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"News You Can Use" <> August 4, 2014



Three Great SDCMS Training Sessions for SDCMS Members:

  • Taming Microsoft Outlook Workshop on Saturday, September 13, From 8:00am to Noon: Click Here for Details and to Register
  • Leader’s Toolkit Seminar on September 27–28 for Members Interested in Focused Learning About Leadership and Management: For details or to reserve your spot, email me at Gehring@SDCMS.org.
  • Work-Life Balance Workshop on Saturday, October 11: Take an honest look at your life, reacquaint yourself with what you find most meaningful, and then make the changes that will bring your life into greater balance! Join your colleagues and Helane Fronek, MD, certified physician development coach, on Saturday, October 11, from 9:00am to noon to begin to see your life, and your choices in it, in a new light! Workshop limited to 12 physicians. Email Dr. Fronek at hsfronek@aol.com for details or to reserve your spot today!

We Hope to See Everyone at the SDCMS Foundation Solana Beach Sunset 5K Run / Walk on Saturday, September 27 at 5pm: Click here for more information or email Kathleen.Kramberg@SDCMS.org for a team sign-up sheet.


Outbreak of Ebola in Guinea, Liberia, and Sierra Leone: Click Here

Ebola Hemorrhagic Fever Topics:

Free STD Clinical Update at Liberty Station on August 28, 12–5pm (3 Credit Hours): Presented by the California STD / HIV Prevention Training Center and the County of San Diego HHSA. Preregistration required. Click Here


10% Cut in Medi-Cal Rates: AB 97 requires the Department of Health Care Services (DHCS) to implement 10% provider payment reductions to most categories of services in Medi-Cal fee-for-service (FFS), as well as actuarially equivalent reductions in Medi-Cal managed care. Following are the dates on which providers will begin to see the reductions:

  • Medical Transportation: Sept. 5, 2013
  • Dental: Sept. 5, 2013
  • Durable Medical Equipment / Medical Supplies: Oct. 24, 2013
  • Pharmacy: January 9, 2014
  • Physician / Clinic: January 9, 2014
  • Distinct Part Nursing Facility Level B (PT 17 & AC 1,2,3): January 9, 2014

Additionally, since the 10% payment reduction is effective for services provided on or after June 1, 2011, DHCS will also begin recouping a percentage of provider payments to recover overpaid funds during this retroactive period. These retroactive payment recoveries will not occur until after the prospective 10% payment reductions are implemented. DHCS will provide at least 60-day advanced notification of scheduled recoveries.

FFS Payments: In order to preserve and protect access to care for Medi-Cal members, DHCS is also announcing the following provider payment reduction exemptions, subject to federal approval of State Plan Amendments (SPA):

  • Nonprofit dental pediatric surgery centers that provide at least 99% of their services under general anesthesia to children with severe dental disease under age 21 will be exempted prospectively from the 10% payment reduction. After required public notice, the effective date of this prospective exemption will be in the near future.
  • Distinct part nursing facilities, Level B, classified as rural or frontier, based upon the California Medical Service Study Area’s definitions, will be exempted prospectively from the 10% payment reductions and will not be subject to the rate freeze at the 2008–09 levels on a prospective basis. After required public notice, the effective date of this prospective exemption will also be in the near future.
  • Certain prescription drugs (or categories of drugs) that are generally high-cost drugs used to treat extremely serious conditions, such as hemophilia, multiple sclerosis, hepatitis, and others will be exempt from the 10% payment reduction. DHCS has submitted a SPA (SPA 12-014) to exempt these categories of drugs, with an effective date for the exemption of March 31, 2012.

Managed Care: As noted above, DHCS is required to make actuarially equivalent reductions to Medi-Cal managed care. Such reductions will be effective on October 1, 2013, on a prospective basis only. DHCS previously announced that given the differences between managed care and FFS, reductions to pharmacy would not be applied in managed care. DHCS is now announcing that specialty physician services in Medi-Cal managed care will not be subject to a reduction. Guidance on the Medi-Cal managed care implementation will be issued soon in an All Plan Letter.

