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1. CME certification forms are in the mail
Last year, the Medical Board of California changed its continuing medical education (CME) reporting requirements. Physicians are now required to complete 50 CME hours during every two-year licensure period, as opposed to the 100 hours previously required every four years. CME reporting deadlines are now based on the physician's personal license renewal date (the last day of the month of the physician's birthday), not the calendar year.
The California Medical Association's Institute for Medical Quality (IMQ) CME Certification Program, which documents and verifies physicians' CME activities, this week mailed CME reporting forms to physicians with license expiration dates between September 1 and December 31. The next mailing will go out in January to physicians with birthdays/license expirations between January 1 and March 31.
If your birthday was earlier in the year, it's not too late to submit your form and there is no late fee. Download the reporting form from the IMQ website.
When certified by IMQ, physicians' CME credits will automatically be accepted by the medical board, saving you time and hassle. (IMQ also provides documentation of physicians' CME in the event of a medical board audit.) IMQ's CME certification is $29 for CMA members, $49 for nonmembers. Physicians also can request that their CME certification information be sent to hospitals, health plans, specialty societies, and others for credentialing or membership renewal purposes at no additional charge.
For more information, visit the IMQ website.
Contact: Paulette Richardson, 415/882-3387 or prichardson@imq.org.
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2. Modesto physician appointed to California Medical Board
Gov. Arnold Schwarzenegger has appointed Silvia Diego, M.D., of Modesto to the Medical Board of California.
Diego, a 45-year-old family practice physician, is the chief medical officer at Golden Valley Health Centers and a member of the California Medical Association. She must be confirmed by the state Senate and is expected to be sworn in in November.
Diego says she is honored to receive the appointment.
"In this new role, I hope to improve the health care of Californians as well as represent our physicians in a just and respectful manner," says Diego. "I am especially excited to be able to bring representation to the Central Valley and to community health centers."
Before becoming chief medical officer in 2005 at Golden Valley, Diego was an associate medical officer for the health centers from 1997 to 2005. She has also been assistant clinical professor at the University of California, Davis, Department of Family and Community Medicine since 1998.
Diego is a member of the Stanislaus Medical Society and the Doctors Medical Center Board of Directors. She is a clinical committee member of the California Primary Care Association and a fellow at the California HealthCare Foundation. Diego earned her medical degree from Stanford University School of Medicine.
The governor has also appointed Eric Esrailian, M.D., to the board. He is a full-time faculty member of the David Geffen School of Medicine at the University of California, Los Angeles. Esrailian is the chief of development, chief operating officer for clinical affairs and the section head for general gastroenterology in the Division of Digestive Diseases. He earned his medical degree from the Loma Linda University School of Medicine and has a master's degree in public health from UCLA.
Contact: Yvonne Choong, 916/551-2884 or ychoong@cmanet.org.
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3. Applications now available for California's
new preexisting condition insurance plan
Applications are now available for California's Pre-existing Condition Insurance Plan (PCIP), the state's federally funded high-risk pool. PCIP will provide coverage to individuals who have been denied health coverage or offered only unaffordable options.
This new program was authorized and paid for under the federal health reform legislation enacted in March 2010. California will receive $761 million in federal funds to operate PCIP through the end of 2013, when private insurers will be required to accept all applicants regardless of pre-existing conditions.
The program is administered by the Managed Risk Medical Insurance Board (MRMIB), which is currently accepting applications and plans to begin covering enrollees by the end of September. State health officials expect the program to serve up to 25,000 subscribers a month.
PCIP will operate concurrently with the existing state-funded Major Risk Medical Insurance Program (MRMIP), which currently provides coverage to more than 7,000 Californians with preexisting conditions. Federal rules require applicants to the new program to have been without health care coverage for six months, meaning that existing MRMIP subscribers are not eligible for PCIP. Individuals may apply for both programs at the same time to learn which program they qualify for and which may be the better option for them.
Applications and information on subscriber premiums and benefits are available at the new PCIP website
Contact: California's Pre-existing Condition Insurance Plan, 877/428-5060.
4. More health reform provisions take effect September 23
Many provisions of federal health care reform, passed and signed into law last spring, take effect on September 23.
