Thursday, December 14, 2017

OCMA Blog

Physician Financial Transparency Reports (Sunshine Act) Begins August 1, 2013

Tracking of Industry Gifts to Physicians Begins in August

Don't miss your chance to challenge false or misleading data before it goes public!

Beginning August 1, 2013, manufacturers of drugs, medical devices and biologics that participate in federal health care programs must begin tracking and reporting certain payments and items of value—including consulting fees, travel reimbursements, research grants and other gifts—given to physicians and teaching hospitals. The new law, known as the Sunshine Act, also requires manufacturers and group purchasing organizations (GPOs) to report certain ownership interests held by physicians and their close family members.

The intention of the law is to increase transparency and reduce the potential for conflicts of interest that can influence research, education and clinical decision making.

The reports will be submitted to the Centers for Medicare and Medicaid Services (CMS) on an annual basis. The majority of the information contained in the reports will be made available on a public, searchable website beginning in September 2014. Physicians will, however, have the right to review their reports and to challenge any information that is false, inaccurate or misleading. By statute, physicians are provided, at a minimum, 45 days to review the transparency reports and make corrections before they are made public.

“Data accuracy is the number one goal of our program,’’ said Anita Griner, CMS’s deputy director for the Data Sharing and Partnership Group, speaking to the American Medical Association's House of Delegates in June. “We do not want to perpetuate any false information about a physician or teaching hospital…. And that will come from you tracking your own transfers and checking the website before it goes public.’’

 

 

The Sunshine Act covers all physicians who have an active state license, even if they do not participate in federal health care programs, but excludes residents and medical students.

Payments of less than $10 do not need to be reported unless the aggregate amount exceeds $100 annually. The $10 threshold will increase every year, based on the Consumer Price Index.

How to challenge false, inaccurate or misleading reports

Physicians will have 45 days after the annual reports are completed to challenge the data before it is made public. The reports will be available to physicians for their review via an online portal sometime after the close of the calendar year. The portal will also facilitate contact between a physician with a dispute and the manufacturer/GPO that submitted the disputed information.

 

Manufacturers then have 15 days to correct any misinformation. If a resolution is not reached within the allotted time period, the disputed information will be flagged, but the report will be posted on a public webpage. Physicians will, however, have two full years to contest or seek corrections to data contained in the reports, even after it has been made public.

 

Physicians are encouraged to proactively check with any manufacturer from which they have received payments or any items of value to see what information they are tracking and intend to report. If you hold any ownership interests, you should also check to ascertain what they intend to report. (Ownership or investment interests in publicly traded securities and mutual funds are excluded from reporting.)

What you can do now to prepare for the Sunshine Act

Update your disclosures regularly. Ensure that all financial disclosures and conflict of interest disclosures required by employers, advisory bodies and entities funding research, for example, are current and updated regularly.

If you have an NPI, update the information and ensure your specialty is correctly designated. Physicians who have a National Provider Identifier (NPI) should ensure all information in the NPI enumerator database is current and regularly updated as needed. This information will be used by industry reporters, among other unique identifiers, to ensure that they have accurately identified you.

Inform your industry contacts that you want ongoing notice of what they report to the government. Ask all manufacturer and GPO representatives with whom you interact to provide you with notice and an opportunity to review and, if necessary, correct all information that they intend to report before it is submitted to the federal government.

For more information

 

Physicians are encouraged to register for the CMS Open Payments listserv to receive periodic email updates about the program. To register, visit http://go.cms.gov/openpayments. Questions about the program can be sent to openpayments@cms.hhs.gov.

Some information in this article was republished with permission from the American Medical Association. For more information, visit www.ama-assn.org/go/sunshine.

 

Sidebars

Key Dates

August 1, 2013: Manufacturers begin collecting and tracking payment, transfer and ownership information.

January 1, 2014: CMS is expected to launch the physician portal that allows physicians to sign up to receive notice when their individual consolidated report is available for review. This portal will also allow physicians to dispute the accuracy of a report.

March 31, 2014: Manufacturers/GPOs report 2013 data to CMS.

