SDCMS "News You Can Use" (2009.09.10)

SDCMS "News You Can Use"
— September 10, 2009

SDCMS Healthcare Reform Townhall • Sept. 15, 7:00pm-8:00pm
Please join us for an SDCMS Healthcare Reform e-Townhall meeting on Tuesday, Sept. 15, from 7:00 p.m. to 8:00 p.m. SDCMS member and nonmember physicians are invited to participate. Following a brief introduction, the townhall format will have a moderated panel answering your in-person, Web-based, or call-in healthcare reform questions.

• If you would like to join us in person, please email me (Gehring@SDCMS.org) for location and RSVP details.
• If you would like to join us via an interactive Web simulcast, please pre-register by clicking here.
• If you would like to listen in via teleconference, call (866) 214-4652 at 7:00 p.m. on Sept. 15. To ask a question over the telephone, call (619) 206-8282.

SDCMS "News You Can Use" Healthcare Reform Survey Results
Thanks to the over 100 physicians who participated in the August survey of physician attitudes toward healthcare reform. Click here to access our Aug. 17 survey results. Here are the highlights:

• There is overwhelming opposition to a single-payer system (67%-32%), a slight majority for keeping the current system (52%-47%), and good support for a combination of the two (56%-38%).
• There is overwhelming support for an individual mandate for catastrophic health insurance (75%-21%), but no support for an individual mandate for comprehensive health insurance (39%-44%).
• There is opposition to an employer mandate for employers with more than 10 employees (49%-35%), and overwhelming support for the creation of health insurance exchanges for employers with fewer than 10 employees (77%-11%).
• The preferred way of paying for health insurance reform is an across-the-board tax increase, as opposed to more targeted tax increases.
• Almost everyone took Medicare, and 65% felt Medicare rates were poor (40%) or unsustainable (24%).
• Only 50% took Medi-Cal, and an overwhelming majority felt Medi-Cal rates were poor (30%) or unsustainable (57%), with a strong exodus from Medi-Cal absent changes.
• There is a strong belief (63%-26%) that that physician-driven over-utilization is part of the cost problem in healthcare.
• There is overwhelming belief (90%-6%) that patient-driven over-utilization is part of the cost problem in healthcare.
• There is overwhelming belief (93%-6%) that physicians practicing defensive medicine is part of the cost problem in healthcare.

The demographics were as follows: overwhelmingly SDCMS members (which is itself representative of the larger San Diego County physician community), evenly split politically, normal gender and age distribution, disproportionally solo/small, and proportionally specialist versus primary care.

SDCMS Healthcare Reform 2009 Resource Center
Click here to access the following and other healthcare reform resources at SDCMS' website:

• "How American Healthcare Killed My Father" (Sept. Atlantic Monthly) • Click Here
• "Health Costs — No Quick Fix" (July 27 L.A. Times) • Click Here
• "The Cost Conundrum: What a Texas Town Can Teach Us About Healthcare" (June 2 The New Yorker) • Click Here

Pandemic H1N1 Updates

• Executive Director's Note: I most strongly urge you to view the video (click here) and consider becoming a vaccinator!
• From the County Public Health Officer: The coming fall influenza season will present the challenge of the simultaneous circulation of H1N1 and seasonal influenza viral strains. Many providers may already have seasonal flu vaccine. The County will have its allocation from the State in late September. The seasonal flu vaccine is not expected to protect against the pandemic H1N1 flu. H1N1 flu vaccine is expected to be available in late October or early November. The H1N1 flu vaccine will be made available at no cost. Vaccine providers will, however, be able to charge an administrative fee.
• Providers can register with the State to become vaccinators for the H1N1 vaccine. You can register to become a vaccinator at The California pandemic H1N1 influenza vaccine website. By registering at this site, providers will be able to order vaccine, receive vaccine information and updates, and report their use of H1N1 vaccine. In order to register, you will need to provide your medical license number and an estimate of the number of patients in your practice in the priority groups for H1N1 vaccine. Complete instructions for registering are available on the website
• Every physician who sees patients should click here to view this 16-minute webinar: "Pandemic H1N1 Influenza Vaccine."

