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SDCMS "News You Can Use" (2010.08.13)

by: San Diego County Medical Society
Published August 13, 2010

SDCMS "News You Can Use"
— August 13, 2010

What the Heck Is an Accountable Care Organization (ACO)? Mon., Sept. 13 (Two Times)
SDCMS members only, join us on Monday, September 13, 2010 [two times: during lunch (11:30am–1:00pm) and during dinner (6:00pm–7:30pm)] at SDCMS’ offices on 5575 Ruffin Road as CMA’s general counsel will provide insights into this potential change. Click here for further information or to register.

OSHA Refresher Seminar/Webinar • Aug. 18, 11:30am–1:00pm
This SDCMS members-only refresher course will help ensure you know what employers are required by law to provide to their employees with regard to OSHA, what employee rights and responsibilities in the workplace are with regard to OSHA, and much more. Click here for further information or to register.

HIPAA Updates Seminar/Webinar • Aug. 25, 11:30am–1:00pm
The HITECH Act has introduced many changes — recently published as proposed rules by the federal government — to HIPAA and compliance. Enforcement and penalties have increased for noncompliance! Don't miss this valuable, members-only seminar/webinar. Click here for further information or to register.

SDCMS Young and Resident Physician Summer Social • Sat., Sept. 11, 2010
You and your families are invited to SDCMS’ 5th Annual Young and Resident Physician Summer Social and Swim Party on Saturday, September 11, 2010, 5:00pm–8:00pm. The social will be held at a private residence in Rancho Penasquitos. There will be a pool, a playset, and plenty of room to run around, so we encourage you to bring family and kids. It’s free, and there are no vendors or sales reps. This is a fabulous opportunity to network and to have fun with your fellow physicians and their families. We’ll “open the doors” at 5:00pm. Come when you want and stay however long you want. Be sure to bring swimsuits and pool toys for the kids! Dress code is San Diego “extreme” informal! RSVP to Jen Ohmstede at JOhmstede@SDCMS.org to let us know how many are coming and the number of kids. Jen will then email you the detailed directions so you can join us. We hope to see you there!

CONTENTS

  • 2011 Medicare Fee Schedule Dramatically Shifts Funding From Urban to Rural States
  • Rosy Predictions for Medicare Solvency Are Unrealistic, Says Medicare Actuary
  • Enhanced Medi-Cal Rates Extended
  • Legislative Update From CMA's Center for Government Relations
  • California State Budget Update
  • Most Major Health Plans Will Not Delegate Timely Access Requirements
  • One Small Victory for CMA re: TriWest’s Sudden Decreased Payment for RotaTeq Oral Vaccine
  • Unclaimed Property Search
  • SDCMS "Physician Leader’s Toolbox" Seminar • November 12 & 13, 8:00am–4:00pm
  • Nominate Your Office Manager for SDCMS’ Second-annual “Outstanding Medical Office Manager” Contest!
  • “Retired Physicians Society” Luncheon • September 15 • "San Diego Water Purification Demonstration Project"
  • SDCMS SEMINARS / WEBINARS / EVENTS
  • SAN DIEGO COUNTY HEALTHCARE EVENTS

FEDERAL

2011 Medicare Fee Schedule Dramatically Shifts Funding From Urban to Rural States
CMS has proposed a number of changes in the 2011 Medicare physician payment rule that would shift more than $1 billion in Medicare funding from urban to rural states. As a result, many physicians in urban and suburban areas could be hit with a payment reduction of up to 6% — on top of the 23% SGR cut set to take effect December 1, 2010, and the 6.5% SGR cut scheduled for January 1, 2011. CMA is vigorously opposing this arbitrary and politically driven change to the Medicare fee schedule. Physicians interested in submitting comments can do so by clicking here. Click here to read the letter sent to San Diego County's five congressional representatives.

Executive Director Comment: In an ironic twist, because San Diego County is incorrectly classified as a rural area, we actually (unlike other major metropolitan areas in California) would (and I emphasize "would" because this is not likely to go far …) get a very small plus up (1.5%) vice a 6–10% reduction.

