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1. State facing pertussis epidemic; CDPH urges physicians to
vaccinate patients against whooping cough
According to the California Department of Public Health (CDPH), the state is in the midst of a pertussis (whooping cough) epidemic. Infection rates have risen this year, with a four-fold increase in the number of reported pertussis cases in California, compared to the same time period in 2009. If current trends continue, California could experience a 50-year high in pertussis cases, despite wide availability of a vaccine to protect both adolescents and adults.
In order to protect infants who are too young to be vaccinated, it is important to vaccinate anyone with potential infant contact. CDPH is making additional Tdap (tetanus, reduced diphtheria, and acellular pertussis) vaccine available at no charge to eligible hospitals, so that they can immunize post-partum women and their close household contacts. For more information, visit the CDPH website.
Health care providers are also urged to receive the Tdap vaccine, to protect themselves and their patients. Effective September 1, 2010, the Cal/OSHA Aerosol Transmissible Disease Standard requires all hospitals, outpatient medical facilities, and other employers covered by the standard to offer Tdap immunization to their employees who may be exposed to pertussis. Employees who choose not to be vaccinated will be required to sign a declination form.
Physicians are also reminded that pertussis immunity from previous infection or vaccination wanes over time. Even fully immunized children become susceptible to pertussis by adolescence. Additionally, because pertussis vaccine for adolescents and adults was not available until 2005, immunization rates in these populations remains low.
The American Academy of Pediatrics has released clinical guidelines for clinicians providing care for infants with pertussis. The AAP guidelines are available at the AAP website. Additional resources may be found on the CDPH website.
Contact: Veronica Ramirez, 916/551-2887 or vramirez@cmanet.org.
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2. CMA objects to proposed regulations requiring
physician participation in lethal injections
CMA has filed formal comments objecting to proposed regulations that would require physician participation in lethal injections. The regulations set forth a framework of procedures to be followed before, during, and after an execution. Although the regulations do not require a physician to administer lethal injection chemicals, they do require a number of execution-related tasks to be performed by a physician. The recently amended proposal would require a psychiatrist to certify that an inmate is mentally competent for execution – a direct violation of AMA and CMA policy.
CMA believes that a physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not participate in executions. Regardless of its method of delivery, capital punishment is not a medical task, it does not require medical skills, and the use of a physician’s medical skills for this nonmedical task is inappropriate and a breach of one of the medical profession’s most important ethical boundaries. CMA believes that physician participation in capital punishment threatens the public’s trust in physicians. This trust is central to the physician-patient relationship.
The regulations were proposed by the California Department of Corrections and Rehabilitation in response to a 2006 court order. In February 2006, a federal court judge ordered state officials to change the way they administer the fatal dose, to ensure condemned inmates are unconscious before they deliver the standard mix of sedatives, paralytic agents, and heart-stopping chemicals.
CMA has submitted comments to the Department of Corrections, urging that the regulations be amended to expressly prohibit CDCR from requiring staff physicians, or contracting with non-staff physicians, to participate in executions in any direct or indirect manner.
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Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
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3. President signs six-month Medicare patch
President Obama signed legislation on Friday stopping the 21 percent cut in Medicare payments to physicians and retroactively raising rates by 2.2 percent, effective June 1.
The new Medicare rate applies only through November. If Congress fails to intervene, Medicare cuts mandated by the sustainable growth rate (SGR) will take effect on December 1, 2010.
The Centers for Medicare & Medicaid Services (CMS) has directed contractors to hold all claims for services rendered June 1 and later until the new 2.2 percent update can be loaded into claims processing systems.
CMS announced that it expects to start processing June claims at the new rates no later than July 1. CMS also said that June claims already paid at the reduced rates will be reprocessed as soon as possible.
Physicians who submitted June claims with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment. Charges on claims cannot be altered without a request from the physician or provider. CMS directed physicians not to resubmit claims already submitted to their Medicare contractor.
The U.S. House of Representatives passed the six-month patch last Thursday after days of political intrigue and congressional maneuvering over a larger bill containing tax breaks and an extension of jobless benefits that would have blocked Medicare cuts for 19 months.
