Sunday, December 17, 2017

OCMA Blog

Your Input is Needed: Susan G. Komen Breast Health Needs Assessment

OCMA is partnering with Susan G. Komen® in order to help disseminate a survey regarding Orange County's needs assessment for the 2015 Community Profile on Breast Cancer and Breast Health. The goal and purpose of the Community Profile is to communicate the status of breast health and breast cancer in the Orange County community, as well as to inform planning of programs and grants for the next several years.
 
As part of the data gathering process, Susan G Komen® has developed a brief provider survey to identify existing gaps and barriers to service as well as patients' beliefs and attitudes towards breast health services. Physicians should answer these questions based on their day-to-day interaction/experience with their patients. The survey should take no more than 20 minutes to complete, and all responses to the survey will be kept confidential. As an incentive, providers who complete the survey will have the opportunity to win a $100 gift card.
 
The last day to complete this survey is Friday, September 19, 2014.
 
Please follow the survey link below to participate in the survey:
https://www.surveymonkey.com/s/breasthealthneeds

 
Thank you in advance for your participation.

Arpan Global Charities Mission Moshi, Tanzania

August 10-17, 2014

At the foothills of Mount Kilimanjaro in Tanzania, Arpan Global Charities 16th volunteer medical mission was held in the town of Moshi. This mission was unique for a few reasons: a) there was a relatively smaller team totaling 10 volunteers, including one anesthesiologist, one dentist, two thoracic surgeons, one pediatric orthopedic surgeon, one ophthalmologist, two pediatricians, one nurse and one non-medical volunteer. Of the10 total team members, 5 were from St Joseph Hospital in Orange. b) The team members came from 3 different hospitals, including St Joseph Hospital, Kibosho Eye and ENT Hospital and Machame Lutheran Hospital. The team stayed at Torchbearer Lodge run by Mama Lynn Elliott, who at the same campus also runs a non-profit organization, the Light in Africa, where 166 orphans are cared for. All the children at this orphanage receive shelter, meals, education and treatment for various underlying medical conditions including cerebral palsy, HIV and other acute as well chronic conditions.

During one week at Moshi our team members saw about 650 patients at different locations, including 3 hospitals in Moshi. Masai patients were seen and treated in remote areas in the bush. A total of 55 surgical procedures were performed including 17 eye surgeries, 16 general surgical and pediatric orthopedic procedures and 22 dental procedures. We delivered gifts from the sisters of St. Joseph Hospital in Orange to sister Leiymo of St Joseph Hospital in Soweto Moshi. In addition, our team members also delivered new clothes donated by St. John’s Friendship Quilters in Orange to the orphans at the Light in Africa. Our team dentist donated hundreds of toothbrushes and toothpaste to the local underserved population.


Overall, Mission Moshi in Tanzania was another successful mission for Arpan Global Charities, fulfilling its mission to bring health and hope to the medically underserved population around the world, while providing humanitarian assistance and medical education to those who need it the most.

For more information on Arpan Global Charities, visit http://www.arpanglobal.org/


New guidance from CDC on Ebola

Below message is from the Orange County HCA / Epidemiology & Assessment

Guidance for Safe Handling of Human Remains of Ebola Patients in U. S. Hospitals and Mortuaries (August 25, 2014) 
http://www.cdc.gov/vhf/ebola/hcp/guidance-safe-handling-human-remains-ebola-patients-us-hospitals-mortuaries.html

From Dr. Erin Epson, Assistant Chief / Public Health Medical Officer of the CDPH Healthcare-Associated Infections Program:
CDC has issued Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus, available at: http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html. Although the role of the environment in transmission of Ebola virus has not been established, in this guidance CDC recommends higher levels of precaution to reduce the potential risk posed by contaminated surfaces in the patient care environment “given the apparent low infectious dose, potential of high virus titers in the blood of ill patients, and disease severity.” Disinfection products with higher potency than what is normally required for an enveloped virus such as Ebola are therefore now recommended. Such products include Environmental Protection Agency-registered hospital disinfectants with a label claim for a non-enveloped virus (e.g. norovirus, rotavirus, adenovirus, poliovirus), and would also include bleach solution. In addition, the new guidance recommends that porous surfaces that cannot be made single use (e.g. carpeting, upholstered furniture and curtains) should be avoided in rooms of suspect Ebola virus disease (EVD) patients, and that potentially contaminated textiles (e.g. linens, non-fluid-impermeable pillows or mattresses, and privacy curtains) be discarded as regulated medical waste. This guidance regarding appropriate disinfection products and management of potentially contaminated textiles is different and replaces the environmental infection control elements of the previously issued Infection Prevention and Control Recommendations for Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals.

