AMA study says physician cost of ICD-10 transition will be dramatically higher than original estimates A new study conducted by the American Medical Association (AMA) found that physician practices will have to spend anywhere from an estimated $83,290 for a small practice up to $2,728,780 for a large practice in order to meet the transition to ICD-10 code set by the October 1, 2014, deadline. In a letter to Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, the AMA said “the transition to ICD-10 represents one of the largest technical, operational and business implementation in the health care industry in the past several decades. “Implementing ICD-10 requires physicians and their office staff to contend with 68,000 diagnosis codes—a five-fold increase from the approximately 13,000 diagnosis codes in use today,” the letter said. The costs the AMA study looked at included training, vendor and software upgrades, testing and payment disruption. It also took into account the convergence of dynamic and financially demanding physician requirements; several of which focus on the cost to purchase new or upgraded software. “The markedly higher implementation costs for ICD-10 place a crushing burden on physicians, straining vital resources needed to invest in new health care delivery models and well-developed technology that promotes care coordination with real value to patients,” said AMA President Ardis Dee Hoven, M.D. Dr. Hoven said that compelling physicians to adopt this new coding structure threatens to disrupt innovations by diverting resources away from areas that are expected to help lower costs and improve the quality of care. ICD-10 (The International Classification of Disease tenth revision) is a system of coding created in 1992 as the successor to the current ICD-9 system. The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). For more information, see the AMA website. February 20, 2014 General ICD-10 0 0 Comment Read More »
Field Poll shows broad voter support for health warning labels on sugar sweetened beverages Sacramento- The California Medical Association (CMA) is pleased to see the recently released poll figures suggesting that California voters support the notion of applying health-warning labels on sodas and other sugar sweetened beverages. The poll, which was conducted by The Field Poll and The California Endowment, found that 74 percent of voters support the requirement to apply health warning labels to sugar sweetened beverages, with 52 percent of voters “strongly” endorsing the requirement. Support for the labeling of potentially harmful beverages was also bipartisan, with 80 percent of Democrats, 64 percent of Republicans and 75 percent of non-partisan voters endorsing the labeling requirement. These results come only a week after Senate Bill 1000, the Sugar-Sweetened Beverages Safety Warning Act, was introduced in the state legislature. The bill, authored by state Senator Bill Monning (D-Carmel) and co-sponsored by CMA, would require bottles, cans, vending machines, dispensers and restaurateurs offering high calorie drinks with added sugar to display a warning label outlining the health risks associated with such beverages. “California voters are now echoing what the scientific and medical communities have been saying for some time, that sugar sweetened beverages pose serious, and unique, health risks and should be treated as such,” said Richard Thorp, M.D., president of the California Medical Association. Sugar-sweetened beverages are the number one source of added sugars in the American diet, making up at least 43 percent of the 300 additional calories added to the average American’s daily consumption since the 1970s. These beverages are also one of the leading causes of preventable diabetes, a disease which has seen its rate among American adults double over the past 30 years. If current obesity trends continue, one in three children born today is expected to develop preventable diabetes in their lifetime. The problem is worse for communities of color, where nearly half of children born since 2000 would develop type 2 diabetes in their lifetime should current trends continue. February 20, 2014 General Advocacy, State Legislative Advocacy, Public Health 0 0 Comment Read More »
First infant death reported as rates of pertussis more than double in California The California Department of Public Health recently reported the first death of an infant from pertussis since 2010, the last time the disease peaked in the state. That year, pertussis reached epidemic levels with more than 9,100 cases and 10 deaths in California alone. Whooping cough rates typically rise and fall in a three- to five-year cycle. According to public health officials, pertussis cases had been declining since they peaked in 2010, but began to go up again in mid-2013. The state's preliminary case count for 2013 is 2,372, up from just 1,022 in 2012. It is too soon to know how pertussis cases will trend in 2014, but the rising rates highlight the importance of vaccination. State public health officials remind physicians that the best way to protect infants against fatal or severe pertussis infection is to vaccinate pregnant women with Tdap