Monday, March 19, 2018


IMQ Expands Peer Review Services

Does your medical staff need help with peer review? The Institute for Medical Quality is expanding its services to include Clinical Case Review of individual cases and Judicial Review services in addition to our existing Comprehensive Peer Review services.

Through off-site patient chart review, an IMQ Clinical Case Review consultation provides an objective evaluation of the clinical practice of one or more physician members of a hospital medical staff, physician group, or ambulatory care practice through peer review of selected cases. IMQ's involvement is especially helpful when an organization will benefit from expert review of one or more patient cases, but needs physicians of the appropriate specialty who have no real or perceived conflicts of interest.

Additionally, IMQ is seeking physicians to support this expansion of services. For more information about any of IMQ’s peer review services, or about becoming a physician reviewer, please contact Julie Hopkins at 415-882-5165 or

OCMA CEO Advocacy & Legislative News Update

Local: CalOptima

Thanks in part to OCMA advocacy, in March, the CalOptima Board of Directors approved establishing a 'Community Network', allowing direct contracts with physicians in order to provide greater access to services for CalOptima enrollees.
Also in March, the County Board of Supervisors modified the county ordinance governing CalOptima to require an additional supervisor be added to the CalOptima Board of Directors. As a result, Supervisor Todd Spitzer has joined Supervisor Janet Nguyen on the CalOptima Board. 
For details and resources on the state's Coordinated Care Initiative (CCI) - Dual Eligibles Demonstration, please click here.

State: Health Care Bills

SB 1215 (Hernandez): Healing arts licensees: referrals (CMA Position: OPPOSE) - which aimed to eliminate the in-office exception to the self-referral law for advanced imaging, anatomic pathology, radiation therapy, and physical therapy. This bill would have been a major blow to the integrated care model, resulting in increased costs as these services would have been driven toward the more expensive hospital setting and inhibit the development of practices that integrate and coordinate care. We have successfully managed to defeat this harmful bill in committee.
SB 1000 (Monning) the Sugar-Sweetened Beverages Safety Warning Act (CMA Position: SPONSOR)  - passed the Senate Floor after receiving 21 yes votes. Facing significant opposition from the beverage industry, it was a hard-won vote. 
AB 1771 (V.M. Perez) Telehealth Reimbursement (CMA Position: SPONSOR)  - was approved through a 76-1 vote. This bill seeks to require health insurance companies licensed in the State of California to pay contracted physicians for telephone patient management. 
AB 2400 (Ridley-Thomas) Health care coverage: provider contracts (CMA Position: SPONSOR) - was approved through a 55-8 vote. If signed into law, this bill will prohibit contracts issued, amended or renewed after January 1, 2015, from including a provision that terminates a provider if he or she exercises the right to negotiate, accept or refuse a material change to the contract. It would also prohibit plans from requiring participation in unspecified current and future products or product networks, unless the plan discloses the reimbursement rate, method of payment and any other contract terms that are materially different from those of the underlying commercial agreement. 

National: Medicare SGR

Over CMA's strong opposition to another short term patch, on March 31, the night before the SGR cut, the House and Senate voted on the 17th patch in a decade.  With the President's signature, the bill takes effect and provides the following: 

  • Stops the 24% Medicare physician payment cut for 1 year until April 2015.
  • Provides a 0.5% payment increase through Dec 31, 2014; 0% through April 1, 2015.
  • Delays the burdensome ICD-10 coding system until October 2015.
  • Permanently Reforms the California physician payment localities. 

For the full OCMA CEO Advocacy & Legislative Report, click here.

Stepping Up to Leadership Courses Available Online

Couldn’t make it to the IMQ-PACE Stepping Up to Leadership conference this spring? Why not make the conference content come to you? Selected courses from Stepping Up to Leadership are now available online at IMQ Online Education!  All content is available for AMA PRA Category 1 CreditTM—take this opportunity to earn CME credit at a time and place that’s convenient for you.

Stepping Up to Leadership courses cover a variety of important skills for successfully running a medical staff, particularly issues of communication, problem-solving, and improving outcomes for patients and staff.  Choose from Nancy Dickey, MD’s keynote presentation, Successful Leadership: What It Really Takes, Donald David, MD on The Role of the Physician In Patient Safety, Carol Havens, MD on Using CME as an Organizational Improvement Tool, and a 2014 Legal Update by Greg Abrams, Esq. covering hot medico-legal topics in California. To browse the full IMQ Online Education catalog, visit

2014 CalOptima Circle of Care Award: Requesting Nominations

About CalOptima and the Circle of Care Award
CalOptima’s mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner.

