Thursday, December 13, 2018

Volunteers Needed to Serve on RCMA Strategic Plan Work Groups

Dear RCMA Members:

Recently your Board of Councilors held its tri-annual Board Leadership Retreat to identify the Strategic Priorities for the RCMA for the next two years. DOWNLOAD REATREAT SUMMARY. Three top priorities were identified and we are now soliciting interest and expertise from our membership to help us attain these goals on behalf of our members.

Please consider volunteering to serve on one of three (3) workgroups that will be forming to address our Strategic Priorities. The Priorities are:

Priority #1: Assisting Members’ Practices in Transitioning to Value Based Care
This workgroup will help practices identify areas of improvement and provide strategies to increase efficiency, lower costs, prepare for risk-based contracts, use technology efficiently, design effective workflows, provide business training for physicians and staff and build effective teams.

Priority #2: Physician Wellness – “The Joy of Medicine”
The Physician Wellness Workgroup will collaborate with CMA on their new Statewide Wellness Program and develop local Riverside County programs and resources to support the local physician community including peer support groups, regional meetings/retreats, socials, community wellness/well-being committees, intervention best practices and work/life balance tools.

Priority #3: Membership
The Membership Workgroup will develop membership campaigns focused on different modes of practice, increase member engagement through the use of Podcasts/YouTube, local social group activities and identifying relevant educational programs to serve members and nonmembers,

To volunteer to serve on one of these workgroups, visit www.surveymonkey.com/r/RCMASurvey. If you would like to read the Retreat Summary or more information on the Priorities please go to www.rcmanet.org

We anticipate that each workgroup will meet via conference call 3-4 timers per year unless an in person meeting becomes necessary.

Thank you for volunteering and helping to guide the RCMA in continuing to develop programs and services to assist its members. Please feel free to call or email our Executive Director, Dolores Green, (951) 686-3342 or dgreen@rcmanet.org with any questions.

Best regards,

Raj Sindher, M.D.                 Frank Flowers, M.D.
President                              President-Elect


Social Media Tips for Medical Practices: A How-To Guide

The benefits of using social media in a medical practice are becoming increasingly recognized, which makes the pressure to get involved even greater. As medical practices become more and more sophisticated at using social media for knowledge sharing, marketing, and other forms of communication, those who fail to participate will fall behind. These social media tips for medical practices can help you get started.


RCMA/CMA's Advocacy Secures $1 Billion+ for Medi-Cal Providers

In 2016, and with a $1 million investment, the California Medical Association (CMA) led a coalition to take on Big Tobacco to improve access to care through Medi-Cal.

California voters overwhelmingly approved Prop 56, which added a $2 tax on tobacco products and stipulated that funds should increase access by improving provider payments. California's 2018-2019 state budget continues to provide over $1 billion annually to improve provider payments so more Medi-Cal patients can access care when they need it most. Other key investments include graduate medical education (GME) funding increases and school loan repayments.

What Does This Mean For Riverside County Doctors?
This supplemental funding affects both fee-for-service Medi-Cal as well as Medi-Cal Managed Care. Click Here to view a comparison of Prop 56 payments by year as well as how these new reimbursements compare to current Medicare Rates in Riverside County.

RCMA has been informed that Inland Empire Health Plan (IEHP) will be paying FY 2018/2019 at the enhanced rates, including the additional E&M codes, starting July 1, 2018. However, given the lag in encounter data and timing of payments, the first enhanced payments physicians will see this Fall will be 2017/2018 timeframe payments.  The first quarter payment for 2018/2019 will not be until early 2019.  

Look for further communication from IEHP in the next few weeks. Payments will be made directly to IEHP providers based on encounter submissions reflecting the E&M codes shown in the Rate Comparison Chart

For Further Information Please Contact:
Riverside County Medical Assoication
(800) 472-6204

or

Inland Empire Health Plan (IEHP)
(909) 890-2054
 


Opioid Advocacy Update

From the beginning of the opioid epidemic, the California Medical Association (CMA) has been one of the most engaged and determined stakeholders working to strike a balance between patient access to necessary medicine and preventing and addressing abuse.

