SBCMS News/Media

Early bird deadline for the 2014 NEPO Leadership Summit is July 31

The California Medical Association Foundation and the Network of Ethnic Physician Organizations (NEPO) invite you to attend the 2014 NEPO Leadership Summit, September 19-21 at the new Riverside Conference Center. Register by the July 31 early bird deadline and save $150.

The NEPO Summit is an opportunity for physicians, public health professionals and community leaders who work with underserved communities to learn about emerging health care policy issues, share best practices on how to reduce health disparities and increase access to health care services for the populations they serve. The NEPO Summit empowers attendees to be advocates for positive change in their communities.

As in previous years, CME will be offered and the agenda will include a thought-provoking array of plenary sessions and workshops.

This year's Summit will be held at the new Riverside Conference Center, in Riverside, California with a room block availabe at the historic Mission Inn and Spa, one of California's National Historic Landmarks. To register, click here.

For more information, or sponsorship opportunities, please contact Liza Kirkland, NEPO Program Manager at (916) 779-6643 or lkirkland@thecmafoundation.org.

California among six states that pay the least for Medicaid beneficiaries, says GAO report

According to a report released this week by the U.S. Government Accountability Office (GAO), California is one of six states that spends less than $6,000 per Medicaid (Medi-Cal in California) enrollee per year. The other states include Illinois Alabama, Arkansas, Mississippi and Tennessee. In contrast the report found that eight states, including New York, spend at least $10,500 per beneficiary. The report also found that Medi-Cal fee-for-service pays on average 61 percent of what private insurers in the state pay for the same evaluation and management services, with Medi-Cal managed care paying only 65 percent. These numbers underscore California's dismally low Medi-Cal rates and the need to increase rates, especially with millions of new patients now eligible for Medi-Cal under the Affordable Care Act's Medicaid expansion.

Despite having some of the lowest numbers, California continues to move forward with a 10 percent Medi-Cal rate cut, passed by the legislature in 2011. The California Medical Association (CMA) immediately filed a lawsuit seeking to stop the cuts. Though cuts were enjoined for two years while the case was making its way through the court system,  the 9th Circuit Court of Appeals cleared the way for implementation of these rate reductions in 2013. In September 2013, CMA filed a petition with the United States Supreme Court, asking them to review the appeals court ruling. The court decided not to take up the case.

With 8.5 million beneficiaries estimated to be eligible for the Medi-Cal program this year, or a third of the state’s population, California cannot continue to add millions of people to Medi-Cal and simultaneously cut the resources available to that program.

The cuts to reimbursement rates were made when California was facing much more dire fiscal times. With the state's budget in the black for the first time since 2007, the state no longer needs to be balancing the budget on the backs of our poorest and most vulnerable patients. CMA is aggressively urging the legislature and the Governor to restore the 10 percent cut should be restored, ensuring those patients have timely access to quality medical care.

CMA is part of an unprecedented coalition of physicians, dentists, health care workers, community clinics, emergency responders and hospitals that maintain a commitment to reversing the cuts. The coalition, called “We Care for California," hosted the largest health care rally in Sacramento history last year, brining 8,000 providers, health care workers and patients to the state’s Capitol to advocate against the cuts.

Under the ACA, more than 3 million patients are expected to enter Medi-Cal over the course of the next two years. “As the rest of the nation looks to California for an example of health reform success, we simply cannot move forward with a 10 percent prospective cut to the Medi-Cal program while simultaneously adding new patients to the program," says CMA President Richard Thorp, M.D. “CMA and our stakeholder partners will look toward reforms that will result in real access to care so that health reform is more than an empty promise of an insurance card."

As this new GAO study confirms, California's Medi-Cal provider payment rates were among the lowest in the nation even before the cuts. Low reimbursement rates have forced many of California’s providers to stop seeing Medi-Cal patients. As a result, 56 percent of Medi-Cal patients report difficulty finding a doctor. If these cuts are not stopped, Medi-Cal will become nothing more than a broken promise of access to care.

To read the report click here.

CMA files brief with CA Supreme Court in case that could undermine MICRA's longstanding definition of professional negligence

The California Medical Association (CMA), together with other amici, has filed a brief with the California Supreme Court, urging reversal of an appellate court opinion that thwarts the long-standing definition of "professional negligence" in California's Medical Injury Compensation Reform Act (MICRA). The ruling, if allowed to stand as precedent for future cases, could be misused to undermine the goals of MICRA and adversely affect the entirety of the health care system and safety net in California.

