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1. It’s Time to Fill Out 2005 CME Certification Forms
Physicians can now submit their 2005 CME for certification to CMA’s Institute for Medical Quality (IMQ). Reporting forms were recently mailed to all CMA members. The forms are also available online.
IMQ, a CMA subsidiary, certifies physicians’ CME activity for credentialing purposes to the Medical Board of California, as well as to hospitals, health plans, specialty societies, and others.
CME certification is $29 a year for members, $49 for nonmembers.
Click here for more information. Contact: Paulette Richardson, 415/882-5151 or prichardson@imq.org.
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2. CMS Directs Drug Plans to Expedite Coverage Decisions
To ensure that Medicare patients have uninterrupted access to medically necessary prescription drugs, the Centers for Medicare & Medicaid Services (CMS) has directed all Part D prescription drug plans to expedite coverage decisions for Medicare beneficiaries. The plans must make and communicate coverage decisions within 24 hours for an “expedited” request and 72 hours for a standard request.
Physicians can request an expedited decision if the patient’s health will be seriously jeopardized by waiting 72 hours for a standard decision.
CMS also directed all plans during this transition period to provide patients on stabilized drug regimens with at least a 30-day supply of their current medications, even if their particular drug is not on their plan’s formulary. The Bush administration has also asked drug plans to provide beneficiaries with an additional 60-day supply in emergency cases.
If these back-up systems fail, physicians and patients should immediately call 800/MEDICARE to resolve the issue and get patients their medications.
Click here for more details, including drug plan contacts and information on appealing a coverage decision.
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3. Federal Court Dismisses CMA’s RICO Lawsuit Against Pacificare
A federal court this week dismissed CMA’s RICO lawsuit against Pacificare. In a summary judgment, U.S. District Judge Federico Moreno ruled that CMA and the other plaintiffs had not presented sufficient evidence that Pacificare had conspired to underpay physicians.
This ruling does not affect the cases pending against the remaining defendants, United Healthcare and Coventry.
In the ruling, Judge Moreno noted that Pacificare is in a different situation than the other defendants in the case because it does the vast majority of its managed care business through capitation with IPAs, which were not parties to the case.
Seven of the 10 HMO defendants have already settled with CMA and the other plaintiffs in the case, including more than a dozen other state medical societies and more than 900,000 physicians and their beneficiaries. CMA is extremely disappointed by this ruling and will vigorously pursue the case against the two remaining defendants, United Healthcare and Coventry. CMA is also considering an appeal of the Pacificare ruling.
Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
4. Congress Finally Passes Budget; Restores Higher
2005 Medicare Physician Payment Rates
The U.S. House of Representatives Wednesday approved the federal budget package, freezing Medicare physician reimbursement at the higher 2005 rates for one year. The legislation, which does not include any pay-for-performance provisions, now goes to the president for his signature.
The payment freeze reverses the 4.4 percent cut that took effect January 1. The Centers for Medicare & Medicaid Services (CMS) has agreed to retroactively adjust claims to compensate physicians for the 4.4 percent cut once the payment freeze is signed into law. Physicians will not have to resubmit claims. Medicare carriers will automatically make retroactive payments for eligible claims.
Although the 2006 Medicare participation enrollment period is over, CMS has indicated that it will allow physicians to retroactively change their participation status.
The budget bill does not fix the flawed geographic payment (GPCI) formula or provide a permanent solution to the flawed sustainable growth rate (SGR). CMA and AMA will continue to aggressively advocate for a fair physician payment formula that is based on actual practice costs.
As this is a one-year freeze, Congress will have to deal with the Medicare payment issues again very soon. Having this issue before Congress in an election year will give CMA improved leverage as the association continues to aggressively fight for a real fix to Medicare’s SGR and GPCI formulas.
Click here for more information. Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
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5. CMA Participates in National Flu Summit
CMA last week participated in a two-day National Flu Summit in Atlanta. The annual summit, sponsored by AMA and the Centers for Disease Control & Prevention (CDC), brings together various experts and stakeholders to discuss flu vaccine supply and distribution.
During this year’s summit, CMA recommended a number of procedural changes to improve vaccine distribution next year. Among those recommendations: extend the period during which only high-risk patients can be vaccinated; allow earlier prebooking of vaccine orders; and release the CDC’s stockpile of vaccine much earlier in the season, with priority given to physicians.