CDC has also updated a poster depicting the sequence for putting on and removing personal protective equipment (PPE), available at: http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf. This updated poster emphasizes guidance to perform hand hygiene between steps if hands become contaminated, in addition to immediately after removing all PPE. 

There are multiple acceptable sequences and methods for removing PPE. Regardless of the sequence or method used, the important principles are that the most contaminated items are removed first, and that the person removing PPE does not contaminate themselves or others during the process. If two pairs of gloves are used, the most contaminated outer gloves can be removed first and the inner gloves last, in order to limit additional contamination of remaining PPE during removal.  Performing hand hygiene between steps, and especially prior to removal of a mask or respirator, can help prevent contaminating one’s eyes and/or mucous membranes while removing the mask or respirator. Healthcare personnel should familiarize themselves and practice methods of donning and removal of any PPE used, in advance of the time when PPE will be needed. 

Availability of PPE supplies, hand hygiene, and appropriate waste containers at the point needed can be facilitated by placing any suspect EVD patient in a room with an anteroom.  An anteroom is particularly helpful if airborne isolation is implemented and respirators must be removed after leaving the patient room and closing the door. If a room with an anteroom is unavailable, a suspect EVD patient can be placed in a room that is spatially separated from other occupied patient rooms in a low traffic area (e.g., at the end of a hallway), with a designated area for hand hygiene and waste containers outside the room and separate from other patient care areas.

If you have any comments or questions or would like to be added to the distribution list, please email us at epi@ochca.com.


Covered California Provider Education News: Know Your Participation Status

Covered California: Know Your Participation Status

In late April 2014, the California Medical Association (CMA) surveyed physicians about their contracting experience with Covered California plans. Eighty percent of respondents reported that they had been confused about their participation status in a Covered California plan and that they believed such confusion had negatively impacted patient care.

Unfortunately, checking your practice's participation status is not as straightforward as it might seem. Plagued with inaccuracies, Covered California took down its cross-plan provider directory earlier this year. Add to that the fact that some exchange plans have used vague contract terms and amendments that rope physicians into participating in their exchange networks, often without their express consent or knowledge, and you'll see that "do you take my insurance" is not always an easy question to answer. 

CMA has developed a toolkit to assist physicians with checking their participation status within Covered California. Click here to download the Know Your Status toolkit.

Meet your Covered CA Provider Educator, Karli Nevarez

Karli is available to provide and distribute multilingual patient education materials for your practice or medical group, as well as appear in person to facilitate a brief presentation or answer questions for your staff. These presentations are for physicians and their staff to gain a better understanding of Covered California and the products offered through the exchange. Karli's services are available to both members and non-members of OCMA.

If you would like Karli to come to your practice or medical group to deliver materials and/or present to your staff, you may contact her at: (310) 818-6998 or knevarez@thecmafoundation.org.  
 
You can also fill out the Covered CA Information Request Form and fax or email the form back to the OCMA. 


No On 46 Campaign Launches First Statewide TV & Radio Media Buy Highlighting the High Cost of Prop 46

Ads tell the real story behind this year’s most fiscally-reckless measure

Tuesday, August 19, 2014

SACRAMENTO – The No on 46 campaign announced today that it has launched its first statewide television and radio ad buys in both English and Spanish.

The ads, “Risk” (TV :30) and “Real Story” (Radio :60), focus on the first – and most obvious – of the myriad of reasons for California voters to reject Proposition 46: the fact it is written and nearly exclusively funded by trial attorneys for their financial benefit while everyone else in California – health consumers, taxpayers, and state and local governments – will pay more.

View the ad here: http://www.noon46.com/the-real-story-video/.

