sharon’s Ride Run Walk for Epilepsy 2012! • Deanza Cove Mission Bay Park • $25 Individuals/$50 Family/Phil’s BBQ Lunch Included • 7:30am-1:00pm • http://sharonsride2012.kintera.org/
  • APR 27–29: 15th Annual California Health Care Leadership Academy • Disneyland Hotel, Anaheim, Calif. • Models of healthcare financing and delivery will change as implementation of federal health reform kicks into high gear. What are the best options for successful medical practice in the new environment? Hear from the experts and leaders of change, and attend a comprehensive slate of practice management seminars and workshops to position your practice for success. Details coming in January — stay tuned!
  • NOV 2: 13th Annual Science and Clinical Application of Integrative Holistic Medicine • Hilton San Diego Resort

Executive Director Comment: Written more than 170 years ago (below) by, of all people, a Frenchman — and wonderfully à propos …

“Scarcely any political question arises in the United States that is not resolved, sooner or later, into a judicial question.”
— Alexis de Toqueville

Read more about: Managing Your Practice, NYCU, News You Can Use

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