Wednesday, January 16, 2019

California Health Benefits Exchange Opens

As Covered California, the state’s Health Benefit Exchange, opened today, California Medical Association (CMA) physicians remain optimistic. Throughout the health care reform debate, CMA strongly advocated for affordable access to care for California’s uninsured and for an expansion of health insurance coverage.

“CMA has long supported access to health care for all patients,” said Paul R. Phinney, M.D., CMA president. “Today marks a positive inflection point in our nation's commitment to access to health care for all Americans

Five categories of plans will be available through Covered California, consisting of four metal tiers (bronze, silver, gold and platinum) and a catastrophic plan. If offering a metal-tier health plan in Covered California, issuers also must offer the same plan at the same premium outside of the exchange marketplace.

“The opening of Covered California is an opportunity for patients who have gone without access to medical care for months, years or even decades to see a physician” added Dr. Phinney. “There is still work to do, since access to insurance does not always guarantee access to a physician. The doctors of CMA look forward to working with Covered California to ensure that all Californians have access to the care they need and deserve."

CMA, in conjunction with the CMA Foundation, the Latino Physicians of California and the American Academy of Pediatrics, California, was recently awarded a $1.5 million grant for outreach and education to physicians about Covered California. The focus of the grant is to educate physicians and their office staff about coverage eligibility and patient enrollment.

"We are on the ground, communicating with our member physicians and colleagues about Covered California," concluded Dr. Phinney. "We want to make sure physicians and their patients have the information they need to make the goals of Covered California a reality. As with any effort of this magnitude, there will be bumps along the road. We remain committed to the effort nonetheless, and will do our utmost to educate our partners and patients on the significance of this historic change in the delivery of health care."


Riverside County Public Health Ready For Meaningful Use Stage 2

Download Letter

Dear Health Care Provider:

The County of Riverside Department of Public Health (DOPH) is committed to the improvement of our health information systems and to ensuring our local providers and medical facilities attain meaningful use certification as defined by the Health Information Technology for Economic and Clinical Health (HITECH) Act. As part of this process, this letter is to inform you that DOPH is declaring readiness for Meaningful Use Stage 2 (hereafter MUS2). Incentive payments you may receive or will receive under meaningful use may be affected if you or your facility is not able to meet the requirements for MUS2, including the public health integration objectives. In addition, your Medicare payments may be adversely adjusted in 2015 if you are not a meaningful user of electronic health record (EHR) technology, which include MUS2 requirements.

DOPH has partnered with the Inland Empire Health Information Exchange (IEHIE) to facilitate health care facilities’ compliance with the public health integration requirements of MUS2. DOPH believes that IEHIE is a vital part of improving coordinated care in the Inland Empire and encourages all health care facilities to join. The use of the IEHIE is not required to attain MUS2 requirements, but is strongly encouraged, and may greatly reduce the implementation cost and effort required for your facility to be compliant with MUS2. For more information on joining the IEHIE, please visit www.iehie.org

MUS2 has five public health objectives, three of which in the County of Riverside rest with DOPH. Eligible professionals (EPs) must meet the core public health objective of immunization reporting, and must meet three of six “menu set” requirements, two of which are public health objectives. Critical access hospitals (CAHs) must meet three core public health objectives, namely immunization reporting, reportable lab results/electronic lab reporting, and syndromic surveillance. Even if the IEHIE transmits this information on your behalf, you alone are responsible for ensuring the objectives are met. Please note that if your facility covers or operates in multiple jurisdictions, you may be responsible for different implementation requirements in jurisdictions outside of the County of Riverside. The five objectives are implemented for the County of Riverside as follows:

1.  Electronic immunization reporting is to be done to the California Immunization Registry (CAIR), Region 8. Your facility or medical office is responsible for the registration and onboarding process with CAIR if you are not already registered. You may submit this information yourself from your own EHR system; contact the CAIR Gateway for technical requirements. DOPH cannot offer technical support for implementation. If you are a “live” member of the IEHIE, this information is submitted to CAIR for you; self-registration is still required. Registration for all submitters, including IEHIE members, is through the CDPH Health Information Exchange Portal. 

