Monday, July 28, 2014



Read the latest medical news for the San Bernardino County area.

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


Deadline to submit meaningful use hardship exception is July 1

Beginning January 1, 2015, Medicare physicians who have not successfully attested to meaningful use of a certified electronic health record (EHR) system may incur payment penalties, as mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act. These payment adjustments will be 1-2 percent of total Medicare charges in 2015, to 2 percent in 2016 and 3-5 percent in 2017 and beyond.

The 2015 penalties are based on 2013 reporting data. Physicians who failed to successfully demonstrate meaningful use in 2013 can apply for a hardship exception to avoid the upcoming Medicare payment adjustment for 2015. Hardship exception applications must include supporting documentation that proves that demonstrating meaningful use would be a significant hardship for the physician. The deadline to submit a hardship exception application for 2015 is midnight Eastern time on July 1, 2014.

The Centers for Medicare Services (CMS) will review applications to determine whether or not you will be granted a hardship exception. If approved, the exception is valid for one year.

Eligible professionals can apply for hardship exceptions in the following categories:

  • Infrastructure: Eligible professionals must demonstrate that they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband).
  • New Eligible Professionals: Newly practicing eligible professionals who would not have had time to become meaningful users can apply for a 2-year limited exception to payment adjustments.
  • Unforeseen Circumstances: Examples may include a natural disaster or other unforeseeable barrier.
  • Patient Interaction:

          Lack of face-to-face or telemedicine interaction with patient 
          Lack of follow-up need with patients

CMS has posted hardship exception applications on the EHR website at CMS has also published a hardship exception tip sheet for physicians.

For more information on the federal EHR incentive program and meaningful use, see CMA On-Call documents #4301 "Electronic Health Records: Federal Incentive Program," #4302 "Meaningful Use of EHRs: Stage 1," and #4305 "Meaningful Use of EHRs: Stage 2."


Medicare Advantage plans to see a modest increase in payments

The Centers for Medicare and Medicaid Services (CMS) announced this week that Medicare Advantage plans would see a 0.4 percent boost in payment rates for 2015.
This small payment boost is a change from CMS's February proposal that would have reduced Medicare Advantage plans payment rates by 1.9 percent.
This announcement comes on the heels of new data that predicts falling Medicare costs due to healthier baby boomers aging into the system. Healthier beneficiaries in Medicare have led to a downward drop in risk adjustment for the program. CMS has also proposed an improved risk adjustment methodology to account for patient’s health status (severity of illness) and demographics. Plan bids will be based on these criteria.
Along with this modest payment increase for Medicare Advantage plans, CMS announced that it plans to discontinue a three-year quality bonus demonstration project that shielded some plans from cuts required by the Affordable Care Act. CMS also said it will limit how much Medicare Advantage plans are allowed to increase beneficiaries’ premiums in 2015. This proposal limits these increases to the equivalent of $32 per month annually in 2015, down from $34 in 2014.
With Congress’s recent passage of a bill that will update California's outdated Medicare localities, the Medicare Advantage rates in the 14 affected counties will see an even greater increase because the rates are partially built on the Medicare fee-for-service rates.
Contact: Elizabeth McNeil, (800) 786-4262 or

