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SDCMS "News You Can Use" (2010.07.30)

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

SDCMS "News You Can Use"
— July 30, 2010

CMA’s General Counsel to Speak on Accountable Care Organizations (ACOs) and Medical Foundations — Monday, September 13, 2010
Seminar/webinar presentations will be made both during lunch (11:30am–1:00pm) and during dinner (6:00pm–7:30pm) at SDCMS’ offices on 5575 Ruffin Road. For further information or to register, click here.

“Microsoft Outlook for Busy Docs” SDCMS Seminar • Saturday, August 7, 2010 • 8:00am–11:30am
This Saturday-morning, SDCMS-members-only course on how to make Microsoft Outlook your servant and not your master. This will be a very, very practical and user-focused seminar taught by the CEO of SDCMS. Please mark it down on your calendar and email me (Gehring@SDCMS.org) or click here for registration form if interested.

What Has Organized Medicine Done for You Lately? How About $25.8 Million Reimbursement for a Stopped 10% Medi-Cal Cut?
California Medi-Cal physicians recently received checks totaling $25.8 million as retroactive payment for claims processed between July 1 and August 18, 2008. Click here for details.

CONTENTS

  • CMS Releases Final “Meaningful Use” Requirements for EHRs
  • Meaningful Use References
  • Meaningful Use Key Barriers
  • New 2011 Medicare Payment Rule Implements Key Provisions of Reform Law
  • Pertussis Epidemic and New California Tdap Policy
  • Seasonal Illnesses of Public Health Significance: West Nile Virus, Rabies, and Vibriosis
  • New County of San Diego HHSA Video for San Diego Physicians on Fall Prevention
  • New Aerosol Transmissible Disease Standards Take Effect September 1
  • CMA Regulations Quick List (July 13, 2010)
  • Blue Cross Payment Policy Revision Modifier -78
  • SDCMS SEMINARS / WEBINARS / EVENTS
  • San Diego County Healthcare Events

MEANINGFUL USE — FINAL RULE

CMS Releases Final “Meaningful Use” Requirements for EHRs
On July 14, CMS released the final rule defining “meaningful use” of an electronic health record (EHR) system. The reporting requirements in the final rule are greatly simplified, and physicians have more flexibility to choose measures that apply to their specialty. There are also protections for physicians practicing in areas lacking health information technology (HIT) infrastructure, such as health information exchanges and immunization registries There are three stages for demonstrating meaningful use. This final rule pertains to stage 1, which covers the first two years of adoption and meaningful use of certified EHR technology. Stages 2 and 3 will be defined in future rulemaking.

Meaningful Use References:

  • Summary of the Final Meaningful Use Rule • Click Here
  • Stage 1 Meaningful Use Criteria • Click Here
  • Overview of Clinical Quality Measures Reporting • Click Here
  • Overview of Medicaid Incentives • Click Here
  • Overview of Medicare Incentives • Click Here
  • For more information, see Chapter 7 of CMA’s Best Practices toolkit, “Successful Preparation and Implementation of an Electronic Health Records System” • Click Here

Meaningful Use Key Barriers Include:

  • Product Availability: There is no EHR in the market today that does all of the things required for physicians to successfully meet Stage 1 meaningful use criteria. CMS and the Office of the National Coordinator expect certified EHRs (i.e., that support the achievement of Stage 1 meaningful use) to be available this fall.
  • Timing: Physicians will only have a couple of months to purchase, implement, and assess the usability of certified EHR technology prior to January 2011, the start date of the incentive program.
  • Volume of Measures: The volume of measures that physicians must meet totals 20, which is still too high, especially for smaller practices that have not yet adopted or used EHR technology.
  • Hospital-based Professionals: Hospital-based physicians are not eligible for incentives if they provide 90% or more of their services in an inpatient or emergency room setting.
  • Timeframes for Furnishing Patient Information Electronically: The measures that require physicians to electronically produce, within several days, health information contained in EHRs conflict with HIPAA requirements that allow for a longer period of time (at least 30 days) for the production of medical records.
  • Threshold Requirements Still Too High: Some of the threshold requirements are still too high, and some of the measures have narrow exclusions, which will be burdensome for physicians to meet (e.g., one measure requires physicians to maintain an up-to-date problem list of current and active diagnoses or indicate that no problems are known for more than 80% of patients seen during the reporting period, with no exceptions. Another requirement (a menu option) is to provide a “summary of care” record for more than 50% of patient transitions or referrals within three business days, which will be difficult to meet).
  • No Appeals Process: There is no mechanism for physicians to appeal any aspect of the incentive program (e.g., payments or eligibility).
  • Usability: The certification process does not take into account whether a product will meet a physician’s unique workflow and practice needs, rather, it will only provide the means for meeting the meaningful use criteria.
  • Early Adopters: Physicians who are “early adopters” of EHRs have already invested substantially in EHR technology and must now upgrade their systems to meet certification criteria in order to be eligible for incentives.
  • Testing of Re-tooled Measures: CMS expects the EHR certification process to carry out the necessary testing to assure that applicable certified EHR technology can calculate sufficient clinical quality measures required to qualify. Physicians are required to report summary clinical quality information (number, denominator, and exclusion) in stage 1, but there is no guarantee that the e-specifications imbedded in EHR vendor products are accurate and operational. As a result, physicians may capture the wrong data, or worse, report via attestation in 2011, invalid clinical quality information to CMS or the states (if Medicaid).

