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1. New Joint Commission Standard on “Disruptive Behavior”
Does Not Supersede State Law on Medical Staff Self-Governance
The Joint Commission is calling on hospitals to crack down on “disruptive behavior” by health care professionals, over concerns that such behavior contributes to medical errors, poor patient satisfaction, and higher cost of care. A new commission standard taking effect in January 2009 (Leadership Standard LD.03.03.01) will require hospital “leaders” to adopt codes defining disruptive behavior and develop procedures to discipline physicians and others who violate those codes.
CMA is concerned that this standard could be used to create vague “codes of conduct” that could be used against physicians who are vocal advocates for their patients or who own competing specialty hospitals or surgery centers. California law does not condone this type of hospital control over the self-governing medical staff and this new standard must be interpreted within the framework of California law. Medical staffs, not hospitals, have the authority to determine when and how “disruptive behavior” should be handled.
While medical staffs should respond to truly disruptive behavior that impacts patient care, physicians should not be labeled as being “disruptive” if they violate onerous and overbroad codes of conduct designed to squelch medical advocacy or target competitors. CMA urges medical staffs that are faced with hospital-directed codes of conduct to have them independently reviewed by legal counsel.
More information on this issue as it relates to California law can be found in the newly updated CMA On-Call document #1241, “Disruptive Behavior Involving Members of the Medical Staff.” ON-CALL documents are available free to members at the members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in the CMA Bookstore.
Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org
2. Palmetto Inundated with Calls About Medicare Part B Transition
We are now two weeks into the transition of the administration of Medicare Part B from NHIC to Palmetto GBA. Palmetto has informed CMA that its phone lines are overwhelmed and people are having a hard time getting through. According to Palmetto, the answers to the majority of callers’ questions are readily available on the website. Physicians and their staff are urged to check the FAQ on the Palmetto website before calling so that the phone lines are freed up for those with urgent payment issues.
CMA has been in close contact with Palmetto during this transition and continues to have weekly calls to discuss physician concerns. Because physicians have complained of busy signals and long wait times when calling Palmetto, the Centers for Medicare & Medicaid Services (CMS) has authorized Palmetto to hire 35 additional call center staff and add more telephone lines. In a few weeks, after these new staff are hired and trained, you should experience significantly less hold time and get fewer busy signals.
Below are answers to some of the most frequently asked questions regarding the transition. Additional FAQ can be found at http://www.palmettogba.com/J1B.
Q: How can I find out the status of claims I submitted before transition?
A: To check the status of a claim, call Palmetto’s Interactive Voice Response (IVR) system at 866/931-3903. If you have questions about the IVR, please see the user guide at the palmetto website.
Q: I early boarded (or sent my submitter application prior to August 15) but did not receive my submitter number. When will I get it?
A: All passwords were emailed to early boarders/registrants before the transition. Check your junk or spam mail for a message from medicare.edi@palmettogba.com. If you still cannot find your password, e-mail medicare.edi@palmettogba.com with “Resend Password” in the subject and someone will respond as soon as possible with that information.
Q: I just submitted a new EDI submitter application. How do I find out if Palmetto received it and when will I receive my submitter number?
A: When your application is processed, you will receive an e-mail containing your submitter number. Given the current backlog of applications, you can expect to receive your password within 20 days of submission. If after 20 days you have not received your password, check your junk or spam filter for a message from medicare.edi@palmettogba.com. If you still cannot find your password, e-mail medicare.edi@palmettogba.com with the subject line “Resend Password” and someone will respond as soon as possible with that information.
Q: When can I expect to get payments from Palmetto?
A: All claims that were still pending at the time of the transition were transferred to Palmetto and will be processed as usual (14 day hold for electronic claims, 29 days for paper). Palmetto has assured CMA that the volume and amount of claims being processed on a daily basis has not changed since the transition.
Q: Where can I get Palmetto’s addresses and phone numbers?
A: All contact information for Palmetto is available at http://www.palmettogba.com/J1B. (You can also download the information in PDF format here.)
Q: I have had trouble getting through to Palmetto by phone. What is the best time to call?
Because of an unusually high call volume due to the transition, Palmetto is asking physicians to first read the FAQ on its website before calling. If you have an urgent payment issue, the best time to call Palmetto is between 7 am and 9 am (operating hours are 7 am to 5 pm). For EDI/EFT related questions, call 866/749-4301. For all other issues, call the main customer service line, 866/931-3901.
Click here for more information.
Contact: Michele Kelly, 888/401-5911 or mkelly@cmanet.org.
3. Key CMA Victory - DHCS Now Paying Medi-Cal Claims at Full Rate
On September 5, the California Department of Health Care Services restored the 10 percent Medi-Cal reimbursement cut and began paying Medi-Cal physicians the full rate for all claims. DHCS will also reprocess all claims for services provided after August 18 that were previously paid with the 10 percent reduction.
As previously reported in CMA Alert, a federal court on August 18 ordered the State of California to reverse the 10 percent Medi-Cal reimbursement cut that took effect on July 1, finding that the cuts would irreparably harm access to health care for nearly 7 million Californians.
Unfortunately, the federal court judge ruled that the injunction is not retroactive to Medi-Cal services provided between July 1 and August 18, a decision CMA will attempt to reverse.