during every pregnancy. Vaccinated pregnant women develop antibodies to pertussis that are passed to the fetus and may protect young infants until they are old enough to be vaccinated at six weeks of age. To maximize the maternal antibody response and passive antibody transfer to the infant, optimal timing for Tdap administration is between 27 and 36 weeks of gestation. In addition to providing pertussis antibodies to the infant, the mother herself will be protected and less likely to become infected and transmit pertussis to her infant. Vaccination during pregnancy is highly preferred over postpartum vaccination. However, if a woman is not vaccinated prior to giving birth, it is recommended that she receive the vaccine before hospital discharge (breastfeeding is not a contraindication). In addition the other family members and close contacts of infants who have not received Tdap, should be vaccinated at least 2 weeks prior to any contact with the infant. Babies can get their first dose of the pertussis vaccine at 6 weeks of age, and should have three doses by the time they are 6 months old, according to the Department of Public Health. Children should also receive booster shot in their second year, before kindergarten and at 11-12 years of age. Adults and teens who never received a vaccine during their preteen years are also encouraged to get vaccinated. For more information and guidelines on pertussis vaccination, see the California Department of Public Health website. Contact: Scott Clark, (916) 551-2887, sclark@cmanet.org. February 20, 2014 General Faccination, Pertussis, Department of Public Health 0 0 Comment Read More »
Legislation introduced to restore Medi-Cal funding Today Assembly Budget Chair Nancy Skinner and Assembly Health Chair Richard Pan, M.D., introduced two bills, one that would restore the 10 percent Medi-Cal physician payment cut that went into effect this year and another that would extend the temporary Medi-Cal primary care rate increases called for under the Affordable Care Act (ACA). “I have sought to make the Medi-Cal program more cost-effective, transparent and accountable,” said Dr. Pan. “The legislation that we are introducing today continues this effort.” Medicaid rates in California are the lowest in the nation, while the state has arguably the highest practice costs anywhere in the country. With physicians paid just $18 a visit for primary care services, many patients are already having a tough time finding access to quality medical care. “Without adequate payment, Medi-Cal becomes an empty promise of coverage without actual access to care,” added Dr. Pan. “Getting a pizza delivered costs about the same as what California now reimburses doctors for Medi-Cal patient visits, it should be clear to everyone which service is worth more,” said Assemblymember Skinner. “California needs to fix reimbursement rates so we don't undermine the very program designed to cover millions of individuals and families in need of health care.” AB 1805 will improve health care access by bolstering provider participation in Medi-Cal, a program California expanded last year as the state moves forward in aggressively implementing the ACA. Specifically, AB 1805 will restore the 10 percent cut to Medi-Cal provider reimbursement rates that were enacted as part of the 2011 State Budget Act. AB 1759 extends through 2015 (and indefinitely beyond) the reimbursement increase for certain Medi-Cal primary care providers called for under the ACA and set to expire on December 31, 2014. “Patients in our communities are already having a difficult time finding access to care,” said Richard Thorp, M.D., California Medical Association (CMA) president. “The legislation being introduced today will help to ensure that patients have real access to care as millions of new patients are enrolled in Medi-Cal.” More than 8.5 million Californians receive their health care from the Medi-Cal program – one in every five patients in the state – and this number will rise drastically this year when over 2 million new patients enter the system under the ACA. The bill continues the work that CMA has already been engaged in since 2011 when the California Legislature passed and Governor Jerry Brown signed AB 97, which included a 10 percent reimbursement rate cut for physicians, dentists, pharmacists and other Medi-Cal providers. The cuts were enjoined for two years while the matter was being argued in a CMA-filed lawsuit. Despite earlier favorable rulings, a three judge panel of the 9th Circuit Court of Appeals cleared the way for implementation of these rate reductions in 2013. CMA requested a rehearing from the full Ninth Circuit Court of Appeals, which was denied. In September 2013, CMA filed a petition with the United States Supreme Court, asking it to review the appeals court ruling. The Court decided not to take this petition in January 2014. CMA is part of an unprecedented coalition of physicians, dentists, health care workers and hospitals that is working to stop the cuts. The coalition, called “We Care for California," includes the largest statewide organizations representing physicians, dentists, hospitals and health care workers, as well as health plans, first responders, caregivers and other health providers. February 20, 2014 Medi-Cal ACA, Insurance/Reimbursement, Medi-Cal, Medi-Cal Cuts, State Legislative Advocacy, Affordable Care Act, We Care for California 0 0 Comment Read More »