This objective is a Stage 2 core requirement for both EPs and CAHs. For more information, visit http://cairweb.org/cair-regions/ 

2.  Electronic laboratory reporting of reportable results is to be done to the California Reportable Disease Information Exchange (CalREDIE-ELR). Your facility is responsible for the registration and onboarding process with CalREDIE-ELR if you are not already registered. You may submit this information yourself from your own ELR system; contact CalREDIE for technical requirements. This process is distinct from the CalREDIE Provider Portal. Enrollment for the Provider Portal is a separate process, does not meet this meaningful use requirement, and must go through DOPH. DOPH cannot offer technical support for implementation. If you are a “live” member of the IEHIE, this information is submitted to CalREDIE for you; self-registration is still required. Registration for all submitters, including IEHIE members, is through the CDPH Health Information Exchange Portal.

Please note that this requirement is specific to electronic laboratory reporting of reportable results under title 17 §2505 et seq. if your health care facility or medical office is not participating in reporting title 17 reportable conditions through the calredie provider portal, reporting must still occur via confidential morbidity report. the calredie provider portal and reporting of title 17 conditions is distinct from calredie-elr. also, under all circumstances, doph still must receive telephone notification on conditions designated as “report immediately by telephone.

This objective is a Stage 2 core requirement for CAHs only. For more information, visit http://www.cdph.ca.gov/data/information/tech/Pages/CALREDIE.aspx

 3.  Syndromic surveillance reporting is to be done to CDC BioSense. You must first register an operational relationship with our BioSense Data Steward, Rick Lopez (rilopez@rivcocha.org), to ensure that data you transmit is available to DOPH for review. Only emergency departments may apply at this time; non-EDs and provider offices must select another menu set option (see https://questions.cms.gov/faq.php?faqId=2903). Non-EDs cannot onboard with BioSense currently, but this may change in the future. This statement is not a waiver from this requirement.

Once you have established an operational relationship with DOPH, you may then transmit data to BioSense from your own EHR. Unlike other Meaningful Use information, this data is de-identified. Although DOPH will assist you with constructing this relationship, it cannot offer technical support for actual implementation. If you are a “live” member of the IEHIE, this information is submitted to BioSense for you; self-registration is still required. Certain aspects of county syndromic surveillance will still be maintained in the ReddiNet system, but use of ReddiNet by itself does not meet MUS2 objectives. Registration for this objective is not through the CDPH HIE Portal. All submitters, including IEHIE members, must register with the DOPH Data Steward directly.

This objective is a Stage 2 core requirement for CAHs. For more information, visit http://www.cdc.gov/biosense/ and http://biosenseredesign.org/

4.  Cancer reporting is not operated by DOPH. The California Cancer Registry (CCR) is operated by the California Department of Public Health (CDPH), not by the County of Riverside Department of Public Health. If you select this menu set option, you must specifically contact CCR. DOPH does not monitor CCR’s readiness status and cannot offer technical support for implementation; it is expected that CCR will be ready to receive electronic reporting by January 1st, 2014. As of this letter, there is currently no interface between the IEHIE and the CCR. Regardless of whether you select this option, you are still mandated to report certain cancer diagnoses to the CCR in general. This objective is a Stage 2 menu set option for EPs only. For more information, visit http://www.ccrcal.org 

5.  DOPH does not currently operate specialized disease registries. This may change in the future. DOPH will provide advance notification of any specialized disease registry we plan to operate and how to integrate with them. This does not change any existing reporting requirements to other state or federal disease registries which may still apply. This objective is a Stage 2 menu set option for EPs only. 

Although DOPH does not offer technical support for implementation, we do wish to ensure that all providers and facilities in the county are able to comply. We are working with both the IEHIE and the Riverside County Medical Association (RCMA) to make this possible. The Department is available for questions regarding public health meaningful use requirements and I may be reached by telephone personally at (951) 358-7036 or by E-mail at ckaiser@rivcocha.org

I look forward to our cooperatively improving the health of all county residents through the superior technical interaction and care coordination meaningful use will make possible. 