June 2014: CMS is expected to provide physicians with access to their individualized consolidated reports for the prior calendar year. Physicians will be able to access the reports online and will be able to seek correction or modification by contacting the manufacturer/GPO via the web portal.

September 30, 2014: CMS will release most of the data on a public website.

Exemptions

The Sunshine Act includes a number of exemptions from the reporting requirements; among them are:

  • Samples intended for patient use, including coupons and coupons to obtain samples
  • Certified and accredited continuing medical education activities funded by manufacturers
  • Educational materials ultimately intended to be used with patients (for example, wall models or anatomical models)
  • Buffet meals, snacks, soft drinks, or coffee generally available to all participants of large-scale conference or similar large-scale events
  • The loan of a medical device for a short-term trial period
  • Discounts (including rebates)
  • In-kind items used for the provision of charity care
  • A dividend or other profit distribution from a publicly traded security or mutual fund

ACA Self Attestation Form Now Available

July 22, 2013


The ACA Self Attestation Form is now available on the ACA Increased Medicaid Payment for Primary Care Physicians page of the Medi-Cal website. Providers must use this form to self-attest that they are eligible for the increased payment available under the Affordable Care Act (ACA). Providers can reference the Primary Care Physician Self Attestation Form Completion Instructions for step-by-step instructions and additional information about the form.


BACKGROUND

The Patient Protection and Affordable Care Act (PPACA), as amended by the H.R. 4872-24 Health Care and Education Reconciliation Act of 2010, Section 1202, requires payments to be increased to the Medicare equivalent for certain primary care services. The increased payments are retroactive for dates of service on or after January 1, 2013, for both fee-for-service and managed care programs.

 According to the final rule, physicians must meet the following criteria to be eligible for increased payments:


  • A physician as defined in 42 Code of Federal Regulations (CFR) 440.50, with a specialty designation of family medicine, general internal medicine, pediatric medicine or a subspecialty within one of the listed specialties.

AND

  • Meeting at least one of the following qualifications:

o    Board certified in a specialty or subspecialty as recognized by the American Board of Medical Specialties, the American Osteopathic Association and the American Board of Physician Specialties.

OR

o    At least 60 percent of the services billed to Medi-Cal for the most recently completed calendar year fall within the Evaluation and Management (E&M) or vaccine administration codes covered by the regulation.


Services provided at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are not eligible and will continue to receive their prospective payment system (PPS) rate. Physicians must attest online to be eligible for the increased payments.

The Department of Health Care Services (DHCS) is working with Xerox State Healthcare, LLC, (Xerox) the DHCS Fiscal Intermediary (FI), to make the necessary system changes. Upon complete implementation of the system, DHCS will initiate payment corrections for eligible services provided on or after January 1, 2013. Eligible providers will receive the increased payments for future claims as defined in the Centers for Medicare & Medicaid Services (CMS) Final Rule.


State Offering Webinar on Coordinated Care Initiative

The California Department of Health Services is offering two more educational webinars on the Coordinated Care Initiative (CCI) in July. It is important to note that these webinars will NOT be recorded or available for on-demand playback.


Physicians and their staff in affected counties are encouraged to participate in one of the live webinars, Tuesday, July 23 or Tuesday, July 30.

 

The initiative, also known as "CalMediConnect," was authorized by the Assembly in July 2012 in an effort to save money and better coordinate care for the state's low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that will transition more than 450,000 of the state's dual eligible beneficiaries - those eligible for both Medicare and Medi-Cal - into managed care plans.

 

Enrollment begins no sooner than January 2014 in 8 counties (Alameda, San Mateo, Santa Clara, Los Angeles, Orange, San Diego, Riverside and San Bernardino).

 

Physicians, other providers and their staff are invited to participate in one of the July webinars:

  • Tuesday, July 23 at 6:00pm (Click here to register)
  • Tuesday, July 30 at 5:00pm (Click here to register)

Each webinar will include a 30 minute overview of the program, including continuity of care provisions, and 30 minutes of Q&A. Note that the content of the overview will be the same on both dates. Additional webinars will be scheduled as enrollment nears.

