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SDCMS "News You Can Use" (2010.05.12)

by: San Diego County Medical Society
Published May 11, 2010

SDCMS "News You Can Use"
— May 12, 2010

Executive Director Comment: We realize this NYCU has a lot of information in it. We try to make our NYCUs concise, but this particular issue is long (and concise) only because there are so many alligators out in the swamp — and we want you to know about them all. Please at least skim all the titles!

Executive Director Comment: This is truly a great deal (see directly below). Hope you take advantage!

Free iPhone/iPad SDCMS Directory Application PLUS Run of the Fashion Valley Apple Store — Sunday, May 23, 2010, 7–9pm
SDCMS, in partnership with a developer, is making available to SDCMS members an iPhone and iPad application that places the entire SDCMS directory at your i-fingertips. We are doing a preliminary rollout of this endorsed product, called DocBooks, on Sunday, May 23, 2010, 7:00pm–9:00pm at the Apple store in Fashion Valley [Address: 7007 Friars Road, San Diego, CA 92108, (619) 682-3477]. Everyone who attends the event will get the DocBooks application for free — and you’ll get to enjoy the run of the Apple store. While there are no special discounts on Apple stuff, SDCMS members (and family) will be the only folks in the store. RSVP to Jen at (858) 300-2781 or at JOhmstede@SDCMS.org.

SDCMS Media Training • Saturday, May 22, 2010
Last call for this great opportunity to convert “ummms” to intelligent discourse with the media. If you have questions or comments or would like to reserve a space, please let me know at Gehring@SDCMS.org.

Executive Director Comment on SGR and GPCI:

  • Congress has approved a temporary stay of the 21% cut to Medicare, until June 1, 2010.
  • Physician options on the (un)Sustainable (non)Growth Rate (SGR) formula are not good. While we “want” a permanent fix, we did not get either SGR or GPCI in the healthcare reform bill, and we are now stuck with no leverage and a horrid negotiating position.
  • There is now only $90 billion of exemptions to the pay-as-you-go (PAYGO) rule — remember that unless Congress specifically waives PAYGO, for every dollar of increased spending, you have to come up with a dollar of spending reduction, and voiding a cut is an increase in spending — a very tough challenge in this era of vociferous calls to reduce massive budget deficits.
  • Physicians have strong House support for a permanent fix to the SGR and removal of the Geographic Practice Cost Index (GPCI), which treats San Diego County (unlike Orange County) as a rural county with a concomitant reduction in Medicare rates of 5–7% (ditto TRICARE/CHAMPUS and anything else denominated in Medicare rates).
  • Senate support for anything more than an SGR bandaid is much, much weaker.
  • We are presented with “spending” the $90 billion on a five-year “no-raise” for physician reimbursement for Medicare, or a two-year “raise” for physicians who provide Medicare, but no way does it pay for a permanent SGR fix ($290 billion and climbing).
  • And in the last eight years, the before-inflation net increase in Medicare rates for physicians has been almost zero:
    • 2002: 5.4% cut
    • 2003: 1.6% increase
    • 2004: 1.5% increase
    • 2005: 1.5% increase
    • 2006: freeze
    • 2007: freeze
    • 2008: 0.5% increase
    • 2009: 1.1% increase
    • 2010: freeze so for
  • And people wonder why physicians have SGR fatigue …
  • We will continue to lobby for a permanent fix, but the political realities are not pretty.

So, Have YOU Signed the Medicare Petition?
Click here to add your name to the call for action to permanently fix the SGR by signing a petition. Forward it to friends and colleagues to sign as well. CMA has also prepared a flyer — click here to download — that you can place in your waiting room to encourage patients to get involved.