Rosy Predictions for Medicare Solvency Are Unrealistic, Says Medicare Actuary
According to the Medicare Board of Trustees' annual report, because of cost-cutting measures in the federal health reform legislation, Medicare will remain solvent until 2029, fully 12 years later than last year’s projection. The savings are based on an assumption that hospitals, physicians, and other healthcare providers will become more efficient. The report also assumes that Medicare will cut payment rates for doctors’ services by 23% on December 1, 2010, and by an additional 6.5% on January 1, 2011, as required by SGR. Although the current political and economic climate makes a permanent physician payment fix by the end of the year unlikely, Congress is expected to once again step in and stop the cuts. CMA, which is working with AMA and others to develop a strategy to avoid another retroactive stoppage of the cuts, is working to make sure Congress understands that California’s solo and small-group physicians cannot sustain another cut, even if adjusted retroactively! Click here for further details.

Executive Director Comment: The assumptions underlying this rosy prediction are not realistic. There is no way that the stakeholders dependent on access to physicians taking Medicare will allow those cuts to go through. It will be ugly in November and December, and no one will be happy, but a 30% reduction in Medicare is not politically realistic.

Enhanced Medi-Cal Rates Extended
California received some good news from Washington last week, when Congress voted to extend Medicaid assistance to states by the Federal Medical Assistance Percentage (FMAP) it has been paying to the states since the passage of the American Recovery and Reinvestment Act (ARRA) in February 2009. Under ARRA, the federal government has, since October 2008, paid about 62% of the cost of California’s Medi-Cal program. That higher rate — the federal government normally only pays 50% of Medi-Cal’s cost — was due to expire on Dec. 31. The new legislation would provide California with about $1.5 billion over the first six months of 2011 (California lawmakers had expected $2 billion in extra Medi-Cal assistance for the 2010–11 budget; the net result is the bill would increase the state’s estimated budget deficit by $500 million). The bill now goes to the White House for the president’s signature. Click here for further information.

STATE

Legislative Update From CMA's Center for Government Relations
August 13, 2010, is the last day for California’s fiscal committees to hear and report bills to either the Assembly or Senate floor. Three of CMA's sponsored bills moved successfully this week:

  • AB 2093 (M. Perez) on adequate vaccine reimbursement.
  • AB 2533 (Fuentes), which requires disclosure of policies and procedures for any kind of health insurer physician rating system.
  • AB 2248 (Hernandez), which addresses weaknesses in the accounting practice of counties for the EMS / Maddy Fund.

Many of the first round of bills on state implementation of federal healthcare reform were placed on suspense, including:

  • AB 1602 and SB 900, two legislative vehicles to establish the Health Insurance Exchange in California;
  • AB 1825, AB 2244, and SB 1088, market reform and coverage expansion bills;
  • AB 591, AB 2578, and SB 1163, rate review / rate regulation bills.
  • AB 2470, which protects patients from unlawful rescission of health insurance, was also placed on the suspense file.

August 31, 2010, is the last day for any bill to complete the legislative process. For details, see CMA's updated Legislative Hot List.

California State Budget Update
As of Monday, August 9, 2010, the State's budget was 40 days late. The governor's office estimates that the fiscal crisis worsens at a rate of $52.3 million dollars per day. On August 3, 2010, Democratic leaders in the Legislature presented a proposal to close the $19 billion gap, which included a tax swap (raising personal income taxes while lowering the state's sales tax), and an increase on the vehicle licensing fee. This proposal was firmly rejected by the Republicans, who oppose increasing taxes, calling the swap "fuzzy math."

Most Major Health Plans Will Not Delegate Timely Access Requirements
California Department of Managed Health Care (DMHC) regulations requiring that patients be seen in a timely manner take effect January 2011. The “timely access” regulation, as it is known, requires DMHC-regulated health plans (all HMOs and Blue Shield and Blue Cross PPOs) to ensure that patients can see a provider within a certain timeframe and that plans have adequate provider networks to meet these requirements. At CMA’s urging, DMHC conducted a survey to find out which health plans intend to delegate the responsibility for compliance with timely access requirements to their contracting medical groups and physicians. The survey revealed that most major health plans indicated they would retain responsibility for compliance with the regulation. Several smaller HMOs, however, notified DMHC that they did intend to delegate the responsibility for the screening and triage requirement to contracting medical groups and physicians. Click here for further information.