For more information on the initiative, please visit http://www.CalDuals.org


Orange County Medical Association Welcomes Dr. Kockinis as New President

Article written by Physicians News Network,  

www.physiciansnewsnetwork.com/orange_county 


Last Saturday, July 13, OCMA welcomed doctors to a special installation of OCMA’s new president, Dr. Thomas Kockinis.

Members and guests had a chance to meet and talk to Orange County public officials and members of California legislature, network with each other, and hear about the history of Orange County Medical Association, organized in 1889, back when an increase from two to six beds was considered a major hospital expansion.

Dr. Kockinis said a lot of positive changes during the last year at OCMA were in big part due to the leadership of Dr. Standiford Helm who worked hard during his term as the president of OCMA to take the organization to the next level.

“Membership”, Kockinis said “is now growing at a rapid pace, infused by a new generation of doctors eager to make a positive impact”. Advocacy, according to him, has never been stronger, and OCMA has excellent working relationships with legislators.

Dr. Dennis Jordanides, who is not a member of OCMA but attended the event for the first time as a guest, said that from his perspective “OCMA is becoming increasingly relevant in this era of unprecedented health care reform, and President's dinner was an excellent venue for physicians of all specialities to engage in discussions regarding future collaboration”.

He added that  “the community support of OCMA was clearly evident by the presence of a number of high-profile state and national political representatives."

The main message from the legislators attending the event was that they need to hear from physicians in order to understand the issues that physicians are concerned about. Assembly woman Diane Harkey went as far as give the audience her cell number saying “Call me, text me! Contact me any time, any time at all. I will look into it, we will take care of you because we need you!”

Eric Handler, Orange County Health Officer, told PNN that “partnership of his organization with OCMA has flourished under the current OCMA administration, and OC Health will continue to collaborate with physician community over public health issues, such as hunger, homelessness and prescription drug overdose.

He encouraged physicians to reach out to him and use him as a resource when they have any requests or concerns.

The event was attended by over 200 OCMA members and guests, and was held at the Center Club Costa Mesa.

See pictures from the event on OCMA's Facebook page


Announcement: Noridian Transition Dates Set

The Centers for Medicare and Medicaid Services (CMS) recently announced that the cutover to the new Medicare Administrative Contractor (MAC) for Jurisdiction E (including California) will begin in August. The Part A cutover will be August 26 and the Part B cutover will be September 16.

 

CMA has and will continue to work closely with CMS and the new contractor to ensure a smooth transition.

 

Jurisdiction E (previously called Jurisdiction 1) covers California, Nevada and Hawaii, as well as the U.S. territories of American Samoa, Guam and the Northern Mariana Islands. Jurisdiction E includes over 3.5 million Medicare fee-for-service beneficiaries, 500 Medicare hospitals and 86,500 physicians. MACs process Part A and Part B claims and perform other critical Medicare operational functions, including enrolling, educating and auditing Medicare providers.

 

To help physicians understand what is changing, Noridian is offering a series of Implementation 101 and EDI Support Services web-based workshops. Noridian is also holding in person "Meet and Greet" workshops throughout the state.


 Important Dates:

August 26, 2013 - Part A implementation

September 16, 2013 - Part B implementation

Orange County Meet and Greet:


July 9 - July 11

Embassy Suites Anaheim South

11767 Harbor Blvd

Garden Grove, CA 92840

Registration is required to attend these workshops. Specific times and registration information are available on the Noridian website: 

https://www.noridianmedicare.com/je/schedule.html

    

Other programs will be added as they progress through the transition. CMA encourages physicians to join the Noridian mailing list to stay apprised of changes.


If you have any questions or concerns on how this might impact your practice, members may contact OCMA's Physician Advocate, Mitzi Young:

Phone: 888-236-0267

Email: myoung@cmanet.org 


Orange County Medical Association Selects Solution21 as Preferred Business Partner

Irvine, Calif., May 21, 2013 - The Orange County Medical Association is pleased to announce another benefit of membership. The OCMA has designated Solution21 Inc., as its Business Partner for physicians seeking to generate more patient leads through custom design websites and internet marketing.