CONTENTS

  • California Physicians Required to Notify Patients They Are MBC-licensed Effective June 27, 2010
  • CMA Legal Case List May 2010: Click Here for a Summary List of All Legal Cases Being Tracked by CMA
  • Have You Checked Your Medical Board of California (MBC) Profile Recently?
  • Faulty Blue Shield Physician Ratings Go Public on June 1, 2010
  • CMA Advocacy Gets California's Physicians One-time Licensing Fee Credits
  • CMA Regulations Quick List (May 10, 2010)
  • 2010 Frederick K.M. Plessner Memorial Award Call for Nominations
  • “Microsoft Outlook for Busy Docs” SDCMS Seminar — Saturday, August 7, 2010
  • SDCMS’ White Coat Gala (Installation Dinner & Dance)
  • SDCMS 2009 Physician Workforce and Compensation Survey
  • Project Access San Diego Success Story
  • Do You Know a Physician Hero?
  • Physicians Enrolling in PECOS Are Automatically Enrolled in Electronic Funds Transfer (EFT)
  • Pilot Program #1 in the Healthcare Reform Bill: ACOs/Medicare Shared Savings Program
  • Pilot Program #2 in the Healthcare Reform Bill: Payment Bundling
  • AMA Offers Physicians Help Claiming Damages From UnitedHealth Settlement
  • FTC Red Flags Rule Take Effect June 1, 2010
  • Red Flags Rule Resources From SDCMS and CMA
  • Some Private Payors Changing Consultation Code Payment Policies
  • Update on Medicare Claims: Payments for April Dates of Service
  • DEA Issues Interim Rule on Eprescribing for Controlled Substances
  • RAND Study demonstrates Serious Flaws in Cost-profiling of Physicians
  • Important Clarification Regarding the Medicare/Medicaid EHR Incentive Programs
  • Copy Machines, a Security Risk?
  • Community Health Briefs From the Center for Healthier Communities at Rady Children’s Hospital
  • Preventable Risk Factors Cut Four to Five Years off Lifespan
  • SDCMS SEMINARS / WEBINARS / EVENTS
  • SAN DIEGO COUNTY HEALTHCARE EVENTS

STATE

California Physicians Required to Notify Patients They Are MBC-licensed Effective June 27, 2010
Effective June 27, 2010, physicians practicing in California must inform their patients that they are licensed by the Medical Board of California (MBC) and include the MBC’s contact information. Member physicians can click here to access sample notice from CMA.

CMA Legal Case List May 2010: Click Here for a Summary List of All Legal Cases Being Tracked by CMA

Have You Checked Your Medical Board of California (MBC) Profile Recently?
MBC cautions physicians against using their home addresses as their address of record because the addresses become widely available to the public on the Internet. You may designate a post office box as your address of record, but, by law, you also must provide MBC with a street address. If you designate a PO box as your official address, MBC will not make public your street address. Click here for more information.

Faulty Blue Shield Physician Ratings Go Public on June 1, 2010
CMA vehemently objected to this program and is evaluating all avenues to protect physicians from Blue Shield's misleading physician rating program. Click here for more information.

CMA Advocacy Gets California's Physicians One-time Licensing Fee Credits
Physicians who were licensed or renewed their licenses between July 1, 2008, and June 30, 2009, will receive a $22 licensing fee credit at their next renewal as a result of the termination of MBC's Diversion Program.

CMA Regulations Quick List (May 10, 2010)
Click here to access CMA’s Regulations Quick List, which provides summaries of various regulations tracked by CMA’s Center for Medical and Regulatory Policy. For more information on a specific regulation, contact the CMA staff member listed.

2010 Frederick K.M. Plessner Memorial Award Call for Nominations
This award honors a CMA member physician residing and practicing in California who best exemplifies the practice and ethics of a rural practitioner. Please send all nominations by May 28, 2010, to CMA Committee on Nominations (ATTN: Ginnie Yee), 221 Main Street, Suite 560, San Francisco, CA 94105.

LOCAL

“Microsoft Outlook for Busy Docs” SDCMS Seminar — Saturday, August 7, 2010, 8:00am–11:30am
This three-and-a-half hour course on how to make Microsoft Outlook your servant and not your master. This will be a very, very practical and user-focused seminar. Please mark it down on your calendar and email me (Gehring@SDCMS.org) if you’re interested.

SDCMS’ White Coat Gala (Installation Dinner & Dance) …
… will be at the Hyatt Regency Mission Bay on Saturday, June 5, 2010, 6pm–11pm. Special Note: For those physicians who have been SDCMS members 33 or more years, in celebration of your long-standing membership with us, we would like to invite you to attend our White Coat Gala as our guest, free of charge! (Guest tickets may also be purchased at the standard ticket cost of $75.00 each.) Please contact Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org to RSVP or for additional details.

