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SDCMS "News You Can Use" (2010.03.29)

by: San Diego County Medical Society
Published March 29, 2010

SDCMS "News You Can Use"
— March 29, 2010

Executive Director Extended Comment: Congress left on recess without implementing a complex legislative package that would have pushed the 21% Medicare cut to October 1, 2010. This was a result of one senator — Tom Coburn, MD (R-OK) — using existing Senate rules to halt that process long enough that the congressional recess took effect before the complex legislative package could be voted on by the whole Congress.

What does it mean?

  • "You have got to be kidding us …." Emotionally, the physician community is fed up with this ridiculous behavior — we’re tired of being hostages.
  • As a practical matter, I believe that Congress will come back from recess and quickly enact the legislation to push the 21% cuts out to October (when, incidentally, the cuts go to 25%). Realistically, failure to stop the cuts would result in wholesale political anger organized by patient constituency groups (who would be affected by the wholesale abandonment of Medicare by doctors as a result of either a 21% now or a 25% cut in October).
  • CMS will hold all Medicare claims for 10 business day, starting 1 April (see below under "FEDERAL" for details).
  • The real political issue is the recurring failure to eliminate the SGR in favor of a more realistic cost-of-living adjustor (and the cancelation of the patently unfair geographic modifier (the GPCI) that punishes San Diego as a rural county).
  • Of note, our San Diego congressional delegation get it — Dems and Reps alike — but it would not hurt to have you tell them (see below under "FEDERAL" for contact information) of the substantive impact on your patients of the “perpetual-perils-of-Pauline” Medicare brinksmanship.

Karl Marx wrote, in a critique of Hegel: “He [Hegel] remarks somewhere that all great world-historic facts and personages appear, so to speak, twice. He forgot to add: the first time as tragedy, the second time as farce.” I wonder what Marx would have said about the “perpetual-perils-of-Pauline” Medicare brinksmanship.

Executive Director Comment: SDCMS’ April 15, 2010, recovery audit contractor (RAC) seminar/webinar is “must-see TV”! If you don’t understand the impact and implications of a RAC audit, you are at risk. SDCMS Members: Please view or attend live, or access the webinar at SDCMS’ website after the fact to review! Click here for more information.

SDCMS Membership Social • Friday, April 16
Mark your calendars to attend SDCMS’ upcoming Membership Social at the Rock Bottom Brewery on Friday, April 16, from 6:30pm to 9:30pm. First 100 SDCMS members to RSVP to Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org are in!

Physicians: What’s Your Gripe? SDCMS Is Devoting Its June 2010 Issue of San Diego Physician Magazine to “The Hassles of Being a Doctor”
Our December 2009 issue of San Diego Physician was devoted to the “Joy of Being a Doctor” — now it’s time to hear the other side! SDCMS member physicians are invited to submit their 100–400 word gripes (submission deadline: April 22, 2010) on what they find most frustrating about the practice of medicine today. We will select the most representative submissions for our June 2010 issue of San Diego Physician magazine, and we will communicate your gripes to our political representatives. Here is your chance to vent! Let us know what your frustrations are, what you’d change if you could, and where you see the practice of medicine heading. Click here for submission details.

CONTENTS

  • Anthem Blue Cross, Anthem Blue Cross and Blue Shield, and Empire BlueCross BlueShield Experience a Claims Production Issue Impacting Vaccination Claims
  • Court Strikes Down Furloughs for Medical Board
  • State Budget Update (March 26, 2010)
  • HIT Update (March 29, 2010)
  • SDCMS Physicians: Last Chance to Verify Your Listing in San Diego Magazine’s May 2010 Health Annex
  • “Notes on Haiti” — CEO Journal Wednesday, March 10
  • California Recruitment
  • UCSD Student-Run Free Clinic Project Annual Benefit & Award Celebration on April 24, 2010
  • Things to Be Aware of re: the 2010 Census
  • Information Regarding the Holding of April Claims for Services Paid Under the 2010 Medicare Physician Fee Schedule (03-26-10)
  • Erratum: Balance Billing in March 23, 2010, “SDCMS Special Update on Healthcare Reform”
  • Click Here for a Brief Legislative Summary of the Senate Health Reform Act and the Budget Reconciliation Act From CMA
  • Click Here for a Healthcare Reform Implementation Timeline From CMA
  • Click Here to Read SDCMS’ March 23, 2010, Special Update on Healthcare Reform
  • Click Here to Read SDCMS’ March 19, 2010, Special Update on Healthcare Reform
  • National Doctors Day: March 30
  • Update on Rotarix Vaccine
  • SDCMS SEMINARS / WEBINARS / EVENTS
  • SAN DIEGO COUNTY HEALTHCARE EVENTS