 

OCMA members may receive complimentary consultations and discounted rates on a wide range of internet marketing and website development services, including  custom built websites that are search-engine friendly, Search Engine Optimization (SEO), Social Media Marketing, and internet marketing solutions (Google Adwords and remarketing).

 

"We are knowledgeable about medical and dental practices and have streamlined the process to minimize the amount of time you need to spend on each website and marketing project. Our focus is on bringing the maximum number of new patients to your medical or dental practice by developing the best websites and marketing programs." said Fred Parvini, CEO at Solution21. "We look forward to offering our services to OCMA members through this special arrangement with OCMA."

 

Solution21 Inc., now celebrating its 10th year, provides service from its office in Irvine, California. The company is known for its support of local college graduates, graphic designers, web developers, and internet marketers. The Solution21 design team is known for its ability to develop websites that are comprehensive, state-of-the-art, and search-engine friendly, fulfilling both the professional and personal needs of its clients. The firm is focused solely on medical and dental practices and business with the medical community.

 

The strategic business partnership with Solution21 Inc. reinforces OCMA's commitment to bring added value to its members by aligning with companies that offer business practice expertise, allowing physicians to focus their attention on patient care.

 

 

About Solution21

Solution21 was established to fulfill a worldwide demand for cost-effective medical and dental custom website solutions and marketing services. The company is staffed by experienced healthcare, medical professionals, website designers, computer programmers, and marketing specialists who combine their talents to create an unrivaled lineup of products that will enable any practice to increase its production. For more information, visit www.solution21.com.

Upcoming Fundraising Event for Dr. Richard Pan, Assemblymember

Please Join the OCMA Board of Directors

for a Dinner Reception in Support of


 

DR. RICHARD PAN, ASSEMBLYMEMBER 

Friday, June 28, 2013


7:00 - 8:30 p.m.


Orange County Medical Association Conference Center

17322 Murphy Avenue
Irvine, CA 92614



$1,000 Host * $500 Co-Host $250 Supporter 

* $100 Friend * $50 Ticket


Dr. Richard Pan, a pediatrician and former UC Davis educator, currently represents the people of Sacramento and San Joaquin counties in the California State Assembly and serves as Chairman of the Assembly's Committee on Health.  He also continues to practice medicine. Dr. Pan has served in numerous capacities for his county, state, and national medical associations. He is past-President of the Sierra Sacramento Valley Medical Society and past-Chair of the CMA Council on Legislation. He is also the past-Vice-Chair of the California American Academy of Pediatrics (AAP) as well as past-Chair of the AMA Council on Medical Education and has served on the board of the Accreditation Council on Graduate Medical Education.  For a full bio, please see: http://www.asmdc.org/members/a09/biography. 



Please RSVP to Linda Johansen at: 


949-398-8100 Ext. 102 or ljohansen@ocma.org



Click here for the RSVP/Donation form



Please make checks payable to:

Dr. Richard Pan for Senate for 2014

915 L Street, Suite C415 Sacramento, CA 95814

 

You may also contribute on line at rally.org/panmd/donate

 


Department of Defense authorizes temporary waiver for TRICARE authorizations and referrals

As previously reported, since the transition of TRICARE managed care services from TriWest to United Health Military & Veterans (UMVS) on April 1, 2013, physicians are reporting significant delays in processing of authorizations and referral requests, which is affecting patient care.

The California Medical Association (CMA) recently surveyed members about the transition, and 30 percent of physicians surveyed reported significant delays in the processing of authorization and referral requests for TRICARE patients. While the standard timeframe for processing of authorization and referral requests is two business days for urgent request and five business days for routine requests, the payor has been weeks behind in processing of these requests. CMA has been working closely with UMVS to seek a resolution to this issue as soon as possible.

To address the delays, the Department of Defense (DoD) has waived authorization and referral request requirements for all TRICARE covered services April 1 through May 18, 2013. Physicians will not be required to seek or wait for an approval from UMVS for any covered services.

