SBCMS News/Media

UC medical centers ready to provide in-patient care for confirmed cases of Ebola

Last week, the University of California (UC) Office of the President informed the California Department of Public Health (CDPH) that all five UC medical centers were ready to provide in-patient care for Californians who have confirmed cases of Ebola.

According to the UC Senior Vice President for Health Sciences and Service John Stobo, M.D., the UC medical centers—which include Davis, Irvine, Los Angeles, San Diego and San Francisco facilities—are “committed to addressing the health needs of this population and the public at large, as well as ensuring the safety of our health care workers.” These UC hospitals will closely coordinate with CDPH and local health officers in the event that Ebola infections occur in California.

“All of the UC medical centers specialize in complex care and operate as or staff level one trauma centers,” said Ron Chapman, M.D., director of CDPH and state health officer. “We appreciate their leadership role in willingness to treat Ebola patients.” However, Dr. Chapman said that all California hospitals are expected to screen, identify and isolate any patients with Ebola virus risk.

CDPH is reviewing guidelines set by the Centers for Disease Control and Prevention Services (CDC)  for Ebola preparedness, screening and treatment guidance to ensure that the UC medical centers have the most up-to-date information on how to treat and care for Ebola patients, should confirmed Ebola cases appear in California.

CDPH has also committed to helping UC obtain the necessary personal protective equipment (PPE), should the hospitals have sourcing challenges. The CDC recently updated its PPE guidance, aligning them with California’s already stronger infection control standards. State officials will also work with these medical centers to ensure that medical waste generated from the treatment of an Ebola patient will be properly handled and disposed.

The CDPH published information for all sectors of California health care providers and consumers on its website. It has also developed an interim case report form for reporting suspected cases of Ebola to CDPH and has distributed CDC guidance on specimen collection, transport, testing and submission for patients suspected of having Ebola.

CDPH has also posted interim guidelines for Ebola medical waste management and recommended that all health care facility environmental services personnel and infection control staff work together to develop facility-specific protocols for safe handling of Ebola related medical waste.

Pomona Valley Hospital Medical Center is winner of national Pink Glove Dance Competition for breast cancer awareness

Congratulations Pomona Valley Hospital Medical Center - winner of the national Pink Glove Dance Competion for breast cancer awareness!

The Pink Glove Dance Video Competition is an annual national breast cancer awareness campaign and competition sponsored by Medline, a manufacturer and distributor of health care supplies. The competition started because of the overwhelming and enthusiastic response to the original Pink Glove Dance video, featuring 200 workers from Providence St. Vincent Medical Center in Portland, Oregon, dancing in support of breast cancer awareness and prevention.

For winning the competition, Medline donated $15,000 to the Los Angeles affiliate of the Susan G. Komen foundation on behalf of PVHMC. Congratulations Pomona Valley Hospital!

Watch video here

CMA publishes duals project FAQ

The 2012 California state budget authorized a three-year demonstration project that transitions dual eligibles into managed care and allows them to receive medical, behavioral, long-term supports and services and home-and-community-based services coordinated through a single health plan.

The Cal MediConnect project was approved in 8 counties: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. No more than 456,000 individuals will be allowed to enroll into Cal MediConnect. Los Angeles’ enrollment will be capped at 200,000.

To help physicians and their patients better understand the program, the California Medical Association (CMA) has published "Cal MediConnect Physician FAQ: What you need to know about keeping your patients and billing for the dual eligible population." The FAQ is available free to members in CMA's online resource library.

For more details on Cal MediConnect, visit www.calduals.org and www.cmanet.org/duals.

Contact: Lishaun Francis, (916) 551-2554 or lfrancis@cmanet.org.

Election day is just two weeks away - Vote NO on Prop. 46!

In just two weeks, California voters will be weighing in on Proposition 46, the trial lawyer's ballot initiative that would quadruple the state’s Medical Injury Compensation Reform Act (MICRA) cap on non-economic damages. If lawyers get their way, medical lawsuits and jury awards will skyrocket – leading to a big increase in health care costs. It is critical that every single physician in California votes NO on Prop. 46 on Election Day.

Vote-by-mail ballots were mailed out by the state last week. If you vote by mail (also known as "absentee"), please don't wait until the last minute to vote No on 46. Missing the voting deadline is one of the main reason absentee ballots aren't counted. Mail in your absentee ballot today.

