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"News You Can Use" <> December 17, 2014



Three-minute Video Update From SDCMS President Steve Poceta, MD: Click here if you’re at a computer. Click here if you’re on a smartphone or tablet.

We Think We’ve Earned Your Membership — We Want You to Join SDCMS!

  • CMA/SDCMS spent $8 million of CMA reserves and raised an additional $52 million to kill Prop. 46 to keep MICRA intact.
  • Medi-Cal: CMA held off a 10% across-the-board Medi-Cal cut for three years and ensured that the cut would not have to be repaid.
  • Permanently solved the GPCI inequity for San Diego County to the tune of roughly 5% of Medicare billings.
  • Kept optometrists from doing ophthalmology (as one example).

Click here to join or click here to renew your membership for 2015.

United Healthcare to Amend Physician Contracts to Include Medi-Cal Participation in Sacramento and San Diego Counties: Click Here



Question: One of our patients is recommending that their friend come to us for care. This friend has Covered California through Sharp HMO. We are not contracted with this plan. Are we OK to bill the patient directly? Click Here for the Answer



Mandatory Influenza Vaccination or Masking for San Diego County Healthcare Personnel: San Diego County’s public health officer has issued a health officer order mandating that all licensed acute care hospitals, skilled nursing facilities, ambulatory and community clinics, and ambulance providers in San Diego County develop a program requiring that their healthcare personnel receive an annual influenza vaccination and that persons who decline to receive the vaccine be required to wear a mask while in contact with patients or working in patient care areas during the influenza season. This action, in conjunction with your ongoing efforts to provide influenza vaccine to all of your patients six months of age and older, including pregnant women and persons with chronic medical conditions, will help reduce employee absenteeism and prevent the spread of influenza to vulnerable patients.



Join Your Fellow South Bay Physicians on Jan. 23 for a Networking Event and Social: Friday, January 23, 6pm–9pm. RSVP to JOhmstede@SDCMS.org for the address and details.

Don’t Have a Clue About Leadership and Need to Learn Quickly? SDCMS Members: Attend SDCMS’ Leader’s Toolkit seminar on March 14–15. For details or to reserve your spot, email me at Gehring@SDCMS.org. Filling up fast, only 3 more seats left.

Family Medicine / General Internal Medicine Physicians Needed to serve as role models and teachers to UCSD first- and second-year medical students in their Ambulatory Care Apprenticeship Program. Click Here for Details

UCSD PACE Program Is Recruiting Practicing Physicians Above Age 50 for a Compensated PACE Aging Physician Assessment (PAPA) Pilot Study: Contact Patricia Reid, MPH, at (619) 471-0569, or click here.

Can You Help Spread the Message of Health by Making a Brief Presentation in Your Community? 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. Contact Barbara.Mandel@SDCMS.org to say YES, you will volunteer just one or two times a year, quarterly, or however your schedule allows.

Free EHR Training From Alliant University: Through a federal grant, Alliant University now offers a free (no cost) EHR training and certification course for medical staff who are under-employed or working fewer than 32 hours per week. Candidates will get all training material electronically on a laptop that they can keep on completion of the program. It is good incentive for employees to get trained on EHR/EMR systems and get certification in healthcare information technology. Training cost otherwise would be $5,000 for certification. For more information, visit www.alliant.edu/asm or contact Ash Mehta at (858) 304-1500 or at amehta@patientclick.com.



Potential Medicare Pay Cuts Coming in 2015 — Participation Selections Due December 31, 2014: Physicians have until this December 31 to make changes to their status for 2015. In addition to the annual threat of steep payment cuts as a result of the SGR formula, 2015 will be the first year that CMS will impose penalties under the value-based modifier program for medical groups of 100 or more physicians. Click Here for Details

Lame Duck Session of Congress Adjourns, Leaving SGR Reform Until 2015: Click Here for Details

Congress Passes a Number of Healthcare Provisions in the Current Budget: Congress narrowly passed a $1.1 trillion federal budget that will fund most of the federal government through September 2015. Below is a summary of key healthcare provisions in the bill:

  • Congress asks CMS to reconsider the bundling of surgical codes in the final rule of the Medicare Physician Fee Schedule.
  • The budget includes $5.4 billion of emergency funding to prepare for and respond to the Ebola outbreak.
  • NIH will receive $30.3 billion (an increase of $150 million), including $283 million for Ebola-related research.
  • CMS receives no increase in funding over last year ($3.6 billion).
  • CDC will receive money to combat prescription drug abuse around the country.
  • The bill looks at the Medicare RACs and how audits may be reducing patient access to care.
  • The bill urges the Office of the National Coordinator for HIT to decertify EHR products that block the sharing of information and to certify only those products that meet current meaningful use program standards.

