Inland Empire Care Transitions Collaborative Inland Empire Health Plan (IEHP) along with several organizations, including the Health Services Advisory Group and the Hospital Association of Southern California, have formed the Inland Empire Care Transitions Collaborative, which hopes to raise awareness in the medical community about the need for community wide Solutions for high readmission rates. The collaborative is inviting physicians, hospitals, nursing homes, home health agencies, health plans, community based organizations, and other healthcare providers to their upcoming "Supporting Transitions in Patient Care Across the Provider Continuum-Reducing Readmissions in the Inland Empire" event scheduled for Thursday, April 4, 2013, 11:30 am to 3:30 pm. The event objectives are to: Develop an understanding of current readmission reduction efforts in the Inland Empire. Gain knowledge of evidence-based models and practical strategies Explore opportunities for collaboration and discuss ideas about how to move forward as a community Free to attend, but you must pre-register by March 29, 2013, at www.cvent.com/d/2cqf94. Questions, contact Lindsay Holland, (818) 265-4671 or lholland@hsag.com. March 18, 2013 General readmission reduction, Inland Empire Care Transitions Collaborative, reducing readmissions 0 0 Comment Read More »
Medi-Cal extends 2012 EHR attestation deadline to April 30, 2013 Xerox, the vendor in charge of the Medi-Cal electronic health record (EHR) incentive payments has resolved the technical difficulties that were complicating some providers' ability to complete their 2012 attestations. Specifically, the Medi-Cal State Level Registry was not properly allowing some providers who have been designated as members of groups to inherit and utilize the group’s information. As of Friday, March 15, the system is fully functional. Because of the difficulties and resulting attestation delays, the California Department of Health Care Services (DHCS) has received federal authorization to extend the 2012 attestation deadline to April 30, 2013. This deadline extension applies to all eligible professionals, not just those affected by the group attestation problem. Despite this extension, groups and providers are urged to submit their applications for 2012 as soon as possible. DHCS also recommends that group/clinic representatives do not begin the 2013 attestation process until their providers have received their 2012 payments. For more information visit www.medi-cal.ehr.ca.gov or call Xerox's EHR Program at (866) 879-0109. Contact: CMA reimbursement help line, (888) 401-5911 or kmarck@cmanet.org. March 18, 2013 Medi-Cal Health Care Reform, Insurance/Reimbursement, Medi-Cal 0 0 Comment Read More »
CMA Webinar: Act now to avoid Medicare penalties in 2015 Over the past six years, the Centers for Medicare and Medicaid Services (CMS) has launched a number of initiatives that offer physicians the opportunity to increase their net revenue by participating in quality reporting programs. Until now, these programs have been voluntary and physicians have received bonuses for participating. That's about to change. Failure to participate now means physicians could face significant penalties. The American Academy of Family Physicians estimates that participating in these initiatives in 2013, rather than waiting until 2014, could save a physician $19,000 in avoided penalties. To help physicians understand the bonuses and penalties associated with key Medicare initiatives, the California Medical Association (CMA) will be hosting a free webinar for members ($99 for nonmembers), "Quality Reporting Programs: What Physicians Need to Know and Do Now to Improve Care and Avoid Penalties." During the April 9 webinar, participants will learn directly from CMS Region 9 Chief Medical Officer, Betsy L. Thompson, M.D., about the major quality reporting and e-health incentive programs currently underway for eligible professionals. The session will cover the basics of the Physician Quality Reporting System, the Medicare and Medicaid Electronic Health Records Incentive Programs, the Medicare E-Prescribing Incentive Program and the new value-based payment modifier. The content will be geared toward physicians, nurse practitioners and physician assistants and what they need to know, although other health care professionals and medical office staff are welcome to attend. Each of these programs has specific deadlines and reporting