1. State Attempts to Circumvent Federal Law to Cut Medi-Cal Rates
The California Department of Health Services recently submitted a proposal to the Centers for Medicare & Medicaid Services (CMS) requesting a waiver of California’s responsibilities under the Medicaid Act. The Schwarzenegger Administration’s proposal seeks to amend California’s State Plan in an attempt to implement various rate reductions for non-institutional services, including the Medi-Cal physician payment cuts enjoined by the federal court.
Current Medi-Cal payment rates are among the lowest in the country. Despite the requirements of federal law, the California Legislature last year again voted to cut Medi-Cal reimbursement rates without any consideration for the devastating impact these rate reductions would have on patients’ access to physician services. The federal courts intervened and stopped the cuts, confirming that the state shirked its responsibility under federal law to consider efficiency, economy, quality of care and access to services when it enacted the rate reductions.
CMA is appalled that the Schwarzenegger Administration is ignoring the devastating impact lower rates would have on access to quality medical services. In a letter to Health and Human Services Secretary Kathleen Sebelius last week, CMA urged CMS to deny the proposed State Plan Amendment.
“CMS approval of the rate reductions to physician services…will simply rubber-stamp the California Legislature’s unlawful actions,” wrote CMA’s chief legal counsel Francisco Silva in the letter dated June 8, 2009. “Approval will simply encourage the State of California to raid the Medi-Cal program whenever it is short on funds, in direct contravention of federal law and the current administration’s clear commitment in maintaining access to health care for our most needy residents.”
Click here for more information.
Contact: Clarisa Sanchez, 916/551-2867
or csanchez@cmanet.org.
2. CMS Opinion: Noncontracted Physicians Cannot Appeal
Underpaid Medicare Advantage Claims
In a recent opinion, the Centers for Medicare & Medicaid Services (CMS) confirmed that noncontracted physicians do not have the right to dispute downcoded Medicare Advantage claims. Unlike the Medicare Fee-for-Service (FFS) program, the Medicare Advantage program does not afford payment dispute rights to noncontracted physicians.
CMA is working with CMS Region 9 to address this issue. CMS has indicated that it plans to extend the current FFS payment dispute rights to Medicare Advantage plans in 2010. Additional information on these expanded payment dispute rights will be made available later this year.
Contact: CMA’s reimbursement help line, 888/401-5911 or fnavarro@cmanet.org.
3. CMA Publishes “Best Practices” for Physician Practices Toolkit
A practice cannot provide quality medical care unless it can keep its doors open. Physicians who work in well-run practices can spend less time dealing with administrative hassles or worrying about making ends meet, which, in turn, affords them more time for patient care. CMA, with generous support from the Physicians’ Foundation, has published a 140-page toolkit to help physicians improve the efficiency, and in turn the quality, of their practices.
In this tool kit, you will learn:
- What every physician needs to know about running a practice;
- How to find and keep qualified staff;
- Why your receptionist can make or break your business;
- How to make sense of your revenue stream;
- When it makes sense to cancel a payor contract;
- And much more.
The Best Practices toolkit, available free to all physicians, is organized into nine chapters that can be read sequentially or on an as-needed basis. Download the toolkit today at http://www.cmanet.org/bestpractices.
CMA will also be presenting live lunchtime “Best Practices” seminars at county medical societies around the state. These seminars will highlight some of the important features of the document to help you optimize your practice. If you would like to see the “Best Practices” seminar in your area, contact your local county medical society.
Contact: Frank Navarro, 888/401-5911 or fnavarro@cmanet.org.
4. CMA Designing New Website: Your Input Needed by June 19
As part of our efforts to communicate more effectively with California physicians, CMA is embarking on the process of redesigning its website. To ensure the end product is a CMA website that best meets the needs of California physicians and your myriad interests and ways of practice, we need to hear from you.
- Click here to take the survey online.
- Click here to download a PDF version of the survey
to be printed and submitted by fax.
Thank you in advance. Your input is invaluable.
Contact: CMA communications, 916/551-2072 or pharbison@cmanet.org.
