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SDCMS "News You Can Use" (2010.02.08)

by: San Diego County Medical Society
Published February 5, 2010

SDCMS “News You Can Use”
— February 8, 2010

Executive Director Comment: We endeavor to present relevant and compelling seminars and events for San Diego County's physicians. Here are the next five offerings:

CONTENTS

  • Job Opening for the SDCMS "Medical Office Manager"
  • SDCMS Members: Meet One-on-One With Palmetto Medical Director on February 23
  • Beginning April 5, Medicare Will Reject Claims If an Ordering Physician Is Not Identified in Its PECOS Enrollment System
  • CMA Files Lawsuit to Enforce Patient Protections of California Scope of Practice Laws for Anesthesia
  • CMA Medical Board of California (MBC) Lawsuit Update
  • CMA Objects to DMHC Attempt to Legitimize Illegal Discount Health Plans
  • EMS (Maddy) Fund Accountability
  • Information on DMHC “Timely Access” Regulations
  • Dustin Corcoran Named CMA CEO
  • Obama Budget Freezes Physicians' Medicare Pay for 10 Years
  • CMS Projections for Future Healthcare Spending
  • Senate Votes for Partial PAYGO Exemption for SGR Repeal
  • Doctors, Dentists, and Veterinarians Petition FTC for Relief From Red Flags Rule
  • CMA Letter to President Obama and Members of the California Congressional Delegation RE healthcare REFORM
  • SDCMS SEMINARS / WEBINARS / EVENTS
  • SAN DIEGO COUNTY HEALTHCARE EVENTS

LOCAL

Job Opening for the SDCMS "Medical Office Manager Advocate"
SDCMS is accepting applications for our “Medical Office Manager Advocate,” an independent thinker with a “can-do” attitude who will provide exceptional support to the staffs of more than 1,000 small and medium-sized medical offices. Three-plus years medical office management experience required, and seminar planning and execution experience desired. Click here for further information or to apply.

SDCMS Members: Meet One-on-One With Palmetto Medical Director on February 23
Art Lurvey, MD, medical affairs director for Palmetto GBA, will be in San Diego the evening of February 23, and will give a 30-minute presentation on Medicare updates, and will meet one-on-one with SDCMS member physicians who request an appointment. Please contact Marisol Gonzolez (email MGonzalez@SDCMS.org), your SDCMS physician advocate, to set up an appointment. Following are the times that remain available:

  • 5:15pm – 5:30pm: 2nd Appointment
  • 5:30pm – 5:45pm: 3rd Appointment
  • 5:45pm – 6:00pm: 4th Appointment
  • 6:15pm – 6:30pm: 6th Appointment
  • 6:30pm – 7:00pm: Medicare Updates Presentation
  • 7:15pm – 7:30pm: 8th Appointment
  • 7:30pm – 7:45pm: 9th Appointment
  • 7:45pm – 8:00pm: 10th Appointment

STATE

Executive Director WARNING: If you do not appear on this list, you will need to revalidate your enrollment with Medicare. Please, please, please read the following in detail!

Beginning April 5, Medicare Will Reject Claims If an Ordering Physician Is Not Identified in Its PECOS Enrollment System
New rules, which take effect April 5, 2010, authorize Medicare to reject claims if a physician is not identified in Medicare’s PECOS enrollment system. If you are not sure if you are already in the PECOS system, the Centers for Medicare and Medicaid Services has posted a list of all physicains enrolled in PECOS on its website. Be aware that this is an enormous document, containing over 13,000 pages, and as such it will take time to download. To see if you are on the list, go to the search tool and enter your type 1 (individual) NPI number, or last name, and hit enter. This list will be updated periodically so applications currently being processed can be added to the list. If you determine that you do need to submit a new enrollment form, you can do so online using the web-based PECOS system or by filling out the appropriate paper enrollment form(s) (CMS-855I and CMS-855R, if appropriate) and mailing the forms, along with any required additional supplemental documentation to Palmetto, who will enter your information into PECOS and process your enrollment application. If you enroll online, be sure to mail to Palmetto as well the signed and dated certification statement within seven days.

