Monday, December 18, 2017

OCMA Blog

Physician Advocate Tip of the Month - What you need to know about "the grace period"

February Tip:
What You Need to Know About "The Grace Period"

 Federal law allows Covered CA enrollees who receive financial subsidies to keep their health insurance for three months, even if they have stopped paying their premiums. This is known as the "grace period."

CMA made significant progress through their advocacy efforts to help ensure that physicians are not on the hook for unpaid claims in months two and three of the three-month grace period. Instead, coverage will be suspended during those two months. CMA has prepared an easy-to-understand fact sheet to help physicians and their staff understand what the grace period means for their practices and their patients. Click here to download a copy of the grace period fact sheet.

 Upcoming: OCMA Exchange Seminar  

Mitzi Young, OCMA/CMA Physician Advocate, will be hosting an exchange seminar at OCMA on Thursday, February 27. The seminar will focus on how the California health benefit exchange will affect physician practices. Attendance for this seminar is free for OCMA members. For more information and to RSVP, visit https://caexchange.eventbrite.com.


Receiving practice management guidance from Mitzi 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
888.236.0267
myoung@cmanet.org


Orange County Public Healthcare Update: OC In+Care Newsletter


OC In+Care: A newsletter for providers serving people living with HIV/AIDS in Orange County


How does ACA affect patients? 

 
There are three ways in which ACA may affect people living with HIV/AIDS (PLWH/A). 
 
1) ACA will not impact your patient if they:

  • Would like to keep their current private insurance plan
  • Have employer-based insurance
  • Are receiving Ryan White medical care and ineligible for ACA
  • Are CalOptima (Medi-Cal in Orange County) or Medicare patients

2) ACA offers an opportunity for Individuals living with HIV/AIDS to quality for CalOptima coverage based on Federal Poverty Level (FPL) which is about $15,000 per year for one person.

  • Individuals who are legal residents with income below 138% FPL.
  • Patients who are currently on Medical Services Initiative (MSI) will be automatically enrolled into CalOptima for individuals below 138% FPL.

3) ACA requires that your patient purchase insurance and enroll in the health insurance exchange through Covered California if the individual is above 138% of the FPL. Depending on the individual, financial assistance such as: subsidies, health insurance premium payment, and/or waivers may be available. 

For patients who do not qualify for private health insurance, Medi-Cal, or will receive services not covered by their current coverage, they may be eligible for the federally-funded Ryan White program. This program offers medical, supportive services, and medication assistance for individuals who have no other source of paying for care services.

Covered California Enrollment Locations- Orange County
 
AIDS Services Foundation- (949) 809-5781 -Sky Park Circle, Irvine
 
AltaMed- (877) 462-2582 - S. Bristol Ave., Santa Ana 
 
APAIT Health Center- (714) 636-1349 - Garden Grove Blvd, Garden Grove 
 
Delhi Community Center- (714) 481-9600 - E. Central Ave., Santa Ana 
 
The Center OC- (714) 953-5428 ext. 336- N. Spurgeon St., Santa Ana

Covered California
 
For patients who are interested in health insurance options other than their current plan, or their income puts them above the 138% FPL, they will have to apply through the health insurance exchange. In California, this is called Covered California.

Multiple locations in Orange County have enrollment workers who can help patients enroll in appropriate health coverage; whether it is into private insurance or Medi-Cal. Individuals can also visit the Covered California website at www.coveredca.com..

Subsidies may be available to patients who have enrolled in a Covered California approved plan.

Office of AIDS-Health Insurance Premium Payment (OA-HIPP)

OA-HIPP is a program for individuals living with HIV/AIDS and need assistance in payments for health insurance premiums. Individuals above 138% FPL who qualify for AIDS Drugs Assistance Program (ADAP), may also qualify to receive assistance with premiums. For more information on OA-HIPP, visit: www.cdph.ca.gov/programs/aids/Pages/tOAHIPPindiv.aspx

Important Reminders 

  • If the patient currently has ADAP or Ryan White coverage, s/he will be screened at their eligibility appointment for all programs s/he may be eligible. 
  • Patients should be reminded to attend their eligibility appointment.
  • If the patient has a case manager or a care coordinator, they can assist the patient in addressing questions regarding ACA.
  • Enrollment varies depending on coverage.
  • If patient is eligible for Medi-Cal, enrollment began October 1, 2013. Coverage will begin January 1, 2014, but patients can apply at any time.
  • If the patient is above 138% FPL and is eligible for a Qualified Health Plan through Covered California, enrollment began October 1, 2013 and ends March 31, 2014. Open enrollment is between October through December thereafter.
  • Remind clients to open and read their mail as important information regarding health coverage is being disseminated via mail.