Click Here for Details

New Prescription Drug Prior Authorization Form Required on Jan. 1 for DMHC-regulated Products: Click Here for Details

Medicare Administrative Contractors (MACs) Continuing to Require Physicians to Revalidate Their Medicare Enrollments: Revalidation notices have been sent out and will continue to be sent out until March 23, 2015. Click Here for Further Information



United Healthcare to Amend Physician Contracts to Include Medi-Cal Participation in Sacramento and San Diego Counties: United Healthcare is pursuing regulatory approval to participate in the Medi-Cal Managed Care program in Sacramento and San Diego. The effective date will be determined once regulatory approval is received, but is expected to be sometime prior to January 1, 2016. In preparation, United Healthcare is mailing notices to 1,450 contracted physicians in San Diego County and 750 contracted physicians in Sacramento County beginning December 15. The subset of physicians in these counties will receive either a notice advising them that they have automatically been opted into the new Medi-Cal product or a written amendment requiring physician signature before it becomes effective that confirms the physician’s willingness to join the United Healthcare Community Plan. Rates and terms will be included with both notices. Physicians receiving the notice advising that they are being automatically opted in to the Community Plan have the option to opt out of the Community Plan product without affecting their underlying United commercial contracts. Physicians who do not wish to participate in the United Community Plan product must notify United of their decision to opt out within 30 days of receipt of the notification. The opt out notice should be sent via certified mail with return receipt, to United Healthcare, 1311 W. President George Bush Highway, Suite 100, Richardson, TX 75080-1152. Physicians with questions can contact United Healthcare’s Debra Pearson at (661) 944-5236. Click Here for Details

Supreme Court Opinion — Rashidi v Moser: The Supreme Court decided that in a medical professional negligence case where there is no evidence at trial of the proportionate liability of other defendants, section 3333.2 applies only to the amount of non-economic damages awarded in court and does not require an offset of amounts received in settlement. In other words, a defendant who goes to trial can be held liable for $250,000 in non-economic damages even if plaintiff recovered non-economic damages before trial from settling defendants. The court’s language did not question or undermine the broad scope of MICRA or its constitutionality, but instead was very focused on interpreting the narrow legal question at issue. Click Here to Read the Court's Decision



Get Insights on Patient Safety Delivered to Your Inbox: SDCMS invites you to sign up for The Doctor’s Practice, a complimentary monthly newsletter brought to you by our exclusively endorsed partner, The Doctors Company. Each issue of The Doctor’s Practice features a new article or video in a simple, one-click email. These articles feature expert tips to help you reduce malpractice risk, avoid claims, and make the practice of medicine more rewarding. Click here to sign up for this valuable publication. The insightful content in The Doctor’s Practice is part of The Doctors Company’s commitment to defending, protecting, and rewarding the practice of good medicine.

Dec./Jan. Issue of CMA Practice Resources:

  • Verifying Your Patients’ Eligibility and Benefits in 2015 May Save Your Practice Thousands of Dollars: Click Here
  • CMA Creates New Resource Summarizing Medicare Incentive and Penalty Programs: Click Here
  • DHCS Identifies Glitch in UCR Web App for CHDP Primary Care Rate Increase Payments: Click Here
  • Annual Medicare Benefit Changes: Click Here
  • New Reassignment of Medicare Benefits (855R) Enrollment Form Coming: Click Here
  • DMHC Audit Finds Anthem, Blue Shield Covered California Directories Misleading and in Violation of State Law: Click Here
  • Duals Project Sees Additional Setbacks: Click Here
  • Medi-Cal Provider Training Announced: Click Here
  • Reminder: Anthem Expanding Its Medi-Cal Managed Care Network: Click Here
  • The Coding Corner: CPT 2015: Summary of Additions and Revisions: Click Here

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



Please Spread the Word About Covered California Open Enrollment! Click here for a message from Peter V. Lee, Executive Director, Covered California, and Dustin Corcoran, CEO, CMA.

Enrollment Information and Deadlines:

  • Open enrollment for new coverage or change in plan runs Nov. 15, 2014, to Feb. 15, 2015.
  • Current enrollees will be automatically reenrolled in their plans (even if there has been a change in the premium rate) if they are making no changes (either tier level or plan).
  • Current enrollees who do want to make changes to their plans must do so by December 21 (extended from December 15) for the newly updated coverage to go into effect on January 1, 2015.
  • All changes must be made by February 15, 2015, for this enrollment period.
  • Medi-Cal enrollees don’t need to renew until they hear from Medi-Cal about next steps.

Physician Resources:


“Those who prepared for all the emergencies of life beforehand may equip themselves at the expense of joy.” — E.M. Forster, English Novelist, Short Story Writer, Essayist, and Librettist (1879–1970)

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