CMS to publicly release Medicare physician payment data

The Centers for Medicare and Medicaid Services (CMS) announced yesterday that it would soon begin publishing individual Medicare physician billing data, despite objections from the American Medical Association (AMA) and other provider groups. CMS intends to publicly post the data as early as April 9.
The release will cover some $77 billion worth of Medicare Part B payments made to physicians in 2012 and will include physicians’ provider IDs, their charges, their patient volumes and what they received in reimbursements from Medicare. Individual patient level data will not be released. The information released will include data on 6,000 types of services and procedures that will allow data analysts to pinpoint outliers in charges and volume.
For more than three decades provider groups have successfully argued that such data could reveal proprietary details about physicians’ practices and could cause harm to doctors by publishing inaccurate or misleading presentations of the data.
Last May, however, a federal judge lifted a 33-year-old injunction that prohibited CMS from releasing any individually identifiable payment information. After the injunction was lifted, AMA had urged CMS to ensure the information be released only for purposed intended to improve the quality of Medicare services and to set appropriate safeguards.
Despite these concerns, CMS said yesterday that individual Medicare payment data on 880,000 health care providers, including 550,000 physicians, would be made publicly available as early as next week.
“Release of physician-identifiable payment information will serve a significant public interest by increasing transparency of Medicare payments to physicians and shed light on Medicare fraud, waste and abuse,” wrote Jonathan Blum, principal deputy administrator for CMS in an April 2 letter to AMA.
While the AMA is “committed to transparency” and supports the release of some physician data, the group is urging CMS to give physicians the opportunity to review and correct their information prior to its public release.
“The AMA is concerned that CMS’ broad approach to releasing physician payment data will mislead the public into making inappropriate and potentially harmful treatment decisions and will result in unwarranted bias against physicians that can destroy careers,” said AMA President Ardis Dee Hoven, M.D., in a statement released late Tuesday.

Congress passes California Medicare GPCI fix

After 10 long years of lobbying efforts by the California Medical Association (CMA), Congress has finally passed a bill to update California's outdated Medicare localities. The long overdue fix will update California’s Medicare physician payment regions to the same Metropolitan Statistical Areas (MSA) used to pay hospitals and raise payment levels for urban counties misclassified as rural, while holding remaining rural counties harmless from cuts.
The MSAs used to determine payment rates for hospitals are continuously updated, so that reimbursement accurately reflects local costs to deliver care. The physician payment localities, on the other hand, have not been updated in 15 years. As a result, 14 urban California counties are still designated as rural. This has caused many California physicians to be paid up to 13 percent per year below what Medicare says they should be paid if they were in the correct region.
These counties are currently experiencing significant access to care problems. About a third to one half of the physician groups and hospitals in these regions report difficulty recruiting physicians to treat seniors because the cost of living and the cost to practice are high, but the Medicare locality payments have not kept pace with real costs.
For instance, San Diego is now the sixth largest city in the United States, yet under the old Medicare localities, it is still designated by as rural. San Diego physicians and patients alone lose $26 million in Medicare funding each year because of the inaccurate rural designation.
The locality update (known as the California "GPCI fix") is part of the “Protecting Access to Medicare Act of 2014” bill passed by the House and Senate last week to postpone for one year the 24 percent cut to Medicare physician payments as called for under the fatally flawed sustainable growth rate (SGR). The bill (H.R. 4302) was signed into law by the President on April 1.
The California GPCI fix will increase payments to physicians in 14 counties by $50 million annually to over $400 million in the next decade. The rate increase begins in 2017 and will be phased in each year until full implementation in 2022. The counties poised to see reimbursement increases are San Benito, Santa Cruz, Marin, Santa Barbara, San Diego, Monterey, Sonoma, Placer, El Dorado, Yolo, Sacramento, San Luis Obispo, Riverside and San Bernardino.
Because private health plans in these areas tie their fee schedules to the Medicare fee schedule, this will help access to care for all California patients, not just Medicare seniors.
Locality 3 counties of Napa and Solano and Locality 99’s remaining rural counties will be held harmless from cuts. (In other words, their geographic rates will never be lower than their current rates.) Their rates can increase as costs go up but they will never be cut below the current floor. San Francisco, Santa Clara, San Mateo, Alameda, Contra Costa, Orange, Ventura and Los Angeles counties have always been in their own localities and reimbursed at their local costs to provide care. This will continue under the MSA system.
This is a huge win for California patients and physicians. It will maintain and improve access to care in many regions of California.
CMA has many California Members of Congress to thank for the herculean bipartisan team effort to finally get the California locality reform through Congress and signed into law. CMA extends its strongest thank you to our long-time Congressional GPCI quarterback, Congressman Sam Farr (D-Santa Cruz, San Benito, Monterey) for his perseverance to see this through. Congressman Farr and Congressman Darrell Issa (R-San Diego) led the Congressional effort and were extremely effective in passing this law. CMA also extends its gratitude to Congressman Henry Waxman (D-LA), ranking Democrat on the Energy and Commerce Committee, who originally included the California provision in the Committee’s bipartisan Medicare SGR bill, setting the stage for its final passage. CMA must also express its deep appreciation to California's Senators Dianne Feinstein and Barbara Boxer who, for the first time in six years, were able to convince the Senate leaders to include the California reform in the Senate Medicare SGR legislation. Senator Feinstein’s leadership on the Senate side was key. And sincere thanks to House Majority Whip, Congressman Kevin McCarthy (R-Bakersfield), for his willingness to protect California’s rural physicians and include the California reform in the final SGR patch legislation.
California Energy Commerce Committee members, Anna Eshoo (D-Santa Clara), Lois Capps (D-Santa Barbara) and Doris Matsui (D-Sacramento), Ways and Means Committee members Mike Thompson (D-Napa, Sonoma, Solano) and Devin Nunes (R-Tulare), and House Leader Nancy Pelosi made this issue a priority and were instrumental in moving it through their committees and the House.
Contact: Elizabeth McNeil, (800) 786-4262 or

