New Member Benefit: Prescriber's Letter The California Medical Association (CMA) is pleased to announce that members can now receive 43 percent off Prescriber’s Letter (PL) subscriptions. PL is an advisory service for physicians and other prescribers, to keep them up to date on new developments in drug therapy. PL provides unbiased recommendations that help you improve patient compliance, avoid costly medication errors and prescribe cost-effectively. PL helps you get drug-related facts quickly and digest them easily. PL's “to-the-point” approach means that you can learn about the most pressing drug therapy issues in about 15 minutes. Plus you can get evidence-based details online anytime you wish. Subscribe at the special CMA member rate of $147/yr (regularly $257) and get the monthly Prescriber’s Letter, online access to PL Detail-Documents, PLUS the opportunity to earn evidence-based continuing medical education (CME) credits from reading the Letter, and point-of-care credit when you search the database for answers. Subscribers also get access to the PL VOICES Clinical Webinar Series, where you can hear the experts debate significant therapeutic dilemmas, and get additional CME credits, for a total of up to 56 per year. Go to www.PrescribersLetter.com/CMA to learn more and get the special CMA member rate. October 31, 2013 General Member Benefits, Prescription Drugs, Drug Prescribing 0 0 Comment Read More »
POLST: Improving patient care in the emergency department By True McMahan, M.D. Emergency department (ED) physicians are a very diverse group of providers. Some of us are cavalier, shooting from the hip as called for by the situation at hand. Others are meticulous and obsessive planners, taking no chances and casting a wide net of differential diagnoses. But MOST, if not all of us, work in a daily melee of balancing a multitude of patients with emergency medical conditions, all the while putting out administrative fires and juggling family and visitors. Is it any wonder then that we crave simplicity? Why not have one less decision, one less stack of nursing home records and advance directive jargon to sift through? That is the beauty of the bright pink POLST form that I have come to know and love. POLST stands for Physicians Orders for Life Sustaining Treatment. Since 2010, when I first learned of this initiative to simplify and standardize end-of-life wishes, I have been a passionate supporter of its implementation. My hope is that by the end of this article, a few more physicians will be persuaded to join with me in promoting this valuable tool. First of all, what is it? POLST is a doctor’s order that delineates specific medically appropriate measures desired by the patient or his/her surrogate decision maker should the patient become seriously ill, mostly what we ED physicians and providers call “code three” patients. It is a single piece of paper and is bright pink so that it is easily recognized in a stack of medical records. When used correctly, the POLST follows the patient from acute care to primary care. Stories of its utility include EMS finding it hanging from a patient’s refrigerator when neighbors called 911 and the patient lived alone, and designated health care agents having electronic versions and emailing or faxing a copy to the ED while they are en route. I challenge all providers in the ED and acute care setting that as physicians we not only have a duty to treat, but to only treat as the patient’s dignity and health goals require. Paternalistic medicine serves to help no one. Non-beneficial care leads to more emotional pain and financial devastation than we realize. As for the ED practitioner, taking a few seconds to find that POLST form, even if hidden in the stack of papers brought in by the paramedics, may mean the difference of peace for patients and their survivors or end-of-life trauma and havoc. Because the POLST form requires the patient or family to have the courageous conversation about end-of-life wishes BEFORE the crisis, it allows that moment of crisis to be expected, allows us Emergency providers to be facilitators of thoughtful care, while taking the guesswork out of hectic, desperate situations. For me, finding that pink POLST form brings calmness to the gathered team of resuscitators. As I read aloud the wishes delineated on that form, I am able to provide care as if I had just consulted the patient and family, and I can perform that care under the grace of the Hippocratic Oath and with the grace of a doctor who cares about what the patient or family would want. The California Medical Association (CMA) publishes a POLST kit, available in English and Spanish, which includes legal forms and wallet identification cards, and answers many of the most frequently asked questions about end of life issues. These kits are available in CMA's online resource library at www.cmanet.org/resource-library. For more information on palliative care and POLST, visit www.coalitionccc.org and www.capc.org. Dr. McMahan is the medical director for the Garden Grove Emergency Department in Garden Grove, CA, and the Associate Medical Director of Emergency Services for Monarch Health Care. October 31, 2013 General POLST, End of Life Issues 0 0 Comment Read More »
