Sunday, March 18, 2018


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:


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


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

Upcoming Fundraising Event for Dr. Richard Pan, Assemblymember

Please Join the OCMA Board of Directors

for a Dinner Reception in Support of



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: 

Please RSVP to Linda Johansen at: 

949-398-8100 Ext. 102 or

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


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

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

Contact: CMA’s reimbursement helpline (888) 401-5911 or

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


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

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.


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. 

Health Reform Heats Up

By James Noonan, CMA Staff Writer

More than three years have passed since the Affordable Care Act (ACA) was into law, setting into motion some of the most dynamic and volatile years the nation’s health care industry has ever seen.

Since its inception, the law has been a subject of controversy, inspiring hotly contested debates in Washington, D.C., Sacramento and across the entire nation. For some, this dramatic overhaul of the nation’s health care system represents our national leaders finally making good on the long-overdue promise of “health care for all.” Others claim that the law is a clear overreach of federal authority that threatens to overburden an already fragile economy.

Although the law remains controversial, the United States Supreme Court has ruled that the law is constitutional and active steps are being taken to move forward at the federal and state level.

Despite being signed into law more than three years ago, the vast majority of activity has yet to come. With many of the provisions set to take effect on January 1, 2014, state officials across the nation are scrambling to make sure they’re ready to implement the law’s sweeping changes.

The road has already been a somewhat rocky one.

Throughout the implementation process, the U.S. Department of Health and Human Services has been narrowly meeting its own deadlines, often times leaving states waiting for federal guidance that could dramatically alter their own implementation plans. With several major deadlines coming in the next few months, many observers expect this problem to only get worse.

Adding to the headache for the federal government is the fact that the ACA has received mixed support from the states, which has complicated implementation efforts nationwide. As of early February, only 19 states had elected to develop their own state-run “exchange,” an online marketplace where consumers can purchase subsidized coverage. An additional five states will form state-federal partnerships to operate their marketplaces, while the remaining states have declined to participate, meaning the federal government will be responsible for operating exchanges in those areas.

Despite these problems, the march toward reform continues on.

The Next Major Milestone

The next major milestone toward full implementation is set to take place on October 1, 2013, when state exchanges are set to begin their pre-enrollment. In the first years following these marketplaces going live, more than 32 million currently uninsured Americans are expected to gain coverage, either through an exchange plan or the ACA’s massive expansion of the Medicaid program. Some analysts expect as many as 5 million of these newly insured to come from California.

Three months after the pre-enrollment begins, January 1, 2014, exchanges are set to go live, meaning that millions of Americans will, for the first time, be able to purchase coverage using the federal subsidies promised in the ACA.

In order to navigate this massive undertaking, states will need to decide which plans will be offered through their exchanges, construct the actual online marketplaces through which consumers will purchase coverage and implement major public outreach campaigns to ensure that these citizens – many of whom have never had the benefit of “open enrollment” or a similar purchasing period – understand how and where they can sign up for coverage under the reform law.

The task is daunting on its own, but with a deadline looming only months out, skeptics would be forgiven for questioning whether such a task is even possible.

California Leads the Way

Despite the uncertainty swirling around the ACA’s implementation, California looks to be on track to meet the coming deadlines.

In the days following the ACA’s passage, California was the first state to establish a health benefit exchange (Utah and Massachusetts were operating their own versions of an exchange before the ACA was signed into law) and has been working toward implementation ever since. That exchange, recently named Covered California, has already launched its online consumer marketplace,, and is one of 25 states that have gained conditional approval from the federal government to operate its own insurance marketplace.

There is, however, still much work to be done at the state level.

Unlike most other states, California opted to adopt an “active purchaser” model when building its new exchange, meaning Covered California’s Board of Directors will be responsible for selecting which insurance providers will be allowed to offer products on the exchanges. The selected products, known as qualified health plans (QHPs), will be required to meet a set of benefit standards finalized by the Covered California board late last year. The QHPs will be selected through a competitive bidding process set to begin in the coming months, and it’s anticipated that somewhere between three to five QHPs will be selected for each one of California’s 19 geographical rating regions.

While the selection process is still far from over, it looks as though the Covered California board will not be short on options when it comes time to award the QHP designation. In October, more than 30 distinct insurance providers issued a “notice of intent to bid” to the board, and most of the state’s major insurance providers have since gone public with their intent to participate in California’s exchange.

The fact that insurance companies appear more than willing to play ball with the exchange, and that Covered California was established as an independent government entity operating outside the control of the Legislature and governor, means that the exchange’s Board of Directors has a considerable amount of power when it comes to shaping California’s post reform heath care landscape.