 Sincerely, 

Cameron Kaiser, M.D.
Public Health Officer



CALL FOR NOMINATIONS: 2013 RCMA Outstanding Contribution Awards

The RCMA is soliciting nominations to recognize and honor deserving individuals for the 2013 Annual Outstanding Contribution 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 31, 2014.

NOMINATION DEADLINE: FRIDAY, NOVEMBER 1, 2013

AWARD CATEGORIES

  • Outstanding Contribution to Organized Medicine - Presented to a 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 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 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

Download Nomination Form

Complete Nomination Form Online

DEADLINE FOR NOMINATIONS IS FRIDAY, NOVEMBER 1, 2013

 Submit Completed Form:

  • Mail to RCMA, 3993 Jurupa Ave., Riverside, 92506
  • Fax to 951.686.1692
  • E-mail to nbernstein@rcmanet.org   

    • CMA Launches Exchange Resource Center

      In 2010, Congress passed historic sweeping health care legislation, the Patient Protection and Affordable Care Act (ACA), which reformed the individual and small group health insurance markets and, beginning in 2014, will provide health insurance to much of the nation's uninsured. Under the ACA, two-thirds of California's uninsured may be may be eligible to purchase coverage through the health benefit exchange. The exchange's goal is to begin open enrollment on October 1, 2013 – with coverage beginning on January 1, 2014.

      To help educate physicians about the exchange and ensure that they are aware of important issues related to exchange plan contracting, the California Medical Association (CMA) has developed a resource page where physicians can find all of CMA's exchange-related news and resources.

      The new exchange resource center can be found at www.cmanet.org/exchange.

      For more information about California's Health Exchange, contact RCMA’s physician advocate Mitzi Young at (888) 236-0267 or myoung@cmanet.org.

       


      Legislative Alert: Urge Legislators to Oppose Bill that would Require Medical Board Investigations for Prescription Drug Deaths

      On June 26, the Assembly Business and Professions Committee will be considering a bill that would require a coroner to file a report with the medical board when a controlled substance is found to be a contributing factor in a death.

      While well-intentioned, SB 62 simplifies a very complicated issue to the potential detriment of patients. CMA is urging physicians to contact their assembly members today and ask them to oppose this flawed bill.

      Click "take action" below to quickly and easily contact your legislator via CMA's grassroots action center.

       Call (877) 362-8455 to be connected with your legislator

      Take Action

      I Made the Call!

      Description

      SB 62 (Price) would expand provisions to require a coroner to file a report with the Medical Board of California when he or she determines that a Schedule II, III, or IV drug was a contributing factor in a death.

      Senator Price's stated assumption that a coroner’s report connects the dots between overdose deaths and so-called physician over-prescribing is fundamentally flawed.

      This bill is a response to growing concern about prescription drug abuse, an issue that is of great concern to CMA and physicians across the state. However, the statistics show that the vast majority of people who abuse prescription drugs acquire them from friends and family (often without their knowledge) or from sources other than the prescriber. There are also many circumstances in which individuals with legitimate prescriptions for controlled substances might die, including non-compliance with prescriber's orders or mixing the drugs with other substances like illicit drugs or alcohol.

      As currently written, this bill would make it increasingly more difficult for patients being treated for pain to get appropriate treatment, as physicians will become less likely to prescribe controlled substances for fear of a medical board investigation.
      CMA has requested an amendment to the bill that would require the medical board to notify a physician when a report with his/her name is received. This amendment would help provide some balance by providing physicians the opportunity to seek ongoing education on opioid prescribing or identify fraudulent activity being done in their name, but the author has refused to accept it.

      We ask that you and your colleagues
      call, fax or email your legislators
      TODAY and ask for a NO vote on this bill

      The bill is expected to be heard in the Assembly Business and Professions Committee this week.

      Phone calls and office visits are most effective, but faxes and emails are important too. If you choose to fax or email your legislators, we strongly encourage that you personalize the letter (provided below), which will greatly increase its impact.

      If you are logged into the CMA website, your legislators should automatically be displayed. If not, you can click here to locate your legislators by zip code.

      Talking points, a sample email, and background information are below.