If you aren't already signed up to vote-by-mail, and would like to do so, the deadline to request a vote-by-mail ballot is October 28. You can do so online at the Secretary of State (SOS) website. If you are not registered to vote, the deadline to do so is October 20. You can register online at the SOS website.

There's still time to order free campaign materials for your office, including buttons, bumper stickers, brochures and more. To order campaign materials, please visit www.NoOn46.com or email Juli Reavis at jreavis@cmanet.org.

You can also show your neighborhood that you oppose Prop. 46 by putting up a yard sign. Pick up a No on 46 yard sign at a location near you.

The California Medical Association (CMA) has also published its 2014 Voter Guide, with information on CMA's position on the propositions and candidates on the November 2014 ballot. You can download the guide at http://cal.md/2014-voter-guide.

To learn more about Prop. 46, visit www.NoOn46.com.

State issues report cards for HMOs, PPOs and large medical groups

The California Office of the Patient Advocate yesterday released its 14th annual “California Health Care Quality Report Cards” that rate the state's health plans and medical groups on a four-star scale.

Available in English, Spanish and Chinese, the report cards allow consumers to compare the quality of care that more than 16 million commercially insured consumers receive from the state’s 10 largest HMOs, six largest PPOs and more than 200 medical groups. The data for the report cards is drawn from claims data and patient surveys for 2013.

Users can drill-down online to see specific plan performance on topics of greatest interest to them, such as chronic disease management, pediatric care and mental health care.

Although the report cards are usually published annually in January, officials have changed the release date so it would coincide with the fall open enrollment period for many Californians and their families, including those purchasing coverage through Covered California, the state's health benefit exchange. Covered California's next open enrollment period runs from November 15 to February 15.The report cards are part of a larger national push to bring greater transparency to the health care industry and help consumers choose services that best fit their needs.

The report cards are available at the Office of the Patient Advocate's website.

AMA assembles Ebola resources for physicians

The Centers for Disease Control and Prevention (CDC) on Sept. 30 confirmed the first U.S. case of Ebola, and developments associated with the virus continue to unfold.  In the past week, two Dallas nurses have been diagnosed with Ebola after treating Thomas Eric Duncan, the first U.S. ebola patient, who died last week after travelling from Liberia to Texas to visit family. Both health care workers were with Duncan during what the CDC says is the highest risk period—when a patient is vomiting and having diarrhea.

To help you prepare your practices and patients to understand and prevent Ebola, the American Medical Association (AMA) has assembled resources developed by Ebola experts. Visit AMA's online Ebola Resource Center for information from the CDC and other public health groups. Resources cover:

• Understanding the virus
• Preparing your hospital or practice
• Screening and diagnosing Ebola
• Treating patients with the virus

The resource center will be updated regularly with the most up-to-date information needed for physicians, practice staff and patients.

The California Department of Public Health (CDPH) recently hosted a teleconference for health care providers to discuss the agency's efforts to protect Californians and prevent the spread of the virus in our state. The teleconference can be played back on-demand on the CDPH website.

The CDC is also planning more opportunities for U.S. health care providers to receive additional training and to get their questions answered by CDC experts. Upcoming training and educational sessions will include:

• October 20: CDC and the U.S. Department of Health and Human Services will host joint conference calls for U.S. health care workers to discuss health care preparedness and answer questions or concerns. These calls will be scheduled regularly.
• October 21: CDC will host a live event in New York City to educate frontline health care workers on Ebola; the event will be streamed live to hospitals across the country.
• CDC will host a series of ongoing webinars tailored to specific health care specialties on preparedness.
• CDC will host conference calls with professional organizations to discuss member questions or concerns and to increase dissemination of critical information to health care providers.

Clinicians can get updates on these events at www.cdc.gov/ebola.

Blue Shield makes positive changes to reimbursement policy for physicians treating out-of-network exchange PPO patients

Blue Shield of California recently announced a two-part reimbursement policy change for contracted providers that do not currently participate in the plan’s Individual and Family Plan (IFP) PPO product, otherwise known as its exchange/mirror PPO product.

Effective with September 14, 2014 dates of services, Blue Shield will implement changes to the out-of-network claims payment process and will now reimburse providers directly when PPO exchange/mirror product patients are seen out of network. Previously, Blue Shield issued payment directly to the patient. The notice also states that out-of-network physicians may continue bill patients for the balance of billed charges.