A scaled-back version of that legislation – HR 4213, the “American Jobs and Closing Tax Loopholes Act of 2010” – failed to garner the 60 votes needed in the Senate for that body to take up the measure.
HR 4213 sought to stop Medicare cuts for 19 months, extend extra federal Medicaid matching (FMAP) funds to cash-strapped states, extend unemployment insurance, restore some tax breaks and raise taxes on managers of buyout funds and other investment partnerships. HR 4213 also included the California geographic payment (GPCI) fix, which would have provided $400 million so that 14 currently underpaid counties would be reimbursed based on more accurate geographic practice costs.
The legislation signed Friday does not include the California GPCI fix. CMA will pursue that provision in other legislation. An extension of extra Medicaid funding is not in the bill either, and it may be placed into separate legislation.
CMA will continue to advocate as strongly as possible for the GPCI fix and for a repeal of SGR.
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Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
4. Highlights from AMA’s annual meeting
The California delegation to AMA’s House of Delegates presented a number of important resolutions at the association’s annual meeting in Chicago. The following are summaries of some of the resolutions that the AMA House adopted as policy.
Health Care Standards (Res. 205): The delegates adopted a California resolution that asks AMA to support the ability of nongovernmental organizations to evaluate new medical therapies, procedures, and medications. The resolution also supports the position that any practice guidelines, best practices models, or clinical recommendations, including those that result from any comparative effectiveness research or evidence-based medicine system, do not, and should expressly state that they do not, establish standard of care or create specific requirements for physicians that restrict the exercise of their clinical judgment.
Adult Film Industry Worker Safety (Res. 407): The delegates adopted a California resolution that asks the AMA to support legislation mandating the use of condoms in the production of adult films. The resolution also urges that existing OSHA and other occupational standards be vigorously enforced to reduce exposure to infectious diseases within the adult film industry.
Free Electronic Claims Billing (Res. 702): The delegates adopted a California resolution that asks the AMA to support the ability of physicians to submit claims directly to payors, either electronically or by mailing paper claims. The resolution also calls on AMA to oppose clearinghouses that charge physicians for claim submission, alter codes, or otherwise inappropriately reduce reimbursements.
Contact: Ginnie Yee, 916/551-2024 or gyee@cmanet.org.
5. CMA publishes payor contract amendment action guide
To help physicians understand their rights when it comes to health plan contract amendments, CMA has published “Payor Contract Amendments: An Action Guide for Physicians.”
California law prohibits health plans from unilaterally amending both HMO and PPO contracts, unless the amendment is necessary to comply with state or federal law, regulations, or accreditation requirements. California law also requires plans to provide contracted physicians with prior notice of any material contract change and the opportunity to terminate the agreement prior to the effective date of the change.
Physicians are encouraged to carefully review all proposed amendments to health plan or medical group/IPA contracts. You do not have to accept substandard contracts that are not beneficial to your practice.
CMA’s contract amendment action guide is available free to members at the members-only website.
Contact: CMA’s reimbursement help line, 888/401-5911 or economicservices@cmanet.org.
6. The 2010 California Physician’s Legal Handbook is here
The 2010 California Physician’s Legal Handbook (CPLH) is now available. CPLH—an annual publication of CMA’s Center for Legal Affairs—answers medical-legal questions most frequently asked by physicians. CPLH 2010 offers more than 4,500 pages of comprehensive legal information including current laws, regulations, and court decisions related to medical practice in California.
The handbook is available in a seven-volume print format and on CD-ROM. The CD-ROM offers all the content of the print version, plus many enhancements, including fully searchable content and hyperlinks that let you navigate within the CD-ROM and onto the web, as well as links to Findlaw for information on the cited court cases.
The CD-ROM is priced at $398 for members ($480 for nonmembers), the print version costs $798 ($960 for nonmembers), and the CD-ROM/print combo version costs $898 ($1,080 for nonmembers). To place an order, visit the CMA bookstore or call 800/882-1262.
Don’t forget, CMA members can access most of the CPLH content free via CMA On-Call, CMA’s online library of medical-legal information, at the members-only website.