SDCMS 2009 Physician Workforce and Compensation Survey
Click here to access the full report of SDCMS’ 2009 Workforce and Compensation Survey. SDCMS-CMA members can click here to access physician compensation tables, sorted by specialty. If you are a nonmember who completed the survey, please email me at Gehring@SDCMS.org with your password and we’ll send you the compensation survey information.

Project Access San Diego Success Story
Since starting in December 2008, Project Access San Diego has arranged for over $1 million in donated healthcare services and served over 400 patients. One patient, Lenora, recently received her second donated cataract repair surgery. Lenora had been suffering from near blindness for years. She works at a local pizza restaurant, where her damaged eyesight has prevented her from performing one of her most important job duties: delivering pizzas. With both eyes repaired, Lenora looks forward to returning to work full time. She states, “It is nice to know there are still medical professionals who care so much for the people they care for.” To learn more about Project Access, contact Lauren Radano at LRadano@SDCMS.org.

Do You Know a Physician Hero — Someone Whose Lifesaving Action Went Beyond the Scope of His or Her Job to Help Another in Critical Need?
The American Red Cross San Diego and Imperial Counties Chapter is seeking nominations for the 8th Annual Real Heroes Breakfast, to be held on September 30, 2010, aboard the USS Midway Museum from 7:30am to 9:30am. Click here to nominate a Real Hero or contact the Red Cross at (858) 309-1200.

FEDERAL

Executive Director Comment: An important "gotcha" (see directly below) — make sure your office manager knows this!

Physicians Enrolling in PECOS Are Automatically Enrolled in Electronic Funds Transfer (EFT)
Physicians who have recently enrolled or re-enrolled in Medicare via the PECOS system are also now automatically enrolled in electronics funds transfer (EFT) for payment. EFT is now a mandatory step in completing your PECOS enrollment or re-enrollment. If you were receiving your reimbursement for Medicare via a paper check, and you have recently enrolled in Medicare via PECOS, you are now receiving your payment via EFT, as this is now a requirement as part of your Medicare program enrollment. If you have any questions, please contact Marisol Gonzalez, your SDCMS physician advocate, at (858) 300-2782 or at MGonzalez@SDCMS.org.

Executive Director Comment: The creation of ACOs (see directly below) has the potential to become a legal way around anti-trust regulations that prevent physicians from coming together to negotiate collectively — stay tuned as we flesh this out.

Pilot Program #1 in the Healthcare Reform Bill: ACOs/Medicare Shared Savings Program
By January 1, 2012, the HHS secretary is required to establish certain Medicare shared savings programs commonly known as ACOs for various providers. These providers include groups of physicians, networks of individual practices, partnerships or joint ventures between hospitals and physicians, hospitals employing physicians, and any other provider groups that the secretary determines is appropriate. To qualify, an ACO must agree to be accountable for the quality, cost, and overall care for the Medicare fee-for-service beneficiaries assigned to it. An ACO must have at least 5,000 assigned Medicare beneficiaries and have in place, among other things, the following: 1) a formal legal structure that would allow the organization to receive and distribute payments for any shared savings; 2) a leadership and management structure that includes clinical and administrative systems; 3) defined processes to promote evidence-based medicine; and 4) processes to report on quality and cost measures. Payments will continue to be made to physicians and other ACO participants under the usual Medicare payment structure (e.g., the Medicare fee schedule). Additionally, ACOs would share among their provider participants a portion of any savings achieved in excess of a threshold benchmark. ACOs must agree to participate in the demonstration for at least three years.

Executive Director Comment: This (see directly below) has the potential to create a food fight between hospitals and doctors …

Pilot Program #2 in the Healthcare Reform Bill: Payment Bundling
By January 1, 2013, the HHS secretary is required to establish a Medicare pilot program for integrated care. This will include episodes of care involving a hospitalization to improve the coordination, quality and efficiency of healthcare services, such as: 1) physician services delivered inside and outside of an acute care hospital setting; 2) other acute care inpatient services; 3) outpatient hospital services, including emergency department services; 4) post-acute care services, including home health, skilled nursing, inpatient rehabilitation, and inpatient services furnished by long-term care hospitals; and 5) other services the secretary determines are appropriate. The secretary will also establish a payment methodology, including bundled payments or bids for episodes of care. Payment will be made to the entity that is participating in the pilot program.