How the Heck Do I Buy an EMR? Should I Buy an EMR? Which One? Come to SDCMS' "EMR Trunk Show" on Sept. 17 and Find Out!
Can't figure out what to do about EMRs? Check out side-by-side demonstrations of 10 leading EMRs on Thursday, September 17, 2009, at SDCMS' "EMR Trunk Show," an all-day event (11:00am-7:00pm) hosted by SDCMS to allow physicians and office staff to see the major EMR/EHRs in operation, to meet the sales staff, and to learn HOW to choose an EMR. Click here for more information. Executive Director's Note: If you have not made an EMR decision, or are about to, then this is a must-attend event. We will spread the educational portion out throughout the workday to accommodate everyone's busy clinical schedule.

CONTENTS

• Physicians Asked to Discuss the POLST Form With Their Patients With Advanced Illnesses
• Significant Problems With the California Physician Performance Initiative (CPPI) Data
• CPPI Horror Story #1
• CPPI Horror Story #2
• Blue Cross Fee Schedule Changes Take Effect January 1
• Blue Cross Switches to Paperless EOBs • Doctors Can Still Opt to Receive Paper
• Blue Cross to Change Claim Editing Software
• Blue Cross Will Continue to Pay Claims From Physicians Who Have Not Signed New Healthy Families Contract
• Physicians Who Decide Not to Sign the New Blue Cross Contract
• Healthy Families to Reopen Enrollment
• Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010
• FTC Further Delays Enforcement of Red Flags Rule to November 1, 2009
• Mark Your Calendars to Attend the Following Upcoming SDCMS Seminars and Webinars!
• SDCMS Media Training for Physicians
• Physician Leader's Toolbox Seminar • October 2 & 3
• What Has SDCMS Done for You Lately?
• New Human Resources Member Benefits
• Best Practices: Hiring the Right Receptionist
• Events

MEDICAL

Physicians Asked to Discuss the POLST Form With Their Patients With Advanced Illnesses
Do you care for frail elderly or patients with advanced illnesses? Taking a few minutes to discuss their wishes regarding intensity of treatment can relieve their families of the burden of having to make decisions in a moment of crisis. The most effective tool for documenting those wishes that assures they are followed is the POLST form (Physicians Orders for Life-Sustaining Treatment). For more information and to download a form, click here.

STATE

Significant Problems With the California Physician Performance Initiative (CPPI) Data
See the two horror stories directly below. CPPI sent letters on July 24 notifying physicians of their preliminary scores on a series of quality measures, using insurance data (not clinical records) from Anthem Blue Cross, Blue Shield, or UnitedHealth PPOs or with Anthem Blue Cross or Blue Shield HMOs from 2007 to 2008. We strongly encourage physicians who requested their CPPI patient list (the due date was extended to Sept. 4) to go through the steps to verify the accuracy of that data and submit corrections before Sept. 18. Physicians who take these steps will reduce the chance that invalid or improper data is used to determine their CPPI score. The organization overseeing CPPI has indicated that the participating health plans may share these scores with their enrollees or otherwise use the scores for business purposes.

CPPI Horror Story #1
I had six patients who were indicated as not having received a certain test. When I checked each chart, not one should have been attributed to me. Three patients refused the mammograms I suggested, and this is documented. I was not the main doctor for another patient, and I wasn't seeing her for the Pap smear. Another patient didn't need a Pap smear because she had a hysterectomy. The CCPI response: The person at CCPI said that there is no human reviews this data, so if a hysterectomy was done or if the patient refused service, the doctor would be dinged unless the doctor reviewed all the information themselves. Also, if a patient sees a doctor who handles testing in a given area, that doctor will be dinged if the screening test in that area wasn't done, even if the test was done by her primary care doctor. For example, if I see a patient for a GYN problem like mastitis and don't do a Pap smear because it was done by her primary care MD, I'll get dinged. Quoting the doctor: "These people are idiots if they think this data is even remotely valuable."

CPPI Horror Story #2
We just completed our analysis for Dr. X's mammograms data and I filled out the CMA survey on the website. The research job required to verify the CPPI data is somewhat onerous (a new cost imposed on physician practices). The data is erroneous (of the 34 of the 144 reported patients that Dr. X apparently "mistakenly" did not order mammograms, all were actually ordered). Since we do not own the imaging facility, which provides and bills for the mammograms, it is not reasonable to hold the doctor responsible for anything other than actually giving the patient the Rx (therefore, billing is not a good measure of the doctor's performance in this case). As far as we can tell, all patients not receiving mammograms either directly denied the service to us or just didn't get them (although they were ordered). Quoting the doctor's office manager: "The conclusion about Dr. X's "quality" is completely flawed and should not be reported on private health plan websites. Is there any way we can "opt out" of this poorly conceived and executed measure of "quality"?

