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1. Congress at the Brink of Health Reform
After more than a year of debate, Congress is at the brink of passing historic legislation to expand health care coverage to millions of Americans. The final legislation will contain a number of provisions that CMA has been fighting to achieve for years, such as insurance industry reforms to protect patients, measures to make coverage more affordable for low-income families, as much as $350 billion in physician payment fixes in Medicare and Medicaid, and increased funding for primary care, physician training, and wellness and prevention. Unfortunately, it will contain some provisions that CMA opposes and will require our continuing legislative and regulatory advocacy to rectify.
House and Senate leaders are meeting over the next few weeks to reconcile the remaining differences between the House and Senate reform bills. Despite these differences, we fully expect – based on our conversations with congressional leadership – that the House-Senate conference committee will have the votes to produce legislation that will pass both houses of Congress and be signed by the President as soon as the end of January.
Outstanding issues still remain that CMA believes must be addressed if the legislation is to deliver on its promise of increased access to care. Now is our last chance to improve the legislation that appears will certainly pass out of Congress. In these final weeks, CMA is focused on improving the legislation on six critical issues:
- Repealing the Medicare Sustainable Growth Rate. The current formula would cut funding by 40 percent in future years if left in place and would hurt senior citizens’ ability to find a doctor to treat them. The viability of Medicare is crucial as millions of baby boomers retire and enter the program.
- Eliminating or modifying the proposed Independent Payment Advisory Board (IPAB), which could slash spending and coverage options for senior citizens with little input from others.
- Increasing Medicaid’s low reimbursement rates. As it is, patients covered by Medi-Cal often struggle to find a doctor because rates are so low that only about one third of the state’s physicians participate in the program. Both bills dramatically expand eligibility, meaning up to 2 million more patients could enter Medi-Cal, further complicating access.
- Updating the Medicare locality system to reflect changes in practice costs;
- Ensuring that any physician quality reporting program is accurate, fair, and offers physicians an opportunity to correct mistakes in the data or process;
- Ensuring patients have the right to privately contract with Medicare physicians.
You can get more information and details in our letter to the House-Senate Conference Committee, which is available on our health reform webpage.
As historic as this legislation is, much of the work to effectively implement the legislation will occur in the coming months and years. CMA is committed to continue working with Congress, federal agencies, and regulators to ensure that this legislation doesn’t fail to deliver on its promise.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
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2. CMA Sends Delegation to DC to Lobby for
Health Reform Improvements
Members of CMA’s Executive Committee will visit Washington, D.C. this week to talk with congressional leaders and advocate for changes in health reform legislation that would ensure patients get the access to care they need. Attending are CMA President J. Brennan Cassidy, M.D., President-Elect James Hinsdale, M.D., Immediate Past-President Dev GnanaDev, M.D., Speaker of the House James Hay, M.D., Vice-Speaker of the House Luther Cobb, M.D., and Board Chair Paul Phinney, M.D.
“We want members of Congress to know that California’s physicians strongly support reform that fixes what is broken but preserves what is working,” says CMA President Brennan Cassidy, M.D. “Our main concern is making sure the final bill includes the funding and framework necessary to give patients access to doctors and real health care coverage, not a false promise.”
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
3. CMA Polling Members on Health Reform
CMA is currently conducting a telephone survey of members’ opinions on health reform. Some of you may be contacted this week to share your perspective and thoughts on health reform to ensure our stance on this landmark legislation is consistent with your perspective and needs. Your opinion is very important to us. If you get called, we ask that you take the 15 or so minutes to answer the questions.
4. Federal Officials Announce Meaningful Use Criteria
Federal health officials in late December released proposed standards for the use and certification of electronic health records. As you know, Medicare and Medi-Cal physicians who demonstrate “meaningful use” of certified electronic health records (EHR) will qualify for incentive payments under the 2009 federal economic stimulus package.
The meaningful use definition proposed by the Centers for Medicare & Medicaid Services (CMS) sets forth the basic guidelines physicians must follow in order to receive Medicare incentive payments. Among other things, it lays out which quality measures physicians will have to report and which functions (computerized physician order entry, for example) physicians will have to use. CMS’s proposal would phase in meaningful use requirements in three stages between now and 2013.
