Tuesday, March 20, 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 jhopkins@imq.org

Physician Advocate Tip of the Month: Give your patients the answers they need about Covered CA

June Tip:

Give your patients the answers they need about the Covered California networks and more.

Download "Frequently Asked Patient Questions about Covered California."

With the recent launch of California's health benefit exchange, Covered California, millions of Californians are now eligible to obtain insurance through this new online marketplace. Understandably, patients have many questions. Download this document to provide answers to the most common patient questions.

Receiving practice management guidance from Mitzi Young is a FREE OCMA member benefit!
Contact Mitzi to schedule a one-on-one consultation to discuss your practice management needs: 
Mitzi Young
Physician Advocate, CMA Center for Economic Services


Orange County Medical Association Selects Universal Financial Systems as its Business Partner

Universal Financial Systems will extend special offers to OCMA Physician Members 

Irvine, Calif., June 3, 2014 - The Orange County Medical Association is pleased to announce another benefit of membership.  The OCMA has designated Universal Financial Systems as its Business Partner for physicians seeking collections and pre-collections help on past due receivables. Universal Financial Systems is a full-service collection agency based in Southern California. 

Free Insurance and Patient Collection Performance Analysis ($300 Value)

  • Patient Collection Analysis
  • Insurance Collection Analysis
  • Accounts Receivable Analysis
  • Full Detailed Report

Pre-Collection Program - Offering a "5 %" rate for account referrals received and collected within 120 days from the date of service

  • This is exclusive for OCMA members. All other clients get the "5%" until 90 days from date of service

Standard Collection Program: 120+ days from date of service -> 30% of collected revenue

  • Competitors' rates can be as much as 40 to 50% rates of collected revenue
  • State-of-the-art tools to locate debtors
  • Active Account Monitoring - allows tracking and notification when debtor's finances improve, purchase assets, etc.
  • Month-end Status Reports
  • Client Account Reviews
  • Judgment Collections Expertise
  • Litigation Services Available 

For more information, please contact:
Greg Apostolou
(310) 386-9085

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 http://imq.inreachce.com.

The Doctors Company Risk Tip: Including Risk Management in Your Vacation Planning Allows You to Relax

Because liability never takes a holiday, your vacation plans should include medical coverage arrangements for your practice, particularly when you use locum tenens. The following tips will help reduce risks in your practice and promote the safety of your patients as you plan your vacation:

  • Review managed care contracts for relevant coverage requirements. Some managed care contracts contain very specific language on this topic and many contain indemnification clauses that could expose you to the liability of the covering physician (as well as breach of contract). 
  • Whenever possible, make secondary coverage arrangements. Confirm coverage arrangements via e-mail or fax with the locum tenens who are covering your practice in order to avoid misunderstandings, possible uncertainty of dates or time frame, and exposure to abandonment.
  • Ensure that the practice coverage arrangements include an understanding about patient billing practices in conjunction with any managed care contracts or plans. 
  • Choose covering physicians who share your medical specialty and have privileges at the same hospitals that you do. 
  • Determine if covering physicians carry professional liability coverage and the limits of such coverage. While asking these questions could be awkward, you may be required to ask under certain managed care plans, provider agreements, and hospital bylaws.
  • Before leaving on vacation, prepare a list of patients who are hospitalized or are in the midst of diagnostic work-up, or who have special medical problems or needs. Give this information to the covering physicians and document any specific advice you provide. 
  • Inform the attending physicians or hospitalists of any hospitalized patients you are following about your coverage arrangements, and document the hospital chart to reflect these conversations. 
  • Advise your patients of the coverage arrangements and give them the covering physicians’ names.
  • Make each hospital where you have on-call responsibilities aware of the dates of your unavailability and the identity and phone numbers of the covering physicians. Give similar notice to your answering service and office staff.
Upon returning from vacation, promptly confer with all covering physicians. Document what you were told by the covering physicians about any significant developments in patients’ clinical course or treatment while you were away. 

Consider implementing these fundamental loss prevention measures for even brief periods when you are unavailable, such as observance of religious holidays, attending medical conferences, personal illness, or a long weekend. Unfortunately, vulnerability to claims is not diminished on these occasions. 

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.


Experts Agree MICRA Measure Mandate “Won’t Work” While Opening Floodgates to Personal Prescription Drug Records of Millions of Californians with No Additional Security Safeguards 

SACRAMENTO – A coalition of business, medical, labor and civil liberties organizations have come together to fight a misguided, deceptive initiative that would increase health costs, reduce health access, and rely on a government-run computer system that isn’t close to fully functional – all while putting the prescription drug histories of millions of California patients at privacy risk with no additional security protections.

The initiative, which qualified for the November ballot on May 15, 2014, is written and funded by trial attorneys and their allies.  In addition to increasing the overall number of medical lawsuits and the cost of health care across the board, it contains a number of unrelated provisions designed to mislead and deceive voters – including a little-discussed mandate relying on a massive expansion of a government-run prescription drug database, which third-party analysts say cannot be implemented as written and will leave personal medical information vulnerable to privacy breach.   
“We always knew this flawed measure was bad for the pocketbooks of everyday Californians, but the more they read the fine print, the more they realize it’s equally bad for their personal privacy,” said Jim DeBoo, campaign manager for the broad-based coalition of Californians formed to oppose the initiative.  “If this measure passes, it will mandate a database that isn’t properly working and open the privacy floodgates to the sensitive personal medical data of millions of Californians with no increased security safeguards or funding.  It’s a hacker’s dream – and a privacy nightmare.”