Now is the time for a new Dental Plan! Now is the time for a new Dental Plan! It’s Open Enrollment time for the San Bernardino County Medical Society sponsored Group Dental program. This plan is designed to help you, your family and your employees minimize the out-of-pocket expense of regular dental care. This program helps you maximize your out-of-pocket savings by using network dentists, but also allows you to use any dentist you like and receive lower benefits. Following are many valuable benefits that can save you money: • Annual Benefits of $2,000 per person for dental care, using network providers ($1,500 if you use non-network providers). • During Open Enrollment only, members may join as an individual or as a group with your employees. • Low calendar year deductible of $50 per person, ($100 per calendar year maximum for families). • Pay no deductible on oral exams, x-rays and routine cleanings. Remember, the open enrollment period is available once per year. To be eligible for coverage, applications must be received during the special open enrollment period ending on January 1, 2014. Call a Client Advisor at 800-842-3761 for more information. Or visit www.CountyCMAMemberInsurance.com to download a brochure and application. d/b/a in CA Seabury & Smith Insurance Program Management • CA Ins. Lic. #0633005 • AR Ins. Lic. #245544 60960 (11/13) ©Seabury & Smith, Inc. 2013 • 777 South Figueroa Street, Los Angeles, CA 90017 800-842-3761 • CMACounty.Insurance@marsh.com • www.CountyCMAMemberInsurance.com October 28, 2013 General Membership Benefits, Dental Plan 0 0 Comment Read More »
CMA part of national effort to urge House leadership to act on Medicare SGR payment overhaul before the year ends The California Medical Association (CMA) is part of a national multi-state, multi-specialty effort headed by the American Medical Association to keep bipartisan momentum going to address Medicare fee-for-service sustainable growth rate (SGR) reform. CMA has asked the California congressional delegation to sign a letter to House Speaker John Boehner and House Minority Leader Nancy Pelosi urging them to make it a priority to reform the Medicare physician payment system before the end of the year. The joint letter is being circulated in Congress by Rep. Bill Flores (R-TX) and Rep. Dan Maffei (D-NY). With the current full cost of repeal cut in half to $138 billion, repealing the SGR formula is a fiscally responsible step toward overall reform, the letter says. Congress, over the past decade, has spent $146 billion in short term SGR patches, more than the current cost of repeal. Continuing to enact short-term patches is bad fiscal policy — equivalent to paying the monthly minimum on a credit card bill — and increases the cost of full repeal. In July, the House Energy Commerce Committee passed H.R. 2810 with a unanimous bipartisan vote. It would repeal the SGR, establish a five-year period of stability and enact alternative payment models for physicians. CMA is urging Congress to keep the momentum going and enact final payment reform before the end of the year. With the drastically lower price tag for a repeal of the SGR and bipartisan support for the necessary policy changes, this year represents a great opportunity to implement a new payment system, reform health care delivery to drive quality and efficiency, and set Medicare on a more stable and predictable course for current and future generations of patients and physicians. Click here to read the letter. October 28, 2013 Medicare Insurance/Reimbursement, Medicare, SGR, Sustainable Growth Rate, Advocacy 0 0 Comment Read More »
CDPH launches new public health reporting gateway The California Department of Public Health (CDPH) recently launched an online portal for public health reporting called the CDPH Health Information Exchange (HIE) Gateway. The gateway will serve as a single point of entry for data submission to many state public health programs, including the California Immunization Registries (CAIR) and the California Reportable Disease Information Exchange (CalREDIE). The goal of the gateway is to improve upon data exchange, analysis and reporting capabilities, while helping hospitals and health care professionals meet the public health reporting objectives under the Centers for Medicare and Medicaid Services electronic health record (EHR) "meaningful use" incentive program. All eligible health care professionals and hospitals in California that wish to register and submit data to CAIR (7 regions only: NorCal, Bay, Greater Sacramento, Central Coast, Central Valley, LA-Orange, and Inland Empire) or CalREDIE should do so through the CDPH HIE Gateway, regardless of whether they are seeking to fulfill meaningful use requirements. (Note: The CAIR Immunization Messaging Portal is now integrated into the CDPH Gateway. If you have already registered at the CAIR Portal and are only interested in immunization reporting, you will not be required to re-register at the CDPH Gateway.) In future phases, the CDPH HIE Gateway will be expanded to include other CDPH electronic reporting systems, including the California Cancer Registry and Childhood Lead Poisoning Prevention Program. To access the gateway and begin the registration process, visit http://hie.cdph.ca.gov. October 28, 2013 General Public Health, Reporting Diseases, Health Information Technology 0 0 Comment Read More »
