Friday, April 18, 2014

OCMA Blog

Call to Action from CalOptima Regarding Duals Demonstration

Dear Orange County Physicians:

CalOptima is measuring physician interest in a direct contract model for the dual-eligible demonstration that will launch in Orange County in April, 2014.  If there are not enough physicians interested in the direct contract model, it may be difficult for the CalOptima board of directors to support the model.  See the "Call to Action" below that CalOptima issued to the physician community.  As always, if you have any questions or comments, please contact us.

 

Thomas C. Kockinis, MD                                                   Robert McCann, MHA

President                                                                           CEO / Executive Director


 


Thinking About the Duals Demonstration? 
We Want to Hear From You!


The time for you to respond is now! The CalOptima Board of Directors is exploring the interest level of a direct contracting option with CalOptima for Cal MediConnect (also called the Duals Demonstration). Based on the interest level of the Orange County physician community, the CalOptima Board may grant authority to make this new option available.
 
If approved, the direct network will be based on managed care principles, providing support for your patients who may be difficult to manage through: coordinated care, case management, physical and mental health coordination, as well as home and community-based support services.
 
We need to hear from physicians who are interested in contracting directly with CalOptima, as the window for measuring interest is narrowing. In order for the model to be viable, a substantial number of physicians need to indicate their desire to participate. Currently, we do not have enough physicians displaying an interest to proceed with this option.
 
Orange County is one of eight California counties selected to participate in Cal  MediConnect. With Cal MediConnect, Medicare patients who are 21 years of age or older receiving full Medi-Cal benefits will have the option to transition from fee-for-service Medicare to this Duals Demonstration no sooner than April 1, 2014.
 
If you are a provider interested in directly contracting with CalOptima for this demonstration, please contact our Provider Relations department at 714-246-8600 or providerservices@caloptima.org to let your voice be heard and receive additional information about your contracting options. 

 


CALL TO ACTION: CONTACT CONGRESS AND URGE THEM TO PROTECT HEALTH CARE TODAY!

Congress has three weeks left to stop the 26.5 percent Medicare sustainable growth rate (SGR) physician payment cuts (to take effect on January 1, 2013) before they adjourn for the holidays. The Orange County Medical Association urges physicians to keep the pressure on Congress to stop these cuts.

Call AMA's Grassroots Hotline, (888) 434-6200, to be connected with your members of Congress.

Description

Members of Congress have returned to Washington, D.C. for a Lame Duck Session to address the so-called "fiscal cliff" issues affecting the future of medicine and our country. These issues must be addressed before January 1, 2013 or the following occurs:

  •  26.5 percent Medicare physician fee-for-service rate cut because of the SGR formula;
  • Across-the-board spending cuts known as "sequestration" - $109 billion/year. While Medicaid is exempt from the sequestration cuts, the Medicare program faces 2 percent cuts; Defense takes $500 million in cuts and the rest comes from domestic programs.
  • Expiration of the Bush 2001 and 2003 tax cuts (including individual rates, capital gains, dividends, child tax credit, marriage penalty reduction, and the estate tax).
  • The Alternative Minimum Tax patch expires.
  • The Social Security Payroll tax cut expires.
  • Unemployment benefits extension expires.

It is important that members of Congress work together in a bipartisan way to resolve these vital issues and avoid going over the "fiscal cliff." Most economists speculate that if Congress fails to act, economic growth will drop significantly, unemployment will rise, and the country will slip back into a deep recession. 

CALL your members of Congress and urge them to work together to stop the Medicare SGR physician payment cut of 26.5 percent and the Medicare sequestration cut of 2 percent before they take effect on January 1, 2013.


How to contact members of Congress:

Phone:  Call AMA's Grassroots Hotline, (888) 434-6200, to be connected with your members of Congress. You will be asked to enter your zip code and select your Representative.

Email: Federal legislators must be contacted via the email forms on their websites: www.writerep.house.govwww.boxer.senate.gov and www.feinstein.senate.gov.


Talking Points

Urge California Senators and your member of Congress to:

  • Repeal the Medicare SGR and stop the 26.5% physician payment cut.
  • Stop the Medicare 2% Sequestration Cut.    
  • Adopt long-term Medicare Payment Reform.
  • Update the California Medicare Geographic Payment Localities.
  • Stop Medicaid and Other Health Care Cuts  


Background

Tough decisions will have to be made in the coming weeks but Congress must make Medicare funding a top priority. We can't allow Congress to ignore the nearly 30 percent Medicare cuts facing physicians and patients in California. Such cuts will certainly harm access to doctors for seniors, military families and potentially all California patients because private insurers follow Medicare. 

 

Moreover, comprehensive reform of the Medicare physician payment system is long overdue. Working together, CMA, AMA, the national specialty societies and state medical associations are currently developing an alternative Medicare payment system that will stabilize the Medicare program and promote high quality, high value care. Physicians are leading the way. But first, Congress must act responsibly and stop the scheduled Medicare SGR payment cut of 26.5 percent. Such cuts seriously threaten the viability of California physician practices and your ability to care for patients. Physicians are also important employers crucial to the California economy.

 

In recent days, Senate and House Republicans have forwarded a proposal to cut the Affordable Care Act (ACA) Medicaid (Medi-Cal) physician payment increase as a way to fund the fiscal cliff issues. CMA is opposed to such cuts. California Medi-Cal rates are already some of the lowest in the nation - 50 percent below Medicare. Because of these low rates, 75 percent of physicians cannot afford to participate in Medi-Cal and thus, 50 percent of Medi-Cal patients can't find a physician. Regardless of the ACA, California needs the Medi-Cal rate increase to protect access to care. 

 

CMA will also be working to stop sequestration budget cuts to other vital health care programs, such as public health and graduate medical education (GME).

 

Finally, CMA is pursuing an update to the Medicare physician payment localities in the Medicare/Budget Sequestration legislative package. California's localities have not been updated and thus, 14 urban counties are still designated as rural and physicians in these counties are paid up to 14 percent less than their urban counterparts.  


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