The CalOptima Circle of Care Award recognizes health care professionals, community groups and individuals who demonstrate excellence in the delivery of accessible and high-quality health care services to CalOptima members. The award honors those who go above and beyond in serving their profession, patients or clients. Since the award’s inception in 2000, CalOptima has recognized more than 250 distinguished people or groups whose dedication to our members and community is extraordinary.   

Nomination Criteria and Deadline
Please join CalOptima in recognizing outstanding health care professionals, community groups and individuals who, in the past 12 months, went above and beyond to serve our members by submitting the attached Nomination Form. Award recipients will be selected based on:
•         The nominee’s service to CalOptima members
•         The nominee’s accomplishments during the past 12 months

Nominators, please note the following criteria:

  • A nominee may only be a Circle of Care Award recipient a total of five times.
  • Only one Nomination Form per nominee is needed.
  • Self-nominations are welcome.
  • Completed Nomination Forms must be submitted by Friday, June 20, 2014.

Click here for the Nomination Form

Mail, deliver, fax or email Nomination Forms to:         

CalOptima Provider Relations Department 
Attention: Maria Wahab
505 City Parkway West, Orange, CA 92868
Fax: 714-796-6679  

Award recipients will receive an invitation to attend the Circle of Care Awards luncheon on Friday, September 12, 2014.  
If you have any questions, please contact Maria Wahab at 714-796-6143. Please allow adequate time before the nomination deadline for CalOptima to respond to any inquiry.

Now Accepting Nominations for the 2015 Physicians of Excellence Awards!

Is your doctor the BEST in Orange County?

Nominate him or her for the 2015 Physicians of Excellence Awards!

OC Register Magazine in conjunction with the Orange County Medical Association (OCMA), will publish its annual list of Orange County Physicians of Excellence in the February 2, 2015 issue of OC Register Magazine, and is currently seeking nominations. The Physicians of Excellence program was designed to honor outstanding physicians practicing in Orange County. The selection criteria that will be used to determine physician excellence were developed by a multi-specialty collaboration of the OCMA. Anyone can nominate a physician to be considered for the Physicians of Excellence program. Physicians need to be nominated only once to be eligible to apply for selection as a Physician of Excellence. Multiple nominations for the same physician are discouraged. Self-nominations will not be accepted. Once nominated, an application packet will be mailed to the nominee with the details of the application process. Membership in the OCMA is not a requirement for selection.

Minimum criteria for Physicians of Excellence include:

  • Hold board certification within specialty of nomination.
  • Maintain a primary practice location in Orange County, California for the last 5 years.
  • Be in good standing with the Medical Board of California
  • Have been in practice within his/her specialty field for the last 5 years consecutively
Nominators are not required to certify that the physician they are nominating meets these criteria.

Nomination forms are located at:

You may also download the form by simply clicking here.
Submit your nomination form to the Orange County Medical Association by July 10, 2014
Send to:
OCMA, 17322 Murphy Avenue, Irvine, CA 92614 or 
fax to (949) 398-8120. 
For questions call (949) 398-8100 ext 106 

CalOptima Seeks Candidates to Participate on its Provider Advisory Committee (PAC) 2014-2016

The CalOptima Board of Directors welcomes input and recommendations from the provider community regarding issues concerning CalOptima programs. For this reason, the CalOptima Board encourages providers to become involved through an advisory group known as the Provider Advisory Committee (PAC).

The Provider Advisory Committee advises the CalOptima Board of Directors and staff. The CalOptima PAC is composed of 14 members representing diverse provider constituencies. These include but are not limited to health plans, hospitals, physicians, nurses, allied health professionals, long-term care services and community health centers. The charge of the committee is to:
  • Provide advice and recommendations to the CalOptima Board on issues concerning CalOptima programs as directed by the CalOptima Board;
  • Engage in study, research and analysis of issues assigned by the Board or generated by thecommittee;
  • Serve as a liaison between interested parties and the Board;
  • Assist the Board in obtaining public opinion on issues relating to CalOptima programs;
  • Initiate recommendations on issues for study to the CalOptima Board for their approval and consideration; and
  • Facilitate community outreach for CalOptima and the Board.

At this time, CalOptima is seeking candidates to participate on its Provider Advisory Committee (PAC). Service on the PAC is voluntary and with no salary. You need to be available to attend monthly meetings and serve on subcommittees. The following two-year seats are available:

  • Long Term Care Services Representative (two seats) 
  • Non-Physician Medical Practitioner Representative 
  • Pharmacy Representative 
  • Physician Representative (two seats)

The committee encourages interested individuals with knowledge and support of Medi-Cal and Medicare to apply. To apply or to nominate an individual for the Provider Advisory Committee, please mail, fax, or email the attached candidate application by Friday, April 11, 2014, along with a biography or resume plus two letters of reference to:

Attn: Maria Wahab
505 City Parkway West
Orange, CA 92868
Office: 714-796-6143 
Fax: 714-796-6679 
If you have any questions, please call Maria Wahab at 714-796-6143.  