Click here for more information about this year’s summit, including downloads of
speakers’ presentations.
Contact: Robin Flagg, 415/882-5110 or rflagg@cmanet.org.
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6. IMQ Celebrates 10 Years
CMA’s Institute for Medical Quality (IMQ) celebrated its 10th anniversary on January 20 with a special dinner attended by current and past chairs, members of IMQ’s Board of Directors, and leaders and surveyors from IMQ’s survey programs.
In its first 10 years, IMQ conducted a total of 2,994 accreditation surveys, 75 consultations, 88 educational seminars with 7,424 total attendees, presented 5,977 Category 1 CME hours, and issued 172,784 continuing medical education certificates. |
IMQ, a self-sustaining CMA subsidiary, was established in 1996 to be an innovative leader in improving the quality of care provided to patients by encouraging, developing, and implementing programs that effectively measure and improve the quality of health care. During the past 10 years, IMQ has been a forerunner in quality improvement and accreditation activities, including its acute care hospital survey program, ambulatory care survey program, detention and corrections survey program, CME accreditation and certification programs, peer review and medical staff consultation programs, and educational seminars.
IMQ places a heavy emphasis on education, counseling, and direct involvement of practicing physicians in its survey and educational programs. That design makes it different from other quality organizations by helping to eliminate barriers that negatively impact physicians’ ability to provide patients with the highest-quality care.
Click here for more information.
Contact: Leslie Anne Iacopi, 415/882-5167 or liacopi@imq.org.
7. Highlights from CMA Board of Trustees Available
CMA’s Board of Trustees met Friday, January 27, in Costa Mesa.
Click here for a summary of the board’s major actions.
Contact: Ginnie Yee, 415/882-5170 or gyee@cmanet.org.
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8. Humana Settlement Claim Deadline Is February 17
Physicians have until Friday, February 17, to file a claim for their share of the $40 million Humana settlement.
Even physicians who did not treat Humana patients are still likely eligible for a pro rata share of the $40 million. To be eligible, you need only have provided covered services between August 4, 1990, and October 19, 2005, to any patients covered by any of the defendants in this case—CIGNA, Aetna, Anthem, Coventry, Health Net, Humana, PacifiCare, Prudential, United Healthcare, and Wellpoint.
Humana is the 7th HMO to settle with CMA and more than a dozen other state medical associations in CMA's RICO lawsuit.
Claim forms and filing instructions, including the list of all Humana affiliates whose claims can be used to calculate how many settlement shares you are owed, are available in CMA’s RICO Resource Center.
Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
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9. Students/Residents/Fellows:
Call for 2006-2007 Committee Nominations; Deadline is February 10
CMA invites its students, residents, and fellows to nominate themselves or their peers to serve on CMA committees and councils for the 2006-07 term. Serving on CMA committees is an invaluable experience that allows participants to network with other CMA leaders and play a role in the development of CMA policies and positions.
The application deadline is February 10.
Use the following links for more information, including nomination forms and details about the committees/councils on which student/resident/fellow members may serve.
Contact: Patty Frisk, 916/551-2076 or pfrisk@cmanet.org.
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10. There's Still Time to Register for IMQ's Second Annual Conference on
Medical Staff and Hospital Collaboration, February 23-24 in Monterey
CMA's Institute for Medical Quality (IMQ) is hosting its second annual conference on medical staff and hospital collaboration February 23-24 at the Hyatt Regency in Monterey. Last year's conference, which focused on pay-for-performance initiatives, was attended by a dynamic group of medical staff leaders and administrators from hospitals throughout California.
This year's conference, “Data Collection and Quality of Care Issues,” brings together hospitals and medical staffs to improve their effectiveness in delivering care. This program covers government, payor, and accreditor data-collection requirements; how data collection is tied to charting and reimbursement; the implementation and impact of electronic health records; linking hospital and physician practice data, and new error reporting laws. Presenters and attendees will discuss whether appropriate and accurate data is being collected, how the medical staff can get “buy-in” from colleagues, and external forces currently affecting hospitals. The conference will also cover thorny issues facing medical staff leaders, such as medical staff bylaws and peer review. Participants will learn how to run an effective meeting and handle disruptive physicians.
Click here for more information.
Contact: Leslie Iacopi, 415/882-5167 or liacopi@imq.org.
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