One Small Victory for CMA re: TriWest’s Sudden Decreased Payment for RotaTeq Oral Vaccine
After receiving an inquiry from an SDCMS member physician regarding TriWest’s sudden decreased payment for RotaTeq oral vaccine, CMA investigated and prompted TriWest to admit to a clerical error that had happened several years previously in the North Carolina region, whereby the NDC code was inputted as a two-unit vaccine (rather than 2 ml), thus making effective payment at 50% of acquisition cost. TriWest will correct the error effective July 1 and will work to retroactively adjust claims mispaid over the last several months. Kudos to CMA staff for their excellent work and persistence. One small victory for organized medicine!

Unclaimed Property Search
California's Unclaimed Property Law requires corporations, businesses, associations, financial institutions, and insurance companies (referred to as "Holders") to annually report and deliver property to the California State Controller's Office after there has been no activity on the account or contact with the owner for a period of time specified in the law — generally three years or more. Click here to locate any unclaimed property that has already been sent to the State safekeeping, as well as property that is about to be sent to the State by a business as required by law.

LOCAL

SDCMS "Physician Leader’s Toolbox" Seminar • November 12 & 13, 8:00am–4:00pm
This is an exceptional opportunity for SDCMS members to build your leadership skills and your network. This unique, small-group seminar will be held at SDCMS for physicians who are either leaders or leaders-to-be. The topics will include:

  • Strategic Planning and Execution
  • Leading Your Team
  • Building Your Team: Focusing on Hiring and Firing,
  • Managing Your Time
  • Managing Your Organization’s Money
  • Managing the Message: Communicating One-on-one
  • Speaking to Many
  • Emailing
  • Making Formal Presentations
  • Managing Your Meetings, Including Parliamentary Procedures

For further information or to register, email me at Gehring@SDCMS.org.

Nominate Your Office Manager for SDCMS’ Second-annual “Outstanding Medical Office Manager” Contest!
SDCMS wants to recognize San Diego County’s most outstanding medical office manager, i.e., someone who goes above and beyond their job description, who anticipates problems before they arise, who works efficiently with the practice’s time and resources, and who strikes the right balance between control and morale when supervising staff. Nominate your office manager by explaining in writing (up to approximately 600 words) why your office manager is the best in San Diego County. Email nominations to Sonia Gonzales at SDCMS at Sonia at SGonzales@SDCMS.org. The winner will receive a $250 gift card and recognition as SDCMS’ Outstanding Medical Office Manager for 2010! Nominations will be accepted until October 1, 2010, and contest results will be published in the December issue of San Diego Physician. Contact Sonia with any questions at (858) 300- 2782 or at SGonzales@SDCMS.org.

“Retired Physicians Society” Luncheon • September 15 • "San Diego Water Purification Demonstration Project"
The Retired Physicians Society will meet again on Wednesday, September 15, from 11:30am to 1:30pm. The panel discussion will address questions such as: What is the plan to treat and purify reclaimed water? Why is it important? Is it safe? The luncheon will be held in SDCMS’ meeting room at 5575 Ruffin Road, Suite 250. Socializing begins at 11:30am, lunch at noon, speaker panel at 12:30pm, and adjournment at 1:30pm. $15 per person (make checks payable to “SDCMS” and mail to SDCMS at 5575 Ruffin Road, Suite 250, San Diego, CA 92123). Retired physicians, guests, and interested others are welcome. RSVP to mitsuo@cox.net by Friday, September 10, 2010. Contact mitsuo@cox.net with any questions.

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 18 (WED) • “OSHA Updates” Seminar/Webinar • 11:30am–1:00pm • Click Here for Information or to Register
  • AUG 25 (WED) • “HIPAA Updates” Seminar/Webinar • 11:30am–1:00pm • Click Here for Information or to Register
  • SEP 11 (SAT) • Young Physician Summer Social • 5:00pm–8:00pm • 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 for Information or to Register
  • SEP 15 (WED) • "Retired Physicians Society" Luncheon • "San Diego Water Purification Demonstration Project" • 11:30am–1:30pm • Contact mitsuo@cox.net to RSVP or with any questions.
  • SEP 16 (THU) • “Changes to Medicare Regulations” Seminar/Webinar • 11:30am–1:00pm • Click Here for Information or to Register
  • 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 for Information or to Register
  • 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
  • NOV 12 (FRI) (T) • SDCMS Membership Social • 6:00pm–9:00pm • JOhmstede@SDCMS.org
  • NOV 12–13 (FRI–SAT) • "Physician Leader's Toolbox" • Gehring@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.

“The highest possible stage in moral culture is when we recognize that we ought to control our thoughts.”
— Charles Darwin (1809–1882)

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