MEDICARE SGR ALERT: Physicians: Call Congress Now!





Physicians: Call Congress Now! (800) 833-6354 (Takes 2 Min)

UPDATE MARCH 11, 2014:
House Republican leaders have scheduled a vote for this week on H.R. 4015, with a repeal of the ACA individual mandate as the funding source. (If the mandate is repealed, the government will spend less on premium subsidies and thus, a substantial cost savings will occur.)

This repeal of the ACA is not an acceptable, viable funding option in the U.S. Senate. Knowing that the ACA repeal will not be accepted, House leaders have scheduled a second vote at the end of March to adopt another nine-month patch.

CMA is urging Congress to find bipartisan funding sources. We are opposing another nine-month patch. CMA is calling upon Congress to Fix Medicare Now!

A long-awaited and hard-fought bill to permanently repeal Medicare's fatally flawed sustainable growth rate (SGR) formula finally is before Congress. The SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015/S. 2000) offers a fiscally prudent opportunity for lawmakers to repeal the SGR formula and put Medicare on the path toward a stable, 21st-century program that can meet the growing health care needs of the nation's seniors.

This is the most progress Congress has made in a decade. We must seize this opportunity and make a final push to get this bill passed NOW. To sustain the bipartisan momentum, your Congressional representatives need to hear from you.

There are many powerful groups that are pushing back, objecting to Congress' plans for funding the physician payment fix. That's where you come in. To overcome the opposition, Congress needs to hear from a large volume of physicians. Every single physician needs to call and email the California Senators and your Member of Congress NOW!

Congress has a significant opportunity to finally repeal the SGR and enact payment reform. Why?

  • The cost to repeal the SGR is at an all-time low of $116 billion - down from $238 billion.
  • Congress has already spent $154 billion over the last decade adopting short-term patches to stop the SGR cuts - more than the total cost to repeal the SGR. It is fiscally irresponsible to adopt another one-year SGR patch. The Wall Street Journal calls the "patches" a sham.
  • There is a bipartisan, bicameral agreement on legislation to establish a new payment system.
  • The deadline is March 31, 2014, when the next 24 percent SGR cut occurs.

But reform won't happen unless Congress hears from thousands of physicians!

Physicians must call Congress to fix Medicare now!
To overcome the partisan funding proposals and the other opposition, Congress needs to hear from a large volume of physicians. Every physician needs to call and email the California Senators and your Member of Congress NOW! Please make as many calls and send as many emails as possible. Every one makes a difference! We are asking physicians to call/email the following individuals:

  • Your local congressional representative (use your local zip code)
  • California Senator Barbara Boxer
  • California Senator Dianne Feinstein
  • House Republican Whip Kevin McCarthy (zip code 93309)
  • House Democratic Leader Nancy Pelosi (zip code 94103)

To contact members of Congress:
Call AMA's Grassroots Hotline, (800) 833-6354, to be connected with your members of Congress in Washington. You will be asked to enter your zip code and select your representative. You are also encouraged to call your representatives in their local district offices (click here to download a current telephone roster).

You may also email your federal legislators via the AMA's "Fix Medicare Now" grassroots website. Utilizing the sample letter provided, it takes no more than two minutes.

Urge Congress to tell their House and Senate leadership to:
1. Protect access to care in California and enact Medicare physician payment reform NOW.
2. The cost to fix the Medicare SGR is at an all-time low and there is bipartisan agreement on the legislation.
3. Use bipartisan funding sources.
4. Oppose another one-year SGR patch.

Ask your patients to help:
AMA has also prepared a flyer that you can use to get your patients involved in the fight to protect Medicare. Distribute the AMA's "Fix Medicare Now" flyer to your patients and ask them to call their representatives, too.

Additional information:

Member Resource: Surviving the Third Month of Covered CA

As of February 15, Covered California reports that more than 828,000 individuals have enrolled in exchange plans, which surpasses its original target. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff know what to expect.

To help answer some of the more common questions, the California Medical Association (CMA) offers this third tip sheet to help physicians survive the third month of Covered California.