 

CMA has been a leader in advocating for increased funding, access and availability of preventive services, opioid-use disorder treatment programs and non-opioid therapies, including mental health services and medication-assisted treatment (MAT). We have successfully worked to stop legislation that interferes with the practice of medicine and creates barriers to care, such as government-mandated dosage and duration limits.

 

Over the last few years, the changing landscape surrounding prescribing opioids has been dizzying as payors, legislators, pharmacies and medical boards seek ways to be proactive in addressing the opioid epidemic – sometimes ignoring the actual realities of medical practice and creating barriers to good care. And as you’re aware, California physicians have been engaged in the debate since the beginning, on behalf of our patients and profession.

 

CMA released a white paper, “Opioid Analgesics in California: Relieving Pain, Preventing Misuse, Finding Balance” in 2013. Developed through CMA’s Council on Science and Public Health, it has been the cornerstone of our work to educate physician colleagues, guide the medical board and policymakers, and help health care stakeholders navigate the evolving science related to opioids. At its core is the premise that care must be evidence-based and reflect the individual needs of the patient – ultimately, allowing physicians to make proper care decisions.

 

CMA’s emphasis on these principles has remained constant, including advocacy on opioid-related activities in 2018, which include:

 

Controlled Substance Utilization Review and Evaluation System (CURES): CMA has been working with the state for years to ensure adequate educational and technical support for physicians who will have to check CURES as part of their prescribing workflow, starting on October 2, 2018. CMA has advocated for sustained user outreach and educational efforts by the state that provide clarity of this new law, as well as prioritize the clinician perspective on an ongoing basis following implementation. We will continue to engage as the new requirement to consult CURES is implemented and work with stakeholders to ensure CURES has adequate support.

 

Ensuring Fair Enforcement: The Medical Board of California is examining deaths associated with the use of prescription opioids and is reviewing whether the care and treatment provided by physicians to those individuals met the standard of care. As part of a “routine” review, the board sent letters to physicians who were identified as prescribing opioids in a manner that, after physician review, merited further investigation, and requested that those physicians submit additional information including a summary of the care provided, the patient’s medical records, and any additional materials that would be pertinent to the board’s investigation.

 

CMA has raised concerns about the board’s process and will continue to work with the board to address physician concerns, monitor the board's process to determine whether disciplinary actions are based on the appropriate standard of care, and if the process used to identify physicians subject to these inquiries needs additional transparency or modification. Physicians who are under review may contact CMA (800-786-4262, CMAdocs.org) for information about the disciplinary process and their legal rights.

 

Access to Medication-Assisted Treatment and Overdose Reversal Medications: To help reduce the rates of overdose and stigma associated with opioid-use disorder, CMA sponsored AB 2384 (Arambula), which would have removed barriers to coverage of MAT services and naloxone to ensure that people who face addiction have better access to treatment. Governor Jerry Brown vetoed AB 2384, claiming a need for utilization controls and barriers to patient access of life-saving treatments. In response, CMA issued a statement expressing disappointment and concern, while reiterating our intention to work with the next governor to make this issue a priority in 2019.

 

The federal opioid bill continues to push treatment in the right direction by providing grants to improve access to MAT and codifying the ability for physicians to prescribe MAT for up to 275 patients, which is critical since the current caps are far too limiting and leave many patients on waiting lists for years.

 

Individual Patient Care: At the federal level, CMA successfully fought back against legislation that would have required one-size-fits-all medicine by mandating prescription drug dosage and duration limits.

 

California legislators also sought to statutorily limit dosages and durations of opioid pain relievers through AB 2741 (Burke) and AB 1998 (Rodriguez), using arbitrary and minimal amounts. Both bills were defeated earlier this year.

