1. FTC Delays Enforcement of Red Flag Rules for 3 Months
The Federal Trade Commission (FTC) on Thursday announced it would delay enforcement of its new Red Flag Rule, which requires “creditors” – including many physicians – to develop and implement identity theft detection and prevention programs. The new regulations will now take effect on August 1, 2009, so that creditors and financial institutions have more time to develop and implement written identity theft prevention programs.
Click here for more information.
Contact: Long X. Do, 916/444-5532 or ldo@cmanet.org.
2. Swine Flu Guidance for Physicians
The Centers for Disease Control and Prevention and the California Department of Public Health are encouraging physicians to consider the possibility of Swine Influenza A (H1N1) in patients presenting with febrile respiratory illness. Priority should be given to patients with influenza-like illness, patients who have recently travelled to Mexico, and patients who have been in close contact with someone who has tested positive for swine flu. Below are general testing and treatment guidelines for health care professionals.
Infection Control
Any patient that presents for care at a doctors office or other health care facility with suspected, probable, or confirmed cases of swine flu should be placed directly into an individual room with the door kept closed. The ill person should wear a surgical mask to contain secretions when outside of the patient room.
Health care personnel interacting with the patient should follow standard infection control guidelines, including wearing an N95 respirator or surgical mask/gown/gloves. Dispose of used gowns, gloves, and masks in a biohazard bag. And don’t forget to wash your hands thoroughly with soap and water or alcohol-based hand gel (and remind your staff to do the same). Testing for Swine Flu
If you suspect a patient to be infected with swine flu, do a nasopharyngeal swab, put it in viral transport media, and ship to your local county health department per their usual protocol.
Specimens should be collected within the first 24 to 72 hours of onset of symptoms and no later than 5 days after onset of symptoms. The specimens should be kept refrigerated at 4º Celsius and sent on cold packs if they can be received by the laboratory within five days of the date collected. If samples cannot be received by the laboratory within five days, they should be frozen at -70 º Celsius or below and shipped on dry ice. (Additional details on specimen collection are available at http://www.cmanet.org/swine_flu.)
Physicians are also reminded to take a travel history from anyone with significant acute respiratory illness. Treating Swine Flu with Antivirals
As this is a new virus, people who received flu vaccine this year are not protected. Antiviral treatment should be considered for confirmed, probable, or suspected cases of swine flu. Antiviral treatment should be initiated as soon as possible, as antivirals are most effective when started within 48 hours of the onset of symptoms. Antivirals zanamivir (Relenza)or oseltamivir (Tamiflu) are effective against this virus, but should not be used prophylactically except in very narrow, specific instances (see the CDC website for treatment recommendations). Educating Patients
Physicians should urge patients to use normal precautions to prevent the spread of germs that cause respiratory illnesses like influenza. These precautions include:
- Cover nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
- Wash hands often, especially after a cough or sneeze. Wash hands for at least 15-20 seconds with soap and hot water. Alcohol-based hand cleaners are also effective.
- Avoid touching your eyes, nose, or mouth.
- Try to avoid close contact with sick people.
- If you get sick, stay home from work or school and limit contact with others to keep from infecting them.
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3. CMA Opposes Efforts to Erode the Bar on Corporate Practice of Medicine in California CMA is vigorously opposing multiple legislative efforts (AB 646, AB 648, and SB 726) to erode the ban on the corporate practice of medicine in California by allowing certain hospitals to hire physicians. Under current law, hospitals are barred from hiring physicians as employees. This important law was created to prevent corporations or other entities from unduly influencing the professional judgment and practice of medicine by licensed physicians.
Complicating CMA’s efforts are the facts that the bills have bipartisan authors and at least one of the bills (AB 646) is backed by the powerful labor union AFSCME. Proponents of the bills have argued that allowing hospitals and health districts to hire doctors will increase access in underserved areas. CMA believes and has argued that there are more effective ways to increase access in underserved areas, and that the interests of patient protection served by the corporate bar are too important to be pushed aside.
AB 646, AB 648, and SB 726 passed out of policy committee last week. However, SB 726 was significantly scaled back through amendments that preserve nearly all of the important patient protections of the corporate bar.
Thanks to all the CMA doctors and county medical societies who called their legislators or arranged for doctors to call their legislators on these bills. These efforts played a critical role in helping us position ourselves for a positive outcome on these bills.
For more information on these and other bills of interest, see CMA’s Legislative Hot List.