Covered California Affordable Care Act Resources


Health Care Reform and YOU!

 
HIV Health Reform: www.hivhealthreform.org/ 
 
Greater Than AIDS 
www.greaterthan.org/campaign/obamacare/ 
 
Please visit Orange County Health Care Agency's website for important up-to-date resources on the Affordable Care Act: www.ochealthinfo.com/phs/about/dcepi/hiv/libehiv/aca


OC In+Care is a project of the Orange County HIV Quality Management Committee. The HIV Quality Management Committee works to increase the quality of Ryan White services. For more information about the committee, please call (714) 834-8711.
 
If you have feedback or topic suggestions for future newsletters, please contact Mindy He at Mhe@ochca.com

OCMA hosts Leaders Toolkit: A two-day course for physicians seeking leadership roles in organized medicine


Leadership, except for the amazing few, is a learned art.

The Leader's Toolkit is a Socratic seminar (via a didactic "lecture") that covers the key elements of leadership in a very concise manner. While there will be some theory, we will highlight actionable behavior, tools, and concepts that you will (or should) use every day. This two-day course is available to CMA/OCMA members only.

What Will Be Covered:

  • Strategy: Knowing when to change, change management, strategic planning, strategic execution
  • Leading Your Team: Non-delegatable responsibilities of the leader, setting boundaries - management philosophy, making decisions
  • Building Your Team: Hiring (and firing)
  • Managing Your Time: Setting priorities, managing your time
  • Managing Your Meetings: Running a Meeting, parliamentary procedure
  • Managing Your Organization's Money: assessing your financials from the CEO's perspective and knowing the correct questions to ask
  • CMA/CMS Structure: Understanding and leveraging this critical relationship from a physician leader's perspective
  • Managing Your Message: Communicating by email, communicating one-to-one, having difficult conversations, negotiating, communications with your customer (aka marketing)

Meeting Dates & Times: 
Leader's Toolkit will begin promptly at 8:00 am on Saturday, March 22, 2013 and includes a mandatory dinner that evening. We will convene again at 8:00am on Sunday, March 23rd. We will conclude at 12 noon.
 
Presenter:
Tom Gehring, CEO, Executive Director of the San Diego Medical Society, has taught this immensely popular seminar for the past 5 years. 
 
Location:
OCMA Conference Center
17322 Murphy Ave.
Irvine, CA 92614

Registration Information
 
RSVP: Fax the form to 916.551.2563 or contact Jennifer Moller, CMS Services at 916.551.2541 or jennifer@cmsservices.org.
Space is limited so RSVP today!
 
Cost: This program is FREE to our members and offered as a member benefit. We do require that all participants purchase a set of 13 leadership and reference books which are discussed during the seminar and provide the attendee valuable resources for further study and reference. This collection of books may be purchased directly from Amazon (list will be provided) and most are available as e-Books, hard-bound and/or as paperbacks and cost between $150 - $200 for the set.
 
Class size is limited to 16 attendees and reservations are taken on a first-come, first-served basis. Meals over the two days will be provided by CMA including dinner on Saturday night. Travel and lodging costs are the responsibility of the attendee.  
 
Attire: No ties, no suits, no fancy attire - jeans are just fine. California casual, please.

"My participation in the Leader's Toolkit seminar was useful in so many ways - some unexpected. I have been more effective at communicating within my family, at my workplace and among the leadership at my hospital. I recommend this course to all physicians who want to advocate for patients or for other doctors, who hold any leadership role in their practice, hospital, community or medical group, or who have any aspirations for such a role." 
- Ruth Haskins, M.D.


