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1. Physicians Urged to Read and Understand Health Plan Contracts
CMA has recently received a number of calls from physicians concerned about the new PacifiCare/United Healthcare contract. CMA reminds physicians that before signing a health plan contract, it is important to know what value that relationship will bring to your practice. Physicians do not have to accept bad contracts or contracts that are not mutually beneficial.
Physicians are advised to review payor fee schedules carefully to ensure that the proposed compensation is sufficient to maintain a medical practice. With respect to the PacifiCare contract, physicians should be aware that the fees vary dramatically and do not appear to follow a consistent percentage of Medicare. The rates offered in one region, for example, range between 75 and 86 percent of Medicare for an office visit and are as low as 43 percent of Medicare for some surgical procedures.
It is also crucial that physicians obtain and review a payor’s payment policies and the rules it uses to adjudicate claims. Without this information, you cannot make an informed decision about signing the contract. Of particular concern in the PacifiCare contract is a provision stating that reimbursement is subject not only to PacifiCare’s payment and coding policies, but also to those of other “participating entities.” Further complicating the issue, the contract states that different policies and procedures may apply to United Healthcare enrollees and to PacifiCare enrollees. Physicians should be aware of these variances and request copies of all administrative, policy, and procedure manuals and guides.
As a general rule, physicians should not sign a contract if they cannot meet all of its requirements. For example, the PacifiCare contract states that all business with PacifiCare, including claim submission, must be conducted electronically within one year of the effective date of the agreement. If your practice will not be able to submit electronic claims within that time frame, you should not sign the contract. Also of concern is the fact that the contract can be terminated only once a year on the contract anniversary date, with 90 days’ prior written notice.
To help physicians negotiate and manage complex third-party payor agreements, CMA has published a contracting toolkit, “Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations—A Focus on Payor Contracting.” The toolkit is available free to members at the CMA website. Nonmembers can purchase the toolkit for $100.
Click here for more information.
Contact: Aileen Wetzel, 916/444-5532 or awetzel@cmanet.org.
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2. CMA Partners with Athenahealth to Help Physicians
Increase Revenue and Lower Operating Costs
CMA has partnered with Athenahealth—a leading revenue management company—to help physicians get paid quickly, correctly, and with minimal hassle. CMA members receive 6 percent off Athenahealth’s unique web-based practice management services, which includes eligibility verification, claims submission, and insurance collection.
Athenahealth has even developed a “Prompt Payment Robocop,” to help physicians take full advantage of California’s prompt-payment law. The system monitors every claim, calculates interest when a claim has not been paid on time, and flags the unpaid claim for follow-up.
“Athenahealth’s leading technology will make it possible for physicians and medical groups to increase revenue, dramatically reduce delays, and make practice operations and claims processing more efficient,” says Nileen Verbeten, vice president of CMA’s Center for Economic Services.
Athenahealth is the only revenue management service for physicians that integrates work flow, billing, and collections into a single web-based service. This HIPAA-compliant system was developed by former medical practice managers who have a thorough understanding of the business problems facing physicians in California. Athenahealth has the largest real-time database of payor rules and regulations in the country—a database that helps prevent billing problems before they result in denied claims and lost cash flow. Because it’s a web-based service, every time a new rule or feature is added, your practice benefits immediately.
CMA endorsed Athenahealth’s award-winning solution after an extensive review of its software and services, lengthy discussions with California customers, and independent confirmation of the company’s unusually high user satisfaction rate. On average, practices that use Athenahealth’s revenue cycle management service get paid 30 percent faster and see a 5 to 10 percent increase in collections.
Group practices are eligible for the member discount only if all of the physicians are CMA members.
Click here for more information.
Contact: Jodi Prychun, 916/551-2863 or jprychun@cmanet.org.