Additionally, for Blue Shield contracted providers who see Blue Shield PPO exchange/mirror patients out of network, the plan will process payment based on the provider’s PPO contracted amount. Please note out-of-network benefit rules will still be applied, meaning the patient will still have the same out-of-network cost sharing. Previously, Blue Shield processed out-of-network PPO claims based on the reimbursement rate for its IFP product, which is typically discounted from the PPO rate.

The policy change does not affect services provided to patients with a Blue Shield IFP EPO plan, as there are no out-of-network benefits with an EPO product.

Blue Shield reports the policy change is in response to provider feedback of difficulties collecting from exchange/mirror patients they have seen out-of-network. The policy change also brings its physician payment rules in line with Blue Shield’s facility payment policy for PPO exchange/mirror patients who are seen out of network.

CMA believes the policy change will be positive for physicians and commends Blue Shield for their responsiveness to provider concerns.

To view the Blue Shield notice, click here.

Physicians with questions about the policy can contact Blue Shield Provider Information & Enrollment at (800) 258-3091.

CMA Capitol Insight: Oct. 13, 2014

CMA Capitol Insight is a biweekly column by veteran journalist Anthony York, reporting on the inner workings of the state Legislature.

Rules of the Road

The jury is still out about how California’s new election rules have changed the ideology of the legislature. Voters changed the rules in 2010, not only creating independently drawn legislative districts instead of seats designed by legislators themselves, but by changing the primary system so that the top two vote-getters, regardless of party, advance to the fall runoff.

From 2000-2010, the old rules virtually eliminated electoral competition. Seats were designed to be either safe Democratic or safe Republican seats, and even California’s rapidly changing demographics did little to alter that basic architecture throughout the decade. And since, under the old rules the top vote getter of each party advanced to the runoff, the primaries essentially decided the eventual winner. The winner of a Democratic primary in a San Francisco would have a cakewalk in November, as would a Republican primary winner in Ranch Cucamonga.

The idea was that this would bring more competition and more political moderates to Sacramento. Again, the jury is out on that. But what is undeniable is that the new rules have changed the way candidates run elections.

Take the race for a Sacramento state senate seat being vacated by Senate leader Darrell Steinberg. The race pits two Democratic Assemblymen – Roger Dickinson and Dr. Richard Pan – against each other. Both are popular in their districts. Both are well known. And both were among the top vote getters in June, advancing to a head-to-head matchup this November.

Dickinson has run a traditional Democratic campaign, with strong labor union backing and support from other activist groups. Dr. Pan has his own cadre of Democratic supporters, but has also reached out across party lines and to more moderate political groups. Dr. Pan, for example, has the strong support of the California Medical Association as one of the only doctors in the legislature.

But since all voters, and not just Democrats, are going to decide the eventual winner, Dr. Pan’s campaign is reaching out into places where most Democrats typically dare not tread.

This week, Sacramento voters received a mailer from the National Tax-Limitation Committee, a conservative anti-tax group headed by activist Lew Uhler.

The mailer includes endorsements of Republican Ashley Swearengin for state controller, and urges no votes on Proposition 45, a position shared by health insurance providers, and Proposition 47, a measure that would reduce criminal penalties for thousands of inmates.

The slate mailer also urges voters to support Dr. Pan in the 6th Senate District.

This is a byproduct of the new California campaigns. Slate mailers don’t endorse out of the goodness of their heart. Spots on those mailers are purchased by campaigns.

Dr. Pan’s inclusion on the Lew Uhler slate is a sign that his campaign is actively reaching out to more conservative voters, hoping to leverage his more moderate, business-friendly approach to governing into election victory in November.

The eventual outcome will have little impact on the day-to-day operations of the house. While Pan and Dickinson do disagree on some key issues, the major discussion in 2016 is likely to be over budget and taxes.

With Proposition 30 set to expire in the coming years, the race is on for a new tax plan to replace the higher upper income and sales taxes approved by voters in 2012. The 2016 ballot could be pivotal in that discussion, with voters being asked to weigh in on a state revenue plan to replace Proposition 30.

Much of that discussion will begin in the Legislature, and it will be shaped in large part by Democrats. But in order to place anything on the ballot in 2016 through the legislative process, Democrats will have to hold on to their 2/3 majority in both houses – an effort that is very much in doubt just a couple of weeks before election day. A tough Orange County senate race could decide whether the Democrats hold the supermajority, and an Orange County Assembly race, where incumbent Democrat Sharon Quirk Silva is running against Republican Young Kim, may decide the balance of power in that house.