      Talking Points

      • As a physician, I am very concerned about the growth in prescription drug abuse and want to be a partner in addressing it, but SB 62 is an approach that will have significant unintended consequences.
      •  The reports being required under SB 62 will make physicians less likely to prescribe drugs on Schedule II, III, and IV for fear of investigation even in instances when the care is appropriate. Doing so will impact patient’s ability to get appropriate pain management.
      • There are many circumstances in which a person with a legitimate prescription for a controlled substance may die, including the patient being non-compliant with the prescriber’s orders or mixing the drugs with other substances like illicit drugs or alcohol.
      • Patients being treated for pain may also have comorbities that could result in death. None of these instances reflect inappropriate practice by a physician and yet all of them could be reported to the Medical Board for investigation under SB 62.
      • Further, the vast majority of people (70%) who use drugs for non-medical purposes did not get it from a prescriber, but from other sources.
      •  The risk of negatively impacting patient care must be balanced with the potential benefit. Given all the extenuating factors that exist in assessing overdoses related to controlled substances, SB 62 is not balanced.
      • CMA has requested an amendment to the bill that would require the medical board to notify a physician when a report with his/her name is received. This amendment would help provide some balance by providing physicians an opportunity to seek ongoing education on opioid prescribing or identify fraudulent activity being done in their name, but the author has refused to accept it.
      •  I urge Assembly-member ____________ to vote no on SB 62 unless the requested amendment is taken.

       



      Noridian EDI: Early On-Boarding

      In preparation for the cutover from Palmetto GBA, Noridian is offering “early boarding” to ensure physician offices are transitioned without any interruption in your business.

      For more information about early boarding please go to www.edissweb.com.



      Legislation Jeopardizes Patient Safety


      As health care delivery becomes more complex, expanding the team of health care professionals that serves patients makes sense. However, it is not in the best interest of patients to abandon the current physician-led team approach to health care. California’s SB 491, SB 492, and SB 493 would allow nurses, optometrists, and pharmacists to take on the duties of a medical doctor without a doctor’s training. RCMA/CMA and the Coalition for Patient Access and Quality Care are working together to make sure lawmakers realize that providing allied health practitioners with independent and/or expanded practice will not provide newly insured patients, who are more likely to have complex medical conditions, with access to the health care they deserve

      Find out how you can help by visiting www.qualitycareaccess.org



      Legislation To Repeal SGR Unveiled


      The Energy and Commerce Committee Republicans unveiled draft legislation that would repeal the sustainable growth rate (SGR) formula and replace it with a new system for determining Medicare physician payments. Building off a framework released this spring; the legislation would eliminate the SGR and replace it with a modified fee-for-service system with an emphasis on improving quality and outcomes through performance measures, while also providing means for physicians to participate in alternative payment models.


      Medi-Cal Cuts Challenged


      This week 8,000 physicians, administrators and healthcare workers joined together at the State Capitol to voice their opposition to the Medi-Cal cuts that are scheduled to be implemented next month. A large bipartisan group of legislators support the effort to reverse the Medi-Cal cuts and restore a health care safety net to California. We Care for California, which mobilized the rally, is one of the largest coalitions in state history.  However, the fight to restore funding is not over and RCMA/CMA will continue its multi-pronged efforts aimed at stopping the harmful Medi-Cal cuts, pursuing every path available including advocacy, legal and legislative.


      Covered California Update

      Covered California, the state agency implementing the Affordable Care Act (ACA), has announced participating health insurers and proposed premiums for the state's exchange.  13 commercial health plans were selected to offer products on the exchange, including California's three largest insurance providers, Kaiser Permanente, Anthem Blue Cross and Blue Shield of California. One major concern for contracting physicians is a loophole in the ACA that could see physicians left to foot the bill for services provided to patients who haven't paid their insurance premiums. The law allows for a three month "grace period" for non-payment of premiums, but only requires insurers to pay the claims through the first month of non-payment. The final version of the exchange model contract included a provision that requires 15 days advance notice to physicians when a patient has entered the second month of the grace period, but still leaves the burden of 60 days worth of unpaid claims on the physician and the patient.

      For more information about Covered California, please contact your RCMA Physician Advocate Mitzi Young at myoung@cmanet.org or (888) 236-0267.


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