This definition only applies to Medicare. States will be allowed to create their own definitions. One of CMA’s concerns regarding meaningful use is that this could cause confusion and administrative difficulty for physicians, particularly in a group setting where different physicians may qualify under different programs.
CMS has acknowledged this problem, and has expressed in the proposed rule a strong preference for states’ definitions to be the same or very similar to the federal definition. States that plan to use an alternate definition must get approval from the Federal Secretary of Health and Human Services.
CMA has prepared a summary of the proposed definition and will be submitting comments during the 60-day comment period. The final definition should be released in late February or early March and will become effective 60 days after release.
The Office of the National Coordinator for Health IT (ONCHIT) has released a related set of proposed certification standards for EHR technology. ONCHIT’s interim final rule outlines the technical standards and features that EHR systems must include to receive certification for meaningful use. The EHR certification standards will also be open for comment for 60 days after publication in the Federal Register on January 13. The standards will take effect 30 days after the final rule is published.
Contact: David Ford, 916/444-5532 or dford@cmanet.org.
5. Consultation Code Issue Frustrates Physicians;
CMA Publishes Billing Guide
Despite strenuous objections from CMA and others in organized medicine, Medicare will no longer recognize inpatient and outpatient consultation codes. Effective January 1, 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. While CMS has increased the work RVUs for new and established office visits, as well as initial hospital and nursing facility visits, these changes may result in significant losses for some practices.
Although CMS’s decision was intended to alleviate confusion that has surrounded the reporting of these codes for years, the new policy – and the short notice – has already caused a great deal of confusion as physicians and billing managers try and make sense of the new rules.
To help you understand what this means for your practices, CMA has published a 4-page billing guide that includes an overview of the issue, a code crosswalk, and links to additional resources. The guide is available to CMA members-only at the CMA website. (You may also request a copy by calling our member help center at 800/786-4CMA.)
CMA members can get additional information and guidance on this issue through a members-only webinar with Palmetto Medical Director Arthur Lurvey, M.D. Dr. Lurvey will answer physician questions and explain how to bill for these services in 2010 and beyond. This one hour webinar is Wednesday, January 20, at 12:15 pm. Registration is free, but space is limited, so reserve your space today. If you are unable to participate in the live webinar, it will be available for on-demand viewing beginning the following day.
Physicians who use a third party billing service are also urged to call their vendors to make sure that they are aware and prepared for this rule change. Feel free to provide them with a copy of the CMA consult code crosswalk and billing guide.
CMA is also surveying major payors in California to find out which of them plan to follow Medicare’s lead and eliminate consults. Once we have gathered this data, we will make it available to members.
If you have any additional questions about these new rules, please do not hesitate to call our member help center at (800) 786-4262 (4CMA) and ask to speak with a reimbursement specialist.
Click here for more information.
6. Questions About the New Consultation Code Rules?
Sign Up for CMA's Webinar: How to Bill Medicare in 2010
The Centers for Medicare & Medicaid Services’ recently stopped recognizing consultation codes. To help physicians understand the new billing rules, CMA has scheduled a members-only webinar with Palmetto Medical Director Arthur Lurvey, M.D.
Dr. Lurvey will answer physician questions and explain how to bill for these services in 2010 and beyond. The one hour webinar is Wednesday, January 20, at 12:15 pm.
Registration is free, but space is limited, so reserve your space today. If you are unable to participate in the live webinar, it will be available for on-demand viewing beginning the following day.
Click here for more information.
Contact: Shannon Navarra-Lujan, 916/551-2056 or slujan@cmanet.org.
7. Governor Schwarzenegger Releases
Proposed 2010-2011 Budget
On Friday, January 8, 2010, Governor Schwarzenegger released his $83 billion 2010-2011 budget proposal. The proposal would close a projected $19.9 billion budget deficit over the next 18 months through $8.5 billion in spending reductions/cuts, $4.5 billion in fund shifts and alternative revenues, and $6.9 billion in federal funds.
For more information on the governor's budget proposal as it relates to health care, see CMA's budget summary.