The so-called MICRA (“Medical Injury Compensation Reform Act”) initiative requires health care practitioners and pharmacists to consult a government-run prescription drug database (known as CURES) prior to prescribing or dispensing Schedule II or III controlled substances to patients.

The mandate relies on the uploading of personal prescription drug records of millions of California patients onto the database – accessible by hundreds of thousands of users.  But the initiative fails to add new funding for its expedited expansion or require any additional security standards or safeguards to prevent hacking, theft or improper access by non-medical personnel.

What’s more, experts say the CURES mandate will not work as required by the measure, will not be operational by the law’s effective date and will put doctors in the impossible position of choosing between violating their oath as health providers or violating the law.

“The CURES mandate on physicians cannot be implemented as written.  CURES needs to be updated and modernized and nothing in the initiative does that.” said Tim Gage, former California Finance Director and Principal at Blue Sky Consulting.  “Therefore, the initiative will put health providers in the untenable position of either violating the new law or withholding necessary treatment from patients unless the law is suspended.”

“The consequences of mandating the use of a government-run website that experts say won’t work when required before physicians are allowed to prescribe needed medication is nothing less than a recipe for disaster,” said Dr. Richard Thorp, M.D., President of the California Medical Association.    
The CURES database mandate problem comes at a time of widespread reports of illegal hacking, much of it involving digital medical records. Studies show that public fears about personal privacy are at an all-time high.  Last month, it was reported the FBI had taken the extraordinary step of warning that the entire health sector was particularly vulnerable to “attacks by hackers searching for Americans’ personal medical records” (Reuters, April 23, 2014). 
Since 2009, the U.S. Department of Health and Human Services has reported 991 separate incidences of medical data breaches involving 500 people or more, affecting a total of 30 million patients.  While many states are moving to increase protections for online prescription drug data, this measure would have the opposite effect in California.

“The public and lawmakers are really starting to understand what kinds of threats to privacy come when you start centralizing great quantities of sensitive personal information in giant electronic databases,” said Nathan Wessler, an attorney with the American Civil Liberties Union, last week to the Wall Street Journal (May 7, 2014).

As proposed, the CURES database maintains an accessible online record of every dispensed prescription of a Schedule II or III controlled substance, including highly sensitive and potentially stigmatizing details about a person’s health.  This prescription information could include medicines used to treat anxiety, insomnia, obesity, narcolepsy, drug detoxification, pain, epilepsy, conditions related to cancer and AIDS, asthma, chronic infection, and other sensitive medical conditions.

The MICRA lawsuit measure which qualified today is formally opposed by (partial list):   

  • AFSCME California PEOPLE
  • International Brotherhood of Electrical Workers, Ninth District
  • International Brotherhood of Electrical Workers, Local 477
  • Service Employees International Union (SEIU) California
  • Union of American Physicians and Dentists (UAPD), AFSCME Local 206
  • 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
  • California Chamber of Commerce
  • California Black Chamber of Commerce
  • California Hispanic Chamber of Commerce
  • City of Long Beach
  • American Civil Liberties Union of California 

To learn much more about the myriad hidden costs, consequences and flaws in the trial-lawyer-supported MICRA lawsuit initiative, visit the “Stop Higher Health Care Costs/Protect Access to Care” website at: www.StopHigherHealthCareCosts.com.

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Orange County Medical Association Selects Acentec, Inc. as Business Partner

National healthcare technology firm will extend special offers on HIPAA compliance to OCMA Physician Members

Irvine, Calif., May 20, 2014 - The Orange County Medical Association is pleased to announce another benefit of membership.  The OCMA has designated Acentec, Inc. as its Business Partner for physicians seeking cost effective and complete HIPAA compliance and IT management. 
Acentec has agreed to offer OCMA members discounts up to 20% for HIPAA compliance and IT management needs.
"We're pleased to offer OCMA members the security and protection of our  HIPAA compliance and healthcare IT services," said Jeff Mongelli, CEO of Acentec, Inc. "New HIPAA requirements and increased penalties make the proper care and handling of sensitive patient health information essential for every provider and medical organization. We share in the common goal of OCMA members of keeping private information secure so our community can benefit from the authorized access of those who need it."
The following Acentec services are included in our relationship with OCMA members: discounted HIPAA compliance services including annual risk assessments, documentation, and employee training; IT services including network and systems management and monitoring, HIPAA compliant remote back-up and hosting, secure email & messaging, business disaster recovery that eliminates or minimizes downtime and data loss, and 24/7 access to our support staff.
 Acentec's corporate offices are located in Irvine, CA and they have staff  located nationwide.
About Acentec, Inc.
Southern California-based Acentec, Inc. provides a full range of healthcare IT services to medical practices nationwide. Our services include medical billing, IT management and support, EMR software support, HIPAA compliance, and a certified patient portal. For more information, visit http://www.acentec.com.


Physician Advocate Tip of the Month: Request your FREE Covered CA Contract Analysis

May Tip:

Request your FREE in-depth, paragraph-by-paragraph contract analysis of the four insurance payors participating in Covered California!

OCMA contracted with our business partner Tredway Lumsdaine & Doyle, LLP, to do an in-depth analysis of the contracts of the three insurance payors (Blue Cross, Blue Shield and Health Net) that are offering plans through Covered California. OCMA members can receive a FREE copy of this paragraph-by-paragraph analysis to help aid your understanding of these health plan contracts.
Contact Mitzi Young at:

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
Email: mwahab@caloptima.org 
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.

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