Covered California removes provider directory, again Following numerous complaints from both enrollees and providers, Covered California has removed its provider directory from the exchange website until further notice. "While the combined provider directory was a useful service for many consumers, some enrollees located physicians thought to be in their plan, and subsequently discovered they were not,” exchange staff wrote in a statement, noting that enrollees who relied upon information present in the provider directory should contact their health insurance plan to verify the provider is in the exchange network. CMA is also encouraging patients to contact their physician directly to verify participation in an exchange product. “If enrollees find the resolution unsatisfactory, they can contact Covered California’s Service Center to cancel enrollment in their plan, and enroll in a different plan before the end of open enrollment period, March 31,” exchange staff wrote. The exchange’s provider directory has been a subject of criticism since it was unveiled late last year. After weeks of delays, the online provider directory was launched in early October, only to be removed from the site two days later due to inaccuracies and slow loading times. The directory was relaunched, but then pulled a second time before the end of October. During the directory’s initial debut, the California Medical Association was instrumental in notifying Covered California of multiple errors present within the database. Even in its more recent directories, however, CMA identified more than 300 providers located in states other than California, and as far away as Winnipeg, Canada. With the directory now offline indefinitely, Covered California is asking potential enrollees to locate providers using links to each health insurance plan’s respective provider directories, which are available on the exchange’s website. Meanwhile, California physicians are able to identify which exchange plans are listing them as a participating provider using CMA’s members-only physician participation lookup took. The tool, which is available at www.cmanet.org/exchange-lookup, allows physicians to quickly identify which exchange plans list them as participating physicians. Practices, however, should also take the extra step of verifying participation status with the health plans themselves, as they will have the most updated information. For further information on verifying participation status with the health plans, please refer to CMA’s “Surviving the Second Month of Covered California,” which is available at CMA’s exchange resource center, www.cmanet.org/exchange. Contact: CMA's reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org. February 12, 2014 Managed Care Covered California 0 0 Comment Read More »
Blue Shield exchange/off-exchange plans leading to confusion among physicians The California Medical Association (CMA) has seen a large increase in calls from physicians confused about the plans/products offered by Blue Shield both on and off the exchange. As you may know, federal law requires that every plan offered in the exchange also be offered off the exchange, using the same network. This has resulted in a number of practices unknowingly seeing patients out-of-network for products that use the insurer's narrower exchange network. It has also created an additional level of confusion for physician practices when checking patients' coverage status. In the case of Blue Shield, the insurer offers 12 separate products linked to its exchange network, which it calls the "Exclusive PPO Network" or "Exclusive EPO Network." These products, whether purchased on or off the exchange utilize the Blue Shield "Exclusive" (aka exchange) networks. While plans purchased through Covered California will have the CoveredCA logo on them, the "off exchange" versions of these plans will not. However, regardless of whether they were purchased on or off the exchange, these plans will all utilize the insurer's "Exclusive" exchange networks. When identifying Blue Shield Exclusive Network patients you will need to review both plan and product. Mirror products offered both on and off the exchange may be subject to the lower rate structure. The key in indentifying Exclusive Network products is by verifying the product according to the list in this document. Download the document for a list of all of the various Blue Shield exchange/off-exchange products, a sample eligibility verification and sample member ID cards. Covered California also announced today that it has taken down its provider directories again due to errors in provider participation information. In the meantime, you can still check your participation status via CMA's quick and easy look-up tool at www.cmanet.org/exchange-lookup (available to members only). If you have any questions about your participation status, please contact the plan(s) directly. Contact: CMA's reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org. February 12, 2014 Managed Care Covered California, Health Benefit Exchange, Health Insurance Exchange, Insurance/Reimbursement, Managed Care, Blue Shield 0 0 Comment Read More »