 

Federal Funding and the Congressional Opioid Crisis Response: Earlier this year, Congress approved $10 billion in new funding for states to address opioid-related education, prevention, treatment and law enforcement issues. The House and Senate reached an agreement on the “Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act,” and they will send it to President Donald Trump soon. It is a comprehensive package of more than 300 bills that, among other things, provides grants to states to address prevention and treatment, as well as stop the flow of illicit drugs, such as fentanyl. It also expands the number of Institute for Mental Diseases inpatient Medi-Cal beds available for opioid substance abuse disorder treatment and enhances Medi-Cal patient access to non-opioid options. Medicare coverage for treatment has been expanded, with new Medicare payment and delivery demonstration projects approved for comprehensive management of opioid-use disorder.

 

Unfortunately, the bill package also includes a mandate for physicians to e-prescribe controlled substances for Medicare patients after January 1, 2021. However, it includes many exceptions, and it directs the Centers for Medicare and Medicaid Services to implement additional exceptions. In a major win, the Drug Enforcement Administration (DEA) has been mandated to update its antiquated and burdensome process for e-prescribing. While more than 90 percent of physicians e-prescribe, only 21 percent e-prescribe controlled substances, largely due to the DEA’s burdensome requirements. The state mandate takes effect in 2022.

 

Physician Education on Safe Prescribing and Treatment: Governor Brown recently signed AB 2487 (McCarty), which originally mandated all California physicians to take an eight-hour course required to qualify for a federal waiver to the Drug and Addiction Treatment Act of 2000 in order to allow physicians to prescribe MAT drugs, like buprenorphine, outside of an opioid treatment center.

 

After CMA-led negotiations with the author, the bill was amended to allow physicians who seek to prescribe MAT to fulfill their annual continuing education requirement by completing the DATA-Waivered Physician course along with four additional credit hours on treating substance use disorders. Successful advocacy prevented additional and mandatory continuing education.

 

The road has been long and hard-fought, and California’s comprehensive approach has focused on safe prescribing, naloxone distribution, public education campaigns, local opioid safety coalitions and increasing access to treatment, including MAT.

 

This approach has produced promising results. From 2013-2017, California experienced over a 24 percent decrease in opioid prescriptions, and is only one of five states with a multi-year decrease in prescription opioid overdoses. California is now tied for the lowest per capita opioid prescription rate in the country, while opioid prescribing has decreased for the fifth year in a row.

 

More work remains, as the drugs responsible for these overdose deaths are changing and have been spurred by illicit fentanyl. CMA will continue to work with policymakers, elected officials and health care stakeholders to ensure your voice – and your patients’ voices – are heard.

 

ADDITIONAL RESOURCES:

 

White Papers:

 

Webinars:

 


AB 3087 Defeated

Assembly Bill 3087 (Kalra) has been defeated.  This dangerous legislation would have created a commission of unelected political appointees empowered to arbitrarily cap rates for all health care services in all clinics, hospitals and physician practices in California. 

Thousands of physician members contacted their legislators because AB 3087 would have:

  • Decimated California’s health care delivery system.
  • Disrupted care and limited choice for millions of California patients.
  • Caused 175,000 health care workers to lose their jobs.
  • Forced hospitals to close and pushed health care providers into early retirement.
  • Caused a “brain drain” of talented medical students and residents fleeing California for more ideal working conditions.

 


RCMA's Free Saving Private Practice Consortium 8/18/2018 Murrieta

All physicians and their practice administrators are invited to get the help they need to survive and thrive in the ever-changing world of healthcare. Free 15 minute personal one-on-one consultations will be scheduled with RCMA/CMA subject matter experts and industry experts serving the local physician community. This is a great opportunity for physicians to get their questions answered, problems solved, and explore resources that can help doctors continue caring for their patients irregardless of their mode of practice.