Protecting Physician Interests

Unfortunately several recent decisions by the exchange board have placed California’s physician community on its heels. The California Medical Association (CMA) has been an active participant in stakeholder hearings and is working to ensure that the interests of physicians and their patients are taken into consideration as the exchange prepares to open for business.

Several of issues of concern arose when the board was working to finalize the benefit standards that interested payors will be required to meet in order to have their products considered for the QHP designation. One major concern for physicians is how the exchange plans to deal with monitoring and ensuring network adequacy among of QHPs.

Throughout the benefit design conversation, exchange staff continued to favor the existing method of network monitoring, which calls for the Department of Managed Health Care (DMHC) and Department of Insurance (DOI) to be responsible for ensuring that plans offered to consumers have enough participating providers. In other words, the status quo. Several stakeholders, including CMA, have noted that those two entities are currently unable to ensure adequate networks among existing plans and would likely be overwhelmed by the added task of monitoring additional exchange products. While CMA asked that the exchange take an active role in monitoring networks beginning in 2014, the DMHC/DOI method remained in the final benefit standards adopted by Covered California’s Board of Directors in August, meaning it could become the norm once the state’s marketplace goes live.

CMA also voiced concern over the exchange’s handling of the “grace period” provision included in the ACA. Under current California law, patients who are delinquent on their premiums are allowed a full 90 days to settle up before their policy is terminated for nonpayment. However, under the ACA’s grace period provisions, exchange plans will be allowed to suspend payment for services rendered if an enrollee is more than one month delinquent. If the patient fails to settle up within the three-month grace period, the plan can then terminate coverage for nonpayment and deny all pending claims for services. In this scenario, physicians could potentially be on the hook for 60 days worth of services with no avenue for recourse.

CMA has repeatedly asked Covered California’s board to reconcile the state and federal policies, but to date an adequate fix has not been presented.

Given the exchange’s accelerated timeline, as well as the exchange board’s tendency to revisit issues that were previously thought to be decided, it remains possible that both of these matters, along with others that have caused concern to physicians, could see some sort of resolution before 2014.

Action Under the Dome

With all of the moving pieces present between the federal government and California’s exchange board, it’s sometimes easy to forget that the state Legislature is also playing a large role in ACA implementation, so large, in fact, that Gov. Jerry Brown saw fit to call for a special session dedicated to health care reform in California.

A total of six bills (three identical proposals being heard in both houses of the Legislature) were introduced during the special session, seeking to address individual market reforms (ABX1-1 and SBX1-1), Medi-Cal expansion (ABX1-2 and SBX1-3) and a proposal to establish a “bridge plan” (ABX1-2 and SBX1-3) that would allow for a seamless transition between Medi-Cal and exchange plans for those individuals whose income may fluctuate past the income thresholds called for in the ACA.

Special sessions usually are reserved for a dire situation in need of immediate legislative action, which makes it somewhat surprising that members of the Legislature allowed the spring recess – their “soft deadline” for special session legislation – to come and go without any major action on these bills. As of early April, the individual market reform and Medi-Cal expansion bills had cleared their houses of origin and were set to be heard in committees within the second house, while the bridge plan proposal had yet to be heard on the floor of either house.

There’s also a considerable amount of activity related to health reform taking place outside of the special session, specifically regarding scope of practice expansions as a way of addressing the access to care issues that will inevitably take place when millions of currently uninsured Californians gain coverage beginning in 2014. Three bills, all authored by Sen. Ed Hernandez (D-West Covina), seek to expand the respective scope of practice for pharmacists, optometrists and nurse practitioners, while a fourth, authored by Sen. Fran Pavley (D-Agoura Hills) would call for a similar expansion for physicians assistants.

The ACA had two major goals: First, to expand access to health coverage to all, and second, to ensure efficient, high quality care. Those who are now invoking the ACA as the sole justification for allowing non-physicians to diagnose and treat California patients and perform complex medical procedures are attempting to achieve the first goal by undermining the second. Allowing non-physicians to practice beyond their training can only lead to inferior outcomes, higher costs and greater fragmentation of care.

CMA will be closely following and fighting these scope bills, working to ensure that California meets the ACA's objectives without eroding quality or jeopardizing patient safety.

To be sure, the next few months will be some of the most important and tumultuous times the medical community has faced in recent memory, but as a CMA member you have the comfort of knowing that your interests are being advocated for in front of all the key players driving the nation’s reform efforts.

2014 Physicians of Excellence Nominations

Orange Coast magazine, in conjunction with the Orange County Medical Association (OCMA), will publish its annual list of Orange County Physicians of Excellence in the January 2014 issue 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.

You may also download the form by simply clicking here.