Blue Cross Fee Schedule Changes Take Effect January 1, 2010
Anthem Blue Cross notified physicians of changes to its Prudent Buyer physician fee schedule that will take effect January 1, 2010. In a letter to physicians on September 2, Blue Cross informed physicians that it would be modifying payment levels for many CPT codes, some being increased and others decreased. Physicians are urged to calculate the financial impact the fee schedule changes will have on their practices. (Use CMA's financial impact worksheet, available at the members-only website). The new rates are available at the Blue Cross website. You can also call Blue Cross Provider Relations at (800) 933-6633. If you do not agree with proposed changes, you can terminate the contract anytime before November 11. Termination letters can be mailed to Anthem Blue Cross, Prudent Buyer Plan Contract Processing, Mail Station 8A, PO Box 4330, Woodland Hills, California 91365-4330. Click here for more information on the fee schedule.

Blue Cross Switches to Paperless EOBs • Doctors Can Still Opt to Receive Paper
Physician practices that have previously registered for Blue Cross's online provider portal, ProviderAccess, will no longer receive printed EOBs with their checks. Effective October 6, you will be required to go to Blue Cross website to obtain claims information and to download or print out EOBs, if necessary. EOBs will be only available online for 18 months. Practices that have not registered for ProviderAccess will continue to receive paper EOBs. Thanks to CMA advocacy, Blue Cross has agreed to allow physicians to opt out of the paperless EOB program. If you would like to continue receiving paper EOBs, call Anthem Network Relations at (800) 933-6633. Click here for more information.

Blue Cross to Change Claim Editing Software
Blue Cross is switching to a new claim editing software effective November 7. Because of this change, physicians may notice a difference in how certain codes and code pairs are adjudicated. Physicians will be able to prospectively and retrospectively screen claims via Blue Cross's "Clear Claim Connection" portal to determine if and how the claim auditing rules impact their claims. For more information, visit Blue Cross's provider portal. Questions about any of these new policies should be directed to Blue Cross Provider Relations at (800) 933-6633. Click here for more information on the Claim Editing Software. Contact CMA's reimbursement help line at (888) 401-5911 or at jblack@cmanet.org.

Blue Cross Will Continue to Pay Claims From Physicians Who Have Not Signed New Healthy Families Contract
Blue Cross announced earlier this year that it would require physicians to sign a separate contract and accept reduced rates if they wanted to continue treating Blue Cross-insured Healthy Families and AIM patients. The new rates vary, but generally they are slightly higher than Medi-Cal rates. The effective date on the new contracts is September 1, and the insurer had said claims with dates of service on or after that date would not be paid without a new, signed Healthy Families contract. As a result of CMA advocacy, Blue Cross has decided to allow physicians with Prudent Buyer contracts to continue to treat Blue Cross Healthy Families patients through at least the end of October. In lieu of a newly signed Healthy Families contract, physicians will for most services be paid 125% of Medi-Cal. CMA hopes that this interim policy will ensure a smooth transition for patients and allow more time for physicians to review the new contracts. Blue Cross has also clarified, at CMA's request, how physicians will be paid for vaccines under the new contract. Physicians will be reimbursed at either the current market-based rates (which represent Blue Cross's cost to acquire the vaccine through its group purchasing arrangement), or the official Healthy Families fee schedule rate, whichever is greater. To ensure physicians are not out of pocket for the cost of vaccines, Blue Cross-contracted physicians can purchase vaccine at the reduced group rate from the insurer's preferred vaccine vendors. It remains unclear how/if physicians will be reimbursed an additional amount for vaccine administration. Physicians are reminded that before they sign a health plan contract, it is important to know what value that relationship will bring to their practice. You do not have to accept contracts that are not mutually beneficial. If you have questions about the new contract terms, contact Anthem Blue Cross at (877) 811-3113 or ssbrecruit@wellpoint.com.

Physicians Who Decide Not to Sign the New Blue Cross Healthy Families Contract
Physicians who have decided not to sign the new contract can refer patients to Blue Cross for help locating a participating provider. Healthy Families patients can call (800) 845-3604, AIM patients (877) 687-0549. Adding to the turmoil for Healthy Families patients are the recent devastating budget cuts. Faced with a 50% cut in funding, Healthy Families program in July indefinitely closed its doors to new enrollees. The Senate has passed a bill that would raise revenue for the program by creating a 2.35% tax on the gross premiums of Medi-Cal managed care companies. The bill (AB 1422) has been sent back to the Assembly for concurrence. For more information on this and other bills of interest to physicians, see the Legislative Hot List. For further information, contact CMA's Reimbursement Help Line at (888) 401-5911 or at jblack@cmanet.org.

