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"News You Can Use" <> March 31, 2014



Save the Date: San Diego-wide Physician Networking Opportunity & Mixer This Thursday, April 3Click Here for Details

Executive Director Comment: The MICRA fight is on! Last Monday, Consumer Watchdog, fronting for California’s trial attorneys, submitted ballot initiative petition signatures that will (unless there are signature validation problems) land an initiative aimed at gutting California’s Medical Injury Compensation Reform Act (MICRA) on the November 4, 2014, ballot. Every doctor, every hospital, every community clinic, and every patient will be touched unless we defeat this initiative. Until the completion of the signature validation process by county registrars of voters, the putative initiative will still be just that, putative. Assuming successful signature validation, on or about early July the initiative will be assigned a number and final language will be published. Counterintuitively, not much will happen “in front of the curtain” for the next month or so, while a huge amount will continue to happen “behind the curtain.” What can you do? Simple:

  • Recruit more members, recruit more members, recruit more members! We will need money, lots of it, to defeat the issue.
  • If you are not a member, you need to join.
  • Read NYCU religiously for updates on what’s happening and what to do.
  • Prepare yourself for an intense summer.
  • Prepare to be very, very disciplined — everyone will need to stay on message.
  • Visit www.cmanet.org/micra for ongoing updates and information relevant to the MICRA fight.

And on a Lighter Note, SDCMS Members Can Get Your Photo Professionally Taken: No risk. If you like it, you buy the photos; if you don’t, well, there’s always Photoshop. Click Here for Details

Practice Management Reminders:

  • March 31: Deadline for 2013 Meaningful Use Attestation in Medicare EHR Incentive Program: Click Here
  • March 31: Application Deadline for 2013 Medi-Cal EHR Incentive Program: Click Here
  • April 1: Practices Required to Use New CMS 1500 Claim Form: Click Here


The National Prescription Drug Take Back Day Is Saturday, April 26, From 10:00am to 2:00pm: Click here to access PDF flyers of drop-off locations across San Diego County for your patients.

Two San Diego Wound Botulism Cases Associated With Black Tar Heroin Injection: Click Here

New Measles Case Confirmed in San Diego: Click Here


CMS Suspends RAC Audits, Sets Up Physician Safeguards: Click Here for Details


Healthcare Changes Are Coming for Dually Eligible Medi-Cal and Medicare Patients! Effective April 1, 2014, the California Department of Health Care Services (DHCS) and the Centers for Medicare and Medicaid Services (CMS) will be rolling out Cal MediConnect, a new program to coordinate care for some of San Diego’s most vulnerable patients. Click Here for Details

Cal MediConnect Resources for SDCMS Members: Contact your physician advocate, Marisol Gonzalez, for a letter geared towards patients who are with the “contracting physician” or the “non-contracting physician,” or if you have any further questions about the Cal MediConnect program: MGonzalez@SDCMS.org or (858) 300-2783.

Aetna Seeks to Terminate Its Proposed $120 Million Class Settlement Over Use of Ingenix to Underpay Out-of-network Claims: Click Here for Details

Blue Cross Experiencing Problems With Electronic Eligibility and Benefits Information: Physicians are reminded that when unable to verify eligibility and benefits, they can require patients to pay at the time of service and issue a refund to the patient once benefits are verified and the claim is paid. Click Here for Details

CMA Files Brief in Case of Intentional Retaliatory Actions by Hospital CEO Against Physician Leader: Click Here for Details


Save the Date: Physician Networking Opportunity & Mixer This Thursday, April 3: Come mingle, socialize, and network with your fellow San Diego County physicians this Thursday, April 3, 2014, 5–8pm, at the Handlery Hotel, 950 Hotel Circle North, San Diego, CA 92108. All San Diego County physicians are welcome and encouraged to attend. Complimentary hors d’oeuvres and drinks will be served, and all attendees will be entered to win several exciting raffle prizes! Click here to RSVP or email your name and telephone number to Jen Ohmstede at JOhmstede@SDCMS.org. Call Jen with any questions at (858) 300-2781.