This is an enormous victory for Medi-Cal patients and the physicians who care for them. CMA’s legal efforts will result in slightly more than $100 million going to physicians for providing health care to the poor than would have absent CMA’s efforts.
The state has appealed the ruling and a hearing to consider the appeal is scheduled for today, September 15.
Click here for more information.
Contact: Francisco Silva, 916/444-5532 or fsilva@cmanet.org.
4. Physicians Urged to Carefully Review
Blue Cross Contract Amendment
Physicians contracted with Blue Cross of California were recently notified of the insurer’s intent to amend its Prudent Buyer contract to include Anthem’s Select PPO product, effective January 1, 2009. 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.
The addendum in question requires contracted physicians to always refer Anthem Select PPO Members to other participating Select PPO providers, unless they have obtained authorization to refer out of network. Physicians should be aware that the underlying Prudent Buyer contract authorizes Blue Cross to unilaterally lower the physicians’ fee schedule as a penalty for referring to out of network providers. For this reason, it is important for physicians to determine if colleagues you frequently refer to and those who refer to you participate in the Select PPO network.
The addendum also requires physicians, in the event they refer patients to a nonparticipating provider, to ensure that the referred-to physician abides by the terms of the agreement.
If you do not want to participate in the Select PPO network, you must notify Anthem Blue Cross in writing no later than December 1. Opt out notices should be sent via certified mail with return receipt to: Anthem Blue Cross, Attn: Select PPO Contract Processing, 2121 North California Blvd., 7th Floor, Walnut Creek, CA 94596.
Click here for more information, including a copy of the proposed addendum and CMA's analysis of the Blue Cross Prudent Buyer contract.
Contact: Aileen Wetzel at 916/551-2037 or awetzel@cmanet.org.
5. CMA Sponsored Bills Await Governor’s Signature CMA-sponsored bills have made it through the legislature and are on their way to the governor. The bills take on a wide range of subjects, from physician health to public safety to managed care. Among the bills currently awaiting the governor’s signature are:
- AB 214, which institutes a program within the Department of Public Health to oversee programs that treat and monitor physicians with substance abuse or mental health problems.
- AB 1945, which protects patients from unlawful rescissions of insurance policies by requiring insurance companies to get approval from regulators prior to rescinding a policy.
- SB 1379, which closes a loophole that allowed HMOs to reduce their annual fees paid to the Department of Managed Health Care by the amount they were fined in the previous year. This bill also requires the first $1 million of fines collected by DMHC to go to the Steve Thompson Loan Repayment Program, which provides student loan relief to new physicians that agree to serve in underserved areas. Any additional money goes to MRMIP, the state pool for high-risk insurance.
For more information on these and other bills of interest to physicians, see CMA’s Legislative Hot List.
Contact: Dustin Corcoran, 916/444-5532 or dcorcoran@cmanet.org.
6. Don’t Miss out on Your Chance to Impact CMA Policy
CMA invites all members to visit its online forum to discuss or comment on the resolutions and reports that will be considered by the 2008 House of Delegates (HOD). The delegates, your elected representatives, meet annually to establish CMA policies on key issues that affect the practice of medicine, from medical ethics to critical matters of public health.
The HOD functions very much like our state and federal legislative bodies. Prior to debate of resolutions on the floor of the HOD, the proposals are discussed and debated in one of seven reference committees. Members of the reference committee will consider these comments along with the oral testimony presented at the House of Delegates meeting, October 4-6 in Sacramento.
To participate in the online discussion, log in to the members-only website and click on House of Delegates Forum under CMA Spotlight. You do not need to register to read the resolutions or other members comments, but you will be required to register if you would like to reply or submit your own comments. Registration is quick and simple.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
7. Tickets Now on Sale for CMA Foundation Annual Dinner
The CMA Foundation’s 12th Annual President’s Dinner and Awards Gala is October 5 in Sacramento, during CMA’s annual meeting. Proceeds will support CMA Foundation, a charitable organization that links physicians and their communities to raise awareness about important public health issues.
Honored at the dinner will be incoming CMA President Dev GnanaDev, M.D., and the foundation’s leadership award recipients, Arthur M. Chen, M.D. (Robert D. Sparks, M.D., Leadership Award), and Asian Americans for Community Involvement (Adarsh S. Mahal, M.D. Access to Health Care and Disparities Award).
Tickets are $125 per person, or $1,000 for a table of 10.
Even if you will not be able attend, please consider placing an ad in the dinner program. The foundation is a nonprofit charitable organization, and all ads are tax deductible.
Click here for more information.
Contact: Brittany Ridley, 916/779-6639 or bridley@thecmafoundation.org.
8. Benefit of the Week: Discounted Workers’ Comp Insurance
The WCIRB is recommending an average increase in pure premium rates of 16 percent on January 1. CMA members renewing their workers’ compensation insurance need to make sure they take advantage of a special member premium discount.
The discount is only available through Marsh, CMA’s sponsored insurance program administrator. The program is underwritten by Employers Compensation Insurance Company (ECIC), rated “A -” by the A.M. Best and Company.
For more information call Marsh at 800/842-3761 or visit http://www.marshaffinity.com.
Click here for more information on your membership benefits.
Contact: CMA’s member help line, 800/786-4CMA or vsatt@cmanet.org.
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