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1. FTC Delays Enforcement of Red Flag Rules for Another 3 Months
The Federal Trade Commission (FTC) recently announced it would again 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 are now scheduled to take effect on November 1, 2009.
According to the FTC, it will also release additional guidance to help “creditors” — particularly small businesses and those with a low risk of identity theft—to understand their obligations under these regulations.
For more information on the Red Flag rule, see CMA’s Red Flag Rule toolkit and
webinar, available to free members, at the members-only website.
Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
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2. Have You Corrected Your CPPI Quality Data?
Recently, some 13,000 California physicians received letters from the California Physician Performance Initiative (CPPI). These letters contain raw and relative performance scores for physicians on 16 quality measures based on claims data from United Health, Anthem Blue Cross, and Blue Shield PPOs as well Anthem Blue Cross and Blue Shield HMOs. The letters do not contain the underlying data.
CMA continues to have concerns about the accuracy and integrity of the data used to establish these scores and the potential use of these scores by payors for pay-for-performance, economic profiling, or tiered networks. In order to address some of CMA’s concerns and to improve the quality of the data, CPPI has again provided a reconsideration process that physicians can use to verify their data.
CMA urges all physicians who receive the letter to request their data from CPPI and verify its accuracy. (Instructions for doing so are available at http://www.cmanet.org/cppi.) The deadline to request your patient data is August 28, but CMA urges you to do so as soon as possible. Physicians must submit their corrected data by September 11.
In checking the data, physicians should check whether CPPI correctly listed the patient name, physician name and specialty, and whether the physician performed the procedure. If you did not perform the procedure, make sure to indicate why the particular metric does not make sense as a measurement of the quality of care you provided to your patient.
We understand that this may be a time-consuming process, but it is critical for physicians to take the time to verify their data. If you do not raise concerns now, payors could use this data in the future to adjust your reimbursements and change the flow of patients to your practice.
CPPI has provided CMA with a list of the member physicians who are impacted by this report. If you are one of them, you will receive a letter from CMA later alerting you to that fact. Included with the letter will be step-by-step instructions for requesting and reviewing your patient data from CPPI.
CMA is also hosting a webinar on this issue to help physicians understand the program and what they need to do to ensure the accuracy of the data being used to grade their performance. The 45-minute webinar is scheduled for Tuesday, August 11 at 11 am.
Registration is free for members and their staff. Register online at http://www.cmanet.org/calendar.
Contact: Armand Feliciano, 916/551-2552 or afeliciano@cmanet.org.
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3. Physician Case Study: To EHR or not EHR, that Is the Question
When President Obama signed into law the American Recovery and Reinvestment Act (ARRA) in February 2009, the news was greeted with mixed response from the physician community. ARRA included nearly $20 billion in financial incentives to encourage doctors to adopt Electronic Health Records (EHRs), but also contained the threat of reduced reimbursement for Medicare and Medicaid payments to those physicians who did not adopt EHRs by 2015.
CMA and organized medicine have long insisted that any EHR requirements must not be unfunded mandates. ARRA’s $20 billion – including up to $44,000 for Medicare doctors and $65,000 for Medi-Cal doctors – were a step towards addressing these concerns. Yet, it was unclear whether these incentives would be sufficient to cover the entire cost of implementing EHRs for a doctor’s office, including the purchase of an EHR system, staff time, staff training, and other potential costs.
While many health policy experts and physicians believe that EHRs will play an important role in improving efforts to coordinate care, reduce medical errors, and lower health care costs, many physicians are concerned about what impact EHRs will have on their practice. At the end of the day, will the benefits outweigh the costs for them and their patients?
To help physicians navigate this process and determine whether EHRs are right for their practice, CMA has developed the HIT Resource Center on the CMA website. The resource center currently has basic information on what physicians need to do to qualify for these funds and resources to help physicians begin the process of assessing your HIT needs. The resource center will eventually have an EHR vendor marketplace, called the CMA HIT List. CMA has dedicated staff and selected a five member physician panel to review and assess top-tier vendors providing EHR solutions for inclusion on the CMA HIT List.
In an effort to provide some real-world perspective on the question of whether to purchase an EHR, over the coming months we will be offering in CMA Alert a real-life case study of one physician’s experience tackling the question. The study looks at the practice of Scott Wigginton, M.D., an Internal Medicine physician with a solo practice in Sacramento who has been gracious enough to share his experiences with CMA. The articles are written by his son James, an intern in the CMA Policy Department and prospective law student, who has been helping his father analyze the issue.
We hope the case study and Dr. Wigginton’s experience helps illuminate this issue for physicians. The case study is available in the HIT Resource Center at http://www.cmanet.org/hit.
4. Best Practices: Building a Defensible Fee Schedule
A very important key to practice viability is developing a defensible fee schedule. The fee schedule is the single most important financial tool within a medical practice. Most practices develop their fee schedules with very little, if any, understanding of the methodologies for doing so. Building a defensible fee schedule is not easy, but the physician who takes the time will greatly benefit from doing so.