However, according to the UMVS Frequently Asked Questions (FAQ), if a practice received a denial from UMVS for a previously submitted request for a referral or authorization, the previous denial will remain in effect.

In a May 3 letter announcing the waiver, Lori McDougal, Chief Executive Officer of UMVS, directs physicians to provide a copy of the letter to patients at the time of referral to ensure the specialty physician knows the request is authorized.

CMA continues to work closely with UMVS to ensure the difficulties physician’s have experienced since the transition are resolved quickly.

For more information on the TRICARE transition, see CMA's TRICARE Transition Guide, available free to members in CMA's online resource library at www.cmanet.org/resource-library.

Questions about the waiver should be directed to UMVS Provider Services at (877) 988-9378.

Contact: CMA’s reimbursement helpline (888) 401-5911 or economicservices@cmanet.org.


2013 CalOptima Circle of Care Award Request for 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 230 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 7, 2013

Mail, deliver, fax or email Nomination Forms to:   

CalOptima: Network Management Department

Attention: Maria Wahab

505 City Parkway West, Orange, CA 92868

Email: mwahab@caloptima.org

Fax: 714-796-6679   

Award recipients will be invited to attend the Circle of Care Award luncheon on Friday, September 20, 2013. 

 

 

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.

 

Please click here for the nomination form


Malpractice Claims Consume Years of a Physician’s Career

Risk Tip by The Doctors Company

On average, each physician spends 50.7 months, or approximately 11 percent of an average 40-year career, on resolving medical malpractice cases—the majority of which end up with no indemnity payment. That’s the conclusion of a recent study1 by the RAND Corporation based on data provided by The Doctors Company, the nation’s largest medical malpractice insurer. Researchers found that 70 percent of the time physicians spend on claims is spent defending claims that end in no payment to the plaintiff.


Key findings of the study include:

  • Physicians experience additional stress, work, and reputational damage from the time spent defending claims.
  • Fighting claims takes time away from practicing medicine and from the opportunity for the physician to learn from his or her medical errors.
  • The lengthy time required to resolve claims also negatively impacts patients and their families.
The effect of malpractice claims on physicians’ careers is discussed further by Richard E. Anderson, MD, FACP, chairman and CEO of The Doctors Company, in two short videos that can be viewed at www.youtube.com/doctorscompany.

To help prevent claims that can take up years of your career, follow these key tips to promote patient safety:

1.    Communicate with Patients

·         Understand the new vital sign: health literacy.

·         Do not ask patients if they understand—instead, ask them to repeat back the information.

·         Document patient understanding of instructions.

·         Provide the patient with written instructions.

·         Use a translator when necessary.


2.    Document Carefully and Objectively

·         Do not point fingers at other staff or providers.

·         Do not impeach the integrity of the medical record by altering it.

·         Use only approved abbreviations.

·         Review patient information that is automatically populated in the EMR.


3.    Monitor Handoffs and Ensure Follow-ups

·         Establish a formal tracking system for missed appointments.

·         Follow up with patients to reschedule.

·         Document missed appointments in the patient record.

·         Send a letter to patients who repeatedly miss appointments.

·         Explain the importance of follow-up care.

·         Refer the patient to another physician, if necessary.


4.    Avoid Medication Errors

·         Keep prescription pads secure.

·         Document samples in the medical record.

·         Check allergies at every visit and document in the same place in the record.

·         Review and reconcile medications at every patient visit.

·         Be aware of LASA (look-alike/sound-alike) medications.


5.    Follow HIPAA Regulations

·         Avoid unauthorized release or breaches of PHI (protected health information).

·         Safeguard against lost or stolen PHI through laptops or drives.

·         Examine office practices and layout that may compromise confidentiality.

·         Assess your methods to protect electronic communications.

·         Follow federal requirements and know your state regulations, which may be stricter.

 


Reference
1. Seabury SA, Chandra A, Lakdawalla DN, Jena AB. On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim. Health Affairs. 2013;32(1):1-9. 


Home   |   About Us   |   Membership   |   For Physicians   |   News   |   For Patients   |   Advocacy   |   Events
Copyright (c) 2017 Orange County Medical Association