Contact: Carolyn Ginno, 91/444-5532 or cginno@cmanet.org.
8. CMS Temporarily Extends California's Family PACT Waiver
The Centers for Medicare & Medicaid Services (CMS) recently extended California’s Family PACT waiver through June 30, to allow more time for state and federal officials to come to an agreement on the terms of a new waiver. The current waiver was originally set to expire in October 2008, but it has been extended a few times to allow California and CMS to work out their differences and continue this successful, cost-effective, and patient-centered program.
At issue are CMS’s burdensome new eligibility documentation rules. CMA believes that the new rules proposed by the Bush Administration will discourage low-income women from seeking family planning and prenatal care, ultimately increasing the costs to the state and federal government.
Family PACT, which provides comprehensive family planning services and preventive health screenings to eligible low income men and women, has operated since 1999 under the current Medicaid waiver. According to the state, it has served 1.6 million Californians, prevented 170,000 unintended pregnancies and saved the state and federal government over $1 billion annually.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
9. Blue Cross Extends Healthy Families
Continuity of Care Plan, Again
In March of last year, Blue Cross announced that it would require physicians to sign a separate contract and accept reduced rates if they want to continue treating Blue Cross-insured Healthy Families and AIM patients. The new rates vary, but have been dropped generally to barely above Medi-Cal rates.
Although the effective date on the new contracts was September 1, 2009, the insurer has for the third time extended its continuity of care plan that allows physicians with Prudent Buyer contracts to continue treating Blue Cross Healthy Families patients. Blue Cross has now extended the continuity of care plan through March 31. In lieu of a newly signed Healthy Families contract, physicians will be paid 125 percent of Medi-Cal for most Healthy Families services.
The Department of Managed Health Care (DMHC) is also investigating – at CMA’s request – claims that Blue Cross no longer has an adequate network of physicians to care for the nearly 3,400 Humboldt County children and expectant mothers enrolled in the insurers’ Healthy Families and AIM programs. CMA believes the network inadequacy concerns can be traced back to Blue Cross’ Healthy Families recontracting initiative. Physicians have reported to CMA that the new rates do not cover the cost of providing medical care, leaving them no choice but to leave the Blue Cross Healthy Families network.
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.
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-5911 or jblack@cmanet.org.
10. CMA's 36th Annual Legislative Conference Is April 27
Mark your calendars now for CMA’s annual Legislative Leadership Conference – aka “doctor day” – Tuesday, April 27, in Sacramento. The conference will be held at the Sheraton Grand Hotel, just three blocks from the State Capitol and across the street from CMA headquarters.
This is a unique event for California physicians and is free of charge to all CMA members. Don’t miss the opportunity to meet one-on-one with your elected officials in the State Assembly and Senate to discuss important health policy issues that affect the practice of medicine in California.
Reserve your spot by contacting Nicole Madani at 916/444-5532 or nmadani@cmanet.org.
Stay tuned for more details.
11. Featured Member Benefits
Medical Office Liability Insurance: As a physician, your liability exposure isn't limited to the practice of medicine. You also need to consider your risks as a business professional—risks that go unprotected by your medical malpractice policy.
CMA members have access to a medical office liability policy* that provides comprehensive business insurance coverage tailored specifically for physicians – all at an economical price.
Some important highlights:
- Protects your practice if patient information or other sensitive data is accidently publicized, stolen, or released.
- Coverage to compensate you for lost income to help pay ongoing expenses while your practice is unable to function after a loss.
- Pays damages, medical bills, attorneys' fees, and other legal expenses should someone trip and fall or injure themselves while visiting your practice.
For more information or a quote, please call Marsh at 800/842-3761, or e-mail CMACounty.Insurance@marsh.com.
*Underwritten by Fireman's Fund
10% off Auto Insurance: CMA members receive 10 percent off auto insurance from Mercury Insurance. For more details, call Mercury Insurance Group at 888/637-2491 or visit http://www.mercuryinsurance.com/cma.
For more information on these and other member benefits, visit http://www.cmanet.org/benefits or contact CMA at memberservice@cmanet.org or 800/786-4CMA.
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