Chapter 8 of CMA’s Best Practices toolkit will help physicians understand what makes a sound fee schedule and walks them though the task of creating their own. CMA published the 140-page toolkit, with generous support from the Physicians’ Foundation, to help physicians improve the efficiency, and in turn the quality, of their practices. In addition to learning how to build a defensible fee schedule, the toolkit will also teach you:
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.
Contact: CMA’s reimbursement help line, 888/401-5911 or fnavarro@cmanet.org.
5. Blue Shield Fee Schedule Changes Take Effect October 1
Blue Shield of California recently notified physicians of changes to its standard physician fee schedule that will take effect October 1.
In a letter to physicians on August 1, Blue Shield notified physicians that it would be modifying payment levels for many CPT codes, some being increased and others decreased.
Physicians are urged to calculate the financial impact the fee schedule changes will have on their practices. (Use CMA’s financial impact worksheet, available at the members-only website.)
The new rates are available at the Blue Shield website. If you do not have internet access, you can request the information by fax using the “provider allowance form” that was enclosed with the notice from Blue Shield.
CMA reminds physicians that they do not have to accept bad contacts or contracts that are not mutually beneficial. You should also be aware that you have the right to terminate an agreement if any “material change” to the contract terms is not acceptable to your practice.
If you do not agree with proposed changes, you can terminate the contract before the October 1 effective date. Letters of termination can be mailed to: Blue Shield of California, Attn: Senior VP Network Management, 6300 Canoga Ave, 12th Floor, Woodland Hills CA 91367.
If you have questions about the new fee schedule, call Blue Shield Provider Services Department at 800/258-3091.
Contact: CMA’s reimbursement help line, 888/401-5911 or awetzel@cmanet.org.
6. CMA Submits Brief to Appeals Court in Rescission Case
CMA and the Los Angeles County Medical Association (LACMA) jointly submitted an amicus brief in support of a lawsuit filed against Blue Cross for illegally cancelling patients’ health insurance policies.
Last year, the Los Angeles City Attorney filed a lawsuit against the insurer, on behalf of the people of California, for false advertising and fraud. The suit alleges that Blue Cross sold people false promises of coverage, while systematically cancelling policies after policyholders got sick and filed expensive claims.
The practice, known as “rescission,” not only puts patients at risk, both financially and medically, but it also leaves physicians and hospitals holding the bag for services rendered in good faith, often with prior authorization.
Blue Cross is asking for the cased to be dismissed, arguing that the Department of Managed Health Care has exclusive jurisdiction to enforce violations of the Knox-Keene Act. CMA and others in organized medicine strongly reject this argument. DMHC itself has stated in previous cases that although the agency has comprehensive jurisdiction to regulate Blue Cross, Blue Shield, and all HMOs, it does not have exclusive jurisdiction to enforce violations of the Act.
In early 2007, DMHC pledged to fine the state’s largest insurer for “routinely rescinding health insurance policies in violation of state law.” The agency admitted a year later that it hadn’t even tried to enforce the fine because they knew they would be outgunned in court.
“The important point is that, by its words and deeds, the DMHC has not in practice exclusively enforced violations of the Knox-Keene Act,” CMA and LACMA wrote in the brief. “[We] vehemently refute the notion that efforts to redress wrongs inflicted by unlawful retroactive rescissions should begin and end with the DMHC’s settlements.”
Clarisa Sanchez, 916/551-2867 or csanchez@cmanet.org.
7. Health Reform – Much Undecided as Congress Goes on Recess
With the August congressional recess upon us, much remains in play with federal health system reform. Prior to the recess, most of the action was in the House, where there was a flurry of negotiating between House leadership and the fiscally-conservative Blue Dog Democrats, who are seeking to impose strict cost-controls on public health programs. Eventually, the negotiations allowed HR 3200 to pass out of the last committee, a step many health reform advocates hailed as critical for maintaining the momentum.
HR 3200 would expand coverage to the uninsured by expanding Medicaid eligibility and providing tax credits to the working poor to obtain coverage. The bill would begin to improve access to care for seniors and the poor by providing nearly $400 billion in payment fixes for Medicare physicians and primary care Medicaid physicians, although chronic underfunding issues for Medicaid specialists remain unaddressed. HR 3200 also includes a “public option,” the controversial proposal to have a government-run health plan to compete with private insurers.
CMA sent a letter to Congress supporting the coverage expansions, the insurer reforms, and physician payment fix elements of HR 3200. CMA continues to have concerns about public plan option, scope of practice expansions, and other issues. The letter is not an endorsement, but simply urges members of the California delegation to move the bill to the next stage of the process, so that these important provisions might be protected.
Please keep in mind that we are in the first quarter of a long legislative battle to change our health care system. We must maintain these favorable provisions now to continue tto fight for the best possible end-game outcome.