Another delay for the Cal MediConnect project for dual eligibles The California Department of Health Care Services (DHCS) recently announced yet another delay for the Cal MediConnect project for dual eligibles. Implementation in Orange County has been delayed indefinitely, following a Centers for Medicare and Medicaid Services (CMS) audit of CalOptima—which is the county's only Medi-Cal managed care plan. The audit uncovered a number of serious issues that must be resolved before the duals transition can move forward in Orange County. Previously, Orange County was scheduled to begin passive enrollment on April 1, 2014. According to DHCS, implementation of Cal MediConnect in Orange County has been delayed indefinitely while CalOptima takes corrective action as directed by CMS. Because patients in Orange County have already received the 90-day notice, CalOptima will be sending a follow up letter to notify them that their coverage is not changing. These letters are expected to be mailed by end of next week. Patients who are currently enrolled with CalOptima will continue to receive medical benefits and coverage. DHCS last week announced that passive enrollment has been delayed by one month in Riverside, San Bernardino and San Diego counties, and is now set to begin in May. These delays are in addition to previous notice of delays in Santa Clara, Alameda and Los Angeles counties. DHCS also announced it would be adding additional plans in Los Angeles County (CareMore, Care 1st and Molina). The Cal MediConnect project was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that would see a large portion of the state's dual eligible beneficiaries transition to managed care plans. The project will impact approximately 450,000 duals in eight counties – Alameda, Los Angeles, Orange, Riverside, San Diego, San Mateo, San Bernardino, and Santa Clara. DHCS will be notifying affected patients 90, 60 and 30 days prior to their passive enrollment date. San Bernardino and Riverside Counties: Inland Empire Health Plan and Molina Dual Options, voluntary enrollment period begins no sooner than April 1, 2014; passive enrollment begins no sooner than May 1, 2014. For more information on the duals demonstration project, visit www.cmanet.org/duals and www.calduals.org. February 12, 2014 Medi-Cal, Medicare Medi-Cal, Medicare, Dual Eligible, Insurance/Reimbursement 0 0 Comment Read More »
DHCS pays over $100 million to primary care physicians in initial retroactive Medi-Cal rate increase payment The Department of Health Care Services (DHCS) has now made several retroactive interim payments to primary care physicians who have attested to their eligibility for the rate increases called for under the Affordable Care Act (ACA). These primary care payment increases have been put in place by the federal government in an effort to recruit more primary care physicians to treat low-income patients who will be newly eligible for health coverage in 2014. Although under the ACA the rate increases took effect on January 1, 2013, DHCS had been waiting for approval of its rate increase implementation plan from the Centers for Medicare and Medicaid Services (CMS). Approval was granted in late October, with the increases retroactive to January 1, 2013. These payments, totaling over $100 million, are an estimate of what DHCS believed is owed to physicians for fee-for-service Medi-Cal claims retroactive to January 1. The payments did not, however, include claim level detail. DHCS is also making weekly lump sum payments, in addition to regular Medi-Cal payments, to primary care physicians enrolled in fee-for-service Medi-Cal who have attested. The weekly interim payments represent estimated increase amounts due until DHCS’s computer systems can be updated to begin processing individual claims at the new rates, which could be as late as July 2014. Going forward, DHCS will make retroactive fee-for-service Medi-Cal claims payments on a monthly basis to physicians who have newly attested the previous month. When DHCS updates its computer systems and begins paying claims at the new rates, it will issue a final settlement, which will reflect a “true up” of payment owed but not reimbursed, or possibly a refund request if overpaid. This final settlement will include claim level detail for the entire amount paid as part of this increase. Attest today! The increased payments are not automatic. To qualify for the increased payments, providers must first attest to their eligibility. The attestation form is available on the Medi-Cal website. Physicians are required to complete the attestation online (paper copies will not be accepted). As of early January, DHCS reports that approximately 15,000 eligible providers have completed the attestation process. (For more information on the specialists and subspecialists that qualify, click here or see the CMS Q&A.) The increase also applies to services provided by physicians to Medi-Cal managed care patients; however, funding to the