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SDCMS "News You Can Use" (2009.12.01)

by: San Diego County Medical Society
Published December 1, 2009

SDCMS "News You Can Use"
— December 1, 2009

Red vs Blue: Two Views on Healthcare Reform
On Saturday, December 12, 2009, at 10am in SDCMS’ large meeting room, we will hold a dialogue between representatives of two opposing sides of the national healthcare reform debate. Jim Rowsey, MD, the retired James P. and Heather Gills Professor and Chairman of the Department of Ophthalmology of the University of South Florida, who now works in medical legislation for the United States Senate with Senator Tom Coburn (R-OK), will present a Republican view of healthcare reform. Joe Scherger, MD, formerly the SDCMS Communications Chair and the founding dean of the Florida State University College of Medicine, and now leading the redesign of the primary program at Eisenhower Medical Center in Rancho Mirage, will present a Democratic view of healthcare reform. Each of our distinguished presenters will be given no more than 30 minutes to present their programs for healthcare reform, in the context of current proposed legislation. Following the presentations, the audience will participate in a moderated Q&A. Please RSVP to Gehring@SDCMS.org if you will be joining this lively, informative and timely discussion The program will be simulcast via an invitation-only Webinar. Please click here to register to attend this dialogue via webinar.

Executive Director Comment: Please take the time (see below) — this is critically important to our advocacy efforts to be able to state what our physicians are thinking!!!

SDCMS' 2009 Workforce and Compensation Survey
If you have not yet taken SDCMS' 2009 Workforce and Compensation Survey, please do so now – it'll take only five (5) minutes, and it’s critical to our advocacy efforts. And thanks to the 400+ who have already taken the survey. CLICK HERE

SDCMS Members: Interested in Serving on Our Board of Directors? See Below Under "LOCAL"!

Executive Director Comment: Healthcare Reform (HCR) in 30 Seconds:

  • It’s late in the 4th quarter, and the score is tied. We’re looking at overtime.
  • The House is “done.”
  • The Senate is on the horns of a dilemma: You need 60 votes; there are 58 Democrats and two Independents; four Democratic senators have said they will vote no UNLESS there is a public plan; two Democrats have said they will vote no IF there is a public plan; none of the 40 Republicans have indicated they will vote for it.
  • CMA has come out in opposition to the Senate bill (click here for details and the full letter). There are just too many physician-unfriendly provisions.
  • 2000+ page bills do not sit well with the public. They (rightly) don’t trust the “fine print.”
  • The costs savings are illusory.
  • If the Senate does not complete a bill before Christmas, the odds go down exponentially that a conference committee will even meet.

CONTENTS

  • Updates From the CDC (Nov. 20, 2009) and the County of San Diego (Nov. 20 & 24)
  • H1N1 Vaccine Distribution Plan for the November 30, 2009
  • Here Is a Summary of the CMA Letter Opposing the Senate HCR Bill
  • California Legislative Analyst's Office FY 10/11 Budget Outlook
  • Blue Shield Planning on Publishing the Flawed California Physician Performance Initiative (CPPI) Quality Data on Physicians
  • Elimination of Consult Codes
  • CMS Pushes Back Deadline for 2010 Medicare Participation Decision
  • PECOS Enrollment Delayed
  • CMS Publishes RVUs for 90470 H1N1 Vaccine Administration Code
  • SDCMS Board of Directors Call for Self-nominations
  • Emergency Medical Services "Maddy" Fund Disbursements (SB 1773): $4,262,037.15
  • EVENTS

H1N1 AND SEASONAL INFLUENZA UPDATES

Updates From the CDC (Nov. 20, 2009) and the County of San Diego (Nov. 20 & 24) • Click Here

H1N1 Vaccine Distribution Plan for the November 30, 2009
The County of San Diego, in response to our requests, has developed a very detailed allocations strategy for non-affiliated physicians (i.e., physicians who would not get their H1N1 vaccines from a system, e.g., UCSD or Kaiser or Sharp). The lynchpin to receiving vaccines is that the physician must have requested the vaccines via the computerized ordering system. No order, no vaccines. The County public health officer provided the following philosophy ("guiding principles") for allocation:

  • The consideration of how much vaccine providers ordered thru “http://www.calpanflu.org.”
  • The reality of how much vaccine is available to the entire region of San Diego for this first order (i.e., 140,200 doses for all four formulations).
  • The motivation to vaccinate as many of the five priority groups identified by the CDC vaccination Tier I recommendation.
  • The number of providers registered on “http://www.calpanflu.org” who provide care to patients who fall in the five priority groups mentioned in #3 above.

To see details of allocations for physicians for the November 30, 2009, order, click here.

HEALTHCARE REFORM 2009 UPDATES

Here Is a Summary of the CMA Letter Opposing the Senate HCR Bill
Right now, the Senate bill includes some provisions we support, including:

  • Investments to improve the supply of primary care physicians, including a rate increase of 10% for Medicare primary care physicians and additional funding for primary care training programs.
  • An individual mandate to cover 94% of the uninsured.
  • Tax credits and a Medicaid expansion (up to 133% of the Federal Poverty Level) to help low-income families afford coverage.
  • Market reforms on the health insurance industry.
  • A Health Insurance Exchange that offers competition and a choice of plans and doctors.
  • Incentives to improve coordination of care through Medical Homes.

Unfortunately, the Senate bill also has many shortcomings, including:

  • By not repealing the Medicare SGR payment formula, it fails to establish a stable Medicare program, which threatens access to care.
  • It expands Medi-Cal by more than a half million Californians, yet fails to ensure these patients will have access to doctors.
  • It builds health reform on unproven programs, rather than on successful models from around the country.
  • Through the “value index,” the bill could reduce funding for poor, minority, uninsured patients — harming communities with the greatest healthcare needs.
  • It builds off programs that have historically produced inaccurate physician cost and quality information, failing to help physicians improve quality and misleading patients.
  • It authorizes the Independent Medicare Commission to make draconian provider cuts if Medicare spending exceeds the Consumer Price Index.
  • It fails to allow patients to privately contract with physicians of their choice.

Based on these shortcomings and our guiding principles for health reform, CMA took action to oppose the Senate bill as written. It is our belief that opposing the Senate bill in its current form at this time provides us with the greatest possible opportunity to achieve our legislative objective of improving the Senate bill and, ultimately, our policy goal of meaningful health reform. Our strategy, in short, is to exercise the maximum amount of influence and leverage we can in order to improve the current health reform proposals and elevate them into something we can ultimately support. We have communicated this position and our goals to our senators, and are constructively engaged at all levels in pursuit of the objectives. Click here for details and the full letter.

STATE

Executive Director Comment: We’re shocked, simply shocked, that California is in budget trouble again (see below) … and it will be even less pretty than the last time.

California Legislative Analyst’s Office FY 10/11 Budget Outlook
Legislative analyst Mac Taylor released on Nov. 18, 2009, his fiscal year 2010/11 budget outlook analysis. They're projecting a fiscal deficit of $20.7 billion. This includes a current year deficit of $6.3 billion with an anticipated deficit for FY 10/11 of $14.4 billion. Click here for the complete analysis.

Blue Shield Planning on Publishing the Flawed California Physician Performance Initiative (CPPI) Quality Data on Physicians
Blue Shield is planning to publish results of the CLAIMS-BASED CCPI data at the end of December 2009, despite a Physician Advisory Group recommendation not to publish. Blue Shield is planning to send notices the second week of December 2009 to contracted physicians about its intention to publish. Blue Cross and United remain noncommittal with the publication of 2009 results. What can physicians expect from Blue Shield?

  • Recognize only “top performing physicians” (50th percentile) via a “blue ribbon” designation, and nonpublication of low performing physicians.
  • No gradations of performance (top, middle, bottom).
  • Offer another reconsideration (correction) period for physicians.
  • Provide a disclaimer language on its website about the “blue ribbon” recognition.
  • Results likely to be used for patient steering and narrow networks.