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3. CMS Tells Medicare Advantage Plans to Increase Fees
As the result of CMA advocacy, the Centers for Medicare & Medicaid Services last week told fee-for-service Medicare Advantage plans that they must “pay the same as Medicare using the same rules, including the Deficit Reduction Act fee increase.” Although the federal budget package reversed the 4.4 percent cut to Medicare physician payments that took effect January 1, many Medicare Advantage plans have not yet adjusted their payments accordingly.
CMA had also contacted Medicare Advantage payors in California and strongly urged them to immediately and retroactively increase their payments in accordance with the 2006 federal budget, signed into law last month.
Click here for more information.
Contact: Aileen Wetzel, 916/444-5532 or awetzel@cmanet.org.
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4. CMA and CHCF Team Up to Offer Physicians Deep Discounts
on Handheld Medicare Drug Formulary Information
CMA and the California HealthCare Foundation (CHCF) have collaborated to put easy-to-use technology and valuable information about drug formularies—including Medicare Part D—literally in the palm of physicians’ hands.
For a bundled price of $99, physicians can purchase a Palm Z22 handheld computer and the Epocrates Rx Pro premium software. That’s nearly 40 percent off the regular price. This offer, available to physicians and other clinicians, is only good through the end of May.
With the launch of Medicare Part D in January, Medicare recipients in California now can choose from 48 health plans. The multiple formularies complicate the prescribing challenges facing physicians. These tools will help physicians manage the volume of information needed to pick the correct medicines and provide high-quality care for their patients, especially those with chronic conditions who require multiple medications. Epocrates-enabled handheld computers allow a physician in an exam room to identify which medicines are in which formularies, check for drug interactions, and find drug alternatives.
“We are leveraging easy-to-use technology to simplify the delivery of medicine to patients,” says CMA CEO Jack Lewin, M.D. “This is an important step to make the Part D program safer and more efficient.”
Already have a handheld computer? Access the Part D formularies free through Epocrates’ online and handheld drug reference guides. And don’t forget that CMA members receive 30 percent off one-year subscriptions and 35 percent off two-year subscriptions to any Epocrates product. Students and residents receive 50 percent off all Epocrates products.
Click here for more information.
Contact: CMA’s member help line, 888/233-2937.
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5. Early-Bird Deadline for CMA’s Leadership Academy Is April 7
The early-bird deadline for CMA’s ninth annual Health Care Leadership Academy is April 7. Sign up by that date and receive $100 off your registration. The conference is May 5–7 at the Renaissance Esmeralda Resort near Palm Springs. A dynamic multidisciplinary faculty will discuss trends affecting your economic future as a physician and teach essential leadership skills.
This year’s conference, “Reengineering Health Care: Meeting Future Expectations Without Breaking the Bank,” will address the challenges of cost, quality, and access to care as “locomotives” of health system reform. Noted economists and leaders from government, business, labor, and health care will present a variety of perspectives on how to avert a “train wreck” and put the system on track toward a viable future.
The academy also features a powerful slate of leadership workshops including:
- Leadership skills for managing change
- Conflict resolution techniques
- Preparing a compelling presentation
- Maximizing committee effectiveness
- Delivering medicine’s (or your organization’s) message to the public
The value of these workshops alone makes the CMA Leadership Academy’s low tuition a bargain. Participants can earn up to 17 hours of Category I CME.
Early-bird registration is $595 for members, $895 for nonmembers. Special discounted rates are available for retired physicians, students, and allied health professionals.
See
http://www.cmanet.org/leadership for more information.
Contact: Leadership Academy Hotline, 800/795-2262 or gfonseca@cmanet.org.
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6. Holding Blue Cross and Other Health Plans Accountable:
What the RICO Settlements Mean to You and Your Practice
CMA and AMA are presenting two one-day seminars to educate physicians about the RICO settlements and what the settlements mean to their practices. The seminars will be Thursday, May 18, at the Los Angeles County Medical Association offices in downtown Los Angeles, and Friday, May 19, at the Alameda Contra Costa Medical Association offices in Oakland.