FEDERAL

New 2011 Medicare Payment Rule Implements Key Provisions of Reform Law
CMS’ proposed rules detailing Medicare physician payment policies for 2011 — published July 13 in the Federal Register — implement a number of health reform provisions, including the elimination of deductibles and coinsurance for most preventive services, new coverage of annual wellness visits, and new payment incentives. CMS will be accepting public comment on the proposed rule until August 24.

  • The proposed rule projects a 6.1% reduction to physician payment rates in 2011 under the sustainable growth rate (SGR) formula, absent additional congressional intervention. Executive Director Comment: Yikes … this on top of the 25% cut programmed for January 1, 2011, due to the (un)Sustainable (non)Growth Rate.
  • The rule contains significant changes to the geographic payment formula. It significantly de-weights the impact of rent on practice expenses, so physicians in regions with higher office rents will be paid less. The rule also uses different data sources to calculate rent, wages, and physician work. These geographic payment changes will result in an average payment reduction in California of 4%.
  • The proposed rule clarifies which physicians qualify for the 10% primary care bonus. According to the rule, the 10% payment bonus is available to primary care practitioners for whom more than 60% of Medicare Part B allowed charges are attributable to a defined set of outpatient and nursing visits. To be eligible in 2011, physicians must have met the 60% threshold in 2009 and must have listed family practice, internal medicine, pediatrics, or geriatrics as their primary specialty designation at the time the service was provided. The bonus will be paid on a quarterly basis. Eligibility will be redetermined each year based on claims patterns and specialty designations from two years earlier. This means new Medicare physicians will not be eligible until two years after they enroll in Medicare, although CMS is looking for suggestions on how to get around this problem.

Executive Director Comment: The following two references are really-easy-to-read-and-digest timelines for healthcare reform, specifically designed to be "tear out and post to the wall" material:

  • Click here to access a health reform timeline for 2010 (published in the May 2010 issue of San Diego Physician).
  • Click here to access a health reform timeline for 2011–1018 (published in the June 2010 issue of San Diego Physician).

MEDICAL

Pertussis Epidemic and New California Tdap Policy
Below please find a packet of materials prepared by the County of San Diego Immunization Branch to make physicians aware of expanded guidelines for use of pertussis vaccine in light of the current outbreak of pertussis in California. These guidelines support the off-label use of the vaccine in certain situations:

  • Pertussis Vaccination Recommendations 2010 (California Department of Public Health) • Click Here
  • Confidential Morbidity Report • Click Here
  • Whooping Cough Is on the Rise in California: Protect Your Baby • Click Here
  • Pertussis Is Epidemic in California: Protect Infants, Adolescents, and Adults! • Click Here
  • Is It Just a Cough or Is It Whooping Cough? • Click Here

Seasonal Illnesses of Public Health Significance: West Nile Virus, Rabies, and Vibriosis [July 20, 2010]
This summer, San Diego County clinicians are urged to consider illnesses associated with warmer temperatures and increased outdoor activities.

  • West Nile Virus (WNV): WNV season is here. While no human WNV have been reported in San Diego County to date in 2010, the majority of human WNV cases in previous years occurred between July and September. San Diego County clinicians are encouraged to consider WNV testing for patients presenting with symptoms compatible with WNV infection, particularly those with neuroinvasive disease (e.g., aseptic meningitis, encephalitis and/or acute flaccid paralysis). WNV testing is available, free of charge, through the San Diego County Public Health Laboratory. Suspect cases should be reported to the Epidemiology and Immunization Services Branch. Clinical guidelines, testing algorithms, and specimen submission forms are available by clicking here. For more information about WNV surveillance in San Diego County or to order complimentary educational materials, click here.
  • Rabies: During the month of June 2010, 4 of 13 submitted bats tested positive for rabies at the San Diego County Public Health Laboratory. The public is advised never to touch bats, dead or alive. If direct contact with a bat does occur, the exposed area should be washed with soap and water and medical advice should be obtained immediately. The small teeth of a bat can make a bite difficult to find. Rabies transmission may also occur if a bat’s saliva is in contact with open wounds on the skin or with mucous membranes such as the eyes, nose, or mouth. The Epidemiology and Immunization Services Branch is available 24/7 for consultation regarding bat and other potential exposures to rabies by calling (619) 515-6620 during normal business hours, or (858) 565-5255 after hours.
  • Vibriosis: Vibrio parahaemolyticus cases associated with raw oyster consumption tend to increase in summer with warmer water temperatures. Due to the potential for severe complications from vibriosis infection, please advise patients with chronic liver disease about the risk of consuming raw shellfish. Clinicians are encouraged to consider vibriosis when evaluating patients who report raw oyster consumption before an acute onset of diarrhea. Stool cultures should be requested, and confirmed or suspect vibriosis cases should be reported to the Epidemiology and Immunization Services Branch.

