Wednesday, January 16, 2019

3 Steps To Responding To Negative Online Comments

The growth of online physician rating sites is causing a lot of physicians to feel like they’re losing control of their reputations. When seeing negative comments online, it’s natural for professionals to want to respond immediately to defend their reputations. But is that always the best course of action?

In this special report, NORCAL’s Risk Management experts discuss the pros and cons of responding to negative online comments and lay out three steps to developing a plan of action for responding to online comments.

Download Report


2016 RCMA Annual Outstanding Contribution Awards

CALL FOR NOMINATIONS: The RCMA is soliciting nominations to recognize and honor deserving individuals for the 2016 Annual Outstanding Contributions Awards. Nominations will be screened by the Awards Committee, with final selection determined by the Board of Councilors. The awards will be presented at the RCMA Installation of Officers Dinner on Friday, January 27, 2017.

Make A Nomination

NOMINATION DEADLINE: FRIDAY, SEPTEMBER 30th

AWARD CATEGORIES:

  • Outstanding Contribution to Organized Medicine: Presented to a RCMA member who through his/her constant support and perpetual service has advanced and achieved the goals of organized medicine.
  • Outstanding Contribution to Medicine: Presented to a RCMA member who has displayed dedication to the advancement and improvement of the medical profession through his/her tireless efforts, innovative ideas and commitment to excellence.
  • Outstanding Contribution to the Medical Association and Its Goals: Presented to a RCMA member who has exhibited long-standing dedication and service to the RCMA over and above that expected by the membership-at-large.
  • Outstanding Contribution to the Community: Presented to a physician or lay person who has exhibited sustained interest and participation in one or more medicine-related activities which has benefited the members of his/her community.

Make A Nomination


Nominations Solicitation

The CMA Committee on Nominations is now seeking nominations for elections of Mode of Practice delegates and alternate delegates for the 2016-2018 terms, which begins July 1, 2016 and runs through June 30, 2018. 

The following seats are now open for nominations:

  • Academic Mode of Practice Forum Delegation represents the special concerns of physicians practicing as part of a medical school faculty.
  • Administrative Forum Delegation represents the special concerns of physicians practicing in administrative settings such as medical directors and administrators of medical organizations.
  • Government Employed Physicians Forum Delegation represents the special concerns of physicians employed by the federal, state or county government.
  • Hospital Based Practice Forum Delegation represents the special concerns of physicians whose practice is based in a hospital.
  • Medium-Size Group Forum Delegation represents the special concerns of physicians who practice in professional medical corporations or partnerships with between five (5) and one-hundred and fifty (150) shareholders, partners, and/or physician employees.
  • Large Group Forum Delegation represents the special concerns of physicians who practice in professional medical corporations or partnerships with between one-hundred and fifty (150) and one thousand (1,000) shareholders, partners and/or physician employees.
  • Very Large Group Forum Delegation represents the special concerns of physicians who practice in professional medical corporations or partnerships with over one thousand (1,000) shareholders, partners and/or physician employees.


RCMA members can apply directly. Nominations must be submitted using the forms below and must be e-mailed no later than Thursday, April 14, 2016 to Nominations@cmanet.org 

Instructions: Please submit nominations to nominations@cmanet.org including:

  • Indication in your email subject line which office/ seat you are interested in
  • Statement of Interest/qualifications. If you are selected as a nominee, this statement will appear alongside your name on the ballot (not to exceed 250 words).

For more information, please contact: Michelle Chapanian mchapanian@cmanet.org or (916) 551-2054

 


2015 Meaningful Use Exception Deadline: July 1, 2016

Because of a delay in the publication of regulations governing the Medicare meaningful use program, CMS is allowing eligible physicians and hospitals to apply for an exception under the “extreme and uncontrollable circumstances” category.

Physicians are urged to preemptively file for a 2015 hardship exception to avoid penalties in 2016.  Physicians are encouraged to apply even if they are uncertain whether they will meet the program requirements this year. Doing so will not preclude physicians from receiving an incentive if they do meet meaningful use requirements, but applying can serve as a safety net in staving off a penalty.