STATE

Anthem Blue Cross, Anthem Blue Cross and Blue Shield, and Empire BlueCross BlueShield Experience a Claims Production Issue Impacting Vaccination Claims
[Message From These Health Plans] The related health plans of Anthem Blue Cross, Anthem Blue Cross and Blue Shield, and Empire BlueCross BlueShield experienced a claims production issue in early March following the implementation of a system update. This impacted certain vaccination claims. Claims processed as of 03/01/10 denied payment for the following immunization administration codes: 90465, 90466, 90471, and 90472. This affects most claims received from the following states: California, Colorado, Connecticut, Georgia, Maine, Nevada, New Hampshire, and New York. A system correction was put in place the evening of 03/08/10. We are in the process of identifying the denied claims and re-adjudicating them so that they are paid correctly. If you received a denial and have not received a correction by the end of March, please contact your local provider service area for assistance.

Court Strikes Down Furloughs for Medical Board
Furloughs for the staff of the Medical Board of California are officially over, effective March 24, 2010, after an Alameda County Superior Court ruled that Gov. Schwarzenegger lacks authority to furlough employees of special fund agencies, a victory for CMA, which challenged the furloughs for the Medical Board staff in a separate case, arguing the governor did not have the power to issue them or to take $6 million from the board funds to pay for other state programs. Click here to read more.

State Budget Update (March 26, 2010) [(From the County Health Executives Association of California (CHEAC)]
Legislators have now left town for spring break after a busy week at the capitol. Agreement was finally reached between the governor and legislators on a modest mid-year budget package, including the governor’s signature on the alternative gas tax swap. Meanwhile, budget subcommittees have begun to hold regular budget hearings. Wednesday, March 24, 2010, the Assembly Budget Subcommittee #1 on Health and Human Services held a marathon informational hearing with a twist. Directors of the Departments of Social Services, Health Care Services, Alcohol and Drug Programs, Public Health, Mental Health, Developmental Services and Aging, and the Managed Risk Medical Insurance Board were asked to present the impacts on those they serve of the FY 09/10 program reductions and the anticipated impacts of the governor’s proposed cuts for FY 10/11. Additional Assembly Sub #1 hearings are scheduled for the coming weeks. Click here for more information.

HIT Update (March 29, 2010)
For the past several weeks, while health reform has been dominating the news, there has also been a flurry of activity around health information technology (HIT) issues. The federal government and the State of California have been moving quickly to outline the implementation of the HIT-related portions of the Stimulus Act. In case you missed any of the recent actions, here are the highlights:

  • CMA files comments on draft federal definition of “Meaningful Use.” As you are aware, in order for physicians to receive federal electronic health records (EHR) incentive payments, they will have to demonstrate “meaningful use” of a “certified” EHR system. In January, the Office of the National Coordinator for Health IT (ONCHIT) released a draft regulation that would define “meaningful use.” Specifically, the draft regulation outlines clinical quality measures that physicians would have to report to Medicare. CMA filed formal comments during the official comment period which closed on March 15. In general, CMA is concerned that the draft definition is too ambitious and will be too difficult for many physicians to achieve. Also, CMA is concerned that, as written, the regulations take an “all-or-nothing” approach (physicians will have to achieve absolutely every criteria in order to receive any incentive payments). CMA would like to thank the Council on Information Technology for helping to guide the association's response to this regulation. Click here for a summary of the regulation, and click here for CMA's comments.
  • ONCHIT releases regulations describing how EHR systems will be certified. On March 9, ONCHIT released a corresponding regulation, describing the process by which they will certify EHR systems to allow physicians to demonstrate meaningful use. In the regulations, ONCHIT attempted to balance the need for systems to be certified very quickly with the desire for a comprehensive program. Under the draft regulations, ONCHIT would create two separate programs. In the Temporary Certification Program, a non-profit entity or entities would be named to test and certify EHR systems. This “ONC-ATCB” as it is known would have to move very quickly, and would be actively certifying products as early as late spring/early summer 2010. ONCHIT would then begin the process of developing a more robust permanent certification program. The permanent program would likely begin its work sometime in 2011. The comment period for the Temporary Certification Program runs until April 9, and the comment period for the Permanent Program runs through May 10. The Council on Information Technology will be meeting the last week in March to consider CMA’s response. Click here for a summary of the proposed regulation.
  • State of California releases Health Information Exchange (HIE) Operational Plan. CMA files comments in response. The State of California has received over $38 million dollars to design and implement a health information exchange (HIE). An HIE is an internet-based system that connects EHR systems and facilitates exchange of information between physicians, other providers, and facilities. Connection to an HIE is one criteria physicians will have to demonstrate in order to achieve meaningful use. On March 9, the State of California released its draft operations plan for the State HIE, with a public comment period that closed Monday, March 22. CMA filed comments expressing our desire that HIE be made workable for physicians, and that the development of the system be narrowly focused to help physicians achieve meaningful use. Click here to read CMA's comments.
  • State of California forms Governance Entity to oversee HIE. Dr. Cassidy is named to represent CMA. To oversee the development of the state HIE, the state has created a new entity, named Cal eConnect. CMA’s president, Brennan Cassidy, MD, has been named to represent CMA on the Cal eConnect board. Cal eConnect’s first meeting will take place Thursday, March 25.
  • CalHIPSO (formerly Cal-REC) begins to take shape. Based on public feedback, Cal-REC was recently renamed as the California Health Information Partnership and Services Organization, or CalHIPSO. We’re also pleased to announce that CalHIPSO now has a full-time Executive Director, Speranza Avram. Speranza has an extensive background in HIT issues, with a special focus on rural communities. Along with the new name, CalHIPSO’s business model is also undergoing a facelift. CalHIPSO staff met with staff from ONCHIT on March 10-12, and came away with many new insights about how the federal government views the “REC/LEC” structure we have proposed. Based on our new understanding, the CalHIPSO team is working to tweak our model. CalHIPSO will be releasing details on the new model on April 1.
  • Attachments:

LOCAL

SDCMS Physicians: Last Chance to Verify Your Listing in San Diego Magazine’s May 2010 Health Annex
If you have or will have paid your SDCMS-CMA dues before April 1, 2010, please click here to verify your listing for San Diego Magazine’s May 2010 Health Annex one last time. If you have any questions, please contact Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org.

“Notes on Haiti” — CEO Journal Wednesday, March 10
[From Chris Van Gorder, President and CEO, Scripps Health] While we continue to discuss our recent visits to Haiti and consider the need and our options for support and relief going forward, I wanted to share with you some more comments from members of the last relief team. As I’m sure you can tell from their words and the words of everyone who has been part of this relief effort, our work made a significant difference in a country far from home and made a significant impact personally on those who were able to participate. Not mentioned in the comments, but equally as valuable are the lessons we learned about post-earthquake environments and what we can expect should San Diego, Los Angeles, or any nearby region suffer a major earthquake. From the types of injuries we can expect, to equipment and medications we should have on hand, I want you to know that all of what we learned will now be incorporated into our disaster planning and shared with others. Click here to read more.