What’s at stake with Blue Shield’s partial publication of the 2009 CPPI results?

  • Ignores the fact that CPPI is based on faulty data.
  • Sets a precedent that faulty data is acceptable to be published.
  • Infers physicians who did not receive a “blue ribbon” to be subpar physicians.
  • Removes incentive for HMOs to fix CPPI moving forward.

Executive Director Comment: This a stunningly bad idea. We are writing a letter to Blue Shield that most strongly objects to this plan. Here are excerpts from our proposed letter to CPPI: We find it ironic, even cynical, that poor quality data is being used to report on physician quality. … We are fundamentally opposed to insurers’ reliance on claims data to report on physician quality. This approach has routinely yielded erroneous results. Some physicians performed medical procedures that were not credited to their report card. Others were penalized for a patient’s noncompliance to a recommended procedure, such as colonoscopy. Several reported that they were marked down for not recommending cervical cancer screening to patients who had undergone hysterectomies. Some physicians were penalized for a procedure that they recommended, but were subsequently denied by the HMO for medical necessity reasons.

FEDERAL

Elimination of Consult Codes
SDCMS and UCSD have co-signed a letter to our congressional delegation strongly opposing the elimination of the CPT codes for consults.

CMS Pushes Back Deadline for 2010 Medicare Participation Decision
The Centers for Medicare and Medicaid Services (CMS) announced that they would push back the deadline for 2010 Medicare participation decisions. Physicians who wish to change their participation status for 2010 now have until January 31, 2010, to do so. The effective date of the decision will be January 1, 2010, retroactively if necessary. Participation decisions are binding for one year, unless physicians choose to opt out entirely. Once physicians opt out, they cannot opt back in for two years. The 2010 Medicare Physician Fee Schedule published by CMS contains a 21.2% payment cut. CMA continues to work on passing a permanent SGR fix before the end of the year as part of the health reform package. Physicians, as always, have three choices regarding Medicare:

  • A participating physician must accept Medicare allowed charges as payment in full for all Medicare patients.
  • A nonparticipating provider can choose to accept or not accept assignment on Medicare claims on a claim-by-claim basis. Nonparticipating physician fees are 95 percent of participating physician fees. If you choose not to accept assignment, you can charge the patient 9.25 percent more than the amounts allowed in the participating physician fee schedule.
  • Physicians who opt out of Medicare are bound only by their private contracts with their patients. Medicare’s limiting charges do not apply to these contracts, but Medicare does specify that these contracts contain certain terms. When a physician enters into a private contract with a Medicare beneficiary, both the physician and patient agree not to bill Medicare for services provided under the contract.

For more information on physicians’ Medicare participation options, see CMA ON-CALL document #0151, “Medicare Participation (and Nonparticipation) Options.”

PECOS Enrollment Delayed
CMA has been receiving calls regarding a change in Medicare rules that requires physicians to enroll in PECOS (Provider Enrollment, Chain, and Organization System) — the national database of all Medicare physicians and providers — or risk having their claims denied as of January 1, 2010. Because of CMA’s advocacy, the implementation of this new rule has been delayed indefinitely. Physicians and nonphysician practitioners must be enrolled in PECOS to be eligible to order or refer Medicare services. Enrollment in PECOS is done through the standard Provider Enrollment process. CMA engaged in successful discussions with CMS and Palmetto GBA regarding the PECOS enrollment requirement. CMA fought to move the implementation date out because CMS needed to establish an orderly revalidation process with Palmetto and not disrupt the standard enrollment processes. We do not want to have the chaos that ensued in enrollment following transition to Palmetto. Notably, Palmetto agreed with CMA and helped us convince CMS to delay the implementation date. CMA will continue its discussions with CMS and Palmetto GBA to establish an orderly process for implementation of the PECOS enrollment rule. You will receive details of the process as it becomes finalized. In the meantime, physicians can verify whether they are PECOS by using the PECOS Internet tool at or by calling Palmetto GBA at (866) 931-3901.