These provisions include:
- Lifetime/Annual Limits: The law prohibits lifetime limits on health care benefits. Annual limits on benefits are restricted to no less than $750,000 beginning September 23, 2010, and then gradually phased out until January 1, 2014, when they are completely banned.
- Emergency Room Patient Protections: The law prohibits requiring prior authorization or higher cost sharing for out-of-network emergency services.
- Ob-Gyn Patient Protections: The law prohibits requiring a referral to see an obstetrician or gynecologist.
- Preventive Health Services: The law requires first dollar coverage (no co-payment or deductible) for certain preventive services.
- Dependent Coverage: The law requires insurers to allow adult children under the age of 26 to stay enrolled in a parent's health plan.
- Preexisting Condition Exclusions for Children: The law prohibits denying coverage to individuals under the age of 19 based on a preexisting condition.
- Rescission: The law prohibits insurers from rescinding coverage except in cases where the patient commits fraud or intentional misrepresentation of facts.
- Appealing Insurance Company Decisions: The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process.
For more information on these and other health reform provisions, see the California Medical Association's health reform page.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
5. CMA comments on 2011 Medicare physician payment rule
The California Medical Association (CMA) has submitted formal comments objecting to a number of proposed changes in the 2011 Medicare physician payment rule.
Geographic Payments
CMA's primary concern about the proposed rule is a provision that would shift more than $1 billion in Medicare funding from urban states to rural states. As a result, many physicians in urban and suburban areas could be hit with up to a 6 percent payment reduction. This cut would come on top of the 23 percent SGR cut set to take effect Dec. 1, 2010, and the 6.5 percent SGR cut scheduled for Jan. 1, 2011.
This dramatic funding shift is the result of changes to the "practice expense" portion of the geographic practice cost index (GPCI). The proposed payment rule deweights the impact of rent expenses on physician practices and no longer recognizes local differences in employee wages. The result is that rural areas would end up being paid more than the costs they incur, and urban areas would be paid less than the costs they incur.
CMA is vigorously opposing this arbitrary and politically driven change to the Medicare fee schedule. This is a dramatic change in Medicare payment policy and one that is not supported by the Center for Medicare & Medicaid Services' (CMS) own data, which shows a more than 600 percent variation in wages across the country. For example, hourly wages for a security guard in Southwest Idaho are $6.68, compared to $24.37 in San Luis Obispo, California — a 264 percent differential.
As part of the health care reform legislation, a series of studies were congressionally mandated on this issue. CMA is urging that these studies be completed before any future changes to the geographic payment formula are contemplated.
CMA has been invited to testify before the Institute of Medicine on geographic payment issues later this month in Washington, D.C.
Quality Reporting
CMA urged CMS to implement physician protections in the various quality reporting programs. "The goal of such feedback programs should be to educate physicians to help them improve care," stated CMA in its written comments. "Paramount to the success of such programs is reliable, verifiable data. However, almost every state and federal feedback program to date has experienced serious problems with the accuracy of the incoming data."
CMA voiced strong opposition to the public disclosure of individual physician quality information unless the current attribution methodology, risk-adjustment methodology and reporting mechanisms are vastly improved. CMA also opposes the use of this information to penalize individual physicians until the methodologies are significantly improved. Inaccurate information can mislead patients and physicians without improving the quality of care or reducing costs.
Consultation Codes
CMA also in its comments urged CMS to restore payments for consultation codes, which were eliminated in the 2010 fee schedule. Earlier this year, CMS eliminated payments for inpatient and outpatient consultation codes and now requires physicians to instead bill for either new or established office visits or for initial hospital stays. Physicians asked to provide expert opinions are seeing an 8 percent reduction or more in reimbursement as a result of this policy.
CMS's decision to eliminate the consultation codes is forcing many specialists to reduce services provided to Medicare patients, particularly in the inpatient setting. "Diminishing consultations and communication between physicians…destroys the coordinated care models Congress and the Administration are promoting," CMA stated in the comments.
Click here to read the comments.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
6. Blue Shield pulls out of Healthy Families in 15 counties
Blue Shield of California recently announced it will no longer provide coverage for 15,000 Healthy Families patients in 15 counties. Effective October 1, the insurer is pulling its Healthy Families HMO product out of nine counties (Alameda, Marin, Placer, San Joaquin, Santa Clara, Santa Cruz, Solano, Sonoma, and Yolo) and its EPO product out of six counties (Butte, Kings, Madera, Merced, San Luis Obispo and Stanislaus counties).