Medi-Cal managed care plans for the increase was not expected until the end of January. It is unclear exactly when each plan will make the retroactive payments or implement the increase once the federal funds are received. The California Medical Association (CMA) encourages practices to track all of the estimated lump sum payments received from DHCS, identified with RAD code 1801 (1801 A/R ACA interim payment). This upfront step should ease the reconciliation of those affected accounts once DHCS releases the claim level detail. The rate increase applies to evaluation and management codes 99201 through 99499 and vaccine administration codes 90460, 90461 and 90471 – 90474. More information on the primary care rate increase can also be found in CMA’s Medi-Cal Primary Care Physician Rate Increase FAQs. February 7, 2014 Medi-Cal Affordable Care Act, Insurance/Reimbursement, Medi-Cal, ACA 0 0 Comment Read More »
Become an official opponent of anti-MICRA ballot initiative If you haven't already, please take a moment to sign up to be an official opponent of a possible November 2014 ballot measure being pushed by trial lawyers that would significantly weaken California's Medical Injury Compensation Reform Act (MICRA) and increase lawsuits against doctors, community clinics, health centers, hospitals and other health care providers. It only takes a moment to join and add your and/or your organization's name to the official list of opponents to this greed-fueled initiative. Once you do, you also will receive regular email updates from the campaign to protect MICRA. Ballot measure update To date, trial lawyers and their allies have raised more than $1 million to pay for signatures to qualify the measure for the ballot. The main component of the proposed ballot measure would quadruple MICRA's $250,000 cap on non-economic damages – raising the cap to $1.1 million plus an automatic annual increase. If successful, these efforts would be devastating to California’s health care system. Raising the cap would increase lawsuits against health care providers leading to a significant increase in medical liability insurance costs. Ultimately, this measure will increase health care costs for all consumers and reduce patient access to affordable, quality health care – especially in rural and underserved communities. We need your involvement! Please join us in opposing the trial lawyers' ballot measure. To learn more about MICRA and what you can do to help, visit www.cmanet.org/micra. February 7, 2014 General MICRA, Professional Liability, Grassroots Advocacy 0 0 Comment Read More »
CMA Foundation names Lisa Folberg as new president/CEO Sacramento – After nine years of service at the California Medical Association (CMA), Lisa Folberg has been tapped to head up the CMA Foundation. She replaces Carol Lee, who retired late in 2013. The CMA Foundation, dedicated to improving individual and community health through partnerships between leaders in medicine, health care stakeholders and community based organizations, was established in 1963 as a subsidiary of CMA. “I am thrilled to be joining the CMA Foundation,” said Folberg. “The work the CMA Foundation does in public health, access to care and improving quality of care is an essential part of a changing health care delivery system.” As the Vice President of Medical and Regulatory Policy at CMA since 2009, Folberg has been responsible for the day to day operations of policy development and regulatory advocacy for the 39,000 physician member organization. “Lisa’s development of working relationships between CMA and California’s regulatory agencies, production of physician education materials on a myriad of issues and initiation of writing and managing grants for the organization has been integral to the success of CMA,” said CMA CEO Dustin Corcoran. “Her expertise makes her the natural fit to lead the CMA Foundation.” Prior to her role in CMA's Center for Medical and Regulatory Policy, Folberg lobbied for the association on issues relating to Medi-Cal, budget, public health, managed care and rural health. In her role as Associate Director in Government Relations, she organized the Alliance for Patient Care, a group of more than 60 health care stakeholder organizations aimed at increasing access to care for California’s neediest patients. “With health care delivery changing more rapidly than ever before, the CMA Foundation is at the helm of public policy discussions, education and awareness campaigns that will benefit physicians and their patients across the state,” said David Holley, M.D., Chair of the CMA Foundation Board of Directors. “Lisa’s expertise and leadership will prove invaluable as we embark on existing projects and on new endeavors.” Folberg joined CMA from the California Legislative Analyst’s Office, where she provided the Legislature with analyses on a variety of health and social services budget issues. Lisa has also spent time volunteering and working in health clinics, and spent a year in Colombia, South America, developing a public health program for at-risk youth through a World Health Organization/UCSF collaborating project. February 7, 2014 General CMA Foundation 0 0 Comment Read More »