Healthy Families to Reopen Enrollment
On Sept. 3 the Managed Risk Medical Insurance Board (MRMIB) issued a statement that they will be able to continue to provide coverage to all children currently enrolled in the Healthy Families Program, and that they will begin enrolling children on the waiting list. This was in response to the passage of AB 1422 on Sept. 3 in the Legislature, which is now on it's way to the governor, who has announced that he will sign the bill. Please recall that AB 1422 does several things:

• It imposes a 2.35% gross premium tax on Medi-Cal managed care plans. Thirty-eight percent of the revenues from this tax will be used by the Medi-Cal program (to maintain health plan rates) and 62% will go towards the Healthy Families Program. This provision sunsets on January 1, 2011.
• It allows the State First Five Commission to redirect funds in its Mass Media Communications, Education, Child Care and Research and Development Accounts to the Unallocated Accounts. This frees up the $81.4 million that the Commission has agreed to contribute to the Healthy Families program for children zero to five years of age.
• It also institutes Healthy Families premium increases for families over 150% FPL.

Following are links to statements from MRMIB and the governor after passage of AB 1422.

FEDERAL

Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010
Click here to access a letter From Michael D. Maves, MD, MBA, Executive Vice President and CEO of AMA, to Ms. Charlene Frizzera, Acting Administrator, CMS Dept. of Health and Human Services, outlining AMA's comments regarding the CMS proposed physician fee schedule rule for calendar year 2010.

FTC Further Delays Enforcement of Red Flags Rule to November 1, 2009
The Federal Trade Commission (FTC) has implemented a new regulation known as the Red Flag Rule, which requires "'creditors"' — including many physicians — to develop and implement identity theft detection and prevention programs that much serve three broad functions by November 1, 2009. SDCMS has published several members-only resources to help physicians and their staff understand the scope and requirements of the Red Flag Rule. To access these resources, click here and sign in. For help with signing into SDCMS' website, contact Kyle Lewis at (858) 300-2784 or at KLewis@SDCMS.org.

LOCAL

Mark Your Calendars to Attend the Following Upcoming SDCMS Seminars and Webinars!

• EMR/EHR Trunk Show • Sep. 17
• HIPAA Webinar • Oct. 1
• Financial Issues Seminar/Webinar: "Ten Strategies for Economic Survival" • Oct. 15
• Certified Medical Coder Course • Oct. 23, 30, Nov. 6, 13, 20
• Resident and New Physician Workshop: "Preparing to Practice: What You Need to Know BEFORE You Begin Your Practice" • Nov. 14
• Risk Management Webinar: "Electronic Health Records: Are You Ready?" • Nov. 18
• Risk Management Webinar: "Electronic Health Records: Are You Ready?" • Nov. 19

For further information about these or any of our other seminars and webinars, click here.

SDCMS Media Training for Physicians
If you are interested in polishing your media skills, we have a couple of openings in our free media training for physicians this Saturday, September 26, 2009, from 8:00 a.m. to 11:30 a.m. Email me at Gehring@SDCMS.org if you would like to participate!

Physician Leader's Toolbox Seminar • October 2 & 3
On Friday and Saturday, October 2 and 3, we will conduct our Leader's Toolbox seminar, an exceptional opportunity to build your leadership skills and your network. This unique, small-group seminar will be held at SDCMS for no more than 16 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, and Making Formal Presentations, and Managing Your Meetings, Including Parliamentary Procedures. For further information or to register, email me at Gehring@SDCMS.org.

MEMBER BENEFIT

What Has SDCMS Done for You Lately?
Periodically, we want to let you know "what has SDCMS done for you lately." To read a summary of how we've created value for our members since our last letter, click here.

New Human Resources Member Benefits
SDCMS has contracted with an HR resource to get your HR questions answered free of charge. Please contact our physician advocate, Marisol Gonzalez, at (858) 300-2783 or at MGonzalez@SDCMS.org.