SGR patched through for another year

Today, the U.S. Senate passed a year-long patch to stop the 24 percent Medicare sustainable growth rate (SGR) cut that was to go into effect on April 1. The bill, which already passed the U.S. House of Representatives last week, provides a 0.5 percent physician payment update through December 31, 2014, and then a 0 percent update until April 1, 2015. The bill now goes to President Obama for his signature.
Congress was again unable to come to an agreement on how to fund a permanent repeal of the badly broken formula, despite a bill with bipartisan, bicameral support. Congress appears poised to kick the can down the road for the 17th time in just 10 years. The California Medical Association (CMA) is extremely disappointed that Congress has been unable to find bipartisan funding sources and seize the unprecedented momentum of support for permanent Medicare payment reform.
On a bright note, the patch bill does include the California Medicare locality update, known as the California geographic practice cost index (GPCI) fix. The long overdue GPCI fix will update California’s Medicare physician payment regions and raise payment levels for urban counties misclassified as rural, while holding remaining rural counties harmless from cuts. The bill also delays for one year the ICD-10 medical billing coding conversion, pushing the implementation date to October 15, 2015.
Over 90 national, state and specialty physician organizations called for a no vote on this legislation in both the House and the Senate. The one-year patch is expected to cost roughly $20 billion. A significant chunk of that money will be generated through a budget gimmick, extending Medicare sequester cuts beyond the 10-year window used for budget scoring purposes. It is also funded with other physician cuts from misvalued codes and imaging criteria. Some funding came from hospitals and nursing homes.
CMA has worked hard this past year with the American Medical Association to develop legislation to repeal the Medicare SGR and importantly, establish a new Medicare payment system. The bill was adopted by all three House and Senate Committees on a bicameral, bipartisan, unanimous vote. However, without bipartisan agreement between the House and Senate leadership on how to pay for the repeal, there could not be a permanent fix of the flawed SGR.
“This past year, CMA led the movement for SGR reform at the AMA House of Delegates and worked aggressively with Congress to pass Medicare SGR reform legislation,” said CMA President Richard E. Thorp, M.D. “We will continue to fight for a permanent reform that stabilizes Medicare for physicians and improves access for patients to the doctor of their choice.”
It is unfortunate that Congress resorted to partisan funding sources that destroyed the bipartisan effort that had characterized the process earlier in the year. Congress largely ran out of time to engage in the final tough negotiation over the financing.
CMA and organized medicine will be working in the next few months on a revised political strategy to develop viable funding sources and achieve a permanent solution before next year.
Contact: Elizabeth McNeil, (800) 786-4262 or