In this case, Flores vs. Presbyterian Intercommunity Hospital, a hospital inpatient sued for injuries she allegedly sustained from a fall when her hospital bed rail collapsed. The appeals court ruled that the negligence did not occur in the rendering of professional services and as such was subject to the two-year statute of limitations for ordinary negligence rather than the one-year statute of limitations for professional negligence.

CMA’s brief points out that under the long-standing definitions in MICRA, professional negligence includes any act or omission by a health care provider in the rendering of professional services for which the provider is licensed. Despite this clear definition and the fact that the provision and maintenance of safe hospital beds is a service for which hospitals are licensed, the Court of Appeal’s opinion failed to even address the pertinent licensing laws and regulations.

CMA's brief argues that the rule plaintiff proposes – that MICRA should be limited to conduct requiring specialized medical skills – is contrary to statutory intent as evidenced by the statutory language, longstanding decisional authority, and legislative history.

Read the brief here.

MICRA, California’s landmark professional liability reforms, have for nearly 40 years fairly compensated injured parties while protecting access to care for Californians. For more information on MICRA, visit www.cmanet.org/micra.

Contact: CMA's legal information line, (800) 786-4262 or legalinfo@cmanet.org.

Employment Practices Liability Insurance (EPLI)

• Special First-Time Buyers program
• A Helpline staffed by experienced employment defense attorneys. Any manager, officer or principal of your practice has access to the Helpline for obtaining advice on handling workplace issues, including internal sexual harassment complaints, discipline and employee terminations.  
• If a member seeks Helpline advice on an employee termination which later results in a claim, there is a 50% reduction of the member’s EPLI deductible for that claim.
• Free, comprehensive criminal background checks for newly hired and promoted managers/supervisors.
• EEO compliance training for managers/supervisors. An internet-based training program, compliant with California law, provides supervisors with sexual harassment training.
• Wage and Hour Defense Coverage. (Subject to additional premium.)

For more information on these important benefits, please contact Mercer at 800-842-3761 or email CMACounty.Insurance.service@mercer.com.  

65446 (7/14) Copyright 2014 Mercer LLC. All rights reserved. • 777 S. Figueroa St., Los Angeles, CA 90017
800-842-3761 • CMACounty.Insurance.service@mercer.com • www.CountyCMAMemberInsurance.com
Mercer Health & Benefits Insurance Services LLC  • CA Ins. Lic. #0G39709

Blue Shield data breach affects California doctors

The Department of Managed Health Care (DMHC) has notified physicians of a data breach that disclosed the social security numbers as well as names, business addresses, telephone numbers, medical groups and practice areas of over 18,000 physicians who contract with Blue Shield of California.

DMHC discovered that Blue Shield of California had inadvertently included physician social security numbers in public rosters provided to DMHC. These rosters are generally public documents and subject to disclosure under the Public Record Act (PRA). As a result, DMHC produced the rosters, including the social security numbers, in response to 10 PRA requests made to DMHC between March 2013 and April 2014.

DMHC and Blue Shield have instituted additional protections to prevent any future disclosures of confidential physician personal information and recommend that physicians place fraud alerts on their credit files. Blue Shield is also offering affected physicians one-year of credit monitoring services though Experian's ProtectMyID Alert.

DMHC's data breach notification letter which includes contact information for three nationwide credit reporting agencies can be found here.

For more information on how to protect yourself from identity theft, see CMA On-Call document #1104, "Who's Got Your Number: How Physicians Become The Victims." This document, as well as the rest of the California Medical Association's online health law library, is available free to members in CMA's online resource library. Nonmembers can purchase documents for $2 per page.

Contact: CMA's reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org.

Physicians can review Sunshine Act data starting today

The Centers for Medicare and Medicaid Services (CMS) announced that starting today physicians can complete part 2 of the registration process to review and dispute disclosures under the Physician Payments Sunshine Act. Physicians have 45 days to review and dispute their data (plus an additional 15 days to resolve disputes). The review and dispute process ends August 27, 2014. The information will be published publicly on September 30, 2014.

Under the Sunshine Act, drug and medical device manufacturers are required to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research grants and other gifts. Any payments, ownership interests and other “transfers of value” will be reported to CMS for publication in an online database.

The two-step registration process first requires physicians to register at the CMS Enterprise Portal, a step many physicians may have already completed as the gateway enables access to a number of other CMS programs. Step two, which starts today, is to register with the CMS’ Open Payments system.

The CMS offers a primer called Open Payments User Guide  that includes how to register, review and use the dispute functionality on the website.

More information is available from the American Medical Association's online “Physician Sunshine Act Tool Kit,” which provides a variety of resources to help physicians navigate the Sunshine Act changes, including a free webinar, a list of important dates, answers to frequently asked questions, information about how to challenge incorrect reports and ways to be more transparent with patients about the physician's interactions with the pharmaceutical and medical device industries.