CMA Files Lawsuit to Enforce Patient Protections of California Scope of Practice Laws for Anesthesia
On February 2, CMA filed a lawsuit to stop nurse anesthetists from providing anesthesia to Medicare patients in California without any supervision by a physician. CMA is also seeking a judgment from the court clarifying that California law requires physician supervision of anesthesia provided by certified registered nurse anesthetists (CRNAs). Click here for details.

CMA Medical Board of California (MBC) Lawsuit Update
CMA sued the state in late 2009 to stop the pilfering of doctors’ licensure fees. The lawsuit objected to the state’s transfer of $6 million from the MBC’s funds (totally generated by physicians' fees) into the state’s General Fund to help close the budget shortfall. The lawsuit seeks an end to Governor Schwarzenegger’s furlough plan for MBC staffers. CMA argues that the furlough is illegal because it renders the Medical Board incapable of carrying out its statutory mandates to license physicians, regulate the practice of medicine, and enforce the Medical Practice Act. CMA’s Medical Board furlough lawsuit has yielded positive results: Most if not all of the licensure backlog was cleared as of December 23, 2009.

CMA Objects to DMHC Attempt to Legitimize Illegal Discount Health Plans
The Department of Managed Health Care (DMHC) has proposed regulations that would regulate “discount health plans” in California. CMA has opposed a number of legislative attempts to legitimize these illegal referral services. The California attorney general in 2001 concluded that the discount health plan business model was illegal under California law. CMA believes that the appropriate course of action is for DMHC to enforce the law and to stop the deceptive and illegal marketing of these discount “health plans” in California. CMA is developing regulatory comments and has requested a public hearing on this issue. DMHC is also accepting comments through February 22. Please address all comments to the Department of Managed Health Care, Office of Legal Services, Attention: Regulations Coordinator. Comments may be transmitted by regular mail, fax, email, or via the DMHC's website:

  • Website
  • Email
  • Fax: (916) 322-3968
  • Mail: Department of Managed Health Care, Office of Legal Services, Attn: Regulations Coordinator, 980 9th Street, Suite 500, Sacramento, CA 95814

EMS (Maddy) Fund Accountability
CMA has asked for the implementation of a standard accounting for dollars collected under applicable fines and forfeitures and deposited into the Emergency Medical Services Funds across all participating counties to ensure that the fines and forfeitures collected are properly accounted for and allocated to the EMS Fund and disbursed appropriately.

Information on DMHC “Timely Access” Regulations (Thank You to Alameda-Contra Costa Medical Association for This Information)
On January 17, the Department of Managed Health Care (DMHC) promulgated “timely access” regulations that HMOs and Blue Shield and Blue Cross plans must comply with by January 17, 2011. Physicians are rightly concerned that these regulations impose unrealistic requirements for seeing patients or responding to phone calls within certain timeframes. Importantly, these regulations are imposed on health plans; DMHC cannot penalize physicians for failing to comply. However, to meet these requirements, health plans will look to physicians for compliance. CMA, SDCMS, and other county medical societies are consequently working to ensure that health plans have adequate physician networks to provide access to care and that health plan compliance requirements are reasonable. HMOs must demonstrate how they will comply with the regulations no later than October 17, 2010. Click here for further information.

Dustin Corcoran Named CMA CEO
CMA’s board of trustees appointed acting CEO, Dustin Corcoran, as the new chief executive officer of CMA. Prior to becoming acting CEO, Dustin was responsible for the day-to-day operations of CMA, including CMA’s legislative and political affairs as deputy CEO.

FEDERAL

Obama Budget Freezes Physicians' Medicare Pay for 10 Years
President Obama promised spending freezes during his first State of the Union address, but his $3.8 trillion fiscal 2011 budget proposal would still protect physicians from Medicare pay cuts and extend enhanced federal support for state Medicaid programs. Obama's proposal, unveiled February 1, sets aside $371 billion over a decade to pay for the cost of preventing Medicare pay cuts under the sustainable growth rate formula. But the funding would only be enough to turn annual reductions into rate freezes, not to fund pay raises. Click here to read the complete article.