SPECIAL GUEST SPEAKER: Janus Norman, Senior Vice President, CMA Centers for Government Relations & Political Operations

Download Flyer                              RSVP Online

AREAS OF CONSULTATION INCLUDE:

  • All Practice & Personal Insurance
  • Billing & Collections
  • EHR & HIE Implementation
  • Estate Planning & Asset Protection
  • Information Technology
  • Legal Support
  • Malpractice Risk Management
  • Medi-Cal & Medicare
  • Office Staffing
  •  
  • Professional Liability Insurance
  • Payor Contracting
  • Payor Advocacy
  • Payor Reimbursement Support
  • Physician Employment Contracting
  • Physician Recruitment
  • Practice Management
  • Practice Cost Reduction
  • Strategic Planning
  •  

    MEET THE EXPERTS

    California Medical Association Center for Economic Services
    Areas of Consultation: Practice Management, Medicare, Medi-Cal, Payor Contracting, Denied Claims
    CMA’s Center for Economic Services (CES) is staffed with practice management experts with over 125 years in medical practice operations experience. With the combined strength of all the departments of the CMA, CES is able to empower physician practices by providing resources and guidance to improve the success of the practice. Assistance ranges from coaching and education to direct intervention with payors or regulators.
    CMA CES experts onsite at Saving Private Practice include:
      Cheryl Bradley, Associate Director - Medicare
      Kris Mark, Associate Director - Medi-Cal & Contracting
      Mitzi Young, Physician Advocate - Practice Management & Denied Claims

    Inland Empire Health Information Organization (IEHIO)
    Areas of Consultation: HIE Connections, EHR Implementation, EHR Workflow & Documentation
    IEHIO is a non-profit grass-roots organization providing linkage between healthcare stakeholders in the Inland Empire and Manifest MedEX, California’s HIE. IEHIO goals are to coordinate data sharing services not only for treatment at the point of care, but also for care management and population health analytics specific to participant needs and programs; while promoting a community-wide data-sharing model that improves healthcare for all residents of the Inland Empire.
    IEHIO experts onsite at Saving Private Practice include: Stacy Proctor, IEHIO, Program Director & Cardelia Reid, RN, MSN, MBA, IEHIO Clinical Informatics Director.

    Intalare
    Areas of Consultation: Reducing Practice Costs, Purchasing
    Intalare is a Group Purchasing Organization (GPO) with more 35,000 physicians offices and clinics as clients nationwide who trust Intalare to provide the products and services they need most at the best possible price! By aggregating purchasing volume as a group practices can leverage superior pricing and save money on everything a physician practice buys.
    Intalare experts onsite at Saving Private Practice include: Jennifer Brons, Intalare, Account Manager

    MediQuest Staffing
    Areas of Consultation: Office Staffing (Hiring, Interviewing, Salary Surveys, Retention Strategies, Difficult Employees, etc.)
    MediQuest Staffing matches high-quality healthcare professionals with fully screened, talented medical support staff such as front and back office MAs, billers, coders, medical collections, and practice managers to name just a few.
    MediQuest experts onsite at Saving Private Practice include: Rachael McGarvey, MediQuest, Regional Service & Delivery Manager

    Mercer Health & Benefits Insurance Services, LLC
    Areas of Consultation: Practice Insurance & Personal Insurances
    RCMA’s endorsed Business Partner Mercer provides information to make informed decisions with your needs in mind. Available programs include: Workers’ Compensation, Individual and Small-Group Health insurance, Cyber Liability, Life, Disability, Business Owners Policies, Long-Term Care and more.
    Mercer experts onsite at Saving Private Practice include: Liz Fogle, Mercer, Relationship Manager

    NetServe Systems, Inc.
    Areas of Consultation: IT, Cloud Services, HIPAA, Network/Security Risk Assessments, Technical Consultations
    NetServe Systems is a comprehensive one-stop IT solution for medical offices handling ALL your IT needs.
    NetServe Systems experts onsite at Saving Private Practice include: Abdi Ahmed, NetServe Systems, CEO