Because Proposition 46 is really three different initiatives in one – all of which are too complicated, too costly and too flawed – an unprecedented coalition of more than 600 statewide and community groups have joined to oppose it, including (partial list):

  • California Teachers Association
  • California School Boards Association
  • Association of California School Administrators
  • California State Firefighters Association
  • League of California Cities
  • Urban Counties Caucus
  • Rural County Representatives of California
  • California Special Districts Association
  • California Chamber of Commerce
  • Service Employees International Union (SEIU) California
  • AFSCME California PEOPLE
  • State Building and Construction Trades Council of California
  • California Medical Association
  • California Dental Association
  • California Hospital Association
  • California Pharmacists Association
  • American Congress of Obstetricians and Gynecologists
  • American College of Emergency Physicians, California Chapter
  • California Association of Physician Groups
  • California Association for Nurse Practitioners
  • Planned Parenthood Affiliates of California
  • Community Clinics Association of Los Angeles County
  • La Clínica de La Raza
  • California Association of Rural Health Clinics
  • Central Valley Health Network
  • NAACP California
  • California Republican Party
  • Los Angeles County Democratic Party
  • Yuba County Democratic Party

To learn more, visit www.NoOn46.com


Communicable Disease News: Pertussis Epidemic in OC & Ebola Virus Update

Update on California's Pertussis Epidemic

Pertussis activity continues at epidemic levels in Orange County and statewide.
As of 8/16/2014, 250 pertussis cases have been reported in Orange County, compared with 43 cases at this time last year. Pertussis peaks in incidence every 3-5 years as the number of susceptible people in the population increases; the last epidemic in California was in 2010.

Infants under 12 months of age are at highest risk for severe infection and death. To protect this vulnerable population the following is recommended:

  • Immunize pregnant women with Tdap during every pregnancy at 27-36 weeks gestation. This dose protects mom and provides the infant with high levels of protective transplacental antibodies.
  • Encourage close contacts of infants to be up-to-date with their pertussis vaccine (cocooning).
  • Vaccinate infants and children with DTaP followed by Tdap according to the childhood immunization schedule: http://www.cdc.gov/vaccines/vpdvac/pertussis/recssummary.htm

Diagnostic Testing: Suspect pertussis cases should be tested by nasopharyngeal PCR. PCR is most sensitive within 3 weeks of the onset of the cough (up to 6 weeks for infants). Consider obtaining a CBC: a WBC count that is ≥ 20,000/mm3 with ≥ 10,000 lymphocytes/mm3 in a young infant with a cough illness is strongly suggestive of pertussis infection.

Management of Cases:

  • Treatment: Antimicrobial treatment should begin as soon as possible after diagnosis, particularly in infants. Treatment may lessen symptoms if begun early during illness and will shorten the period of infectivity.
  • Prophylaxis: The CDC and AAP recommend post-exposure prophylaxis for all close contacts of a pertussis case. However, during widespread community outbreaks, OCHCA will focus its efforts on postexposure prophylaxis for high-risk contacts, including infants under 1 year of age, pregnant women, and their contacts.
  • Infection control: Health care workers should use standard and droplet precautions, including a surgical or procedure mask and eye protection when evaluating suspect pertussis patients. Droplet precautions should be maintained until 5 days after the patient is placed on effective therapy, or if no treatment until 21 days after cough onset.
  • Management of cases in school settings: Cases should be excluded from childcare settings until completion of 5 days of antibiotic treatment, from K-12 grade schools until completion of 3 days of antibiotics, and for 21 days if no antibiotic treatment.

Resources:

General pertussis info for clinicians: http://www.cdc.gov/pertussis/
Tdap for pregnant women: http://www.cdc.gov/vaccines/vpd-vac/pertussis/tdap-pregnancy-hcp.htm

Click here for full Pertussis Newsletter.


Ebola Outbreak In West Africa

West Africa has been experiencing a large outbreak of Ebola Virus Disease (EVD) since December of 2013. As of August 15, 2,127 confirmed or suspect cases of disease including 1,145 suspected case deaths have been reported in Guinea, Liberia, Sierra Leone and Nigeria. It was reported last night (August 19) that Kaiser Permanente in Sacramento is testing a patient for suspected Ebloa Virus, aside from that, two United States citizens were transported to Emory University for further care after contracting the disease while caring for patients with EVD in Liberia. Though the risk of Ebola to the United States or Orange County is small, the potential exists for imported disease in persons traveling from countries where EVD is active. Medical providers should keep up to date on this outbreak and know which patients merit evaluation for EVD.