requirements, some of which are overlapping, and are not always simple to understand. CMA's webinar will give physicians the information they need to successfully participate in each program. During the webinar, Dr. Thompson will help participants understand which programs they are eligible for, the associated incentives and penalties for each program, and the deadlines and requirements for participation. The webinar will be presented on Tuesday, April 9, at two convenient times: 12:15 to 1:45 p.m. and again from 6:00 to 7:30 p.m. Participation is free for CMA members. Nonmembers can register for $99. For more information, or to register, visit www.cmanet.org/events. Contact: CMA's member service center, (800) 786-4262 or memberservice@cmanet.org. March 18, 2013 Medicare Bonuses, Penalties, Medicare 0 0 Comment Read More »
Department of Justice to decide Medicare MAC contract protest The Centers for Medicare & Medicaid Services (CMS) announced in September 2012 that Noridian has been named the new Medicare Administrative Contractor (MAC) for Medicare Parts A and B in Jurisdiction E (previously called Jurisdiction 1). Two protests were filed, challenging the award. On January 18, 2013, the Government Accountability Office denied the two protests. As permitted by law, both protestors (Palmetto GBA and CGS) subsequently filed complaints with the U.S. Court of Federal Claims challenging the Jurisdiction E MAC contract award. The protests were filed on February 1, 2013. The Department of Justice is representing CMS before the court. For at least the next several months, Medicare providers in Jurisdiction E (California, Hawaii, Nevada and the Pacific territories) will continue to file their Medicare claims with the incumbent Palmetto GBA. CMS will notify affected Medicare providers about the situation, including any implementation dates, following the Court of Federal Claims review. Jurisdiction E includes over 3.5 million Medicare fee-for-service beneficiaries, 500 Medicare hospitals and 86,500 physicians. MACs process Part A and Part B claims and perform other critical Medicare operational functions, including enrolling, educating and auditing Medicare providers. Contact: CMA member service center, (800) 786-4262 or memberservice@cmanet.org. March 18, 2013 Medicare Noridian, Palmetto, Medicare 0 0 Comment Read More »
Inland Empire Provider Positioning for Growth in Reform Monday, March 11, 2013 Inland Empire Provider Positioning for Growth in Reform by Lauren McSherry, California Healthline Regional Correspondent SAN BERNARDINO -- Marking yet another step in the steady expansion of its reach in the Inland Empire, Loma Linda University Health is planning to construct a medical and educational complex in San Bernardino that could serve up to 250,000 patients each year. Experts said the expansion is likely part of the health system's strategy to better position itself for changes to health care reimbursement and hospital patient volume expected as a result of the Affordable Care Act. In recent years, Loma Linda University Health has undertaken a number of construction projects in San Bernardino County, where its main medical campus is based, and in Riverside County. The health system, which includes the region's only Level 1 trauma center and children's hospital, now has more than 1,000 beds in six hospitals in the Inland Empire. In 2009, the health system opened a 90,000 square-foot outpatient satellite campus in Beaumont. Through partnerships with Beaver Medical Group and Redlands Community Hospital, Loma Linda University Health's Highland Springs Medical Plaza offers specialty services, such as oncology, cardiology, neurosurgery and orthopedics. Two years after the completion of Highland Springs, the health system opened Loma Linda University Medical Center-Murrieta, a 106-bed hospital and medical office complex with clinics near Temecula. Now, the health system is expanding into San Bernardino. LLUH expects to close escrow on a seven-acre parcel near highway 215 this month, said LLUH President Richard Hart. The new medical campus will be an extension of a three-clinic system called Social Action Community Health System that was started by volunteers from Loma Linda University and its medical center in the 1960s. The main clinic near the former Norton Air Force Base recently obtained status as a federally qualified health center, which will be extended to the new clinic, Hart said. Hart said the health