Additionally, CMA has just published a document physicians can provide to their patients to address the most common patient questions. The document is available free for members in CMA's exchange resource center at If you would like patient materials delivered to your office or patient training for your office staff, please fill out a Covered CA Information Request form and fax or email it back to OCMA. 
Still have questions?
Visit CMA's exchange resource center at There you will find all of CMA's exchange resources, including CMA's comprehensive exchange toolkit, "CMA's Got You Covered: A Physician's Guide to Covered California, the state's health benefit exchange." OCMA members and their staff also have FREE access to your Physician Advocate, Mitzi Young for reimbursement assistance and questions about the exchange. Members can contact Mitzi at (888) 236-0267 or

March 14 is early bird deadline for 2014 Leadership Academy; Register today and save $100

Register today for the 17th annual Western Health Care Leadership Academy (formerly the California Health Care Leadership Academy) and save $100. You won't want to miss out on this year's dynamic conference and our very special keynote speaker! 

This year's conference will be held at the beautiful San Diego Convention Center on April 11-13, 2014. 

Continuing its tradition of programming excellence, the conference will examine the most significant operational, financial and environmental challenges facing health care today and present proven models and innovative approaches that will enable you to transform your organization’s care delivery and business practices.  

Registrations received on or before March 14 receive a $100 discount. Additional discounts available for multiple registrations (five or more individuals from the same medical practice, medical group or medical staff). Visit for more details.

New this year, registrants have the option to select the "VIP Upgrade" for a more up close and personal experience. Register with the VIP Upgrade and enjoy express onsite check-in, preferred seating, a private off-site cocktail reception and more! Upgrades are available in a limited number on a first-come, first-served basis, so register today!

Contact: Roger Purdy, (800) 795-2262 or

Former Secretary of State Hillary Rodham Clinton will headline the 2014 Leadership Academy

The 17th annual Western Health Care Leadership Academy is thrilled to welcome keynote speaker Hillary Rodham Clinton, Former Secretary of State and Former U.S. Senator from New York. This year's Academy (formerly the California Health Care Leadership Academy), is scheduled for April 11-13, 2014, at the San Diego Convention Center.  

Top thinkers and doers will share strategies and resources for accelerating the shift to a more integrated, high performing, and sustainable health care system. The conference will examine the most significant challenges facing health care today and present proven models and innovative approaches to transform your organization’s care delivery and business practices. Topics will include leadership development, ACA implementation and practice management.

Click here for the flyer and registration form. 

The County of Orange, Health Care Agency is seeking an experienced Public Health Medical Officer I

Program Emphasis:

The Public Health Medical Officer I provides culturally sensitive, medically indicated care (and supervision of clinical services provided by Family Health nurse practitioners), including clinical assessments, physical exams, diagnostic and medical management, and coordination of case management. The Public Health Medical Officer I also supports on-site program activities in other co-located ambulatory care clinics.


Santa Ana - 1725 W. 17th St., Santa Ana, CA 92706 

The Opportunity:

The County of Orange, HEALTH CARE AGENCY is seeking an experienced Public Health Medical Officer I who can utilize their education and skills to:

  • Examine, diagnose and treat pediatric patients for both acute care and periodic health screenings (CHDP) seen in our Family Health Clinics (Child Health, Immunizations)
  • (In the case of a family medicine physician) provide in the Family Planning Clinic individual reproductive health education and counseling; initiation and management of all FDA-approved methods of contraception, including emergency contraception; clinical and preventive services to maintain reproductive health
  • Prescribe medications to suitable patients; initiate and/or continue medical regimes for new patients; chart treatment records and monitor results; provide medical patient consultations/referrals to other physicians in the community
  • Provide clinical supervision and consultations to nurse practitioners in Child Health (Pediatric or Family Medicine Physicians) and Family Planning (Family Medicine Physicians only)
  • Consult with other program clinical staff regarding care of patients and treatment given
  • Conduct nurse practitioner peer reviews, patient care-coordination and case management
  • Develop, review and update clinical policies and procedures, clinical practice guidelines, developmental screenings
  • Provide clinical oversight of travel immunization clinic, provide consults (including malaria) for travelers; monitor travel and/or health-related advisories
  • Present in-service education and trainings to clinic staff (including new and updated policies and procedures, vaccines)
  • Stay current with care and treatment guidelines; ensure compliance with requirements from Childhood Prevention and Disability Program (CHDP), Family Planning (FPACT), Vaccines for Children (VFC) Program
  • Review billing records for accuracy and appropriate documentation.
  • Participate in staff meetings, problem solving groups, and continuing education programs sponsored by the clinic or other designated agencies.
  • Identify client's medical or psychosocial issues that fall outside the scope of Family Health and refer such cases to appropriate resources for treatment with follow-up.
  • Participate in quality improvement activities, review charts for compliance with established standards, policies, and procedures.


License Required:
  • Possession of a valid Physician's and Surgeon's Certificate issued by the Board of Medical Examiners of the State of California.
  • Possession of a masters degree in public health from an accredited school of public health (one year of experience as a Medical Officer in a public health agency with a generalized program may be substituted for the masters degree).


For more information and to apply, click here.

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