Future Information: Click Here

California Among Six States That Pay the Least for Medicaid Beneficiaries — Less Than $6,000 / Enrollee / Year: Medi-Cal fee-for-service pays on average 61% of what private insurers pay for the same E/M services, with Medi-Cal managed care paying only 65%. California continues to move forward with a 10% Medi-Cal rate cut, passed by the legislature in 2011. CMA is aggressively urging the Legislature and the governor to restore the 10% cut, ensuring Med-Cal patients have timely access to quality medical care. Click Here for Details

Primary Care Physicians: There’s Still Time to Attest! Eligible physicians who have already attested have received over $200 million in ACA primary care rate increases — don’t miss out! To qualify for enhanced payments for fee-for-service Medi-Cal and Medi-Cal managed care plans, you must first self-attest to your eligibility. The deadline to attest, if you haven’t already done so, is December 31, 2014. If you have attested and not received your additional funds, you should confirm the accuracy of the information submitted through the attestation process. If you have questions, call Medi-Cal’s Telephone Service Center at (800) 541-5555. For more information, see CMA’s “Medi-Cal Primary Care Physician Rate Increase FAQs.” Click Here for Details


How to Dispute Incorrect Sunshine Act Data Before It Goes Public: Physicians have until August 27 to review and dispute reports about their financial interactions with manufacturers of drugs and medical devices under the Physician Payments Sunshine Act. The data will be released to the public on Sept. 30. Click Here for Details


Blue Shield Data Breach Affects California Doctors: The data breach disclosed the Social Security numbers as well as names, business addresses, telephone numbers, medical groups, and practice areas of over 18,000 physicians who contract with Blue Shield of California. Click Here for Details

United Healthcare Fined $173 Million by California Insurance Commissioner: Click Here for Details

Medical Board Urges Physicians to Use Online License Renewal System for Fastest Processing — System Still Experiencing Delays: Click Here for Details


Spread the Message of Health! The SDCMS Foundation is partnering with the County of San Diego to educate community members on how to improve their lives and take charge of their health by launching a Live Well Physicians’ Speakers Bureau. Will you make brief presentations at your neighborhood school, community center, or place of worship? Your voice is important as we collectively work together — "Physicians United for a Healthy San Diego."  Contact Barbara.Mandel@SDCMS.org to say YES, you will volunteer just one or two times a year, quarterly, or however your schedule allows.

September 20 CPPPH Workshop for Physician Health Committees: The California Public Protection & Physician Health, Inc. (CPPPH) is holding a workshop for members of medical staff and medical group physician health committees on Saturday, September 20, 9:00am to 12 noon, at the SDCMS Foundation, 5575 Ruffin Road, Suite 250, San Diego, CA 92123. Advance registration is required — click here.

“Physicians of Exceptional Excellence” — aka San Diego’s Top Docs — Gala on November 1: The gala honoring this year’s selectees will be held on Saturday, November 1 at the Birch Aquarium — mark your calendars!


Ask Your SDCMS Physician Advocate, Marisol Gonzalez:

  • Member Question: My patient has requested that I fill out a prescription to be filled in a Canadian pharmacy. Is this legal?
  • Answer: It is illegal for anyone except a drug manufacturer to import prescription drugs into the United States. Although the FDA does not always enforce the provisions against personal importation, it strongly discourages U.S. citizens from purchasing medications from other countries. Physicians should be conscious of potential liability risks when prescribing drugs from a foreign pharmacy for a patient. For more information, please see CMA ON-CALL document #3206, "Drug Prescribing: Drugs From Other Countries." SDCMS-CMA members can email Marisol Gonzalez, your SDCMS physician advocate, to obtain this document: MGonzalez@SDCMS.org.

Receive Specialty-specific Physician Compensation Data: SDCMS member physicians who would like to receive specialty-specific compensation data from SDCMS’s 2013 Physician Workforce and Compensation Survey can email Gehring@SDCMS.org.

Follow SDCMS’ Twitter Feed and Get a Treasure Trove of Healthcare News Delivered Daily to Your Smartphone: Click Here

Is Your Office Manager / Practice Administrator Using SDCMS’ Online Forum? Click Here to Join


CMA's "Covered California: Know Your Participation Status" Guide: Click Here

Resources for SDCMS-CMA Member Physician Practices Only:

Resources for All Physician Practices:


July Event Looked at Current State, Trends, Practical Issues of Concierge Medicine: Click Here

“Laughter and tears are both responses to frustration and exhaustion. I myself prefer to laugh, since there is less cleaning up to do afterward.”
— Kurt Vonnegut, Jr., American Writer (1922–2007)

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