House passes year-long SGR patch, includes California GPCI fix

This morning the U.S. House of Representatives passed a year-long patch to stop the Medicare 24 percent sustainable growth rate (SGR) cut on an unusual 30-second voice vote. Unable to come to an agreement on how to fund a permanent repeal of the badly broken formula, despite a bill with bipartisan, bicameral support, Congress appears poised to kick the can down the road for the 17th time in just 10 years. The California Medical Association (CMA) is extremely disappointed that Congress has been unable to find bipartisan funding sources and seize the unprecedented momentum of support for permanent Medicare payment reform.
The House bill, “Protecting Access to Medicare Act of 2014” (H.R. 4302), provides a 0.5 percent physician payment update through December 31, 2014, and then a 0 percent update until April 1, 2015. It also includes the California Medicare locality update, known as the California geographic practice cost index (GPCI) fix. The GPCI fix holds rural physicians harmless from cuts permanently. The bill also delays for one year the ICD-10 medical billing coding conversion, until October 15, 2015.
Yesterday CMA circulated a letter urging the House to take the time to fund the permanent repeal and pass it rather than adopting another year-long patch. The letter supported the “perseverance of the House and Senate Committees to achieve a bipartisan, bicameral agreement to repeal the flawed Medicare SGR and institute a reasonable new payment system.” The letter also asked the House Speaker Boehner and Senate Leader Reid to return “to the negotiating table and finishing the important work to achieve permanent reform.”
Practically speaking, Congress has until April 14 to resolve the remaining differences over the bill’s financing before the 24 percent SGR cut actually takes effect. Preventing the SGR cut is imperative to maintaining patient access to physicians in California.
Over 90 national, state and specialty physician organizations called for a no vote on this legislation in the House of Representatives. The one-year patch is expected to cost roughly $20 billion. A significant chunk of that money will be generated through a budget gimmick, extending Medicare sequester cuts beyond the 10-year window used for budget scoring purposes. It is also funded with other physician cuts from misvalued codes and imaging criteria. Some funding came from hospitals and nursing homes.
The situation in the Senate is still fluid because new Finance Committee Chairman, Ron Wyden (D-OR), wants a vote on the permanent reform before resorting to a vote on another patch. However, the Senate could vote on a patch before the weekend.
Despite the welcome delay in the costly, burdensome ICD-10 coding system and the permanent California GPCI locality update, CMA could NOT support another short-term patch and is still pushing for real reform to the SGR. A short-term patch is no longer acceptable to California physicians. Some have argued that a patch will give Congress more time to negotiate permanent reform, but history informs us otherwise.
This latest patch is part of a decade long string of patches that have cost U.S. taxpayers $150 billion, close to the cost of a permanent fix. Moreover, many of the physician funding sources in the current patch legislation could be more cost-effectively applied in a permanent reform bill.
To see the bill passed by the House, click here.
Contact: Elizabeth McNeil, (800) 786-4262 or

CMS suspends RAC audits, sets up physician safeguards

Physicians and hospitals will get a short reprieve from Medicare’s recovery audit contractors (RAC) until next fall, according to the Centers for Medicare & Medicaid Services (CMS). The agency says it is temporarily halting audits as it reevaluates its contracts and implements improvements for physicians. The RAC program is responsible for identifying fraud and waste in the Medicare system by detecting improper Medicare payments.
Last month, CMS announced it would pause any new additional document requests (ADR) from RACs until new contracts are settled, in order to reduce provider confusion and create a smooth transition once new RAC contracts are awarded. The document requests primarily affected hospital and facility services.
Although the RAC documentation requests for audits are suspended, recovery auditors will complete the audits for the claims for which they sent ADR requests through February 28, 2014. RAC’s will also continue the automated reviews that do not require additional medical record documentation through June 1.
CMS announced further changes to the program this week that will provide much-needed safeguards for physicians. These include requiring RACs to wait 30 days before asking the Medicare administrative contractor to recoup payments determined to be improper. This delay will allow time for physicians to discuss the results of the audit with the RAC. Previously, the short timeline for appeals meant that physicians had to immediately choose between initiating a discussion and filing an appeal.
RACs will also no longer receive a contingency fee directly following the recoupment of a payment they deemed “improper.” Rather, if a physician chooses to appeal the results of an audit, the RAC will not be paid until the physician has exhausted the second level of appeal. Auditors will also now be required to confirm receipt of a physician's request for discussion within three days. Previously, no such confirmation was required, leading to frustration among physicians, particularly given the short timeline for document production, discussion and appeal.