Patients were notified of these changes in July and were given the opportunity to select a new plan. If they did not select a plan by the August 31 deadline, they were automatically transferred to the default "community provider plan" (CPP) for their county. Patients will have until October 31 to switch to another plan if they are dissatisfied with the CPP. For a list of available plans by county, visit the Healthy Families website.
Physicians in affected counties are encouraged to verify their Healthy Families patients' coverage status before submitting claims with dates of service on or after October 1, 2010.
Under state "continuity of care" laws, Blue Shield must continue to provide coverage for patients if a change in coverage would interrupt an ongoing course of treatment. Patients who might qualify include, but are not limited to, women who are pregnant, children under age 3, and patients with cancer or other chronic disease who are undergoing a regimen of care. To request or inquire about a continuity of care plan, patients should call the member services number on the back of their ID card or they can obtain a copy of Blue Shield's continuity of care request form on the Blue Shield website. (Log in and click on "download forms.") All other questions about this transition can be directed to the Healthy Families Program at 866/848-9166.
For more information on continuity of care, see CMA On-Call document #1055, "Contract Termination by Physicians and Continuity of Care Provisions." On-Call documents are free to members at the members-only website. Nonmembers can purchase On-Call documents for $2 per page in the CMA bookstore.
Contact: CMA member service center, 800/786-4262 or memberservice@cmanet.org.
7. Blue Cross extends Healthy Families continuity of care plan
for physicians in most counties
In March of last year, Blue Cross announced that it would require physicians to sign a separate contract and accept reduced rates if they want to continue treating Blue Cross–insured Healthy Families and AIM patients. The new rates vary, but have been dropped generally to barely above Medi-Cal rates.
Although the effective date on the new contracts was September 1, 2009, the insurer has for the fifth time extended its continuity of care plan for patients in all counties except San Bernardino, Riverside and Orange.
The continuity of care plan has now been extended through September 30. In lieu of a signed Healthy Families contract, physicians with Prudent Buyer contracts will be paid 125 percent of Medi-Cal for most Healthy Families services.
Click here for more information.
Contact: CMA's reimbursement help line, 888/ 401-5911 or economicservices@cmanet.org.
8. Legislature passes bill banning rescissions
The California Legislature has passed CMA-sponsored legislation that will provide patients a vital safeguard to ensure that insurers comply with the federal ban on rescissions. The bill passed in a bipartisan vote and was sent to the governor's desk. The governor has until September 30 to act on it.
The insurance industry has made billions of dollars from its practice of rescission, unfairly canceling health insurance policies after patients get sick. This bill (AB 2470) will give teeth to the federal ban and means plans cannot act as judge and jury whenever they want to cancel a policy. The measure allows patients to appeal insurers' decisions to the Department of Managed Health Care or Department of Insurance. Until a state regulator rules on the appeal and determines whether the cancellation was legal, the patient retains his or her health insurance.
"This bill helps close the door, once and for all, on a reprehensible practice insurers have used for years to boost their profits at patients' expense," says CMA President Brennan Cassidy, M.D.
A 2009 congressional investigation concluded that three insurers used rescissions to systematically cancel more than 20,000 policies over five years, saving the companies $300 million in claims. Rescissions pull the rug out from under patients, ending their insurance coverage and saddling them with huge medical bills when they are at their most vulnerable.
CMA sought to outlaw the conduct since it first came to light, sponsoring bills each of the last three years. But while the governor refused to sign the legislation, Congress used the same legal standard advocated by CMA and put a provision in health care reform that prohibits policy cancellation unless the patient commits fraud or intentional misrepresentation.
For more information on this and other bills of interest to physicians, see CMA’s Legislative Hot List.
Contact: Michelle Champanian, 916/551-2054 or mchampanian@cmanet.org.
9. Bill protecting kids' access to vaccines goes to governor's desk
CMA-sponsored legislation designed to ensure that all children have access to life-saving immunizations has passed the Legislature and is now on the governor's desk awaiting his signature.