AMA Offers Physicians Help Claiming Damages From UnitedHealth Settlement
A new online collection of resources from AMA can help thousands of physicians file claims against UnitedHealth Group — the nation’s largest health insurer. More than $350 million is available to compensate physicians and their patients for 15 years of artificially low payments for out-of-network services, and this new collection of resources provides physicians with step-by-step assistance in determining eligibility, assembling documentation and filing a claim under the terms of the settlement. Click here to access these resources. The deadline for filing a claim to share in the settlement fund is Oct. 5.

FTC Red Flags Rule Take Effect June 1, 2010
The Federal Trade Commission (FTC) will soon begin enforcing its new Red Flag Rule, which requires "creditors" — including many physicians — to develop and implement identity theft detection and prevention programs. The new regulations take effect on June 1, 2010.

Red Flags Rule Resources From SDCMS and CMA

  • SDCMS Brief Webinar on the Red Flags Rule (recorded April 22, 2009) • Click Here
  • SDCMS Sample Policy in Word • Click Here
  • SDCMS' Sample Policy in PDF • Click Here
  • CMA’s Toolkit in PDF • Click Here
  • AMA's Red Flags Rule Guidance Document in PDF • Click Here
  • AMA's Sample Policy in PDF • Click Here
  • The FTC's Do-it-yourself Prevention Program for Businesses and Organizations at Low Risk for Identity Theft • Click Here

Executive Director Comment: Another "gotcha" — look carefully at your new contracts to see if insurance payors are unilaterally dropping consult codes.

Some Private Payors Changing Consultation Code Payment Policies
Medicare is no longer recognizing inpatient and outpatient consultation codes. Effective January 1, 2010, physicians must instead bill using E&M codes from the Office and Other Outpatient Services, Initial Hospital Care, and Initial Nursing Facility sections of the 2010 CPT. As anticipated, some private payors have also made changes to their consultation code payment policies. CMA has published a Managed Care Consultation Code Quick Reference Guide, detailing which major payors in California will be changing their payment policies and the products types specifically affected. The guide is available free to members at the members-only website.

Update on Medicare Claims: Payments for April Dates of Service
Congress was unable to pass legislation to freeze the Medicare fees at the 2009 payment levels before the 10 business day hold expired on April 12. As of April 30, all clean claims received by Palmetto up through April 6 had been paid. All other held April claims (up through receipt date April 14) should be paid within approximately 25 days of the Palmetto receipt date, approximately May 10. Claims received on and after April 15 are being processed and paid under the normal payment floor requirements — no sooner than 14 days for electronic and 29 days for paper claims.

DEA Issues Interim Rule on Eprescribing for Controlled Substances
The Drug Enforcement Agency (DEA) published an Interim Final Rule (IFR) on eprescribing for controlled substances on March 31. The IFR specifies the rules that physicians and other healthcare providers will need to follow in order to electronically prescribe controlled substances in accordance with the law. The DEA is calling for physicians to use two of the following three methods to authenticate their prescriptions: 1) password; 2) biometric (i.e. thumbprint); and 3) hard token (i.e., USB drive). Click here to access the IFR.

RAND Study demonstrates Serious Flaws in Cost-profiling of Physicians
Organized medicine’s long-standing contention that there are serious flaws in health insurer programs that attempt to rate physicians based on cost of care has been corroborated by a study by the RAND Corporation, released in the New England Journal of Medicine on March 18, 2010. According to the study, physician ratings based on cost of care can be incorrect up to two-thirds of the time for some physician specialties, and one-fourth of all physicians are misclassified under the system used by most health insurers. The study concludes that current methods for profiling physicians based on cost of care may produce misleading results, which bring into question both 1) the utility of using cost-profiling tools for high-stakes uses, such as tiered health plan products, and 2) the likelihood that their use will reduce healthcare spending. The significance of incorrect reporting of physician performance is magnified when these incorrect ratings are used to assign physicians into tiers and patients are incentivized to see physicians in the low-cost tier, potentially destroying many long-standing physician-patient relationships. Click here for further information.