Medicare ICD-10 front-end testing week extended

Due to the success of the first week of ICD-10 testing, Noridian has partnered with Centers for Medicare & Medicaid Services (CMS) to continue acceptance testing for EDI submitters and vendors for an indefinite period.
The purpose of acceptance testing is to ensure that base system functionality and front end editing have been updated for ICD-10 and are functioning correctly. Acceptance testing will help ensure you are ready for the October 2014 implementation of ICD-10.
The California Medical Association (CMA) encourages all direct EDI submitters and vendors to test with Noridian. Those who wish to take advantage of this opportunity must register. Additional information is available at the Noridian EDISS ICD-10 Resource Center.
Billing experts advise physicians to start preparing for the ICD-10 transition now if they haven’t yet done so. Steps to take include upgrading software systems, testing those updated systems, training staff and updating payer contracts and fee schedules. The American Medical Association (AMA) offers free educational resources that can help physicians get started. CMA has also partnered with AAPC to provide various ICD-10 training courses to members at a discounted rate. For more information, visit

House-passed SGR repeal with mandate penalty delay is DOA

In a 238-181 vote, the U.S. House of Representatives today passed HR 4015, a bill to repeal the Medicare sustainable growth rate (SGR) and put in place a replacement payment system with an amendment offered by House Republican leaders that would pay for the repeal through a five-year delay of the Affordable Care act's individual mandate penalty.
Though cheered by House Republicans, the legislation is viewed as "dead on arrival" by policy analysts and health care providers, as its defeat in the U.S. Senate is a near certainty. The move is seen as purely a political move that is not likely to go anywhere beyond the House floor.
Although there is bipartisan, bicameral support for the SGR repeal, there is no consensus on how to pay for it. House Democrats, meanwhile, attempted amendments in the Rules Committee to add unspent military funds from Iraq and Afghanistan as the funding source, but those motions were defeated. If the funding proposals are not settled soon, Congress may adopt another temporary nine month patch to stop the 24 percent SGR cuts.
The California Medical Association (CMA) continues to urge Congress to go back to the negotiating table and find bipartisan funding sources. CMA is opposing another nine month patch.  CMA is calling upon Congress to FIX MEDICARE NOW!
On Wednesday, the Senate Leader, Harry Reid, filed a motion to consider the Senate’s identical version of the Medicare legislation, S. 2000 after they return from recess. Like the House bill, the Senate legislation does not include a bipartisan way to pay for the legislation.
The House and Senate have decided to take a one week recess next week and will not be returning to Washington, D.C. until Monday, March 24.  We are at a crucial juncture in the process, and encourage all physicians to call, email and meet with their representatives while they are in the state to let them know that a bipartisan payment solution for the bill needs to be negotiated.
CMA continues to fight to get the bipartisan, bicameral Medicare SGR legislation with the California locality update across the goal line before March 31. CMA and the American Medical Association (AMA) have sent letters to House and Senate leadership letting them know that a nine-month patch is unacceptable.
To overcome the opposition, Congress needs to hear from a large volume of physicians. Tell congress to pass a Medicare SGR bill with a bipartisan funding source and to oppose anther one-year patch.
Please make as many calls and send as many emails as possible. Everyone makes a difference! We are asking physicians to call/email the following individuals:

  • Your local congressional representative (use your local zip code)
  • California Senator Barbara Boxer
  • California Senator Dianne Feinstein
  • House Republican Whip Kevin McCarthy (zip code 93309)
  • House Democratic Leader Nancy Pelosi (zip code 94103)

To contact members of Congress:
Call AMA’s Grassroots Hotline, (888) 434-6200, to be connected with your members of Congress in Washington. You will be asked to enter your zip code and select your representative. You are also encouraged to call your representatives in their local district offices.
You may also email your federal legislators via the AMA's "Fix Medicare Now" grassroots website. Physicians can use the sample letter provided on the page, it takes no more than two minutes.
Physicians can ask their patients to take a "Fix Medicare Now" flyer and call their representatives, too.
Visit the CMA’s grassroots action center for more information, including talking points and legislator contact information.


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