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10 Things to Do and Know About MIPS Reporting Deadlines

Deadlines are fast approaching if you plan to submit data for the 2017 Merit-based Incentive Payment System (MIPS) performance period. Don’t wait until the last minute to submit your data.  Submit early and often. The two key dates are: March 16 at 8 pm Eastern time for group reporting via the CMS web interface March 31 for all other MIPS reporting, including via qpp.cms.gov Now is the time to act. Here are the top 10 things you need to do and know ...

CMS proposes 1.84% Medicare Advantage payment increase

The Centers for Medicare and Medicaid Services (CMS) has proposed increasing baseline Medicare Advantage payment rates for 2019 by an average of 1.84 percent. According to CMS, the proposed payment increase is based on better use of encounter data and changes to the risk adjustment model used to pay for aged and disabled beneficiaries. Medicare Advantage is at an all-time high, with approximately one-third of all Medicare beneficiaries enrolled in a Medicare managed care plan. Enrollment has more than doubled over the past decade. CMS is accepting comments on the proposal until ...

New Anthem anesthesia policy can have blinding consequences

A policy change made by health insurer Anthem, Inc. could result in increased risk for many patients – up to and including blindness – if not immediately rescinded, according to physicians’ groups. The California Academy of Eye Physicians and Surgeons (CAEPS) and the California Society of Anesthesiologists (CSA) have sent letters to Anthem Inc. requesting that they immediately rescind a new policy that deems Monitored Anesthesia Care (MAC) “not medically necessary” during “routine” cataract surgery – a move seen as endangering patients. These were followed up with complaints to the ...

Register today for IMQ's Stepping Up to Leadership Conference

The Institute for Medical Quality’s (IMQ) Stepping Up to Leadership conference will be held at the Paradise Point Resort and Spa in San Diego on February 22-23, 2018.  This program is widely recognized as the “go to” course for acquiring knowledge and skills to successfully lead a medical staff. Offered in conjunction with the University of California, San Diego PACE Program, the program was developed in response to a commonly expressed need for better, more practical hands-on training for medical staff leaders.  In addition to interactive training in communicating and handling ...

State awards $30.5 million in primary care residency program funding

The California Healthcare Workforce Policy Commission awarded upwards of $30.5 million to support more than 175 primary care residency slots for the 2017 cycle of the Song Brown Healthcare Workforce Training Program. A record number of applications were received this year, in large part due to the additional physician workforce funding secured by the California Medical Association (CMA) through the state budget. In 2016, the California legislature passed a budget that committed $100 million over three years ($33 million each year) in health care workforce funding. Although Governor Brown proposed ...

Take the #MoveWithHeart pledge

This American Heart Month, the California Medical Association is joining the National Heart, Lung, and Blood Institute in a national pledge to #MoveWithHeart. We invite you to submit a pledge by recording a video of yourself and upload it to Twitter or Instagram using #MoveWithHeart or go to www.MoveWithHeartPledge.com. Participate in just three simple steps: Record a short video of yourself saying “I pledge to move more for my heart health.” Share it on Twitter or Instagram using #MoveWithHeart. Challenge friends ...

CMA calls for investigation into Anthem policy restricting use of sedation during cataract surgery

On December 27, 2017, Anthem Blue Cross implemented a clinical guideline that restricts the use of intravenous anesthesia to sedate patients during cataract surgery. The California Medical Association (CMA) believes this drastic change in policy will cause significant patient safety concerns and put patients at risk of serious complications, including blindness. The new policy, “Anesthesia for Cataract Surgery,” deems intravenous anesthesia (including moderate sedation, monitored anesthesia care or general anesthesia) not medically necessary, except in very narrow circumstances. Anthem patients wishing to have any form of intravenous anesthesia during the ...

Fake DEA extortion scam resurfaces in California

Scam artists posing as U.S. Drug Enforcement Administration (DEA) agents are calling California physicians and consumers as part of an international extortion scheme. While the scam is not new—it’s been making the rounds for the past five years—a number of California physicians have reported recent extortion attempts. The scammers identify themselves as DEA agents or other law enforcement, telling their victims that purchasing drugs via phone or internet is illegal and that enforcement action will be taken against them if they don’t pay a fine, usually thousands of dollars. No DEA ...

February is Heart Month: Help spread the word

Did you know that 1,458,000 people in California have coronary heart disease? Although heart disease is the leading cause of death in the United States, it is largely preventable and there are many things your patients can do to reduce their risk. To mark the start of this year’s #HeartMonth, the National Heart, Lung and Blood Institute (NHLBI) and its The Heart Truth program have developed a toolkit to help raise awareness about heart disease. The toolkit contains educational materials to use in your practice and your community, social media ...

Health plans terminate contracts with EHS and transition patients to other entities

As previously reported, the California Department of Managed Health Care (DMHC) issued a cease-and-desist order on December 26, 2017, requiring nine health plans to terminate their contracts with Employee Health Systems (EHS) Medical Group Inc. This order comes after SynerMed—a company closely affiliated with EHS—was accused of blocking patient access to specialists to hold down costs. EHS has 600,000 patients statewide—90 percent of whom are Medi-Cal managed care patients. As required by DMHC, health plans affected by this order were required to submit a transition plan by January 3, 2018, ...