To date, six major health plans (Blue Cross/Anthem/Wellpoint, Aetna, Cigna, Health Net, Prudential, and Humana) have settled CMA’s RICO lawsuit, which alleges that the health plan defendants engaged in fraud and extortion by wrongfully denying payment to physicians, in violation of federal racketeering law.
Although the settlements have provided nominal cash payments to physicians, their true value lies in the prospective relief that is estimated to be worth more than $1 billion in increased revenue to physicians over the next few years.
Seminar participants will learn how to maximize their relief under the settlements by identifying inappropriate health plan business practices—including improper health plan claim denials—and holding the health plans accountable for failures to comply with the settlement terms. Under the settlements, the compliance process is overseen by a court-appointed mediator.
Registration for the LACMA seminar is $49 for members, $149 for nonmembers; ACCMA seminar is $49 for members, $199 for nonmembers.
Click here for more information.
Contact: Jewel Thompson, 916/444-5532 or jthompson@cmanet.org.
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7. CMA Cosponsors Health Literacy Conference, May 4–5 in Irvine
CMA is cosponsoring the Institute for Healthcare Advancement’s Fifth Annual Health Literacy Conference, “Beyond the Written Word: Alternative Solutions to Low Health Literacy,” May 4–5 at the Hyatt Regency Irvine near John Wayne Airport.
Attendees will get an overview of health literacy issues and learn how to improve health literacy in their practices and communicate more effectively with patients. CMA members receive a discounted rate of $250. (To receive the CMA rate, use coupon code CMA06 when registering.)
Register at
http://www.iha4health.org.
Contact: IHA, 800/434-4633.
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8. There's Still Time to Register for IMQ’s 2006
PreCALS Conference, April 6-7 in Garden Grove
Medical staff teams are encouraged to attend the Institute for Medical Quality’s PreCALS conference, April 6-7 at the Crowne Plaza Anaheim Resort in Garden Grove. The PreCALS program is a comprehensive introduction to California’s tripartite hospital accreditation and licensure survey process.
Attendees will learn about:
- The new unannounced consolidated JCAHO/IMQ/DHS survey process, with a focus on the systemic survey approach
- Patient and system tracer methodology, including JCAHO’s National Patient Safety Goals
- JCAHO’s 2006 standards, including those related to performance improvement, peer review, and credentialing
- Current Title 22 survey issues
- Ideas and suggestions for achieving continuous survey readiness
The program is of value to all medical staff leaders preparing for the integrated unannounced survey in 2006. Medical staff teams (chiefs of staff, committee chairs, quality-management personnel, and medical staff directors and coordinators) are encouraged to attend.
Click here for more information.
Contact: Leslie Anne Iacopi, 415/882-5167 or liacopi@imq.org.
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 9. Did You Know?
Did you know that women physicians were first made eligible for admission to the Medical Society of the State of California (now CMA) in 1875, 19 years after the society was founded in 1856? The campaign for membership was led by Euthanasia Meade, M.D., on behalf of five women physicians, but the vote to admit them was a tie. So the society’s president at that time, Alexander B. Nixon, M.D., cast the deciding vote. A similar effort three years earlier by former president Thomas Logan, M.D., had failed. Incidentally, history tells us, Dr. Nixon’s second wife was a physician, schooled at California’s first medical school, Cooper Medical College (which later became Stanford).
CMA is celebrating its 150th birthday!
Visit http://www.cmanet.org/150 for more information.
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10. CMA Member Benefit of the Week: Managed Care Contract Analysis
CMA members have free access to CMA’s Model Managed Care Contract and objective written analyses of a dozen major health plan contracts. These documents discuss issues commonly present in managed care and employment contracts.
CMA-contracted attorneys will also provide members with a 15 percent discount on other contract analysis services. These attorneys will review various types of physician contracts for compliance with California and federal law and determine whether, from a business and practical perspective, the contract provisions are physician friendly.
Click here for more information about the benefits and discounts available to CMA members.
Contact: CMA's legal information line, 415/882-5144 or e-mail legalinfo@cmanet.org.
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