Best Practices: Hiring the Right Receptionist
Your receptionist can make or break your business. He or she is the first person your patients and potential patients encounter. As the face and voice of your business, this is one of the most important members of your staff. A bad hiring decision for this position can have far-reaching consequences. Chapter 1 of CMA's Best Practices toolkit will help physicians understand how to examine a receptionist's (or potential receptionist's) core competencies and how to make sure you've got the right person for the job. CMA published the 140-page Best Practices toolkit with generous support from the Physicians' Foundation to help physicians improve the efficiency, and in turn the quality, of their practices. In addition to learning how to hire the right receptionist, the toolkit will also teach you:

• What every physician needs to know about running a practice;
• How to find and keep qualified staff;
• How to build a defensible fee schedule;
• When it makes sense to cancel a payor contract;
• How to make sense of your revenue stream;
• And much more.

The Best Practices toolkit, available free to all physicians, is organized into nine chapters that can be read sequentially or on an as-needed basis. Download the toolkit today.

EVENTS

• SEP 12 • New Advances in Inflammatory Bowel Disease • click here
• SEP 12–13 • Fresh Start's Surgery Weekend September 12-13, and November 7-8 • click here
• SEP 16&17 • Building Clinical Excellence for Mental Health and Drug and Alcohol Professionals • click here
• SEP 16&17 • Southwest Regional Integrated Behavioral Health Conference (Mental Health Systems, Inc.) • (858) 300-2787
• SEP 17 • Free SDCMS EMR/EHR Trunk Show • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org or click here
• SEP 19 • Fourth Annual Medical Student Leadership Conference (USC) • click here
• SEP 21 • Healing the Hidden Wounds of War and Trauma: Understanding and Treating PTSD in the 21st Century (UCSD, room TBD) • (858) 300-2787
• SEP 23–25 • American Academy of Urgent Care Medicine's 2009 Urgent Care Medicine Conference • click here
• SEP 26 • Half-day Seminar on Trauma and Kids II: Psychological and Developmental Consequences Treatment Approaches, Evidence-based Treatment, and Evidence-based Kernels • Rady Children's Hospital, Medical Office Building, 3030 Children's Way, #113 • Angie Corrales at (858) 966-4936 or at sandiegoacap@yahoo.com.
• OCT 1 • Free SDCMS HIPAA Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
• OCT 2–3 • Healthy Babies, Healthy Planet: An International Breastfeeding Conference • Courtyard by Marriott-San Diego Airport/Liberty Station • click here
• OCT 3 • Free Arthritis Expo (National University, 9388 Lightwave Ave., San Diego 92123) • (858) 492-1090, ext. 124
• OCT 3 • The Society of Physician Entrepreneurs (SOPE) Physician Bioscience Commercialization Workshop • San Diego Marriott Hotel and Marina • click here
• OCT 15 • Free SDCMS Financial Issues Seminar/Webinar • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
• OCT 17–18 • 4th Annual Clinical Update on Heart Failures and Arrhythmias: From Prevent to Cure • click here
• OCT 18–23 • 9th Annual Destination Health: Renewing Mind, Body, and Soul • click here
• OCT 21 • Collaborative Care: Treating the whole person (Mental Health America) • click here
• OCT 23, 30, Nov. 6, 13, 20 • Discounted SDCMS Certified Medical Coder Course • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
• OCT 24 • The 12th Annual School Health Leadership Conference: "Back to School" • click here or email Meredith Kennedy at mkennedy@aapca3.org
• OCT 26–Nov 1 • The Faces of Chronic Fatigue Syndrome at the Westfield County Fair, Escondido • click here
• OCT 28–30 • 20th Annual Coronary Interventions • click here
• OCT 29 • Southern California Health Care Summit • Ontario Convention Center • click here
• OCT 30 • 2009 San Diego Day of Trauma • click here
• NOV 4–8 • XVII World Congress of Psychiatric Genetics • Contact (858) 534-3940 or ocme@ucsd.edu
• NOV 14 • New Developments and Best Practices in Colorectal Cancer Screening Admiral Baker Clubhouse (Presidio Room) • sbazzo@sandiegoafp.org or (858) 458-9439
• NOV 14 • Free SDCMS Resident and New Physician Workshop: "Preparing to Practice: What You Need to Know Before You Begin Your Practice" • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
• NOV 18, 19 • Free SDCMS Risk Management Webinars • Contact Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org
• JAN 16–17 • Melanoma 2010: 20th Annual Cutaneous Malignancy Update • click here
• JAN 21–24 • 7th Annual Natural Supplements: An Evidence-based Update • click here
• FEB 13–16 • Scripps Cancer Center's 30th Annual Conference: Clinical Hematology and Oncology • click here

"The most perfidious way of harming a cause consists of defending it deliberately with faulty arguments."
— Friedrich Nietzsche, German Philosopher (1844-1900)