    NORCAL Group
    Areas of Consultation:
    Medical Professional Liability Insurance, Risk Management
    As RCMA’s endorsed partner, NORCAL Group has over 32,000 insureds including physicians, medical groups, clinics, hospitals and healthcare facilities. NORCAL continually strives to remain true to their history and values, and to maintain their singular focus on protecting their policyholders’ careers and professional reputations while supporting the delivery of safe, quality patient care.
    NORCAL Group experts onsite at Saving Private Practice include:
    Bradford S. Dunkin, MHA, NORCAL Group, Sr. Risk Management Specialist & Belinda Ramon, NORCAL Group, Regional Business Development Representative

    RCMA Physician Workforce Development
    Areas of Consultation:
    Physician & Mid-Level Provider Recruitment and Resources

    RCMA is committed to addressing the physician shortage in Inland Southern California and RCMA’s Physician Recruitment Development Director is available to meet with you and provide additional help and resources to help you hire an associate.
    RCMA experts onsite at Saving Private Practice include:
    Sonya Jackson, RCMA, Physician Workforce Development Director

    Thakur Law Firm, APC
    Areas of Consultation:
    Healthcare Law, Employment Law, Business &Corporate Law, Real Estate Law, Estate Planning & Asset Protection
    Thakur Law Firm is a full service law firm with expertise in Health Care Law, Business & Employment Law, Estate Planning, Real Estate, Tax Law and Litigation. Thakur Law Firm, APC is a full service law firm with expertise in Health Care Law, Business & Employment Law, Estate Planning, Real Estate, Tax Law and Litigation.
    Thakur Law Firm experts onsite at Saving Private Practice include: Pamela Thakur, Esq., Jas Sondh, Esq. & Ash Dudheker, Esq.

    Universal Financial Systems
    Areas of Consultation:
    Medical Billing & Collections
    Universal Financial Systems (UFS) is a Southern California based financial services company specializing in medical billing & collections, consumer & commercial collections, litigation & judgment collections, accounting services and general business consulting.
    UFS experts onsite at Saving Private Practice include: George Christidis, UFS, COO

    Zymeda Provider Solutions
    Areas of Consultation:
    Practice Management, Strategic Planning, Payor Contracting, Billing Zymeda Provider Solutions is a full service practice management partner offering services in strategic planning, operational process improvement, billing, medical practice staffing and training, benefit administration and managed care operations.
    Zymeda experts onsite at Saving Private Practice include: Helene Beilman-Werner, Zymeda, CEO & Pam Geukens, Zymeda, Director of Operations

    Are You Ready to Check CURES?

    Effective October 2, 2018, physicians must consult California’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) – prior to prescribing Schedule II, III or IV controlled substances. All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate must be registered to use CURES.

    Because of the critical importance of adequate technical support for physicians who will have to rely on CURES as a part of their prescribing workflow, the California Medical Association (CMA) negotiated into the final legislation a requirement that the mandate could not take effect until the California Department of Justice (DOJ) certified that the database was ready for statewide use and that the department had adequate staff to handle the related technical and administrative workload.
      

    On April 2, 2018—two years after the law was enacted—DOJ finally certified that CURES was ready for statewide use. The certification began a six-month transition period, with the duty-to-consult taking full effect on October 2, 2018.

    What Physicians Need to Know
    Under the new mandate, physicians must consult the database prior to prescribing controlled substances to a patient for the first time, and at least once every four months thereafter if that substance remains part of the patient’s treatment. Physicians must consult CURES no earlier than 24 hours or the previous business day prior to the prescribing, ordering, administering or furnishing of a controlled substance to the patient.

    The law provides, however, that the requirement to consult CURES would not apply if doing so would result in the patient’s inability to obtain a prescription in a timely manner and adversely impact the patient’s conditions, so long as the quantity of the controlled substance does not exceed a five-day supply.