system is seeking to use its medical campus in Loma Linda for more complicated cases and the outlying facilities for community health services, including primary and secondary care. He said it is difficult to foresee how finances will shake out when health care reform takes effect. "There are a lot of unknowns in Obamacare that none of us can see our way through," he said. "We're all nervous about what reimbursements will come out of this." He anticipates increasing the health system's affiliations beyond Beaver Medical Group, Redlands Community Hospital and San Gorgonio Memorial Hospital to include more community hospitals and county hospitals to prepare for new Medi-Cal beneficiaries in 2014. "That's going to push the volume of patients up considerably, and we're striving to help prepare for that," he said. Bracing for Health Care Reform Experts said that with the opening of all these new facilities, Loma Linda University Health is strategically positioning itself to have a strong foothold when federal health care reforms roll out. "I think Loma Linda and the county hospitals are pretty hard to compete with," said Dylan Roby, a professor and researcher at the UCLA Center for Health Policy Research. "Loma Linda can do it in Banning-Beaumont and San Bernardino because they know their population." He explained that in a growing market like the one in the Inland Empire, you don't usually see hospitals built by new players because they won't want to develop a new strategy from scratch. In addition, with unknown financial risks related to health care reform, such a move could be viewed as too dangerous. Loma Linda, however, is well-established and knows its market, he said. "It's not easy to pick up and start in a whole new area unless infrastructure is in place," said Craig Garner, a health care reform law professor at Pepperdine University. "It's much easier to come in and take over a struggling entity than to start a new one from inception." He identified two advantages for LLUH: a number of its facilities are affiliated with an academic institution -- Loma Linda University School of Medicine -- and the health system is expanding to other types of health care delivery beyond hospitals, which could see reductions in revenue as a result of health care reform. Loma Linda appears to have another competitive advantage: The Inland Empire region has a chronic shortage of primary care physicians and hospital beds. Plans for new medical schools and hospitals have been ramping up in recent years to meet demand from a population that has grown to more than four million. "It is one of the fastest-growing areas in California," said Jim Lott, vice president of the Hospital Association of Southern California. "They are in a growing market, so I would think they are certainly a system to watch." Consolidation, Rise of ACOs Go Hand-in-Hand LLUH's increase in affiliations fits with a general trend in diversification as more and more health care systems and organizations are banding together to form accountable care organizations, experts said. "You're seeing physicians groups and health plans coming together with hospitals," Lott said. "Right now, the Affordable Care Act has set integrated delivery systems on steroids." Meanwhile, health care reform has had at least one unforeseen consequence for Loma Linda. In January, the health system bought out the physician group that it had partnered with to launch Loma Linda University Medical Center-Murrieta and obtained not-for-profit status for the hospital because health care reform prohibits hospital ownership by physician groups. The new status, however, seems to be in keeping with the religious not-for-profit status of the faith-based health system, which is a Seventh-day Adventist organization, Lott said. Roby said the expansion could be a way for LLUH to attract commercial insurers and compete against Kaiser Permanente, which has a strong presence in the region. Under the ACO model, employers might see Loma Linda as a worthy investment of premium dollars since the health system will have a wide network of high-quality facilities. "They're bringing a lot more into the fold if they have a campus in Murrieta, Banning-Beaumont, San Bernardino and Loma Linda," he said. The expansion also could help ensure that LLUH will be well-positioned to provide services to Medi-Cal beneficiaries. Hart confirmed that one of the goals of the San Bernardino medical center will be to serve patients coming into the health care system through the ACA, particularly Medi-Cal beneficiaries. The new facility will offer primary care and have a number of specialty clinics. He also said that expansion is warranted not only because of the region's growing population, but because 50% of patients go outside of the Inland Empire to Orange County and Los Angeles to seek health care. Reprinted from California Healthline, A service of the California HealthCare Foundation March 13, 2013 General ACA, Affordable Care Act, Loma Linda University Health, Health care reform 0 0 Comment Read More »