CMS Projections for Future Healthcare Spending
On February 4, CMS released its annual report projecting health spending for the coming decade. The report can be found on the Health Affairs website. Major takeaways from the report include:
for further information.

  • Healthcare spending continued to rise in 2009, growing by 5.7% to an estimated $2.5 trillion, or $8,407 per person (up from $7,681 per person in 2008). The rate of increase of health spending also rose from a 4.4% rise in 2008.
  • Due in part to a 1.1% decline in GDP due to the recession, healthcare’s share of gross domestic product jumped significantly, from 16.2% to 17.3%. This increase is the largest on record since national health expenditure data were first compiled in 1960.
  • Spending by private payers in 2009 rose only 3%, while spending by public payers rose 8.7%. These numbers reflect a recessionary shift in enrollment out of private coverage (declined 1.2%) and into government programs like Medicaid (enrollment increased 6.5%, and spending increased 9.9%). Medicare spending also grew at a rapid 8.1% rate last year, although this number is down slightly from 2008.
  • While federal spending on Medicaid increased 20.8% in 2009, State spending on the program declined by 8.6%, reflecting the shift in funding from the States to the federal government as a result of provisions in the “stimulus” bill. Federal spending on Medicaid is projected to increase by another 10.8% this year.
  • Over the next few years, low disposable personal income due to the recession’s lingering effects means that public spending growth will continue to outpace private spending, such that “the net result is an expectation that public payers will pay for slightly over half of the healthcare purchased in the United States by 2012.”
  • “Because of continued influence from the recession and demographic changes, private spending is projected to grow at a slower average rate over the eleven-year period [i.e., 2009–2019] than public spending.”
  • Healthcare will grow as a share of the overall economy from 16.2% in 2008 to 19.3% in 2019, with public spending accounting for 52% of all health expenditures in 2019.
  • In 2019, federal health spending is projected to total more than $1.7 trillion, nearly double the $918.6 billion projected for this year. By 2019, total federal spending on healthcare will nearly match private spending on both health insurance and out-of-pocket payments combined.

Senate Votes for Partial PAYGO Exemption for SGR Repeal
On January 28, the Senate passed a provision that reinstitutes pay-as-you-go, or PAYGO, rules for new federal spending. Under PAYGO terms, any new spending or tax cuts passed by Congress would have to be offset by corresponding spending cuts or tax increases. Several limited exemptions were made to the PAYGO rule, including one for addressing the Medicare physician payment cuts being produced by the sustainable growth rate (SGR) formula.

Doctors, Dentists, and Veterinarians Petition FTC for Relief From Red Flags Rule
AMA joined the American Dental Association, the American Osteopathic Association, and the American Veterinary Medical Association to reiterate its call to the Federal Trade Commission (FTC) to exclude health professionals from the controversial regulation. In response to a suit brought by the American Bar Association (ABA), the U.S. District Court for the District of Columbia ruled that lawyers should be excluded from the requirements imposed by the red flags rule. In a letter to the FTC, the four organizations maintain that the court ruling sends a clear signal that the FTC should re-evaluate the broad application of the Red Flags Rule. The FTC has delayed the effective date until June 1, 2010.

CMA Letter to President Obama and Members of the California Congressional Delegation re: Healthcare Reform
CMA remains strongly committed to achieving comprehensive, meaningful healthcare reform that provides universal access to care for the 6.7 million uninsured Californians. Click here to read CMA's January 29, 2010, letter to President Obama and members of the California congressional delegation.

SDCMS SEMINARS / WEBINARS / EVENTS
For Further Information on or to Register for Any of the Below Seminars, Webinars, or Events, Contact Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org.