California Recruitment
MAXIMUS Federal Services is looking for California-licensed physicians to do independent medical review involving coverage decisions. This is a desk review that can be performed anywhere and at anytime. Reimbursement ranges from $150 to $500 per case. If you are interested in performing an occasional review, please contact Kim Donselaar at (585) 425-5286 or at kimdonselaar@maximus.com.

UCSD Student-Run Free Clinic Project Annual Benefit & Award Celebration on April 24, 2010
Saturday, April 24, 2010. 6:00pm–10:00pm. Price Center Ballroom at UCSD. Silent auction, opportunity drawing, wine tasting, entertainment and award dinner. Proceeds will go to the UCSD Student-Run Free Clinic Project, dedicated to providing free, high-quality healthcare with underserved communities of San Diego. $175 per person ($150 of ticket price is tax deductible). Tables available at the $1,500 and $1,750 level. Student prices available upon request. To RSVP for dinner tickets or for information about event sponsorship and opportunities to support the Free Clinic Project, contact Anne Crane (acrane@ucsd.edu) or Carol Whitener (cbloomwhitener@ucsd.edu) by email or by phone at (858) 534-6160. Click here for more information about the UCSD Student-Run Free Clinic Project.

Things to Be Aware of re: the 2010 Census

  • During April, May, June, and July 2010, census workers will visit households that did not return a form by mail.
  • If a census worker knocks on your door, they will have a badge, a handheld device, a Census Bureau canvas bag, and a confidentiality notice. Ask to see their identification and their badge before answering their questions, and never invite anyone you don’t know into your home.
  • Census workers are currently only knocking on doors to verify address information. Do not give your Social Security number or credit card or banking information to anyone, even if they claim they need it for the U.S. Census. No matter what they ask, you really only need to tell them how many people live at your address. You don’t have to answer anything at all about your financial situation.
  • No Acorn worker should approach you saying he/she is with the Census Bureau.

FEDERAL

Information Regarding the Holding of April Claims for Services Paid Under the 2010 Medicare Physician Fee Schedule (3-26-2010)
The Temporary Extension Act of 2010, enacted on March 2, 2010, extended the zero percent (0%) update to the 2010 MPFS through March 31, 2010. CMS believes Congress is working to avert the negative update that will take effect April 1, 2010. Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS (including anesthesia services) for the first 10 business days of April. This hold will only affect claims with dates of service April 1, 2010, and forward. In addition, the hold should have minimum impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt. Be on the alert for more information about the 2010 Medicare Physician Fee Schedule Update.

Erratum: Balance Billing in March 23, 2010, “SDCMS Special Update on Healthcare Reform”
The original bill banned balanced billing. CMA got that ban out of the bill; however, CMA did not get an express allowance to balance bill. CMA just won the ability for patients to see physicians outside their health plan network. The bill was silent on balance billing, so state law trumps. In other words, the California ruling on balance billing was not overturned.

Click Here for a Brief Legislative Summary (March 25, 2010) of the Senate Health Reform and the Budget Reconciliation Act From CMA

Click Here for a Healthcare Reform Implementation Timeline From CMA

Click Here to Read SDCMS’ March 23, 2010, Special Update on Healthcare Reform

Click Here to Read SDCMS’ March 19, 2010, Special Update on Healthcare Reform

Executive Director Comment: Lovely to see we are honoring doctors one day before the federal government (see directly below), through inaction, cuts their Medicare reimbursement by 21%. On a personal note, being married to a doctor and watching every day how she changes lives, I hope all of you will accept the thanks of your grateful patients, even if our government does not value your services.

National Doctors Day: March 30
[From http://www.doctorsday.org] National Doctors Day is a day to celebrate the contribution of physicians who serve our country by caring for its citizens. The first Doctors Day observance was March 30, 1933, in Winder, Georgia. On March 30, 1958, a resolution commemorating Doctors Day was adopted by the United States House of Representatives. In 1990, legislation was introduced in the House and Senate to establish a national Doctors Day. Following overwhelming approval by the United States Senate and the House of Representatives, on October 30, 1990, President George Bush signed S.J. RES. #366 designating March 30 as “National Doctors Day.”