Now Accepting Nominations: 2014 OCMA Physician of the Year

DEADLINE: February 18, 2014

The Orange County Medical Association is now accepting nominations for the 2014 OCMA Physician of the Year. This award, which was established in 1983, recognizes a physician who, throughout his/her career, has exemplified what it means to be an accomplished physician. All OCMA members are encouraged to participate by nominating a fellow physician for his/her hard work and dedication, exceptional professional competence, and good rapport with patients. The award also acknowledges the physician for being a motivator, educator and community leader. If you would like to nominate a fellow physician colleague, please send your recommendation letter including: 
 
  • Name and title of nominee  
  • Description of the nominee's accomplishments and contributions. Supporting documents such as a CV, newspaper clippings, etc. are encouraged   
  • Name, title and signature of nominator
Nominees are not required to be OCMA members.
 
The winner will be announced at the OCMA General Membership Dinner.

 

Nomination submission:

 

Attention Holly Appelbaum 2014 OCMA Physician of the Year
Orange County Medical Association
17322 Murphy Avenue, Irvine, CA  92614
(949) 398-8100 ext 106 

Fax: (949) 398-8120

Email: happelbaum@ocma.org

DEADLINE: February 18, 2014


Medical Community Loses Richard F. Kammerman, M.D.

It is with great sadness that we announce that Richard F. Kammerman, M.D., past president of OCMA, passed away at St. Joseph Hospital on January 9, 2014.  He was 83.
 
Dr. Kammerman was board certified in family medicine.  He was a Clinical Professor of the UCI Department of Family Medicine. 
 
Dr. Kammerman was president of OCMA in 1991-92.  In 1997, he was named OCMA's Physician of the Year.  Even after he retired, Dr. Kammerman could be counted on to assist OCMA whenever he was needed.  He was a popular mentor in OCMA's "Speed Mentoring" program that OCMA organized for UCI medical students.  In recent years, Dr. Kammerman served on the Physicians of Excellence Selection Committee.  In addition, Dr. Kammerman founded and served as president of OCMA's Toastmasters Club (chapter 3773).  
 
Dr. Kammerman contributed countless hours to service and leadership positions within OCMA and other professional associations and hospitals since the early 1960's.  In addition to his work within OCMA, Dr. Kammerman served as president of the Orange County Chapter of the Academy of Family Physicians and served as a representative to the California State Academy of Family Physicians and the California Medical Association.  He served on the hospital staffs of St. Joseph Hospital, CHOC, and Western Medical Center, and was elected chair of the Family Medicine Department in each of these hospitals. 
 
Dr. Kammerman's greatest influence on the community has been the positive impact on the lives of the uninsured and under-insured in Orange County.  His tireless work and unwavering commitment to the poor resulted in the unprecedented launching of CalOptima, the county's Medi-Cal managed care organization.  He was involved with the program's design and was instrumental in forging the partnership among the county government, private physicians, hospitals and community clinics that continues to this day.
 
While serving as part of the UCI Volunteer Faculty, Dr. Kammerman was devoted to educating future physicians and volunteered many hours each week to mentor medical students. 
 
In a written statement, Dr. Ralph Clayman, dean of the UCI School of Medicine, said:  "A member of the School of Medicine Alumni Board since its inception, Dr. Kammerman had knowledge and appreciation of the roots and foundation of the School of Medicine and therefore was often looked to as a historian for the group.  As co-president in 2011, Dr. Kammerman helped reengage and reenergize the board. Dr. Kammerman received the Lauds & Laurels Distinguished Alumni Award for the UC Irvine School of Medicine in 2011 in recognition of the tremendous amount of time and energy he devoted to making the UC Irvine School of Medicine the great institution that it is today."
 
Dr. Kammerman volunteered his time and service to many groups and organizations, including the Discovery Science Center, the Santa Ana Junior Chamber of Commerce, and the Lions Club.  He received commendations for service from the Boy Scouts of America, the Orange County Board of Supervisors, the California State Senate, the California State Assembly, and the U.S. House of Representatives.
 
A few years ago, the UCI Department of Family Medicine created the Richard Kammerman, M.D. Award.  This award is presented each year to a volunteer faculty member in recognition of outstanding service to the department and the community.  Dr. Kammerman was the first recipient and the award has continued to be named in his honor in recognition of his service - displaying the characteristics that form the selection criteria for this honor. 
 
Richard F Kammerman, M.D. will be missed by his family, friends and the medical community at large.