Nominating Committee Report 2013 The Nominating Committee held a conference call on January 16, 2013. Members participating in the call included: Drs. Rodney Borger, Victor Ching, Leroy Ounanian, Clifford Walters, Danny Wongworawat, Mohan Mallam and Jim Peterson, Executive Director. Presented January 28, 2013 are the following slate of proposed officers, board members and CMA Delegation: Nomination of Officers One-year term, 7/1/2013-6/30/2014 President: Raman Poola, MD President-Elect: Montri Wongworawat, MD Vice President: Marti Baum, MD Secretary: Michael Sequeira, MD Treasurer: Eric Hansen, DO Past President: Leroy Ounanian, MD Nominations for the Board of Directors Two-year term, 7/1/2013-6/30/2015 District 1: Damodara Rajasekhar, MD, first term, replacing Eric Hansen, DO District 2: C. Perry Chu, MD, first term, replacing David Quam, MD District 2: Mark Bai, MD, reappointed second term District 3: Webster Wong, MD, reappointed second term District 5: Paul Burton, DO, reappointed second term At-Large: Leslie Yonemoto, MD, reappointed second term Nominations for Representatives to the Board of Directors One-year term, 7/1/2013-6/30/2014 Young Physician Representative: Kristina Roloff, DO, reappointed House Officer Representative: TBA, waiting for LLUMC to make appointment Student Representative: Stacy Butler, one year term, reappointed Public Health Officer: Maxwell Ohikhuare, MD; reappointed District II Chair: Rodney Borger, MD; reappointed Nominations for CMA Delegates District 4 Clifford Walters, MD, reappointed (7/1/2013-6/30/2016) Member at Large Conrad Salinas, MD, reappointed (7/1/2013-6/30/2016) Member at Large Guillermo Valenzuela, MD, reappointed (7/1/2013-6/30/2015) Member at Large TBA, to replace Kirk Andersen, MD, Resident 1 year term (7/1/13-6/30/14) Nominations for CMA Alternate Delegates District 1 Akhil Sharma, MD, (7/1/2013-6/30/2015) replacing Mohinder Ahluwalia, MD District 2 C. Perry Chu, MD, reappointed (7/1/2013-6/30/2016) District 3 Webster Wong, MD, reappointed (7/1/2013-6/30/2015) District 4 Montri Wongworawat, MD, reappointed (7/1/2013-6/30/2015) District 5 Varonica Dixon, MD, reappointed (7/1/2013-6/30/2016) Member at Large Woldemarian Gebreselassie, MD, reappointed (7/1/2013-6/30/2015) Member at Large Leroy Ounanian, MD, reappointed, (7/1/2013-6/30/2016) Member at Large Neeta Saheba, MD, reappointed, (7/1/2013-6/302015) Nominations for YPS and Other Representatives One-year term, 7/1/2013-6/30/2014 YPS Representative: Kristina Roloff, DO, reappointed YPS Alternate Representative: TBA March 12, 2013 General CMA Delegation, SBCMS Board of Directors, SBCMS Officers 0 0 Comment Read More »
South Coast AQMD Seeking Hearing Board Candidates South Coast Air Quality Management District (SCAQMD), located in Diamond Bar, performs work critical to the health and well-being of over 17 million people living in four Southern California counties. We are seeking two candidates for appointment to our Hearing Board for three-year terms, from July 1, 2013 through June 30, 2016. The appointments are: One Medical Member and one alternate Medical Member. (Both appointments require a licensed physician with two or more years of practical experience). Since these posts are unusual and traditional advertising is not likely to get the best results, we’re writing to ask for your assistance in spreading the word. SCAQMD’s quasi-judicial Hearing Board was chartered to provide an appellate process for companies and public agencies that are subject to SCAQMD rules and regulations, to ensure fairness in our regulatory actions. The Board has authority to grant variances to SCAQMD rules, revoke and suspend SCAQMD operating permits, and issue Orders of Abatement. As state law requires, Hearing Board Members are appointed by, but act independently of, SCAQMD’s Governing Board. Regular members of the SCAQMD Hearing Board are compensated at a rate of $5,411.51 per month, with alternate members receiving $422.11 per day, as needed. Finding the right individuals with the right qualifications for these key appointments is critical; therefore, if you know of any colleagues who might be interested, then please forward this e-mail to them or direct them to http://www.aqmd.gov/hr/neogov/current-jobs.htm for all details on how to apply. This opportunity closes at 5:00 p.m. on Wednesday, April 17, 2013. March 7, 2013 General SCAQMD, South Coast Air Quality Management District 0 0 Comment Read More »