Click Here to Watch a New County of San Diego HHSA Video for San Diego Physicians on Fall Prevention, With Local Resources

New Aerosol Transmissible Disease Standards Take Effect September 1
On September 1, 2010, new Cal/OSHA standards take effect requiring employers to protect employees from aerosol transmissible diseases (ATDs). ATDs are those that require “droplet precautions” or “airborne infection isolation.” The new standards cover healthcare facilities, including hospitals, nursing facilities, clinics, medical offices, long-term care facilities, emergency services and transport providers, and other defined high-risk workplaces. Under the new standards, covered employers are required to offer influenza, measles, mumps, rubella, Tdap, and varicella vaccines to their employees. (Currently, covered employers are only required to provide the seasonal flu vaccine.) Employees who decline these vaccines must complete declination statements. The new standards also require employers to provide powered air-purifying respirators to employees who perform high-hazard procedures. These new standards are in addition to the standards that took effect last August that require employers to have written infection control procedures in place. The written infection control plan must include, among other things, a list of all high-hazard procedures performed in the facility, a respiratory protection plan, procedures for identifying, isolating, and transferring potentially exposed individuals, and detailed procedures to follow in the event of an exposure incident. CMA is currently developing resources to help physicians comply with the new requirements. In the interim, visit the Department of Industrial Relations.

STATE

CMA Regulations Quick List (July 13, 2010)
Click here to access an updated Regulations Quick List from CMA, which provides summaries on various regulations tracked by CMA’s Center for Medical and Regulatory Policy. For more information on a specific regulation, please contact the staff member listed.

Executive Director Comment: The item directly below is a fabulous example of why organized medicine matters and is effective. CMA and SDCMS advocacy turned around (or at least turned most of the way around) a really pernicious rule by an insurance company — and thank you to member physicians for bringing it to our attention!

Blue Cross Payment Policy Revision Modifier -78
A letter sent by Blue Cross to an SDCMS member physician seemed to indicate that Blue Cross would no longer pay for five specific incision and drainage codes when performed during the post-op period — that they would consider them part of the global surgical period. The letter was silent on whether modifier -78 (return to operating/procedure room) would bypass the edit as it has in the past. Click here for CMA clarification on Blue Cross' payment policy with respect to modifier -78.

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.

  • AUG 7 (SAT) • “Microsoft Outlook for Busy Docs” Seminar • 8:00am–11:30am • Click Here
  • AUG 18 (WED) • “OSHA Updates” Seminar/Webinar • 11:30am–1:00pm • Click Here
  • AUG 25 (WED) • “HIPAA Updates” Seminar/Webinar • 11:30am–1:00pm • Click Here
  • SEP 11 (SAT) • Young Physician Summer Social • 4:00pm–7:00pm • JOhmstede@SDCMS.org
  • SEP 13 (MON) • CMA Counsel Speaks on “ACOs and Medical Foundations” Seminars/Webinars • 11:30am–1:00pm or 6:00pm–7:30pm • Click Here
  • SEP 16 (THU) • “Changes to Medicare Regulations” Seminar/Webinar • 11:30am–1:00pm • Click Here
  • SEP 18 (SAT) • Media Training Workshop • 9:00am–12:00pm • Gehring@SDCMS.org
  • SEP 30 (THU) • “The Art of the Appeal” Billing Seminar/Webinar • 11:30am–1:00pm
  • OCT 1–29 (5 FRIDAYS) • Certified Medical Coder Course • 8:00am–4:00pm • Click Here
  • OCT 7 (THU) • “Economic Survival” Seminar/Webinar • 11:30am–1:00pm
  • NOV 4 (THU) • “Expert Witness, Medical Board Interactions” Seminar/Webinar • 11:30am–1:00pm
  • (T) NOV 12 (FRI) • SDCMS Membership Social • 6:00pm–9:00pm • JOhmstede@SDCMS.org
  • NOV 17 (WED) • “Emerging Patient Safety Issues Impacting Office Practices” Webinar • 6:30pm–7:30pm
  • NOV 18 (THU) • “Emerging Patient Safety Issues Impacting Office Practices” Webinar • 11:30am–12:30pm
  • NOV 20 (SAT) • “Preparing to Practice” Workshop • 8:00am–4:00pm

SAN DIEGO COUNTY HEALTHCARE EVENTS
To submit a community healthcare event for possible publication, email KLewis@SDCMS.org. Events should be physician-focused and should take place in San Diego County.

“There once was a bald man who sat down after work on a hot summer's day. A fly came up and kept buzzing about his bald pate, stinging him from time to time. The man aimed a blow at his little enemy, but — whack — his palm come on his own head instead. Again the fly tormented him, but this time the man was wiser and said, “You will only injure yourself if you take notice of despicable enemies.”
— Aesop (ca. 620–564 BCE)

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

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