In the Senate, the Finance Committee has not yet finalized its proposal. Unlike the House, where HR 3200 passed out of committees largely on party-line votes, the Senate Finance Committee is trying to reach a bipartisan compromise. The Senate Finance bill is expected to be significantly different from HR 3200. Some stark differences are emerging. The Senate Finance bill will not have the “public option.” And, of concern to physicians in California and other populous states, the committee is considering a proposal that creates a new “value index” to calculate Medicare payments. The “value index,” which is being proposed in the name of controlling costs and improving efficiency, would effectively shift billions in funding from higher-cost places like Los Angeles to lower-cost places like Minnesota. The California physician payment cuts could be 10 to 15 percent.
CMA is aggressively fighting the “value index” proposal. CMA and other state medical associations sent a joint letter to the Senate Finance Committee, telling them that it is unacceptable to consider such fundamental changes to the Medicare geographic payment formula without further study to understand what accounts for the differences in medical practice costs by region, such as practice costs and socioeconomic status of patients.
CMA is asking physicians to meet with their Representatives while they are in their home districts during the August recess. If you are interested in doing so, please contact your county medical society for more information and talking points.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
8. Gov. Schwarzenegger Deepens Health Care Cuts
Gov. Schwarzenegger last week used his veto pen to impose nearly $500 million in additional budget cuts, including $245 million in additional health care cuts. These line item cuts are on top of the $1.5 billion in health care cuts already approved by the Legislature.
The budget now slashes almost 50 percent of the funding for the Healthy Families program, which provides health care to nearly one million children from low-income families. The $500 million cut means 500,000 kids will have to be dropped from the program.
The Governor also cut $25 million from the Primary and Rural Health Program, $52 million from the Office of AIDS, $16 million from the Domestic Violence Program, $9 million from the Adolescent Family Life Program, and $3 million from the Black Infant Health Program.
CMA is gravely concerned by the deep health care cuts, which could prevent hundreds of thousands of the state’s most vulnerable residents – children, the elderly, and the poor – from getting the health care they need.
Senate President pro Tem Darrell Steinberg (D-Sacramento) today announced on Friday that he will file a lawsuit against Gov. Schwarzenegger to get these additional cuts reversed. The suit will allege that Governor’s actions violate his constitutional authority and the checks and balances contained in our constitution. According to an opinion issued last week by the nonpartisan Legislative Counsel Bureau, Governor can only line item veto new appropriations, and what the Legislature sent him on July 24 were revised reductions in existing, previously enacted appropriations that were made in February.
Contact: David Ford, 916/551-2554 or dford@cmanet.org.
9. Don’t Miss Your Chance to Influence CMA Policy
CMA is the largest, most influential medical organization in California, and an aggressive advocate for doctors and patients. We are your voice in state and federal government, in the courts, in the media, and in battles with regulators and health insurers. But it is members like you who help set the policies that guide CMA’s advocacy agenda. Don’t miss your chance to influence the future of medicine in California and across the nation.
Submitting resolutions to our policy-making legislative body, the House of Delegates, is the most direct way for members to influence CMA policies on key issues. Any CMA member may author a resolution, but a delegate, alternate delegate, component medical society, or specialty delegation must submit the resolution. Resolutions must be submitted by e-mail to resolutions@cmanet.org by August 18.
10. IMQ Receives Six-Year Recognition from ACCME
The Accreditation Council for Continuing Medical Education (ACCME) recently rerecognized CMA’s Institute for Medical Quality (IMQ) as an accreditor of intrastate CME programs for a term of six years. Six-year terms are rarely awarded by ACCME and are given only to exemplary organizations. IMQ was also recognized for a six-year term in 2003.
IMQ was awarded “recognition with commendation” for, among other things, its excellent communication with CME providers, its educational outreach, and its ongoing efforts to examine and improve its CME accreditation program.
IMQ would like to acknowledge the stellar work of its physician volunteers in their roles as CME committee members and surveyors.
Contact: Sarah Shimer, 415/882-5182 or sshimer@imq.org.
11. Nominate a Senior Physician for CMA’s Young-at-Heart Award
CMA’s Young Physicians Section (YPS) is soliciting nominations for the 17th annual Joseph F. Boyle, M.D., Young-at-Heart Award. This award, presented to a senior physician, recognizes outstanding contributions to the development of medicine’s next generation of leaders.
The award will be presented at the CMA-YPS Assembly, which will be held on October 17 in Anaheim during CMA’s annual meeting. The deadline for nominations is January 16.
Please send your letter of nomination and any supporting documentation to Shannon Navarra-Lujan at 916/551-2036 (fax) or slujan@cmanet.org. Remember to include contact information for the nominee, as well as for the person or organization submitting the nomination.
Contact: Shannon Navarra-Lujan, 916/551-2056 or slujan@cmanet.org.
12. Featured Member Benefits
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 memberservice@cmanet.org.
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