ACTION

Physicians who wish to apply for an exception under the “extreme and uncontrollable circumstances” category need to do the following:

  1. Go to the CMS website and download an application.
  2. Complete the application and check box 2.2.d in order to avoid a penalty under the meaningful use program.
  3. Submit the application.  The deadlines for submitting applications for hardship exceptions are:

For Eligible Physicians: July 1, 2016

 

BACKGROUND

New rules released in 2015 stated that eligible professionals must attest that they met the requirements for meaningful use stage 2 for a period of 90 consecutive days during calendar year 2015. However, the Centers for Medicare and Medicaid Services (CMS) did not publish the updated regulations for stage 2 meaningful use until October 16, 2015. As a result, eligible professionals were not informed of the revised program requirements until fewer than the 90 required days remained in the calendar year.

FOR MORE INFORMATION

 

For more information on the electronic health record (EHR) incentive program, see the CMS tipsheet, "EHR Incentive Programs for Eligible Professionals: What You Need to Know for 2015."

 



The California End of Life Option Act

On October 5, 2015, California became the fifth state in the nation to allow physicians to prescribe terminally ill patients medication to end their lives. ABX2-15, the "End of Life Option Act," permits terminally ill adult patients with capacity to make medical decisions to be prescribed an aid-in-dying medication if certain conditions are met. (ABX2-15, Stats. 2015, Ch.1; Health & Safety Code §§443 et seq.)

The California Medical Association's Center for Legal Affairs has created an On Call document to explain the requirements under the End of Life Option Act.

Download The California End of Life Option Act

Download CA State Death Certificate Instructions

Additional end-of-life resources can be found at www.cmanet.org/endoflife or www.coalitionccc.org/tools-resources/end-of-life-option-act


Why it’s important to verify your patients' eligibility and benefits for 2016

With the new year soon upon us, physicians are urged to be diligent in verifying patients' eligibility and benefits to ensure they will be paid for services rendered. The beginning of a new year means calendar year deductibles and visit frequency limitations reset. With open enrollment there may also be changes to patients’ benefit plans, or patients may even be covered by a new payor.

The new year also brings a host of other challenges that could affect your ability to be paid:

  • Medicare patients can modify their enrollment choices from October 15 through December 7, allowing them to switch between Medicare fee-for-service and Medicare Advantage, or switch from one Advantage plan to another.
  • The Covered California open enrollment period began November 1 and runs through January 31, 2016. Covered California estimates it may enroll more than 300,000 new enrollees during the 2016 open enrollment period. However, existing enrollees also have the option to change plans and/or products.

Along with the 10 existing plans, two new plans are offering coverage on the exchange in 2016. United Healthcare and Oscar are entering the exchange marketplace for 2016 in select regions.

It’s important that physicians and their staff understand their participation status in the various exchange products offered in their areas in order to advise patients before scheduling as to whether they are participating in the patients' plans. For detailed instructions on how to check physician participation status, see CMA’s toolkit, Covered California: Know Your Participation Status, free to CMA members in our exchange resource center at www.cmanet.org/exchange. Contact information for each exchange plan is also included in the toolkit, should practices have additional questions about participation status.

Don’t get stuck with unnecessary denials or an upset patient. Do your homework before the patient arrives by obtaining updated insurance information at the time of scheduling, if possible, and making copies of the insurance card at the time of the visit.

And don't forget that deductibles are typically based on the calendar year and will reset on January 1. Many of the exchange/mirror plans have high deductibles (e.g., $5,000 deductible on the Bronze plan), as do some employer-based plans. This reinforces the importance of verifying patient eligibility – particularly for exchange patients – each time they are seen. Best practice is to communicate with patients upon scheduling to remind them that their plan has a deductible that may be resetting on January 1 and, if that is the case, payment will be due at the time of service. If you offer an appointment reminder service, remind the patient if payment is expected at the time of service. Failure to collect deductibles, copays and coinsurance at the time of service can be very costly for a practice as your ability to collect can decrease significantly after the patient leaves the office.

Taking these proactive steps to protect your practice by preventing denials, delays in payment and disgruntled patients goes a long way toward ultimately saving time and money. 