Participate in National Prescription Drug Take Back Day More than six million Americans abuse prescription drugs, this according to the 2011 Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health. The study also revealed more than 70 percent of people abusing prescription pain relievers got them through friends or relatives, a statistic that includes raiding the family medicine cabinet. Proper disposal of unused prescription drugs helps prevent abuse and helps keep pharmaceuticals out of landfills and waterways. More than 280 locations throughout California will be accepting unused prescription drugs, including controlled substances, as part of National Prescription Drug Take Back Day on Saturday, October 26, 2013. The event aims to provide a safe, convenient and responsible means of disposal, while also educating the general public about the potential for abuse of these medications. The last National Take Back Day held this past April collected 371 tons of prescription medications nationwide. Physicians can take action by encouraging their patients to participate. To find a Take Back Day collection site near your practice, click here. CMA has also produced a flyer to educate patients about proper disposal of prescription medication and National Prescription Drug Take Back Day, which can be placed in offices and waiting rooms. It is available here. Visit the DEA website to get drug disposal information and locate collection sites. The event lasts from 10 a.m. until 2 p.m. time. Contact: Scott Clark, (916) 551-2887 or sclark@cmanet.org. October 23, 2013 General Drug Abuse, Prescription Drugs, Public Health 0 0 Comment Read More »
Are your business associate agreements up-to-date? Physician practices must review and update business associate agreements to comply with new HIPAA regulations. HIPAA requires a physician practice to enter into a written business associate agreement with any third party contractors or vendors that may create, receive, maintain or transmit protected health information on behalf of the physician practice. These agreements describe how the business associate will use and protect the protected health information it receives from the physician practice. The new HIPAA regulations, known as the HIPAA Omnibus Final Rule, implement many of the key provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. These regulations broadened the definition of a "business associate," which may mean that some contractors that were not business associates in the past may now be considered business associates. Physician practices should review their third-party vendors and contractors to determine whether they are business associates and ensure that proper agreements are in place. Business associate agreements that were already in place prior to the September 23 compliance date have one more year until September 22, 2014, to update those existing agreements. The California Medical Association (CMA) has recently updated its business associate agreement with CMA members. In order to advocate on a member's behalf, it may be necessary for CMA staff to receive and review documentation that may include protected health information about patients. Physician practices that contact CMA for certain member services may be asked to sign a business associate agreement. CMA members who have previously signed a business associate agreement with CMA will be asked to execute an updated agreement. If you would like a copy of CMA's updated business associate agreement with members, please contact legalinfo@cmanet.org or (800) 786-4262. For more information on business associate agreements and a sample business associate agreement, see CMA On-Call document #4103, "Business Associate Agreements." For more information on the new HIPAA regulations or HIPAA generally, visit www.cmanet.org/hipaa. October 23, 2013 General HIPAA, Medical Records, Health Information Technology 0 0 Comment Read More »
Paradise internist elected CMA President Richard Thorp, M.D., FACP, was installed as the 146th president of the California Medical Association (CMA) at the close of the association’s 2013 House of Delegates, held in Anaheim last weekend. Dr. Thorp, an internist from Paradise, California, developed an interest in health policy and advocacy while serving as president of Butte Glenn Medical Society in 1994, the year of Clinton health reform. Dr. Thorp continued a leadership role in organized medicine in 1995, serving on CMA’s Committee on Managed Care and subsequently on the Committee on Medical Services. He was the chair of the Committee on Medical Services for 10 years and since 2008 has served as consultant to the committee. “I will not compromise the honor of this profession for the victory of the moment. I will not capitulate or surrender. I will fight to protect this profession you hold so dear,” Dr. Thorp said as he addressed the nearly 500 physician delegates in attendance at the annual meeting. “In this critical time, the house of medicine cannot afford to do business as usual. We cannot afford the status quo. We must come with the audacity to create a dream and a vision for the future of medicine and health care in California.” Dr. Thorp