Contact: Brett Michelin, 916.444-5532 or bmichelin@cmanet.org.
4. CMA Kills Bills to Expand Nonphysicians’ Scope of Practice
CMA recent killed two bills that would have significantly expanded the scope of practice of pharmacists and physical therapists.
One bill (AB 977) would have allowed pharmacists to independently initiate and provide immunizations to children and adults. Currently pharmacists can provide immunizations only under a physician protocol. This bill was an unchecked expansion of pharmacists’ scope of practice that could have had unintended consequences for patient safety and quality care.
The other bill (AB 721) would have allowed physical therapists to evaluate and treat patients without a previous diagnosis or referral from a licensed physician.
For more information on these and other bills of interest, see CMA’s Legislative Hot List.
Contact: Jodi Hicks, 916/444-5532 or jhicks@cmanet.org.
5. CIGNA Clarifies Policy Regarding Claims Documentation
CIGNA recently notified physicians that they would be required to submit supporting documentation for any claims that are appended with a CPT modifier 25 or 59. Modifier 25 is used when there was a significant, separately identifiable E&M service provided by the same physician on the same day as another procedure or service. Modifier 59 is often used when billing multiple procedures with the same CPT code.
CIGNA’s policy, initially imposed on 17,000 code pairs, has caused significant concern in the physician community because of the increased administrative burden associated with this new policy. This policy, which took effect April 20, also requires physician office staff to submit the supporting documents manually via mail or fax.
CMA, AMA, and other medical societies expressed physicians concerns to CIGNA about the administrative burden of this policy and inevitable payment delays that will result.
Responding to physicians’ concerns, CIGNA has significantly reduced the number of NCCI code pairs for which it requires documentation to fewer than 500, rather than the 17,000 codes originally announced.
Physicians should be aware that claims requiring documentation can be submitted electronically. The documentation, however, must be sent by mail or fax. In such instances you should use Loop 2300 to indicate that documentation will be sent via mail or fax. Supporting documentation can be faxed to CIGNA at 570/496-2945 or sent via mail to the CIGNA address on the back of the patient’s ID card.
Click here for more information, including complete lists of current code combinations that require supporting documentation when billed with modifier 25 or 59.
Contact: Aileen E. Wetzel, 888/401-5911 or awetzel@cmanet.org.
6. Physicians Face 21% Medicare Rate Cut in 2010
At the beginning of 2009, it appeared as though the annual kabuki theater of threatened Medicare cuts might not materialize this year. The Obama Administration became the first presidential administration to release a budget that would eliminate the SGR, at a cost of $380 billion. Also, the House Budget Committee agreed in March to waive congressional pay-as-you-go rules (which require new federal spending to be offset by budgetary cuts or tax hikes) for the SGR, further clearing the path towards a permanent Medicare fix.
However, the House recently reversed itself, and voted to uphold the pay-as-you-go rules for all programs, effectively requiring an additional $285 billion. Therefore, Congressional leaders may scale back their plans to completely eliminate the SGR and only reverse the cuts for a few years at a time. If no changes are made, physicians face a 21 percent cut in Medicare rates in 2010.
The Senate Finance Committee released a paper this week on Medicare payment reform. It is the first of three papers they will be releasing this month on health reform. In brief, because of the enormous cost to eliminate the SGR ($380 billion), the finance committee plan stops the SGR cuts for three years and gives physicians a 1 percent payment increase in the first two years. Physicians who provide 60 percent of their services in ambulatory settings would receive 5 percent bonus payments for five years for E&M services for new and established patients. General surgeons practicing in designated rural areas would also receive 5 percent bonus payments. These bonuses would be paid for by reducing payments across the board for all other services. While there are numerous initiatives in the proposal, the major one is the proposed establishment of a shared savings program whereby physicians who affiliate and form coordinated care organizations may receive bonus payments based on the savings achieved in the Medicare program (Part A and Part B) in their area.
While CMA appreciates the commitment the Senate is making to pay for the gradual elimination of the SGR without imposing larger cuts in future years, the proposed 1 percent payment increase and the net reductions in other services are completely inadequate to cover rising physician practice costs. CMA is supportive of the substantial increases for E&M services, however CMA strongly opposes cuts to other services to pay for those gains. CMA will be meeting with the Senate Finance Committee in Washington, D.C., next week to discuss this proposal.