  • Young and Resident Physicians Winter Social • Thursday, February 11, 6:30pm–9:00pm • Join us for a fun and relaxing evening. Unwind with your colleagues and make new friends! Rock Bottom Restaurant and Brewery at 401 “G” Street, San Diego, CA 92101 (downtown across from Horton Plaza). RSVP is a must as space is limited — contact Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org.
  • Medicare Updates Seminar/Webinar • Wednesday, February 17, 10:00am–12:00pm • Topics covered will include changes for 2010, provider enrollment update, recovery audit contractor, ICD-10-CM, and HIPAA X12 5010. Click here to access a registration form.
  • POLST (Physician Orders for Life-Sustaining Treatment) Training for Physicians: Understanding the New State Law Mandates • Friday, February 26, 12:15pm–1:30pm • To be held in SDCMS’s large meeting room at 5575 Ruffin Road, Suite 250, San Diego 92123- 1387. CME and lunch provided. Please RSVP by Feb. 20 by phone to (858) 565-8888 or by email to KDotson@SDCMS.org.
  • Retirement Workshop — End-Game Planning: Charting a Course for Your Last Trimester of Practice • Saturday, February 27, 9:00am–1:00pm • An intensive, half-day workshop conducted by SDCMS-endorsed Practice Performance Group for physicians who want to plan for an orderly and rewarding exit from active practice. Click here to access a registration form.
  • Certified Medical Office Manager Course • Four Fridays, March 5–26, 9:00am–4:00pm)
  • Managed Care Contract Negotiations Seminar/Webinar — “Work Smarter, NOT Harder!” • Thursday, March 18, 11:30am–1:00pm • You will learn 10 things you should know about managed care, including how to build a financially productive practice, how to limit your portfolio to contracts that have quantifiable benefits, how to review EOBs to determine underpayments or bad rates, and much more! Click here to access a registration form.
  • SDCMS New Member Social • Friday, April 2, 6:00pm–9:00pm • Mark your calendars to attend SDCMS’ upcoming New Member Social. All new SDCMS member physicians and guest are invited to attend. RSVP required. For location and additional information, please contact Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org.
  • Best Practices Seminar — What Every Physician Needs to Know About Their Practice • Wednesday, April 14, 11:30am–1:00pm — Geared Toward Office Managers, but Physicians Are Welcome to Attend!
  • Best Practices Seminar — What Every Physician Needs to Know About Their Practice • Wednesday, April 14, 6:00pm–8:30pm — Geared Toward Physicians
  • Risk Management Seminar/Webinar — “eHealth: Telemedicine and Telehealth” • Wednesday, April 21, 6:30pm–7:30pm
  • Risk Management Seminar/Webinar — “eHealth: Telemedicine and Telehealth” • Thursday, April 22, 11:30am–12:30pm
  • Medi-Cal Seminar/Webinar • Wednesday, April 28, 11:30am–1:00pm
  • EMR/EHR Trunk Show • Late April, Early May (Watch for Updates)
  • IT Seminar/Webinar • Thursday, May 6, 11:30am–1:00pm
  • E-town Hall • Wednesday, May 12, 11:30am–12:30pm
  • Workers’ Compensation Billing Seminar/Webinar • Thursday, May 20, 11:30am–1:00pm
  • Young and Resident Physicians Spring Social • Friday, May 21, 6:00pm–9:00pm
  • 140th Annual SDCMS Installation Dinner and Dance • Saturday, June 5, 6:00pm–11:00pm • Hyatt Regency Mission Bay, 1441 Quivira Road, San Diego, CA 92109. For ticket information and sponsorship opportunities, please contact Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org.
  • Physician Leader’s Toolbox Workshop • Friday and Saturday, June 18–19, 8:00am–4:00pm
  • Sexual Harassment Seminar/Webinar • Thursday, June 24, 11:30am–1:00pm
  • Risk Management Webinar — “The Employee’s Role in Decreasing Liability Risks in the Physician Office” • Wednesday, July 21, 6:30pm–7:30pm
  • Risk Management Webinar — “The Employee’s Role in Decreasing Liability Risks in the Physician Office” • Thursday, July 22, 11:30am–12:30pm

SAN DIEGO COUNTY HEALTHCARE EVENTS

“In the second half of life, the necessity is imposed of recognizing no longer the validity of our former ideals but of their contraries. Of perceiving the error in what was previously our conviction, of sensing the untruth in what was our truth, and of weighing the degree of opposition, and even of hostility, in what we took to be love.”

— Carl Gustav Jung (1875–1961) Swiss Psychiatrist

Read more about: Healthcare News and Updates, MBC, Palmetto, PECOS, Scope of Practice, SDCMS News and Updates, News You Can Use

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