is the president/CEO of Paradise Medical Group, Inc., a physician owned multi-specialty primary care group incorporated in 2001. He is also on the active medical staff of Feather River Hospital and divides his time between a private general internal medicine practice, service as a medical director of a rural health clinic and private practice administration. “A trusted colleague and dedicated physician, I could not be handing the reins over to a more capable, committed doctor to lead the CMA into 2014,” said Paul R. Phinney, M.D., immediate past president of CMA. “Physicians across California should know that Dr. Thorp will be the best kind of advocate on a wide range of issues, ensuring patient safety and the preservation of our honorable profession.” Dr. Thorp was elected to the CMA Board of Trustees in 2009 and is an Alternate Delegate to the American Medical Association House of Delegates, representing a portion of Northern California. Also serving with Dr. Thorp on CMA’s 2013-2014 Executive Committee are: • Immediate Past President Paul R. Phinney, M.D. • President Elect Luther F. Cobb, M.D. • Speaker of the House Theodore M. Mazer, M.D. • Vice Speaker of the House Lee T. Snook, M.D. • Chair of the Board of Trustees, Steven E. Larson, M.D. • Vice Chair of the Board of Trustees, David H. Aizuss, M.D. The California Medical Association represents more than 38,000 physicians in all modes of practice and specialties. CMA is dedicated to the health of all patients in California. October 14, 2013 General California Medical Association President 0 0 Comment Read More »
House of Delegates Highlights House of Delegates acts on hospital care The California Medical Association (CMA) House of Delegates has voted to take action on the Centers for Medicare and Medicaid Services' (CMS) "outpatient patient observation" status, finding it to be a practice that places undue financial burden on patients, complicates the practice of medicine and often results in physicians receiving reduced payments for services provided. Resolution 211-13, which received strong support on the floor of the House, was submitted as an emergency resolution and asked that CMA request that CMS eliminate its "outpatient patient observation" status, which is placed upon patients whose anticipated hospital stay is 48 hours or less. Supporters of the resolution noted that this practice places undue financial burden on patients, while also creating administrative hurdles if the patient is subsequently admitted as an inpatient to the hospital. The resolution was adopted by the House and now directs CMA staff to work with CMS to address the issue. Delegates support work towards EHR interoperability The California Medical Association (CMA) House of Delegates today displayed a strong show of support for electronic health record (EHR) interoperability (Res. 518-13) and directed the association to support the development of a secure, interoperable, nationwide health information exchange network. Supporters of the resolution noted that much work needs to be done to achieve meaningful interoperability and facilitate efficient, timely and coordinated patient care among providers in different geographical areas. The resolution directs CMA to support efforts to harmonize standards and specifications that would enable usability and interoperability of EHR systems and facilitate the exchange of health information among health care providers. Delegates show record support for political action committee In a record-setting show of support for CALPAC, the California Medical Association (CMA) political action committee, members of the CMA House of Delegates this weekend contributed a total of roughly $176,000, besting last year’s previous high of $152,000 by $24,000. The remarkable number was reached without harming the facial hair of any physicians in attendance. Last year, if you recall, then CALPAC chair and new CMA president Richard E. Thorp, M.D., promised to shave his famous moustache in front of the House if the delegates hit the $150,000 mark. The new record was instead spurred in large part by the trial lawyers’ all-out assault on California's historic tort reform law, the Medical Injury Compensation Reform Act (MICRA). The trial-lawyer backed Consumer Watchdog has submitted language for a ballot initiative that would more than quadruple California's current $250,000 cap on non-economic damages in medical malpractice cases and create a cash windfall for the trial attorneys who calculate their fees based upon the size of the total jury award. CALPAC is the first line of defense for California’s historic physician protections, which help keep malpractice premiums in-check and ensure that California’s patients have access to affordable health care. While the record breaking donations were a House-wide effort, several districts and sections boasted an unprecedented 100 percent participation, including the medical student and resident/fellow sections. The donations collected over the weekend, as well as all contributions made to CALPAC, will be used to defend MICRA and to support candidates who share medicine’s agenda and priorities and will work to affect policies beneficial to the House of Medicine. Delegates vote to support payment for telephone and