    Physicians are also not held to this duty to consult when prescribing controlled substances to patients who are:

    • Admitted to a facility for use while on the premises;
    • In the emergency department of a general acute care hospital, so long as the quantity of the controlled substance does not exceed a seven-day supply;
    • As part of a surgical procedure in a clinic, outpatient setting, health facility or dental office, so long as the quantity of the controlled substance does not exceed a five-day supply; or
    • Receiving hospice care.

    In addition, there are exceptions to the duty to consult when access to CURES is not reasonably possible, CURES is not operational or the database cannot be accessed because of technological limitations that are beyond the control of the physician.

    CMA Fights for CURES Protections
    CMA worked closely with the bill's author and other stakeholders to reach mutually agreeable language, which was reflected in the final version of the bill (SB 482, Lara). Among the negotiated amendments are liability protections related to the duty to consult the database and changes to ensure that health care providers can meet the requirements under state and federal law to provide patients with their own medical information without penalty. The bill also clarifies that health care providers sharing the information within the parameters of HIPAA and the Confidential Medical Information Act, including adding the CURES report to the patient’s medical record, are not out of compliance with the CURES statute.

    Save the Date: CURES webinar with DOJ on 8/22
    CMA will be cohosting a live CURES webinar with DOJ on August 22, 2018. The webinar will be free to all interested parties. Registration will open soon at cmanet.org/events.

    For More Information
    For more information, see CMA On-Call document #3212, “California’s Prescription Drug Monitoring Program: The Controlled Substance Utilization Review and Evaluation System (CURES).” On-Call documents are free to members in CMA's online resource library at www.cmadocs.org. Nonmembers can purchase documents for $2 per page.

    Additional Resources:
    CURES website: oag.ca.gov/cures
    CURES FAQ: oag.ca.gov/cures/faqs
    Medical Board CURES webpage: mbc.ca.gov/cures
    • CMA CURES webpage: cmadocs.org/cures
    • CMA Safe Prescribing webpage: cmadocs.org/safe-prescribing

    CMA will continue to provide educational resources and work with DOJ to ensure a smooth implementation of the new requirement. Physicians who experience problems with the CURES database should contact the DOJ CURES Help Desk at (916) 227-3843 or cures@doj.ca.gov



    Resources for Physicians Affected by the IEHP/Vantage Contract Termination

    As a follow up to the informational meetings RCMA convened for physicians affected by the IEHP/Vantage contract termination, RCMA has posted the following resources to help physicians understand the options available to continue seeing IEHP patients and the next steps that will need to be taken.


    Medical Assistant Survey

    RCMA is collaborating with Moreno Valley College to revise their Medical Assisting program. The goal is to create a program that will not only meet the national accreditation standards but to serve the needs of the physicians/clinics in the Inland Empire. We want our students to be a valuable asset to your office.  

     
    In order to do this, we would greatly appreciate your assistance by completing the Medical Assisting Skills Survey. In doing so, you will ensure that we design a program that will be beneficial to the students and relevant to the needs of your office.  
     
    Thank you for taking the time out of your busy schedule to complete the survey. Your input is greatly appreciated. 

    Survey: How would the AB 3087 price fixing proposal affect your practice?


    Assemblymember Ash Kalra (D-San Jose) last week announced a radical physician rate setting proposal (AB 3087) that would increase patient out-of-pocket costs, create state-sanctioned rationing of health care for all Californians and force physicians out of state or into early retirement.
    The RCMA/CMA are asking physicians to answer a few questions about how AB 3087 will impact their practices. The survey is anonymous and the results will help in our legislative efforts to fight this dangerous and irresponsible legislation.
    Take the survey now at: www.surveymonkey.com/r/ab3087.
    And, if you are among California's physicians that will be forced into early retirement or out of state if AB 3087 passes, we want to tell your story. Drop CMA a line at communications@cmanet.org.

    To Take Action Now Visit: www.actnow.io/PriceFixing

    For more information about AB 3087 click here.

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