1. Schwarzenegger Signs Budget Deal; Medi-Cal Largely Unscathed
Governor Arnold Schwarzenegger on Thursday signed into law a mid-year budget adjustment meant to close the state’s projected $41 billion shortfall for the next 16 months. The bill includes $14.9 billion in spending reductions, $12.5 billion in new revenues, $5.4 billion in borrowing, and a conservative estimate of $7.8 billion in new federal money. The budget deal will leave the state with a $1 billion reserve.
Among the spending cuts are $183.6 million in savings from the elimination of optional benefits in the Medi-Cal program (adult dental, acupuncture, audiology and speech therapy, chiropractic, optometric and optician services, podiatry, psychology, and incontinence creams and washes). Although there are no additional cuts to Medi-Cal rates for physicians beyond the 1 percent Medi-Cal cut scheduled to take effect March 1, reimbursements to public hospitals would be reduced by 10 percent. All of these cuts would take effect July 1, 2009.
These and other spending cuts may be averted, however, if California takes advantage of the increased federal matching funds available via the economic stimulus plan signed by President Obama last week. Under the legislation, a state’s eligibility and renewal procedures for the Medicaid program cannot be more limiting than they were on July 1, 2008. As part of the budget deal enacted last September, California moved from annual to semi-annual reporting for children in Medi-Cal. If that provision is lifted, California will receive $3.7 billion in additional Medi-Cal funds this year, and $11.2 billion total over the next three years.
Contact: David Ford, 916/551-2554 or dford@cmanet.org.
2. Stimulus Package Provides $87 Billion for Medicaid Programs;
$19 Billion for HIT
California’s Medi-Cal program is expected to receive more than $11 billion over three years as part of the $787 billion economic stimulus package signed into law by President Obama last week. This number is significantly higher than originally anticipated.
The stimulus bill increases federal funding for state Medicaid programs provided that the programs’ eligibility requirements are not more restrictive than they were on July 1, 2008. To receive the funds, California would have to reverse a recent policy change that requires parents to verify children’s eligibility for the program twice annually, rather than just once a year. The state would have to rescind the change by July 1, 2009, to maximize available matching funds.
The economic stimulus package also provides approximately $19 billion in incentives over five years, including bonus payments upwards of $40,000 for each Medicare provider who demonstrates “meaningful use” of an EHR system. Physicians with significant Medi-Cal patient loads (20 percent or more for pediatricians, 30 percent or more for other specialties) may be eligible for additional bonuses paid through state Medicaid programs. As eligibility is based on usage, even physicians who already use EHR systems will be eligible.
While the bill does include Medicare payment reductions (starting at 1 percent) for physicians who do not implement HIT systems, these do not take effect until 2015 and there are exceptions for significant hardship cases.
This is the first substantial federal funding provided to help physicians implement HIT systems—systems that will generate benefits across the health care spectrum.
CMA is currently analyzing the HIT provisions of the bill, and we will provide physicians with details and guidance on how to take advantage of the incentives soon.
The bill also establishes HIT Policy and Standards Committees that are comprised of public and private stakeholders (including physicians) to provide recommendations on the HIT policy framework, standards, implementation specifications, and certification criteria for electronic exchange and use of health information. The bill requires the U.S. Health and Human Services Department to adopt through the rule-making process an initial set of standards, implementation specifications, and certification criteria by December 31, 2009.
CMA continues to work closely with members of Congress and the Administration to ensure the voices of physicians and patients are heard and considered as new health care policies are developed.
Stay tuned for more details.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
3. Joint Commission Requires Ongoing
Collection of Physician Performance Data
The Joint Commission is now requiring medical staffs to collect physician-specific performance data on a regular basis, in addition to the every two-year credentialing cycle. The goal for this “ongoing professional practice evaluation” (OPPE) is to ensure that all physicians with medical staff privileges are monitored routinely and regularly— regardless of whether there are specific performance issues— to find problems in a timelier manner and take appropriate steps to improve quality. The specific data to be collected is to be determined by individual medical staffs, but the Joint Commission has suggested that it could include, among other things: procedures performed and their outcomes, pharmaceutical usage, diagnostic tests ordered, length of stay patterns, and morbidity and mortality data.
More information on the Joint Commission’s OPPE standard (MS.08.01.03) is available in CMA ON-CALL Document #1498, “Ongoing Professional Practice Evaluation.” ON-CALL documents are free to members at http://www.cmanet.org/member. Nonmembers can purchase ON-CALL documents for $2/page in the CMA Bookstore, http://www.cmanet.org/bookstore.
Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
4. It’s Time to Prebook Vaccine for 2009-2010 Flu Season
Physicians can now order flu vaccine for the 2009-20010 flu season. CMA encourages physicians to place their orders early to guarantee that they will receive their supply in time to vaccinate their high-risk patients in the autumn.
Physicians can place orders directly with drug manufacturers or through their regular pharmaceutical distributor. A complete list of manufacturers and distributors taking orders is available at Influenza Vaccine Availability Tracking System website, http://www.preventinfluenza.org/ivats.
Patients of all ages with conditions that put them at an increased risk of influenza-related complications, and those over age 65, are also considered high risk and should be immunized against influenza. Family members, caregivers, health care workers and other people in close contact with high-risk individuals should be vaccinated to reduce the odds of passing influenza to someone for whom it can be life threatening. The Federal Advisory Committee on Immunization Practices also recommends vaccinating all children aged 6 months to 18 years.
Physicians are reminded that it is against California law to administer mercury-containing vaccines—including inactivated influenza vaccine from multidose vials—to pregnant women and children younger than 3 years old. Multidose vials of flu vaccine are made with thimerosal, a mercury-containing preservative.
Only influenza vaccine from single-dose syringes or vials with no mercury or trace levels of mercury (less than 0.5 micrograms per 0.5-milliliter dose for pregnant women, less than .25 micrograms per 0.5-milliliter dose for small children) may be given to pregnant women and children under 3.
Click here for more information, including which vaccines do and do not meet state mercury requirements.
Contact: Teresa Kline, 916/444-5532 or tkline@cmanet.org.
5. Leadership Academy Registration Is Now Open
Physicians can now register for CMA’s 12th annual Health Care Leadership Academy, April 24-26 in Anaheim. This year’s conference will feature presentations on health system reform in a new era of Washington politics, the “medical home” and other emerging models for the delivery of quality care, the promises and perils of hospital EHR initiatives, health disparities, and more.
Attendees will also have the opportunity to select from 14 breakout workshops on topics ranging from survival strategies for practicing in a turbulent economy, to mitigating malpractice risk, developing leadership skills, and more.
Register by March 24 and save $100. Early bird registration is $645 for members, $945 for nonmembers, and $245 for allied health professionals. Tuition for practice managers and other non-MD staff is $295 for CAMGMA members, $395 for nonmembers.
Register online at http://www.caleadershipacademy.com.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
6. Don't Miss These Upcoming CMA Webinars
CMA is excited to be hosting a series of live monthly webinars to educate physicians on a range of topics from health information technologies to reimbursement issues. Upcoming webinars include:
2/24: What the Balance Billing Ban Means for Physicians (12:30 pm to 1:15 pm)
Long Do, CMA’s Director of Litigation will present recent developments in the fight to ensure fair payment for out-of-network emergency services, including the recent California Supreme Court decision to ban balance billing and the ongoing nationwide litigation over the Ingenix database, and discuss physicians’ options for seeking fair payment from payors.
3/5: Success Factors for Becoming an Effective Physician Leader (8 pm to 8:45 pm)
Susan Reynolds, MD, PhD, President and CEO of the Institute for Medical Leadership will discuss the UCLA Physician Leader Success Factor study and registrants will receive a leadership assessment to help them understand their own leadership styles and how they can maximize their leadership effectiveness.
To register, visit http://www.cmanet.org/calendar. Space is limited so register soon.
Contact: Shannon Navarra-Lujan, 800/786-4CMA or slujan@cmanet.org.
7. Last Chance to Take CMA's Physician Survey
Your opinion is important to us! Please take a few minutes to complete our brief and anonymous online survey . This information will be used to help CMA better meet the needs of physicians in California. The survey closes on March 1.
Should you have any questions or comments that you wish to directly communicate with us, please send them to info@cmanet.org and put “CMA E-Survey” in the subject line.
8. Member Benefit of the Week: 6% off athenaCollector
CMA members may receive 6 percent off athenaCollector(sm), athenahealth’s unique web-based billing and practice management service, through the CMA’s participation in athenahealth’s PartnerWise Affinity Program. athenaCollector combines software, a continually updated database of payer rules and a state-of-the-art billing, collections, and service center.
To learn more about athenaCollector, check out the the athenahealth webinar. Participants will learn about the CMA – athenahealth relationship and how athenahealth can help to improve and optimize performance and reverse the negative trends impacting physician practices today. For more information, visit http://www.athenahealth.com/CMA or call 888/402-6942.
Click here for more information on your membership benefits.
Contact: CMA’s member help line, 800/786-4CMA or twilson@cmanet.org.
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