2015 Legislative Wrap Up

By Janus L. Norman, CMA Senior Vice President

It is difficult to imagine, but the 2015 legislative year was even more challenging than the 2014 legislative year, which included the diversion of staff resources to defeat Proposition 46. With a third of legislators (40 out of 120) serving freshman terms, the California Medical Association’s (CMA) Government Relations staff spent a considerable amount of time during the first quarter educating new legislators and their staff about the mission and policies of CMA. Through our educational efforts, we successfully stopped the introduction of a number of harmful legislative proposals and shifted focus to the passage of CMA’s sponsored bill package.

School Vaccines
A majority of our resources this year went to the passage of SB 277 (Pan and Allen), our sponsored bill eliminating the personal belief exemption (PBE) for school vaccination requirements. We faced relentlessly vocal opposition from anti-vaccine activists, who were supported by the California Chiropractic Association and the newly founded Public Health Council. As it moved through the Legislature, SB 277 had four hearings in various committees, each of which was flooded by protesters. Our strategy to overcome this deluge was to counteract on the same grassroots level from which we were attacked. CMA engaged with school districts, county boards of supervisors and all levels of local government to strengthen support for the bill. Through these and our more traditional lobbying efforts, we were able to see the bill passed out of the Legislature and sent to the Governor’s desk. Although the Governor had 12 days to pass or veto the measure, he chose to sign SB 277 into law less than 24 hours after he received it. In his signing message, he wrote, “The science is clear that vaccines dramatically protect children against a number of infectious and dangerous diseases. While it’s true that no medical intervention is without risk, the evidence shows that immunization powerfully benefits and protects the community.”

SB 277 also garnered tremendous support in the press and from the physician community at large. All through the year, this bill made state and even national headlines. The New York Times, often regarded as the national “newspaper of record,” even editorialized in support of the bill. After SB 277 became law, Senator Richard Pan, M.D., was lauded by TIME magazine as a “hero of vaccine history,” while the Journal of the American Medical Association pointed to SB 277 as a potential catalyst and model for stricter vaccine requirements across the nation. The New England Journal of Medicine chronicled the entire SB 277 story, describing a sea change in the national politics of vaccination. We continue to regularly field calls from allies across the country who are seeking to learn more about what we accomplished and how we did it.

Unfortunately, our time to celebrate the hard-won victory was not long, as we quickly had to turn our attention to new attacks: a referendum to overturn the new law and a recall effort against Dr. Pan for his authorship of it. Through CMA’s political action committee, CALPAC, we will continue to work to defend Dr. Pan and his important law from this spurious attack.

Scope of Practice
Throughout the year, CMA dedicated a vast amount of resources to the successful defeat of several scope-of-practice expansion attempts that were before the Legislature. These measures were: SB 323 (Hernandez), for nurse practitioners; SB 538 (Block), for naturopathic doctors; and SB 622 (Hernandez), for optometrists. Each of the bills claimed to expand the scope of practice for allied health professionals as a means of ameliorating California’s access to care crisis, but, in reality, posed a danger to patients. Through diligent lobbying and with the engagement of our physician members calling and writing their legislators, CMA convinced lawmakers of that truth. Each bill was successfully killed in either a policy or fiscal committee, sending an unequivocal rejection of scope expansions as an answer to access to care issues. Year after year, these expansions are rejected by the Legislature, demonstrating that the physician voice still holds sway at the Capitol.

Scope of practice fights generally play out similarly, except, this year, for one unique experience. An amicable solution was reached on AB 1306 (Burke), relating to certified nurse midwives (CNMs). Negotiations with the CNMs were productive and in time we were able to reach an agreement, moving CMA to a neutral position. Ultimately, however, this bill, too, died in committee.

Physician Aid-in-Dying
Another fruitful negotiation centered on SB 128 (Wolk and Monning), the physician aid-in-dying bill. This controversial measure demanded a lot of attention from CMA. We began the year with a longstanding House of Delegates-established policy of opposition to this subject. It soon became clear, though, that this was no longer the overwhelming stance of the membership that it once was. CMA’s physician leaders began a conversation with our physician members so that we could update our official policy to reflect the new, nuanced views of our members. CMA became the first medical association in the nation to move from opposition to neutrality on physician aid-in-dying. Having received permission from our Council on Legislation and from our Board of Trustees to engage with the bill’s proponents in hopes of reaching solutions, CMA’s lobbyists, in conjunction with CMA’s Center for Legal Affairs, entered exhaustive negotiations. Although CMA had become neutral on the concept of physician aid-in-dying, there were still concerns to be addressed about the bill’s language. Through countless meetings, a final comprehensive solution was reached and CMA officially became neutral on the bill. The crucial amendments that were secured to reach that agreement included the strongest statutory immunity protections for physicians, voluntary participation protections and mental health evaluations. After SB 128 failed in the Assembly Health Committee, its cause was revived through a bill, ABX2 15 (Eggman), in the special session on health care called by the Governor. This bill ultimately retained our negotiated amendments and our neutrality, and was passed by the Legislature on its last day in session. On October 5, the Governor signed the bill into law.