email consultations Voting with an overwhelming majority, the California Medical Association (CMA) House of Delegates has said that insurers should be required to reimburse physicians for telephonic and electronic patient management. The resolution (Res. 407-13) asks CMA to sponsor legislation to that effect when politically and economically feasible. The resolution received nearly universal support during testimony, with many speakers noting that patients are increasingly relying upon telephone calls and emails for consultations that previously were conducted during in-office appointments. Under the language adopted by the House, payment for these consultations would be similar to office visits that are similar in complexity or time required from the treating physicians. The issue of payment for telephonic or electronic patient management has come before the House in the past, with CMA previously having adopted policy to support the practice, but this latest resolution explicitly asks the association to sponsor legislation to mandate the practice in California. October 14, 2013 General Advocacy, California Political Action Committee, CALPAC, Electronic Health Record, Health Information Technology, MICRA, Professional Liability, EHR, House of Delegates, Insurance/Reimbursement 0 0 Comment Read More »
Provider search function operational on Covered California website In what has been one of the most fluid deadlines put forth by the state’s health benefit exchange, Covered California launched the online provider search function on Monday, October 7. The search will allow patients to determine if a particular physician is contracted with any of the participating health plans. Though aimed at patients, physicians can also use the search to determine which plans list them on their exchange provider directories. The California Medical Association (CMA) recommends physicians review their status with plans offered in their area to determine whether they are showing as participating or non-participating. The provider search is available through Covered California’s “Preview Plans” tool. To access the search: 1.Visit www.CoveredCA.com and click on the “Start Here” button near the center of the screen. 2.Next, select the “Preview Plans” tab at the top of the next screen. 3.The user will then be directed to provide some general demographic information and click “See My Results” at the bottom right. 4.Click “Preview Plans” again on the next page, then select the “Find Your Doctor or Hospital” bar in the middle of the screen, which opens a dropdown box with both “Find Your Doctor” and “Find Your Hospital” options. 5.Select the “Find Your Doctor” option, and input the physician's name and location. If the desired physician is contracted with a participating Covered California health plan, his or her name should appear in the subsequent provider list. 6.Select the desired name from the list and choose the “Add to My Providers List” option. If you would like to search for another physician, click "Find Your Doctor" again and repeat the process. Once your list is complete, select the “Choose a Plan.” Those plans in which the chosen physician(s) participate will show a green checkmark box in the “My Doctors” row within the summary at the lower half of the page. A red minus-sign box indicates that the physician does participate in the plan. Due to the number of steps and the volume of internet traffic being experienced by Covered California’s website, long load times can be expected. It may be advisable to check the site during low traffic times of the day. Covered California had also promised the ability to download copies of provider directories furnished by qualified health plans via Covered California’s website. This option does not appear to be available yet on the www.CoveredCA.com website as of Monday evening. The topic of provider directories has been one of the most closely watched topics being handled by Covered California, by both patients and the physicians who will ultimately provide care through the state’s new online marketplace. Since early 2013, Covered California has been touting the provider directory as a way to help transform the millions of Californians currently without health insurance into “informed shoppers” when it comes time to enroll. Both provider and patient advocates have been eager to know which providers are being included in the exchange network. Providers’ interest has been stoked by the general ambiguity with which some health plans have conducted their provider contracting, such as failing to identify products as exchange products and using “all products” or “all affiliates” clauses to include physicians in an exchange network. If you find that you are being identified as contracted with an exchange product but did not intend to do so, contact the appropriate provider relations representative at the health plan and CMA’s Center for Economic Services at economicservices@cmanet.org or (800) 786-4262. CMA will continue to monitor the implementation of the Covered California provider directories and keep readers informed of any significant developments. October 8, 2013 General Covered California, Health Benefit Exchange, Health Insurance Exchange, Health Care Reform 0 0 Comment Read More »