With Medicare reform discussions in Congress providing the backdrop, CMA’s Board of Trustees recently adopted new policy dealing with the issue at its April meeting. The new policy is designed to reflect different modes of practice and to ensure that doctors have a choice in determining how and whether they participate in Medicare, and should they do so, receive a fair compensation for their work.
The highlights:
- CMA will continue to support the elimination of the SGR payment formula;
- CMA will urge Congress to provide a Medicare payment update of at least 10 percent in 2010 as a catch-up for the last 7 years of inadequate updates;
- CMA will support a new Medicare physician payment system that allows physicians to voluntarily select a payment track based on five options that reflect their mode of practice. The five options include a solo/small group physician track that pays physicians based on the Medicare Economic Index, a medical home track, and a track that allows physicians to organize into virtual or real groups to coordinate care and receive bonus payments based on the hospital savings they achieve in their region. The plan also allows physicians to privately contract with Medicare patients for certain services.
- CMA will advocate for physicians to be granted anti-trust relief to collectively negotiate contract terms with the private health plans.
Click here for more information. Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
7. Aetna Amends Physician Contracts to Include Medicare Products
Aetna recently notified physicians in 16 California counties that their contracts will automatically be amended to include Medicare HMO, PPO, and private fee-for-service products effective January 1, 2011. Affected are physicians in Alameda, Contra Costa, El Dorado, Los Angeles, Orange, Placer, Riverside, Sacramento, San Diego, San Francisco, San Joaquin, San Mateo, Santa Barbara, Santa Clara, Solano, and Tulare counties.
CMA reminds physicians that before signing a health plan contract or contract amendment, it is important to know what value it will bring to your practice. Physicians do not have to accept bad contracts or contracts that are not mutually beneficial.
If you do not want to participate in Aetna’s Medicare network, you must notify the insurer in writing within 30 days. Opt-out notices should be sent via mail or email (CMA recommends certified mail with return receipt) to: Barbara Brooks, Aetna Network Management, 6303 Owensmouth Avenue, Woodland Hills, CA 91367 or socalnm@aetna.com. The deadline to opt out for southern California counties is May 13, for northern California counties, May 20.
Click here for more information.
Contact: Aileen Wetzel at 888/401-5911 or awetzel@cmanet.org.
8. Nominate an Oustanding Colleague for the
CMA Foundation Leadership Awards
The CMA Foundation is accepting nominations for the 2009 Leadership Awards which celebrate the efforts of individuals or organizations that make a difference in the health of Californians. The Robert D. Sparks, M.D., Leadership Award, the Ethnic Physician of the Year Award, and the Adarsh S. Mahal, M.D., Access to Health Care and Disparities Award recognize the compassion and commitment of California's health care professionals.
The deadline to submit nominations is June 30. Nomination information and packets for each award are available in the “What's New” section of the Foundation website
Contact: Carol Lee, Esq., 916/779-6622 or clee@thecmafoundation.org.
9. 2009-2010 Council and Committee Nomination Deadline Is May 29
CMA depends on the expertise of its members to make smart policy choices. Do you have expertise in medical ethics, professional liability, or other topics related to the practice of medicine? If so, you could serve on one of CMA’s councils or committees.
The nomination deadline for the 2009-2010 term is May 29. Nominees must be endorsed by their county medical societies. Contact your county medical society for information on the nomination process.
Click here for more information, including committee and council descriptions, nomination forms, and instructions.
Contact: Ginnie Yee, 415/882-5170 or gyee@cmanet.org.
10. Board Highlights Now Available
The CMA Board of Trustees met April 23, before CMA’s annual Health Care Leadership Academy in Anaheim. A summary of the board’s major actions is now available online.
The board highlights offer a brief summary of major action and informational items discussed by the board. The highlights are not intended to be all-inclusive of items discussed, and these documents are not official CMA policy.
Members can access complete and official board-approved minutes at the member-only website. (Official board meeting minutes are not posted until approved at the following meeting.)
Contact: Ginnie Yee, 415/882-5170 or gyee@cmanet.org.
11. Benefit of the Week: EHR Best Practice Series Webinars
To help members begin to assess their HIT needs, CMA has partnered with Maxwell IT to provide members with complimentary registration to the EHR Best Practices Series webinars. To register for an upcoming EHR webinar, please visit CMA’s HIT Resource Center, and click on “HIT Webinars.
Members can register FREE for both “How to Best Select an EHR” and “E-Prescribing Best Practices.” A members-only discount code is required to access this discount. Visit the members-only website or call CMA's member help line (800/786-4CMA) to get the code.
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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