5. Anthen Blue Cross Postpones Effective Date of
New Healthy Families Contract
In March, Anthem Blue Cross notified approximately 53,000 physicians statewide that they would have to sign a separate contract and accept reduced rates if they want to continue treating Blue Cross-insured Healthy Families and AIM patients. CMA has reviewed the proposed contract and identified some problematic provisions. CMA is working with Blue Cross to address these concerns before the contracts are mailed to physicians.
Blue Cross has also pushed back the signing deadline to August 31, which will allow physicians more time to review the new contracts and make an informed decision.
When the contract takes effect on September 1, Healthy Families and AIM patients will no longer be able to access physicians through Blue Cross’s Prudent Buyer contract. According to Blue Cross, the new lower rates will be “in line with the funding for these programs.” Physicians who do not have Prudent Buyer Contracts but contract with Blue Cross for Healthy Families/AIM only will also be required to sign a new contract in order to continue to provide services to patients enrolled in these programs. Patients and physicians in 43 counties will be affected by this change. (Blue Cross does not participate in the Healthy Families and AIM program in Alameda, Contra Costa, Fresno, Monterey, Sacramento, San Francisco, San Mateo, Santa Barbara, Solano, Stanislaus, and Yolo counties.)
Physicians who currently treat Healthy Families/AIM patients will receive a copy of the new contract. A contract may also be obtained by contacting Blue Cross at 877/811-3113 or ssbrecruit@wellpoint.com.
Click here for more information.
Contact: Aileen Wetzel, 916/551-2037 or awetzel@cmanet.org.
6.CMA-Sponsored Bill Introduced to Fix California’s Geographic
Medicare Payment Problems
U.S. Representative Sam Farr (D-Calif.) and Senator Dianne Feinstein (D-Calif.) last week introduced CMA-sponsored legislation to correct the long-standing Medicare geographic payment inequity for a number of California counties. Low rates in affected counties have forced many doctors to opt out of Medicare or limit the number of Medicare patients they treat. The net result is that Medicare recipients in these counties have a difficult time finding a doctor.
The Medicare payment formula includes a geographic adjustment factor (GAF) that adjusts the payment rate for local geographic market conditions. The goal is to base physician reimbursement on what it costs to provide care in a particular geographic region. The formula calculates a geographic adjustment factor for every California county, and assigns each county to one of nine of California’s Medicare regions, called payment localities. However, because of rapid growth and development in recent years, physicians in some California counties (El Dorado, Monterey, Placer, Riverside, Sacramento, San Benito, San Bernardino, San Diego, San Joaquin, San Luis Obispo, Santa Barbara, Santa Cruz, Sonoma and Yolo counties) have practice costs that are up to 10 percent greater than the average costs of other counties in their Medicare localities.
The legislation would place California localities into up-to-date Metropolitan Statistical Areas, which more accurately reflect regional costs, and hold harmless all counties that might experience a payment reduction by such a change. By doing this, many areas qualify for higher rates.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
7. House Health Reform Proposal Would Eliminate Medicare SGR;
Physicians Urged to Tell Congress Not to Make Empty Promises
This week, the three House Committees with Health Reform jurisdiction jointly released a general outline of their health reform proposal. Most significantly for physicians, the House proposal would eliminate the sustainable growth rate (SGR) payment formula, which has been an enormous hurdle in our fight to raise Medicare physician payment rates.
The proposal would also, among other things:
- Increase reimbursement for primary care E&M services by up to 15
percent (3 to 5 percent per year for three years);
- Allow physicians to organize into virtual or real groups to coordinate care and receive bonus payments for reducing unnecessary hospitalizations;
- Expand the Medicaid program to cover more low-income families;
- Increase Medicaid rates to Medicare levels for primary care services;
- Require everyone to have health coverage. It also provides tax credits and subsidies to families up to 400 percent of the federal poverty level to help them purchase insurance;
- Require medium and large employers to offer health insurance to their employees or pay into a fund on behalf of their uncovered workers; and
- Create a national health insurance exchange.
Although CMA strongly supports health coverage expansion and insurance market reforms (such as limits on medical loss ratios) called for in this proposal, the association is concerned that these reforms will be illusory if they don’t also guarantee meaningful access to doctors. CMA is urging physicians to contact their representatives in Congress and tell them that they must increase all Medicare and Medicaid reimbursement rates. Without these important rate increases, the promise of access to care for California’s uninsured will be a false one. The uninsured may be given health insurance coverage but they may not be able to find a doctor to care for them.