Contact: CMA’s Publications Line, 800/882-1262.
7. CMA Foundation publishes Diabetes and Cardiovascular
Disease Provider Reference Guide
The CMA Foundation’s Advancing Practice Excellence in Diabetes Program recently published its “Diabetes and Cardiovascular Disease Provider Reference Guide” to help physicians understand the most effective ways to prevent, assess and treat diabetes and related cardiovascular disease.
The “Diabetes and Cardiovascular Disease Provider Reference Guide” was developed in cooperation with an expert panel of physicians to address these issues and improve patient care and outcomes.
Included in the reference guide:
- Guidelines supporting the screening and diagnosis of type 2 diabetes, dyslipidemia and hypertension
- Approaches to the clinical management of type 2 diabetes and related cardiovascular complications
- Effective communication techniques
- Health care provider and patient education resources
- Billing and procedure codes
The guide is available free at the CMA Foundation website.
Contact: Senely Navarrete, 916/779-6638 or snavarrete@thecmafoundation.org.
8. Reminder: PECOS enrollment deadline is July 6, 2010
Physicians who have not updated their Medicare enrollment information in the past five years may need to fill out another application or risk facing payment problems for ordered or referred services.
Under new rules, which take effect July 6, Medicare is authorized to reject claims if an ordering or referring physician is not identified in Medicare’s Internet-based PECOS enrollment system. Thousands of otherwise acceptable Medicare claims could go unpaid merely because they were submitted by providers who enrolled in Medicare before the PECOS database was developed.
Don’t know if you’re in PECOS? CMA has developed a step-by-step guide to walk physicians through the process, from determining if they are already in PECOS to helping them navigate the Internet-based PECOS enrollment system. This guide is available to members only at the members-only website. CMA also hosted a PECOS enrollment webinar with Palmetto, California’s Medicare contractor. The previously recorded webinar is available for on-demand viewing to members only at the members-only website.
Contact: CMA’s member service center, 800/786-4CMA or memberservice@cmanet.org.
9. Physicians must now comply with MBC signage regs
Effective June 27, California physicians are now required to inform their patients that they are licensed by the Medical Board of California, and to provide patients with the board’s contact information.
CMA has prepared a number of resources to help physicians comply with these new regulations, including downloadable posters and customizable patient notices. These resources are available to CMA members only.
According to the medical board, physicians, not facilities, are responsible for compliance with this regulation. In group settings, only one sign must be posted (should that option be chosen), but it must be posted in a location where it can be seen by all patients.
Despite CMA objections, the Office of Administrative Law recently approved these regulations, which are intended to let consumers know where to go for information on or with complaints about California medical doctors. CMA believes these regulations are an unnecessary administrative burden, as state law already requires physicians to post their medical license or wear a name tag indicating their licensing status.
Although CMA strongly supports patient access to information about a physician’s education, training, and other qualifications, we believe that it would be more useful to provide patients with specific information about the education and training of their physicians. To that end, CMA is cosponsoring a “truth in advertising” bill along with the California Society of Plastic Surgeons. Our bill would require all health care practitioners to display their educational degree, license type and status, and board certification either on their name tag or in their offices, to help patients better understand the credentials of a health care practitioner prior to receiving treatment.
Contact: Yvonne Choong, 916/444-5532 or ychoong@cmanet.org.
10. July issue of CMA Practice Resources (CPR) now available
The July issue of CMA Practice Resources (CPR) is now available. The free monthly e-mail bulletin from the reimbursement experts in CMA’s Center for Economic Services is full of tips and tools to help physicians and their staff improve practice efficiency and viability. Sign up now for your free subscription.
Contact: Jennifer Williams, 916/551-2061 or economicservices@cmanet.org.
11. Featured Member Benefits
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Questions about your CMA member benefits? Contact CMA’s member help center, 800/786-4CMA or memberservice@cmanet.org.
For more information on these and other member benefits, visit http://www.cmanet.org/benefits or contact CMA at memberservice@cmanet.org or 800/786-4CMA.
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