CMS Publishes RVUs for 90470 H1N1 Vaccine Administration Code
CMS was originally going to wait until it published its 2010 RBRVS errata to publish the 90470 RVUs, but advocacy efforts by the American Academy of Pediatrics (AAP) have encouraged them to go ahead and publish the values on their website. Work RVU of 0.2 compared to 0.17 for 90465 and 90471, and total RVUs of 0.63 compared to 0.60 for 90465 and 90471. Click here for more information.

LOCAL

SDCMS Board of Directors Call for Self-nominations
To be eligible for service, physicians must have been active members of SDCMS for at least two years as of the date of assumption of duties (June 5, 2010). Additionally, for geographic directors, physicians must have their primary practice located within the geographic district. The young physician director must be in his or her first eight years of practice or under 40 years of age. The 2010–11 ballot will include the following positions (unless otherwise indicated, all terms are three-year terms):

Voting Members of the SDCMS Board of Directors:

  • One (1) East County Geographic Director (one incumbent)
  • One (1) Hillcrest Geographic Director (one incumbent)
  • One (1) North County Geographic Director (one incumbent)
  • Two (2) South Bay Geographic Directors (two incumbents) (one two-year term, one three-year term)
  • Three (3) At-large Directors (no incumbents) (one one-year term, two three-year terms)
  • One (1) Young Physician Director (one incumbent)
  • One (1) Resident Director (one incumbent)

Non-voting Members of the SDCMS Board of Directors:

  • One (1) Kearny Mesa Alternate Geographic Director (one incumbent)
  • One (1) South Bay Alternate Director (no incumbent)
  • Three (3) At-large Alternate Directors (one incumbent)
  • One (1) Young Physician Alternate Director (one incumbent)
  • One (1) Resident Alternate Director (one incumbent)

SDCMS member physicians who wish to serve on the 2010–11 SDCMS board of directors are asked to contact Tom Gehring, SDCMS executive director, at Gehring@SDCMS.org, at (858) 565-8597 (desk), or at (619) 206-8282 (cell). Be sure to let Tom know which position interests you. If you have any questions or wish to discuss the process, please do not hesitate to contact Tom or Dr. Stu Cohen, SDCMS Nominating Committee chair, at scohen98@ipninet.com. If you wish to review the relevant SDCMS bylaws, click here and choose "Bylaws" in the drop down menu, or consult SDCMS' membership directory.

Requirements for Service for Geographic, At-large, and Young Physician Directors:

  • Participate in three quarterly meetings, held the first Tuesday of January, first Tuesday in August, and a Tuesday in mid-September, all at 6:00pm.
  • Participate in SDCMS' annual retreat, held off-site and over a weekend in May.
  • Participate in the annual CMA House of Delegates, held over three days (Saturday–Monday) in October, usually in Sacramento or Orange County.

Requirements for Service for Alternate Geographic and Alternate At-large Directors:

  • Participate in the annual CMA House of Delegates, held over three days (Saturday–Monday) in October, usually in Sacramento or Orange County.
  • Be prepared to participate as an alternate director at quarterly meetings.

Emergency Medical Services “Maddy” Fund Disbursements (SB 1773): $4,262,037.15
The funds collected under SB 1773, reduced by up to 10% for administration, are deposited into the Maddy Fund and, of this amount, 15% of the funds must be used to provide funding for pediatric trauma care throughout the County. The balance of the funds deposited would be distributed consistent with current statutory directives, that is, 25% to trauma care, 58% to physicians providing uncompensated emergency care, and 17% to the Health and Human Services Agency’s Emergency Medical Services. Click here to download the final report for FY 08/09.

EVENTS

"Mankind must remember that peace is not God's gift to his creatures; peace is our gift to each other." — Elie Wiesel (1928 – )

Read more about: board of directors elections, BOD elections, H1N1, Healthcare News and Updates, healthcare reform, SDCMS News and Updates, Workforce and Compensation Survey, News You Can Use

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