This bill (AB 2093) received bipartisan support in both the Senate and the Assembly. It requires insurers to cover physicians' cost to administer vaccinations. The measure is crucial for safeguarding public health and improving vaccination rates. The recent outbreak of whooping cough illustrates the importance of widespread immunizations to prevent the spread of disease and protect public health.
"Every year we're reminded of the vital role vaccinations play in averting disease and keeping the public healthy," says CMA President Brennan Cassidy, M.D. "Unfortunately, when insurance companies do not cover the full cost of immunizations fewer children get vaccinated, and that's a danger to everyone."
California law requires health plans and insurers to provide coverage for recommended immunizations. However, most health plans and health insurance companies don't pay physicians the entire cost to provide vaccines.
Insured patients looking for alternatives to out-of-pocket payment for vaccinations are sometimes referred to local public health clinics for these services, thus utilizing resources that should be preserved for the uninsured.
AB 2093 helps remove the financial obstacles that can discourage patients from getting vaccinations and physicians from offering them.
For more information on this and other bills of interest to physicians, see CMA’s Legislative Hot List.
Contact: Michelle Champanian, 916/551-2054 or mchampanian@cmanet.org.
10. Register now for the 2010 CMA-OMSS Annual Assembly
The California Medical Association's Organized Medical Staff Section will hold its Annual Assembly and Education Conference on Friday, October 1 at the Sacramento Convention Center. The conference immediately precedes the 2010 CMA House of Delegates.
All physicians, medical staff professionals, and interested parties are invited to attend. Registration is free for designated representatives and chiefs of staff from CMA-OMSS member medical staffs. All others may attend for a nominal fee.
Attendees will learn about topics of importance to the growth and development of medical staffs, including the hospitalist/community physician relationship, accountable care organizations, and common mistakes that erode medical staff self-governance. Participants will discuss and take positions on resolutions submitted to the CMA OMSS and to the CMA House of Delegates. Annual elections for the OMSS Executive Board will also be held.
Participating physicians will be eligible to receive continuing medical education credits.
Download the registration form.
For more information, or to register, contact Patti Moyle at 415/882-3342 or pmoyle@cmanet.org.
11. CMA Foundation's Carol Lee Receives
2010 Hispanic Health Leadership Award
Carol A. Lee, Esq., president and CEO of the CMA Foundation, was named one of the recipients of the 2010 Hispanic Health Leadership Award. The award was presented by the National Hispanic Medical Association (NHMA) during its Resident Leadership Program Reception on August 23. Lee received the award for her active role in improving health care issues for the Hispanic community.
"Carol received the award for her vision and leadership in developing the Network of Ethnic Physician Organizations (NEPO)," says NHMA President and CEO Elena Rios, M.D., MSPH. NEPO's goal is to reduce health disparities among ethnic minorities, improve access to health care, and address cultural competency and diversity in the health care workforce.
NHMA is a nonprofit association representing the interests of 45,000 licensed Hispanic physicians in the United States. Its mission is to improve the health status of Hispanics and other medically underserved populations. For more information about NHMA, visit the NHMA website.
Contact: Nela Lee, 916/779-6639 or nlee@thecmafoundation.org.
12. There's still time to register for the CMA Foundation's
Ethnic Physician Leadership Summit
The California Medical Association (CMA) Foundation and the Network of Ethnic Physician Organizations (NEPO) invite you to attend the 2010 Ethnic Physician Leadership Summit, Saturday, September 25, in Los Angeles.
The one-day summit will focus on health reform and health information technology. Attendees will learn about the federal stimulus package, working with diverse communities, and the survival of solo and small group practices. The summit is free for physicians, medical students, and members of a community-based organization. All other attendees can register for $150 per person.
Space is limited, so register today.
Contact: Anna Gutiérrez, 916/779-6627 or agutierrez@thecmafoundation.org.
13. September issue of CMA Practice Resources (CPR)
now available
The September 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.
14. Featured Member Benefit
Epocrates: CMA members save 30 percent on all Epocrates mobile and online products. Epocrates provides point-of-care access (via mobile devices and the web) to information on drugs, diseases and diagnostics.
A members-only link is required to access the discount. To access the link, visit the benefits webpage or contact CMA's member help center at 800/786-4CMA or memberservice@cmanet.org.
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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