The House proposal also establishes a national health insurance exchange, through which the uninsured (and only the uninsured) can purchase insurance. The exchange would include both private insurance plans and a new public government-run plan. While specific details were not provided, it appears that the House proposal may require all participating Medicare physicians to also participate in the new public plan. While CMA understands that House leaders are concerned about building an adequate physician network to compete with the private health plans, CMA vigorously opposes mandatory participation in any health insurance plan. CMA also believes that any government plan must be adequately financed to ensure appropriate access to care.
Click here for more details.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
8. ONCHIT Releases Draft Guidelines on Regional HIT Extension
Center Program
Later this year, the Office of the National Coordinator for Health IT (ONCHIT) will begin awarding grants to establish regional health information technology extension centers. These centers, called for in the health IT section of the economic stimulus legislation, will help physicians and hospitals implement and become “meaningful users” electronic health records.
Beginning in 2011, qualifying Medicare providers who demonstrate “meaningful use” stand to receive up to $44,000 under the program; qualifying Medi-Cal providers stand to receive as much as $65,000. (On Tuesday, ONCHIT will release its draft definition of “meaningful use.” Stay tuned for more details.)
CMA recently submitted comments on ONCHIT’s draft Regional Extension Center (REC) Program guidelines. In the comments, CMA urged ONCHIT to make it clear that one of the REC’s roles is to inform health care providers about which EHR systems are federally-qualified and therefore eligible for the Medicare and Medicaid bonuses. CMA also urged ONCHIT to give preference to REC applicants that have demonstrated experience in meeting the stated goals of the program.
For more details, visit CMA’s HIT Resource Center.
Contact: David Ford, 916/551-2554 or dford@cmanet.org.
9. Physicians: We Need Your Help to Keep Our ERs Open
Governor Schwarzenegger has proposed redirecting $24.8 million from the Maddy Emergency Medical Services Fund into the General Fund to help offset California’s record $24 billion budget deficit. The Maddy Fund reimburses physicians, hospitals, and emergency medical services programs for uncompensated emergency care provided to uninsured patients. Without these funds, many California emergency rooms will be at real risk of closing.
The loss of these funds will be particularly devastating to California’s health care system given that an additional 2 million Californians would be without health insurance under the Governor’s proposals. With an economy that is falling apart, and millions of people losing their jobs, the health care safety net is needed now more than ever. Now is not the time to be pulling the rug out from under our needy citizens.
CMA is urging physicians with legislators on the Budget Conference Committee to call, fax, or email and urge them not to cut emergency room funding. It is critical that legislators understand the impact this cut will have on the quality of care their constituents receive in California. Counties with legislators on the committee include: San Diego, Solano, Sonoma, Orange, Los Angeles, San Bernardino, San Francisco, Marin, Sacramento, and Yuba-Sutter-Colusa.
Click here for more details, including talking points and representatives' contact information.
Contact: David Ford, 91/551-2554 or dford@cmanet.org.
10. Did You Review Your CPPI Data?
Did you review your California Physician Performance Initiative (CPPI) demographic data? If so, CMA wants to know. To help CMA monitor the accuracy of the data, physicians are encouraged to notify CMA if they reviewed their CPPI demographic data and whether or not they made any corrections.
Contact: Armand Feliciano, 916/551-2552 or afeliciano@cmanet.org.
11. Missed a Webinar? View It On-Demand at CMA Website
Did you miss one of CMA’s live webinars? All webinars are available for on-demand playback shortly following the live presentations in the webinar archives at CMA’s members-only website.
Currently archived webinars include:
Contact: Shannon Navarra-Lujan, 800/786-4CMA or slujan@cmanet.org.
12. Featured Member Benefits
Webinar: Long Term Planning in a Recessionary Environment: Wondering if your long term care strategy still makes sense, or if you need to start thinking about one? Marsh is hosting a live one-hour CMA members-only webinar on Wednesday June 17 at 5:30 pm to discuss the recession’s impact on long-term care from a personal risk-management perspective. Register at http://www.cmanet.org/calendar.
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.
Click here for more information on your membership benefits.
Contact: CMA’s member help line, 800/786-4CMA or memberservice@cmanet.org.
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