Workers' Comp
The physician aid-in-dying bill was far from our only instance of exhaustive negotiations this year. CMA also took part in extensive discussions regarding AB 1124 (Perea), a bill that would require the Division of Workers’ Compensation to establish a prescription formulary. After several months of diligent negotiations, we reached an agreement with the author’s office that moved our position to neutral. Through negotiations on this bill, CMA solidified its standing as a full stakeholder in workers’ compensation.

CURES
In the final days of the session, while almost all eyes were watching the major political fights, CMA staff went to work with Assemblymember Travis Allen to extend the Controlled Substance Utilization Review and Evaluation System (CURES) registration deadline for all prescribers and furnishers. On Thursday, September 10, CMA and Assemblymember Allen gutted and amended AB 679 to extend the deadline from January 1, 2016, to July 1, 2016. This extension will allow the Department of Justice to roll out its automated registration process and protect doctors from being disciplined by the Medical Board of California during the system roll-out.

In two days, the bill was heard in Senate Business and Professions Committee, on the Senate Floor and on the Assembly Floor. AB 679, as amended on September 10, passed the Legislature without receiving a single “no” vote. The measure also included an urgency clause, meaning the bill goes into effect as soon as it is signed by the Governor.

“Surprise” Billing
Our other focus in the final days was the completion of a year-long fight. AB 533, introduced by the Chair of the Assembly Health Committee, Rob Bonta, initially seemed like a matter of negotiation. We had a good relationship with the author, and we shared his goal of addressing the “surprise billing” problem. Instead, over the course of the year, those negotiations became increasingly hostile until they finally deteriorated to an all-out war.

Going into the last week of the legislative session, AB 533 would have drastically changed the current health care marketplace by allowing a massive transfer of negotiating power to the health plans at the expense of physicians. The bill would have required non-contracted physicians and dentists to accept Medicare rates as payment in full when performing services in a contracted or “in-network” facility. In addition, the bill would have implemented barriers for PPO patients seeking to access their out-of-network benefits. Overnight, the bill became essentially a health plan-sponsored bill, with the strong support of consumer groups and organized labor.

With myriad resources, the health plans spent tens of thousands of dollars hiring contract lobbying firms to lobby in favor of AB 533. The California Federation of Labor, the California Firefighters and most of organized labor, who were misinformed about the full contents of the bill, also lent their political muscle to the passage of bill, for they believed it would protect patients from exorbitant, unexpected bills. Finally, the California Chamber of Commerce and consumer groups, led by Health Access, also spent their political resources in favor of the bill.

In order to defeat AB 533, it was all hands on deck at CMA and we called upon our Legislative Key Contacts, CMA officers and medical executives, asking them to call their legislators on the last night of session to ask them to vote no on AB 533. CMA was also able to call upon the specialty societies and two of our closest allies to stand in opposition: the California Dental Association and the California Podiatric Medical Association.

After countless hours of lobbying and passionate debate in the halls and on the floors of the State Capitol, CMA and our allies defeated the measure on the floor of the State Assembly. This CMA victory was the final act taken by the Legislature in 2015, solidifying this year as one of the most challenging and one of the most successful.

Significant New California Laws of Interest to Physicians for 2016

The California Legislature had an active year, passing many new laws affecting health care. In particular, bills making major changes to state immunization requirements and end-of-life options were enacted. There was also a strong focus on new legislation related to allied health professionals, mental health, medical records and privacy, and reproductive issues.

CMA’s annual publication, New Health Laws, contains a list of the most significant health laws of interest to physicians for the year 2016.