Providers should contact Orange County Public Health at 714-834-8180 (714-628-7008 after hours) immediately upon identifying any patient with potential EVD. Orange County Public Health can assist with assessment and testing of any case meeting the CDC-defined criteria for a Person Under Investigation, which includes:

1. Clinical criteria:

a. Fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and
b. Additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage

AND

2. Epidemiologic risk factors within the past 21 days before the onset of symptoms, such as:

a. Contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD or
b. Residence in-or travel to-an area where EVD transmission is active* or
c. Direct handling of bats, rodents, or primates from disease-endemic areas.

Persons who have had direct contact with Ebola cases through healthcare work or social exposure in West Africa are at particularly high risk for developing disease. For further description of risk factors and clinical recommendations to prepare for or manage Ebola, see www.cdc.gov/vhf/ebola/hcp/index.html.

*As of August 15, countries where EVD is active include Guinea, Liberia, Sierra Leone and Nigeria.

Infection Prevention and Control
Standard, contact and droplet precautions are indicated for suspected EVD. Personal protective equipment (PPE) should include gloves, gown, eye protection (goggles or face shield) and facemask. Additional PPE is necessary if copious blood or other fluid is present in the environment, including double gloving, disposable shoe covering, and leg covering. PPE should be discarded on leaving room taking care to avoid contamination when removing.

Laboratory Testing
The diagnostic test of choice for EVD is PCR testing of the blood. The virus is generally PCR-detectable from 3-10 days post-onset of symptoms. If the onset of symptoms is less than 3 days prior to specimen collection, a subsequent specimen will be required to completely rule out EVD. Testing is available through the CDC. Orange County Public Health can assist with assuring appropriate transport of specimens.

For updated information on the outbreak, including countries where EVD is active, go to: www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html.

Contact Orange County Public Health at 714-834-8180 with any questions.


Mental Illness and the ACA — Expanding Behavioral Health Benefits and Fighting Stigmas

By Donald Sharps, M.D.
CalOptima Behavioral Health Medical Director

The phrase, “people fear what they do not understand,” is true when dealing with the stigma that surrounds mental illness. In the media, behavioral health is often blamed for irrational behavior and acts of violence. In schools and offices, you can hear name-calling using words like crazy, insane or psycho. A lack of awareness continues to spread this stigma and it can be a barrier for people to get behavioral health services to improve their quality of life. 

Just as diabetes is a disease of the pancreas, mental illness is a disease of the brain. People are not their diseases. Be aware and do not label a person as schizophrenic or bipolar. A person can have schizophrenia or a bipolar disorder, just as a person can have diabetes. It is important that people increase their awareness of mental health and wellness to reduce the stigma of mental illness. To accept and cope with having a mental illness is difficult enough. It is even harder when a person feels there is a stigma associated with mental illness. Treatment is available for behavioral health issues and it is possible for people to achieve and maintain recovery.

How has the Affordable Care Act changed the way people access behavioral health services and treatment for mental health disorders?

As of January 1, 2014, the Affordable Care Act (ACA) expanded health care benefits to include behavioral health services. However, many people still do not access services for reasons ranging from lack of awareness, to the fear of being labeled and being treated differently. By reducing the stigma of behavioral health issues, we can assist people in getting the needed treatment that is available to them.
With ACA, Medi-Cal has expanded so that more people are eligible, by providing coverage for people who earn up to 138 percent of the federal poverty level (about $15,800 for an individual). It has also increased coverage among non-elderly adults by extending Medi-Cal eligibility to childless adults and increasing Medi-Cal eligibility for parents who lose access when their income fluctuates and slightly exceeding the poverty level.

The ACA also ensures that all health plans offer a comprehensive package of services, known as essential health benefits, which includes Mental Health and Substance Use Disorder Services. 