Submit your nomination form to the Orange County Medical Association by 
June 14, 2013.
Send to: OCMA, 17322 Murphy Avenue, Irvine, CA 92614 or fax to (949) 398-8120. 

For questions call (949) 398-8100 ext 106 

OCMA Women Physician Leadership Conference Proves to be Huge Success

Women Physicians Share Insights at Local Conference

Article written by Physicians News Network,

Presentations from Women's Conference speakers available at the end of the article

A women’s conference last week offered local female doctors an unprecedented opportunity to learn from each other, and gain critical insight from top women leaders on how to achieve work-life balance, while taking on leadership roles.

The conference, entitled Retreat, Relate, Reform: Women Physicians Leading Change, took place on March 15 at the Promenade Gardens in Costa Mesa. It was organized by the Orange County Medical Association.

Dr. Lisa Thomsen, a Glendora-based family practitioner in private practice and a board member of the Cooperative of American Physicians Inc. (CAP), said the conference exceeded her expectations.

“It was great to see examples of women doing it all,” Thomsen said. “They are very strong leaders.”

Dr. Kelly Traver, an internal medicine physician, medical director for Crossover Health, delivered the keynote address. She focused on the importance of physicians dealing with increasing levels of stress. The goal is to to adapt, in order to successfully continue practicing, and deliver the best care.

There is a constant pressure on physicians to deliver better care at a lower cost, but according to studies, physicians who are simply in a better mood can come up with correct diagnosis three times faster.

While physicians address the harmful effects of stress when treating their patients, they often ignore to take care of themselves, said Traver.

When speaking about new reimbursement models and payment systems, she said “the more complex compensation systems become, the less effective they become”.

Dr. Sharon Levine, president of the California Medical Board, talked about lessons in physician leadership and the importance of cultivating leaders inside the organizations themselves. She discussed creating a culture that motivates people, fosters new ideas and recognizes those who contribute to the organization.

While the older generation of women physicians felt privileged to have a chance to become doctors, to take on leadership roles, and were eager to take on extra work load at the expense of their personal lives, we cannot expect the current generation to do the same, she said.

Dr. Tanya Spirtos, CMA trustee, gave updates on the current state of the ACA implementation and the issues that directly affect physicians, such as the problem with a three-month grace period for people who will be subsidized on the exchange, which can result in physicians not getting reimbursed by the insurance companies when patients default on their monthly payments.

Spirtos said physicians need positive incentives, not penalties, and they have an unprecedented opportunity now to affect how incentives will work as the ACA gets implemented.

Thomsen said she was impressed with the speakers and their take-away messages. She pointed to Levine’s “quiet strength” as exemplary female physician leadership.

As Levine noted, for many women, their appointment to leadership roles is often accidental, but they take on those roles and rise to the challenge.

Thomsen welcomed the views of a presenter who noted that women can become physician leaders by taking small steps and engaging in different organizations throughout their lives. The gained confidence often catapults women to the next stage, and ultimately, into leadership roles.

She said there was one thing in particular that the keynote speaker said that struck a note with her. “Life is really long,” Traver said. “You don’t need to do everything at once.”


"The Healthiest You" - by Kelly Traver, MD

"Lessons in Leadership: The Challenges of Change" - by Sharon, Levine, MD

"Gender Equity, Ensuring a Positive Work Environment & Executive Contracts"                          -By Shannon Jenkins, Esq.

"Health Care Reform Impact on Physicians" - by Tanya Spirtos, MD - For a copy of this presentation, please contact Ashley Buchwald at

Sequestration FAQ: How will the cuts affect California physicians?

Across-the-board federal budget cuts were triggered on Friday, March 1, because Congress failed to come to an agreement on how to reduce the federal deficit. Although it is still possible that Congress will reach some sort of a compromise before most of the cuts take effect on April 1, physicians should prepare for a 2 percent reduction in reimbursement from the Medicare program beginning in April.


The 2 percent Medicare "sequestration" cuts are part of the $1.2 trillion in cuts required by the Sequestration Transparency Act, part of a deal worked out to end last year's debt-ceiling crisis. The cuts are evenly split between defense spending and discretionary domestic spending. The mandatory Medicare cuts will result in a savings of $11 billion in 2013. Medicaid is exempt from the cuts.


The California Medical Association (CMA) continues to fight these Medicare cuts.While CMA understands the need to address our nation's budget deficit, CMA is urging Congress to take a more targeted approach than arbitrary across-the-board cuts that will harm public health and negatively impact access to care for children, seniors and military families.


For more information, see "Sequestration FAQ: How will the cuts affect California physicians?" This FAQ answers the most commonly asked questions about the sequestration cuts as they relate to health care. This document will be regularly updated as additional details become available.

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