Important Clarification Regarding the Medicare/Medicaid EHR Incentive Programs
HR 4851, the Continuing Extension Act of 2010 signed by the president in April, changes the definition of “hospital-based” physician for purposes of the Medicare and Medicaid EHR incentive programs, specifically limiting the definition of “hospital-based” physician to those who practice in inpatient or emergency room settings. This small but important change will allow physicians in hospital-based clinics to access incentive payments. It is likely that there will be further clarification on the definition of “hospital-based” in the final meaningful use definition soon to be released. This change in the legislative language will allow for that final rule to more accurately reflect the realities of physician practices.

Copy Machines, a Security Risk?
This year marks the 50th anniversary of the good, old-fashioned copy machine. But, as Armen Keteyian reports, advanced technology has opened a dangerous hole in data security.

MEDICAL

Community Health Briefs From the Center for Healthier Communities at Rady Children’s Hospital

  • Data collected by the Partnership for Smoke-Free Families show that the percentage of women in San Diego County who smoked at some point during their first trimester has decreased significantly in the past decade. Click here for details.
  • Research funded by the Anderson Center for Dental Care shows that although prenatal providers are aware of the importance of oral health to their pregnant patients, they often don’t act upon their knowledge. Click here for details.

Preventable Risk Factors Cut Four to Five Years off Lifespan
Family physician Stephen Taylor, MD, had no adolescent patients with type 2 diabetes when he started his rural Vivian, La., practice 26 years ago. Now he treats children as young as 12 for the disease. Rising obesity is one reason Dr. Taylor says there are more adolescents with type 2 diabetes. He works with patients to change their lifestyles and improve their health, but they often won't act. Click here to read more.

SDCMS SEMINARS / WEBINARS / EVENTS
For further information on or to register for any of the following SDCMS seminars, webinars, and events, contact Sonia Gonzales at (858) 300-2782 or at SGonzales@SDCMS.org.

  • MAY 20 (THU) • "ABCs of Workers’ Compensation Billing" Seminar/Webinar • 11:30am–1:00pm • Click Here
  • MAY 22 (SAT) • Media Training • 8:00am–11:30am • Gehring@SDCMS.org
  • JUN 5 (SAT) • 140th Annual SDCMS Installation Dinner and Dance • 6:00pm–11:00pm • Hyatt Regency Mission Bay, 1441 Quivira Road, San Diego, CA 92109 • For ticket information and sponsorship opportunities, contact Jen Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org.
  • JUN 10 (THU) • EMR/EHR Trunk Show • 11:00am–7:30pm • Click Here for Details
  • JUN 18–19 (FRI & SAT) • Leader's Toolbox Seminar • 8:00am–4:00pm both days • Gehring@SDCMS.org
  • JUN 24 (THU) • "Preventing Workplace and Sexual Harassment" Seminar/Webinar • 11:30am–1:30pm
  • JUL 20 (TUE) • “The Employee’s Role in Decreasing Liability Risks in the Physician Office” Risk Management Webinar • 11:30am–12:30pm
  • JUL 21 (WED) • “The Employee’s Role in Decreasing Liability Risks in the Physician Office” Risk Management Webinar • 6:30pm–7:30pm
  • JUL 22 (FRI) • SDCMS Membership Social • 6:30pm–9:00pm • Rock Bottom Restaurant and Brewery, La Jolla • SDCMS Members + Guest, Limited Spacing, RSVP Required • JOhmstede@SDCMS.org
  • AUG 7 (SAT) • "Microsoft Outlook for Busy Docs" Seminar • Gehring@SDCMS.org
  • AUG 18 (WED) • "OSHA Updates" Seminar/Webinar • 11:30am–1:00pm
  • AUG 25 (WED) • "HIPAA Updates" Seminar/Webinar • 11:30am–1:00pm

SAN DIEGO COUNTY HEALTHCARE EVENTS

“Man is a rational animal who always loses his temper when called upon to act according with the dictates of reason.” — Oscar Wilde (1854–1900)

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

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