CMA Develops Simple Tool to Identify Physician Participation Status in Exchange Plans

January 23, 2014

On January 1, 2014, Covered California began providing health coverage to more than 500,000 patients statewide. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff have a clear understanding of their exchange plan participation status so that they can communicate this information to patients before scheduling. It’s equally as important that practices understand the reimbursement rates and other terms associated with the plans with which they are contracted.

Even if you did not intentionally contract with any exchange plans, the California Medical Association (CMA) urges physicians to check their participation status. It is very possible that physicians may have been unknowingly opted into an exchange plan network due to the way that major insurance plans have structured their provider agreements.

If you've attempted to look up your exchange plan participation status on the Covered California website, you know that it's not a straightforward process. Because it is critical that physicians know what plans they are contracted with, CMA has created a quick and easy tool to look up your exchange plan participation status in just a few clicks.

The tool, available to members only, requires simply your first and last name and middle initial and it will tell you which plans list you as a contracting physician (as of September 2013, the most recent data released by Covered California). To access the tool, visit http://www.cmanet.org/exchange-lookup.

Please note: You will be required to login with a member account. If you have not already activated your web account, visit http://www.cmanet.org/activate. If you need assistance activating your account, contact CMA's member service center at (800) 786-4262 or memberservice@cmanet.org.

For more information on Covered California, visit CMA’s exchange resource center at www.cmanet.org/exchange. Physician members and their staff also have free access to CMA’s practice management experts at (888) 401-5911 or economicservices@cmanet.org.


IMQ's Stepping Up to Leadership earlybird pricing ends January 31

Earlybird pricing for the Institute for Medical Quality (IMQ) Stepping Up to Leadership conference ends January 31. Sponsored by IMQ and the PACE Program at UC San Diego, Stepping Up to Leadership is an interactive training course that helps physicians learn best practices and creative approaches for resolving common problems encountered as a medical staff officer or department or committee chair. Through small-group interactive teaching modalities, the course gives both experienced and new physician leaders the opportunity to gain practical knowledge and skills, and to learn the tools and techniques that are essential to effectively lead a medical staff. This is an event for the entire leadership team.The program addresses:

  • What it takes to be a successful leader;
  • Aligning medical staff & hospital interests;
  • Effective communication;
  • Challenges to on‐call panels, credentialing;
  • Disruptive professionals, impaired individuals;
  • Physician well being committees;
  • Using quality measures to enhance outcomes;
  • Legal considerations

The 2014 Stepping Up to Leadership program will take place March 6-8 at the Loews Coronado Bay Hotel in San Diego. A generous grant from the Physicians Foundation allows IMQ and PACE to offer Stepping Up to Leadership at prices as low as $595. Take part in an interactive learning environment led by expert faculty who engage participants through self‐assessments, Q&A, role playing & case studies.

Register now at http://physician-leadership.org/.


Physician Advocate Tip of the Month - Surviving the first month of Covered California

January Tip:


On January 1, 2014, California's health benefit exchange, Covered California, began providing health coverage to more than 400,000 patients statewide. It is critical that physicians and their staff know what to expect. 

In an effort to proactively arm physician practices with important information during the first month of the exchange, the California Medical Association has prepared the resource "Surviving the first month of the exchange" tip sheet. 



Receiving practice management guidance from Mitzi 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
888.236.0267
myoung@cmanet.org


Local charity reports on recent volunteer medical mission to Vietnam

The second volunteer medical mission of the year undertaken by Arpan Global and its large cadre of supporters was October 5-12, 2013, to the Thai Hoa Hospital in Cao Lanh Vietnam (the Dong Thap province). This hospital lies to the south of Ho Chi Minh City by about a 3-hour bus drive in a very rural area.  It is a tropical area, lush with green vegetation and abundant rice fields.  The people are warm, friendly, eager to practice any English they know, curious about the rest of the world, and willing to help in any way possible for whatever reason.  Their hospitality was heartfelt and their kind and gentle words and actions clearly came from the heart.

The Thai Hoa Hospital is a relatively new, private hospital built specifically to serve a large catchment area in the Don Thap province and is located in fairly close proximity to the older public hospital.  The first floor contains the outpatient clinic areas, radiology, pharmacy, emergency treatment and waiting areas.  Upstairs is the labor and delivery units, postpartum, the nursery (which includes three isolettes and a ventilator for premature babies), and the pediatrics ward.  The third floor holds the operating rooms (including one dedicated for cesarean sections), recovery room, and the general wards.  The facility is clean, modern, and there is a real sense of pride of ownership among those who work there.