These Behavioral Health Services are now available to all Medi-Cal members:

  • Individual and group psychotherapy
  • Psychological testing to evaluate a mental health condition
  • Psychiatric consultation and ongoing treatment, that cannot be managed at the primary care level of health care
  • Screening, Brief Intervention, and Referral to Treatment (SBIRT) provided in a primary care setting for alcohol misuse
  • Drug Medi-Cal Services

Members can call the Orange County Mental Health Plan Access Line at 1-800-723-8641 for screening and referral to services. Primary care providers, network providers, community-based organizations and county programs can also call the Access Line. This line is available 24 hours a day, 7 days a week.

To get information regarding the Drug Medi-Cal County Alcohol and Other Drug Program (AOD), call the OC LINKS behavioral health services and referral line at 1-855-OC-LINKS (1-855-625-4657).


Noridian incorrectly denies 300,000 claims for E&M services

Last fall, the Centers for Medicare and Medicaid Services (CMS) experienced some editing issues with new patient E&M codes that resulted in incorrect claim denials. These problems started in October 2013, and was thought to have been corrected in late January 2014. The California Medical Association recently learned, however, that some claims continued to be paid incorrectly through July 15, 2014.
 
Noridian, California's Medicare contractor, in January began making mass adjustments and correcting claims subjected to overpayment recovery. Unfortunately, while implementing the corrections, Noridian inadvertently subjected established patient E&M codes to incorrect editing, resulting in incorrect denial of codes 99211- 99215.
 
Noridian has corrected the editing for both the new patient codes and the established patient codes, and claims received by Noridian on and after July 16, 2014, should be processing correctly. Noridian is now beginning the process of mass adjustments to the incorrectly denied claims. Due to the number of claims involved (~300,000 claims back to October of 2013), this process could take a month or so to complete.
 
Physicians do not need to do anything to have their claims adjusted and they should NOT resubmit the claims. The claims will be automatically adjusted.
 
For more information, see Noridian's notice on this issue.
 
Contact: Mitzi Young, OCMA Physician Advocate (888) 236-0267 or myoung@cmanet.org.

Physician Advocate Tip of the Month: CPT® Modifier 22 – Reporting & Reimbursement

Tip comes from G. John Verhovshek, managing editor for AAPC, a training and credentialing association for the business side of health care.

CPT® modifier 22 increased procedural services allows a provider to gain additional reimbursement for an unusually difficult or time-consuming procedure. To realize that extra payment, your billing staff will have to make a special effort, as well.

Per CPT® Appendix A, modifier 22 may be appended to a CPT® code to indicate that the work performed was “substantially greater than typically required…. ” CPT® does not define a “substantially greater” effort, although some payors do offer guidelines (e.g., the effort and/or time to perform the procedure should be “at least 25 percent greater than usual”). Regardless of payor, you should append modifier 22 infrequently, and for only the most unusual procedures.

Specific circumstances that may call for modifier 22 include:

  • Intra-operative hemorrhage resulting in a significant amount of increased operative time.
  • Emergency situations that require significant effort beyond the normal service. This does not include minor intra-operative complications that sometimes occur.
  • Abnormal pathology, anatomy, tumors and/or malformations that directly and significantly interfere with the normal progression of a procedure.

Also, keep in mind these caveats:

  • Additional time, by itself, does not justify the use of modifier 22.
  • Do not use modifier 22 when the existing CPT® code describes the service.
  • Do not use modifier 22 to indicate that a specialist (no matter how specialized) performed the service.
  • Do not use modifier 22 if the complication is due to the surgeon’s choice of surgical approach.

CPT® guidelines require that provider documentation support “the substantial additional work and the reason for the additional work (i.e., increased intensity, time, technical difficulty of the procedure, severity of patient’s condition, physical and mental effort required).” The provider should explain and identify additional diagnoses, pre-existing conditions, or unexpected findings or complicating factors that contributed to the extra time and effort.

Use comparisons to clarify how the procedure differed, using quantifiable criteria. For example: The patient lost 800 cc’s of blood, rather than the usual 100-200 cc’s lost during a procedure of the same type. Time is also quantifiable (e.g., “the surgery took four hours instead of the usual 1½-2 hours”).