Download New Health Laws

 



Let Doctors Be Doctors

A key factor in the rise of physician burnout and discontent has been the implementation of the Electronic Health Record (EHR). In an interesting twist, Athenahealth, a healthcare technology company, has launched a campaign with a disruptive message: The healthcare industry needs to stop focusing so much on electronic record-keeping so clinicians can do their jobs better. In their “Let Doctors Be Doctor’s” campaign a series of satirical videos has been posted to YouTube showing the effect technology has on patient care.   Read More





RCMA Leadership Retreat Strategic Priorities Summary

2015-2017 STRATEGIC PRIORITIES

Membership in RCMA drives and supports all priorities

RCMA Member Work Groups Now Forming.  Volunteer at:
https://www.surveymonkey.com/r/RCMASurvey

PRIORITY #1: Physician recruitment and retention in Riverside County

What Makes Riverside County “THE” Place To Practice
   • Multi-faceted marketing campaign – which could
       include:
       o Identify Stakeholders in increasing doctors, health
          needs as well as economic impact (Riv. Co. EDD;
          Chambers, Hospitals, Medical Schools, Groups/IPAs, Clinics, Corporation,
          Health Plans, IEHP, Cities and County of Riverside)
       o Showcase Riverside County communities
          - 45 minutes to beaches, desert, mountains; Low Cost
             of Living; Housing & Education; Plenty of opportunity to
             build practice/patients
       o Showcase different models of practice opportunities in
          Riv. Co. using local RCMA physicians
       o Recruitment business partners
       o Focus groups of new docs – what did it take to get them
          to Riv. Co.
       o Focus groups of potential new docs – what would it take
           to come to Riv. Co.
       o Sustainability of doctors in community
       o Develop what a “package” would look like for the smaller
           physician practices needing to recruit
        o Recruitment Fairs for Residents and New Doctors
           - In person and virtual
           - Go to them, i.e. peer to peer (Young Physicians to Residents;
                colleagues, friends, family; use CMA and AMA RSS and YPS Sections
        o Open Houses by local physicians/medical groups
        o RCMA develop a “match.com” type of service using
           overall showcase of Riv.Co with links to doctors/groups
           hiring to highlight their organization
            dynamic with secured
            access to update regularly
        o Social Media: videos, u-tubes, email, etc
   • Survey existing RCMA/Non-Members on need for
      physicians in next 1 yr & 3-5 yrs
    • Develop innovative ideas in funding new doctors
    • Increase funding in RCMA’s Medical Student Scholarship
       Program and expand to Residents/New Physicians

    • Increase physician revenue

Community based residency training
    • Increase number of residency trainings
    • Increase funding for residency programs
    • Job Fairs for residents
    • Provide economic incentives to stay

Mentoring
   • Create new physician mentoring program to help
      attachment to area
   • Develop more “social” mentoring programs to engage and
      make Residents & Interns want to stay in Riverside County.

PRIORITY #2: Addressing physician burnout and discontent

Burnout and discontent is in every mode of practice

How can RCMA Help and Provide Resources?

Practice redesign and innovation
   • Help with practice transformation
   • Identify and educate on new models of medicine
   • Identify creative ways of using extenders(ACPs)
     o Physician productivity – practice at top of license
     o Use of ACPs in hospitals-obstacles to overcome
     o Tools for utilizing staff at top of expertise/license
     o Reengineering staff to assist physicians
     o Identify Best Practices & Benchmarks
   • Physician and patient expectation management
   • Identifying physician burnout intervention methods
   • Tools for managing work and personal lifestyle, stress and
      balance
   • Provide coaching programs for increasing medical practice
      satisfaction

EMR Burden
   • Improving efficiency
   • Analyzing EMR tools and best practices
   • Work with top 10 EMR systems to provide additional trainings
      on best use of system (Kaiser model)
   • Trainings on Voice Recognition Tools (i.e. Dragon Speak)
   • EMR workplace balance training
   • Develop Scribe program offering
   • Improve office workflow


Secondary Priorities as part of RCMA ongoing activities/expertise
1. Co-opetition – RCMA serves as conveyer

     • HealthSystem Collaborative (City of Riverside)

2. Continue to encourage participation in IEHIE

     • Physician Champions to assist IEHIE in bringing on more
        hospitals and provider entities

3. Education on Implications of MACRA – Medicare Access
    and CHIP Re-Authorization Act

I Need News & Information

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