Save the Date: 17th Annual Western Health Care Leadership Academy on April 11–13: This year the Academy is thrilled to welcome keynote speaker Hillary Rodham Clinton, former secretary of state and former U.S. senator from New York. The conference will examine the most significant challenges facing healthcare today and present proven models and innovative approaches to transform your organization’s care delivery and business practices, with topics including leadership development, ACA implementation, and practice management. Visit www.westernleadershipacademy.com for more details.

Save the Date: SDCMS’s 2014 White Coat Gala Will Be Held on Saturday, June 14, 2014: At the Hyatt La Jolla at Aventine from 6:00pm to 11:00pm. J. Steven Poceta, MD, will be installed as SDCMS’s president for 2014-15, and Robert E. Peters, MD, PhD, SDCMS’s current president, will be recognized. Contact Jen with any questions at (858) 300-2781 or at JOhmstede@SDCMS.org.


Ask Your SDCMS Physician Advocate, Marisol Gonzalez:

Member Question: I am very concerned about the Cal MediConnect program, and how it will affect my Medi-Medi patients. How are patients being notified of their choices? Also, I do not contract with any of the participating plans, and I don’t plan to. How do I communicate this to my patients just in case they want to keep me as their physician?

Answer: Three separate notices will be mailed out 90, 60, and 30 days before the start of the passive enrollment period (May 1, 2014). The first notice will simply alert the beneficiary to the implementation of the duals demonstration program. The second notice will include information about plan benefits and provider networks to help them select a plan (these notices have already been sent out to dual eligible patients in San Diego County). The third notice will be sent out 30 days ahead and provide the beneficiary with information about their specific plan.

The state has chosen to do a “choice form” in order to give patients the opportunity to either choose a Cal MediConnect plan that will put them into a managed care plan for both their Medicare and Medi-Cal, or they can choose to remain in fee-for-service Medicare, but they must still pick a managed care plan for their Medi-Cal services.

If SDCMS members are interested in obtaining a letter geared towards patients who are with the “contracting physician” or the “non-contracting physician,” or if you have any further questions about the Cal MediConnect program, please contact your SDCMS physician advocate, Marisol Gonzalez, at MGonzalez@SDCMS.org or at (858) 300-2783.

March 2014 CMA Legal Affairs Case List, Updated: Click Here

SDMCS’s Discounted Disability Insurance Premium May Be Raised: If you submit prior to April 1, you can lock in the older/cheaper rates. Contact Brian Gerwe at SDCMS at (858) 300-2782 or at Brian.Gerwe@SDCMS.org for additional information. Click here to request an illustration.

Microsoft to End Windows XP SP3 and Office 2003 Support on April 8, 2014: 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


Covered California Patients Have Until March 31 to Switch Plans: Patients can contact the Covered California’s Service Center at (800) 300-1506 to switch to a different plan before the end of the open enrollment period, which is March 31.

Sign-up Extension: Individuals who start an online application by 11:59pm on March 31, 2014, will have until 11:59pm on April 15, 2014, to complete their application and select a plan. To start an application, the consumer must take at least the following steps:

  • Create an online account.
  • Fill out all required information on the “Apply for Benefits” page and hit “Continue.” Page 1 contains two required fields (click here to see application screen images).
  • After hitting “Continue,” individuals will be taken to the “Consent for Verification” page, where they need to click on “Save & Exit.”
  • They must return to their online account no later than April 15 to complete the application and select a plan.

Paper applications must be postmarked by March 31, 2014, to meet the open-enrollment deadline for 2014 Covered California plans. To guarantee coverage beginning May 1, 2014, however, consumers are encouraged to enroll online.

Three Major Exchange Plans Provide Guidance for Physicians: Health Net, Anthem Blue Cross, and Blue Shield of California — which account for approximately 75% of Covered California products enrollment to date — have provided additional information to their contracted providers on their exchange / mirror products. Click Here for Details

Covered California Resources for SDCMS-CMA Members:

A plumber attended to a leaking faucet at a neurosurgeon’s house. After a two-minute job, the plumber demanded $150. The neurosurgeon exclaimed, “I don’t even charge that amount and I’m a brain surgeon!” The plumber replied, “I Know. I didn’t either when I was a surgeon. That’s why I switched to plumbing.”

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