California Democratic Party to remain neutral on Prop. 46

Backers of Proposition 46, the MICRA lawsuit measure, were dealt another severe blow this weekend when, despite their intense lobbying, the Executive Board of the California Democratic Party rejected their efforts to gain an endorsement, instead voting to remain neutral.

Over the course of the three-day meeting, Democratic Party leaders and activists who reviewed Prop. 46 found that, if the initiative were to pass, health care costs would go up, access to care would go down, community clinics would be harmed and personal privacy will be put at risk.

Understanding its potentially devastating effects, traditionally Democratic groups such as the American Federation of State, County and Municipal Employees (AFSCME), Service Employees International Union (SEIU), the California Teachers Association, Planned Parenthood and the American Civil Liberties Union (ACLU) have all opposed Prop. 46, and advocated against the measure throughout the weekend, helping secure the neutral position. These groups were also joined by physicians, medical students and health care providers from around the state, each of whom would have their practices threatened by the flawed and deceptive Prop. 46.

More information about Prop. 46’s dangerous impacts, as well as a list of the unprecedentedly broad coalition opposing the measure, can be found at www.NoOn46.com.

CMS proposes to end Sunshine Act CME exclusion

The Centers for Medicare & Medicaid Services (CMS) has decided to eliminate the continuing medical education (CME) exclusion for the Physician Payments Sunshine Act. The news was included in the 2015 Medicare Physician Fee Schedule proposed rule.

The Sunshine Act stems from a provision of the Patient Protection and Affordable Care Act. Under the Sunshine Act, drug and medical device manufacturers are required to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research grants and other gifts. Any payments, ownership interests and other “transfers of value” will be reported to CMS for publication in an online database to be launched this fall.

CMS had initially given sponsorships for CME a pass in the Sunshine Act because it believed adequate safeguards were already in place. However, experts argued that an exclusion could give drug and device companies a loophole for manufacturers to influence physicians without disclosure. CMS felt that the exclusions made the agency appear to be endorsing corporate sponsorships of CME. 

Physicians are reminded that they can now register to review and potentially dispute their data reported by manufacturers of drugs and medical devices under the Sunshine Act. According to CMS, physicians will be able to begin reviewing the disclosure data sometime in July. Physicians will then have 45 days to review and dispute their data (plus an additional 15 days to resolve disputes). For more information on the two-step registration process, click here.

CMA, AMA and others urge CMS to delay new rules authorizing multi-hospital systems to establish system-wide medical staffs

The California Medical Association (CMA), the American Medical Association and dozens of other state and specialty medical associations have asked the Centers for Medicare & Medicaid Services (CMS) to delay for one year new Medicare rules that would allow multi-hospital systems to establish system-wide medical staffs.

CMA commented extensively on this and prior iterations of this rulemaking expressing serious concerns about the proposed amendments to the CoPs and their impact on medical staff self-governance. CMA believes that medical staff self-governance is a vital part of a carefully crafted system designed to ensure the delivery of quality patient care.

The letter says that the organizations have written “to express our extreme disappointment with the CMS final rule…..that makes unprecedented changes to the Medicare Hospital Conditions of Participation (CoPs) that will dramatically alter the make-up and efficacy of hospital medical staffs nationwide.”

The letter asks CMS to delay the effective date of the rule from July 11, 2014, to give medical staffs sufficient time to develop the policies and procedures necessary to comply with the rule.

Major provisions of the final rule related to medical staffs are:

Multi-hospital systems may have the option of having a single unified and integrated medical staff, but a majority of each medical staff must affirmatively vote to accept a unified and integrated medical staff structure or to opt out of such a structure and to maintain a separate and distinct medical staff for their respective hospitals.
The final rule does not require members of the medical staff to serve as representatives on the hospital governing body. However, hospital governing bodies must periodically throughout the year consult directly with each medical staff within the multi-hospital system.
CMA will continue to look for advocacy opportunities to advance physician leadership in hospital and other settings.

Click here to read the letter.

Contact: Yvonne Choong, (800) 786-4262 or ychoong@cmanet.org.

Change in mailing address for Medi-Cal TAR submissions

Effective for dates of service on or after July 1, 2014, all paper treatment authorization requests (TAR) currently being mailed to the Los Angeles Field Office and the Northern and Southern Pharmacy Sections should be mailed to the following address:

West Sacramento TAR Processing Center
820 Stillwater Road
West Sacramento, CA 95605-1630

Updated provider manual sections will be published in a future Medi-Cal Update.