Payors may request a full operative report to verify the unusual nature of the coded procedure. Because most claims are now sent electronically, you should include comments in the narrative field, using everyday language, to explain precisely why (and how much) additional effort and/or time were required to complete the procedure, along with the statement, “Request documentation if needed.” If the payer requests the additional details, be prepared to send the full operative note, along with a cover letter (with provider signature) detailing the unusual nature of the procedure.

The Centers for Medicare & Medicaid Services and other payers scrutinize modifier 22 claims, and primary payor claims submitted with a 22 modifier are often subject to a full medical review. If your claim is correctly coded and well supported by documentation, be persistent in pursuing payment.

Lastly, when submitting your claim with modifier 22, you have to ask for additional payment. Payors won’t automatically increase reimbursement. Instead, you should recommend an appropriate fee. For instance, if a surgical procedure takes twice as long due to unusual clinical circumstances, you could ask the payor to increase the intra-operative portion of the payment by 50 percent. 


MICRA Alert and Prop 46 Resources for Physicians

In less than 100 days, voters will be asked to weigh in on the MICRA health care lawsuit measure known as Prop. 46, which will hugely jeopardize the privacy of patients' personal prescription medical information.
 
The initiative will force doctors and pharmacists to use a massive statewide database known as the Controlled Substance Utilization Review Evaluation System (CURES), which is filled with patients' personal prescription drug information. Though the database already exists, it is underfunded, understaffed and technologically incapable of handling the massively increased demands that this ballot measure will place on it.
 

Most concerning, the massive ramp up of this database will significantly put patients' private medical information at risk and the ballot measure doesn't contain any provisions or funding to help upgrade the system or increase the database's security standards. As many of you know, the CURES database contains highly sensitive patient information including personal and potentially stigmatizing details about their health. Prescription information including medication used to treat obesity, narcolepsy, conditions related to cancer and AIDS, asthma and other sensitive information are all contained within the CURES database. 

In recent weeks and months, the coalition to oppose the MICRA health care lawsuit initiative continues to grow. Teachers, health care workers, local community groups and hundreds of others have pledged to vote NO in November because they too understand the implications this measure would have on patients, taxpayers and consumers across the state.

We know that if this measure passes, it won't just be putting patients' personal medical information at risk, but malpractice lawsuits and payouts will also skyrocket, adding "hundreds of millions of dollars" in new costs to state and local governments, according to an impartial analysis conducted by the state's Legislative Analyst. State and local governments face higher costs in two ways: 
 
  • They provide health care for current and retired employees;
  • They provide health care for low-income residents through Medi-Cal and other locally run health care programs like community clinics and hospitals.

Someone will have to pay for these increased costs, and that someone is you (physicians), taxpayers and consumers/patients.
 
The campaign opposed to the initiative - "Patients and Providers to Protect Access and Contain Health Costs" - is a diverse and growing coalition of trusted doctors, community health clinics, hospitals, family-planning organizations, local leaders, public safety officials, businesses, and working men and women formed to oppose this costly, dangerous ballot proposition that would make it easier and more profitable for lawyers to sue doctors and hospitals. A full and updated list of groups opposing the campaign can be found here.
 
United as one voice, advocating for patients across the state, we can defeat this ballot measure in November, but we need everyone to commit and become engaged along the way. Thank you in advance for all that you do and all that you'll continue to do. 

Join the Fight

CMA and the campaign to defeat Prop. 46 need each and every one of you to help spread the word and educate your colleagues about the critical importance of MICRA. To that end, CMA has developed a MICRA Commitment Card.

We ask that you fill out one of these cards and pledge that you will vote no on the anti-MICRA measure known as Prop. 46.

Campaign Materials

The CMA can provide your office with campaign materials such as patient brochures, posters, buttons, campaign stickers and more. Just fill out the No on 46 order form.

More information

Visit these websites in order to learn more about MICRA so that you can educate your colleagues, friends, peers and family:

- The CMA website

- No on 46 campaign website

- Californians Allied for Patient Protection (CAPP) Website

What else can you do to support MICRA?

- "Like" the No on 46 Facebook page

- Follow the No on 46 Twitter page

- Visit the offical campaign website at www.noon46.com


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