Health Benefit Exchange Toolkit Now Available In 2010, Congress passed historic sweeping health care legislation, the Patient Protection and Affordable Care Act (ACA), which reformed the for-profit health insurance industry and beginning in 2014 will provide health insurance to most of the nation’s uninsured. Under the ACA, two thirds of California’s uninsured will be covered by private insurance through a health insurance exchange purchasing pool. The exchange’s goal is to start pre-enrollment in October 2013. CMA has developed a new toolkit titled, CMA’s Got You Covered: A physician’s guide to Covered California, the state’s health benefit exchange, to educate physicians on the exchange and ensure that they are aware of important issues related to exchange plan contracting. The toolkit is available free to SBCMS/CMA members only at www.cmanet.org/exchange. March 6, 2013 CMA Affordable Care Act (ACA), Covered CA, health benefit exchange 0 0 Comment Read More »
DHCS selects health plans for rural expansion of Medi-Cal managed care The Department of Health Care Services (DHCS) announced last week that it has selected four health plans to provide managed care services to approximately 410,000 Medi-Cal beneficiaries in 28 rural counties. The selections are contingent upon each plan meeting stringent readiness criteria. The California Legislature authorized, as part of last year's budget, the expansion of Medi-Cal managed care into rural fee-for-service counties, expanding Medi-Cal managed care program into all of California’s 58 counties. This expansion is part of the governor's plan to reduce costs in the Medi-Cal program. Under the expansion program, eligible Medi-Cal enrollees will be required to enroll in a Medi-Cal managed care program in order to receive services, effective June 1, 2013. The plans selected by DHCS include Anthem Blue Cross and California Health and Wellness Plan, which received Notices of Intent to Award for the expansion of Medi-Cal managed care to the counties of Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, Sierra, Sutter, Tehama, Tuolumne and Yuba. The state is also planning an exclusive Medi-Cal managed care contract with Partnership HealthPlan of California for expansion in Del Norte, Humboldt, Lassen, Modoc, Shasta, Siskiyou and Trinity counties. In addition, Lake and San Benito counties would become County Organized Health System managed care counties served by Partnership HealthPlan of California and Central California Alliance for Health, respectively. DHCS is currently working with Imperial County on its managed care plan selection process. Click here for more information on Medi-Cal Managed Care Rural Expansion. The California Medical Association will provide members with additional details as they become available March 5, 2013 Medi-Cal California State Budget, Department of Health Care Services, Managed Care, Rural Health, Medi-Cal 0 0 Comment Read More »
2013 Outstanding Awards Do you know of someone who has made a significant contribution to the healthcare field; displayed extraordinary professional competence; been active within SBCMS; been active in health promotion and disease through public speaking presentations and/or involvement with community organizations; or made charitable, benevolent and humane gifts or participated in acts demonstrating a desire to help mankind? If you answered yes, then this is your chance to nominate that colleague or citizen! Complete the official nomination form and return by fax to 951-787-8795; email lmyers@sbcms.org; or mail to SBCMS, Attn Outstanding Awards, 3993 Jurupa Ave. Suite 102, Riverside CA 92506. Nominations due Friday, March 8, 2013. Awards will be presented at the Annual Installation of Officers and Awards Recognition on June 11th. SBCMS Executive Committee File March 4, 2013 Awards Outstanding Awards 0 0 Comment Read More »