Senator Contact Information
You may call (800) 833-6354 (AMA's Grassroots Action Center) and be in touch with the senators' offices in under 30 seconds, or you may call, fax, or email (via their websites) with the information below:

Representative Contact Information
To find your U.S. House representative, click here. You may call (800) 833-6354 (AMA's Grassroots Action Center) and be in touch with your congressional representative's office in under 30 seconds, or you may call, fax, or email (via their website) with the information below:

MEDICAL

Update on Rotarix Vaccine
FDA is updating clinicians on information that recently has become available about Rotarix, a vaccine used to prevent rotavirus disease. FDA has learned that components of an extraneous virus are present in Rotarix. There is no evidence at this time that this finding poses a safety risk. While the agency is learning more about the situation, FDA is recommending that clinicians and public health professionals in the United States temporarily suspend the use of Rotarix. FDA will keep the public and the clinical community updated as more information becomes available. Click here for additional background information and Questions and Answers for patients and providers.

SDCMS SEMINARS / WEBINARS / EVENTS
For Further Information on or to Register for Any of the Below Seminars, Webinars, or Events, Contact Sonia Gonzales at (858) 300-2782 or at SGonzales@SDCMS.org.

  • APR 15 • Recovery Audit Contractor (RAC) Seminar/Webinar • Thursday, April 15, 11:30am–1:00pm. Topics covered include: update and overview on CMS/OIG oversight, initiatives, and Medicare audits; overview of the RAC (recovery audit contractor); implications to the healthcare industry; preparing with welf-audits and professional activation compliance; reviewing insurance options; regulatory insurance overview; application of coverage to various enforcement initiatives, including RAC success stories; underwriting concerns and process. Click here for further information.
  • APR 16 • SDCMS Membership Social • Friday, April 16, 6:30pm–9:30pm • Mark your calendars to attend SDCMS’ upcoming Membership Social at the Rock Bottom Brewery. Only SDCMS member physicians can attend. Space is VERY limited, so please RSVP as soon as possible to Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org.
  • APR 21 • Risk Management Seminar/Webinar — “eHealth: Telemedicine and Telehealth” • Wednesday, April 21, 6:30pm–7:30pm
  • APR 22 • Risk Management Seminar/Webinar — “eHealth: Telemedicine and Telehealth” • Thursday, April 22, 11:30am–12:30pm
  • APR 28 • Medi-Cal Seminar/Webinar • Wednesday, April 28, 11:30am–1:00pm
  • MAY 6 • IT Seminar/Webinar • Thursday, May 6, 11:30am–1:00pm
  • MAY 12 • E-town Hall • Wednesday, May 12, 11:30am–12:30pm
  • MAY 20 • Workers’ Compensation Billing Seminar/Webinar • Thursday, May 20, 11:30am–1:00pm
  • MAY 21 • Young and Resident Physicians Spring Social • Friday, May 21, 6:00pm–9:00pm
  • MAY 27 • EMR/EHR Trunk Show • Late April, Early May — Watch for Updates
  • JUN 5 • 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.
  • JUN 18–19 • Physician Leader’s Toolbox Workshop • Friday and Saturday, June 18–19, 8:00am–4:00pm
  • JUN 24 • Sexual Harassment Seminar/Webinar • Thursday, June 24, 11:30am–1:00pm
  • JUL 21 • Risk Management Webinar — “The Employee’s Role in Decreasing Liability Risks in the Physician Office” • Wednesday, July 21, 6:30pm–7:30pm
  • JUL 22 • 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

“How queer everything is to-day! And yesterday things went on just as usual. I wonder if I’ve been changed in the night? Let me think: was I the same when I got up this morning? I almost think I can remember feeling a little different. But if I’m not the same, the next question is, Who in the world am I? Ah, that’s the great puzzle!”
— From Alice in Wonderland by Lewis Carroll (1832–1898)

Read more about: Healthcare News and Updates, NYCU, SDCMS News and Updates, News You Can Use

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