This was one of the largest mission teams that Arpan Global has assembled, with 52 dedicated individuals making their way to the other side of the planet in order to participate.  The range of medical and healthcare services represented was quite wide:  

  • Anesthesiology
  • Pediatrics, including neonatology
  • Internal Medicine, including cardiology
  • Radiology, including ultrasonography
  • Surgery, including plastics, GI, urology, orthopedics, ENT
  • Obstetrics and Gynecology
  • Dentistry
  • Nursing
  • Occupational therapy
  • Pharmacology
  • Social worker

Even nonmedical experts were present, willing and able to do whatever they could to help with patient flow and even patient care when possible.  

While the hospital isimpressive for its modernity, it attracts a patient population that can be limited in size.  The outpatient sites serviced by the team were another story.  Patients in local towns and villages lined up for the chance to get a lottery ticket to be seen by the visiting medical team and they were there early in the morning, ready and willing to wait all day if necessary.  Triage desks were set up at each site with local volunteers from Cao Lanh serving as translators.  Vital signs were taken and after the concerns of the patient were ascertained, they were directed to an available medical team for evaluation, diagnosis and treatment.  (If specific specialty needs were identified, they were sent to the experts on site).   A space for occupational and physical therapy was created at each site, as was an impromptu pharmacy and dispensary.  The dental area was extremely popular and often the last to finish each day.  After several of these day-long outpatient visits, it became clear that hypertension (often severe and completely uncontrolled), osteoarthritis, chronic low back pain, and lack of oral hygiene were among the preeminent and common complaints in the general population. 

Trips to orphanages along with visits to government sponsored homes for disabled children and the elderly homeless were also part of the itinerary.  Arpan Global was able to donate a water filter, washer and dryer, and a computer to some of these facilities.  A day-long trip to a shelter for women and girls who had been victims of human trafficking highlighted the impact that desperate levels of poverty and lack of vocational skill sets play in enabling trafficking to occur. 

By the end of the week, the team had seen over 800 patients, performed 125 dental procedures, several complex medical procedures, and many diagnostic procedures, allowing for appropriate treatment and intervention to begin for those patients.  More importantly, the team members felt like they had made a difference in the lives of people and the only issue of concern was the feeling that they wanted to do more.   Vietnam has been called Asia’s ‘comeback kid’ economically and while many are feeling the success, there still remains a great need for modernization and improvement in the health care system.  Arpan Global is proud to have had the opportunity to make its own contribution towards meeting that need in its own way.

For more information please contact Sudeep Kukreja, MD at (714) 585-1920

Vietnam mission team, Arpan Global Charities

Physician Advocate Tip of the Month - Don't miss out on your ACA Medi-Cal Payment Increase!

December Tip

Don't miss out on your ACA Medi-Cal Payment Increase!

Attesting is easy, so visit www.medi-cal.ca.gov and complete the ACA Self Attestation Form before 12/31/2013. Physicians must attest individually. Checks are currently being distributed to those who have attested!

Medi-Cal Resource:

Over the past year, there have been a number of changes for Medi-Cal patients and for the physicians who treat them with more to come in 2014. Be sure to review CMA's new Medi-Cal Survival Toolkit available for free at www.cmanet.org/ces (members only).

BONUS TIP:

The deadline to avoid a 1.5% fee schedule penalty in 2015 is fast approaching. There is still time to report at least one valid individual measure via claims for dates of service in 2013. There are many measures that only need to be reported once per reporting period (January 1 through December 31, 2013) that meet the requirement.  
 
The 2013 Physician Quality Reporting System (PQRS) Implementation Guide is a good place to start to identify any measure that might pertain to your practice. The 2013 PQRS Individual Claims Registry Measure Specification Supporting Documents provides the specifications that must be met in order to report the measure (frequency of reporting, procedure codes, diagnosis codes, and reporting measure code(s)). Remember, you cannot go back and add a measure code to claims already submitted.

Receiving practice management guidance from Mitzi 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
888.236.0267
myoung@cmanet.org


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