Editorial Windfall

As the clock ticks down to election day, California newspapers continue to roll out their electoral endorsements. Thus far, every editorial board that has taken a position on Proposition 46 has recommended (rather vehemently, in some cases) a no vote. Even the typically trial lawyer friendly Los Angeles Times argued that the “methods the measure would use to achieve (its goals) are too flawed to be enacted into Law.” With that powerful statement, the Los Angeles Times joined the Orange County Register, Santa Rosa Press Democrat, Sacramento Bee, San Jose Mercury Tribune, San Diego Tribune, San Francisco Chronicle and Los Angeles Daily News in opposing Prop. 46.

CMA leaders meet with Congress on Capitol Hill before election recess

California Medical Association (CMA) physician leaders were in Washington, D.C., for the last week of the Congressional session, reminding California legislators about priority physician issues, such as the repeal of the Medicare sustainable growth rate (SGR) and adoption of long-term Medicare payment reform.

Congress has scheduled a very short lame duck session following the November election during which leadership on both sides hopes to come to an agreement on a spending bill to keep the government running.

Earlier this year, both houses of Congress were very close to a permanent repeal of the badly broken SGR formula. Unfortunately, they were unable to agree on how to fund the repeal, even though the cost to do so was dramatically lower than in previous years.

Unable to come to an agreement on how to fund the repeal, Congress passed a patch to stop the SGR-triggered payment cuts for the 17th time in 10 years. The patch is due to expire on April 1, 2015.

In addition to the SGR, CMA leadership asked that California Members of Congress continue the Medicaid primary care rate increase to Medicare levels after it expires on January 1, 2015, and reauthorize the Healthy Families program, which expires in the fall of 2015.

The CMA physicians also met with Sean Cavanaugh, deputy administrator and director of the Center for Medicare at the Centers for Medicare & Medicaid Services (CMS) about the proposed Medicare 2015 Physician Payment Rule. During the meeting, CMA focused on the implementation of the problematic Value Based Modifier, which directs CMS to reward and penalize physicians based on their efficiency and quality reporting. CMA urged CMS to reduce the penalties and change the program to ensure that it does not prevent physicians from treating the poorest, sickest elderly patients or force physicians out of the program altogether.

CMS reopening meaningful use hardship exception deadline

The Centers for Medicare and Medicaid Services (CMS) announced that it is reopening the submission period for meaningful use hardship exception applications so that physicians can avoid the 2015 payment penalty. The new deadline will be November 30, 2014.

As part of the American Recovery and Reinvestment Act of 2009, Congress mandated payment adjustments under Medicare for eligible professionals that are not meaningful users of Certified Electronic Health Record Technology (CEHRT). The Act allows the Secretary to consider, on a case-by-case basis, hardship exceptions for eligible professionals to avoid the payment adjustments.

While all Medicare physicians have until February 28, 2015, to attest to any 90-day reporting period in 2014 to obtain a meaningful use incentive, Medicare physicians who started the program this year were required to attest by October 1, 2014, to avoid a penalty of up to 2 percent in 2015. Those new to the program can now apply for a hardship exception to avoid this penalty if they missed the October 1 deadline. This reopened hardship exception application submission period is only for eligible professionals who:

• Have been unable to fully implement 2014 Edition CEHRT due to delays in 2014 Edition CEHRT availability; AND

• Were unable to attest by October 1, 2014, using the flexibility options provided in the CMS 2014 CEHRT Flexibility Rule.

These are the only circumstances that will be considered for this reopened hardship exception application submission period. Applications must be submitted by 11:59 p.m. EST on November 30, 2014.

The hardship exception, however, only provides relief from the meaningful use penalty and will not earn you an incentive. If you are prepared to attest by February 28, 2015, you can still apply for a hardship exception as a fallback precaution to avoid the penalty. The American Medical Association believes this hardship exemption will be interpreted broadly by CMS and therefore encourages all physicians who meet the criteria to apply by the November deadline.

Visit the Payment Adjustments and Hardship Exceptions webpage for more information about Medicare EHR Incentive Program payment adjustments.

The CMS EHR Information Center can be reached at (888) 734-6433 and is open Monday through Friday from 7:30 a.m. – 6:30 p.m. (Central Time), except federal holidays.