Sunday, December 17, 2017

OCMA Blog

ALERT: Legislation aimed at repealing the Medicare sustainable growth rate (SGR) was approved in the Senate Finance & the House Ways and Means Committees

Bipartisan House-Senate Medicare payment reform legislation passes out of committee; Congress includes 3 month patch to stop the 25% SGR cuts in budget deal

The Orange County Medical Association (OCMA) and California Medical Association (CMA) are pleased that legislation aimed at repealing the Medicare sustainable growth rate (SGR) was approved in the Senate Finance Committee and the House Ways and Means Committee yesterday, December 12, 2013. 
 
The Senate Finance Committee and the House Ways and Means Committee this week unveiled revised legislative proposals to repeal the Medicare sustainable growth rate (SGR) and establish a new payment system. Both committees have said that they expect to "mark-up" (pass out of committee) the legislation on Thursday, December 12.  The changes they have made since the initial October "discussion draft" are all positive and address most of the issues raised by the California Medical Association (CMA).
 
Yesterday's committee votes came just before Congress recesses for the holiday, pushing any further action into 2014. Congress has also included a three-month SGR patch-with a 0.5 percent payment raise-as part of the federal budget agreement, which will give lawmakers a little more time to finalize the long-term Medicare payment reforms. The bills are being passed out of Committee without funding sources. When lawmakers return in January, they will begin to marry the funding sources to the Medicare payment overhaul legislation.   
 
"With the drastically reduced price tag of $116 billion, Congress must seize the opportunity to set Medicare on a more stable course for current and future generations of physicians and patients," says CMA President Richard Thorp, M.D. "While the bill still needs work, CMA supports moving the bills through committee to continue to move the process forward. This is the most progress Congress has made on Medicare physician payment reform in a decade and we need to keep the momentum going."  
 
The revised proposals will first and foremost eliminate the badly broken SGR formula that has plagued policymakers and physicians for more than a decade. The legislation also establishes two payment tracks. A fee-for-service payment track coupled with a streamlined reporting program, called the Value Based Performance Program. The bill provides substantial physicians bonuses up to 12 percent. It also includes penalties. (However, existing law includes 8-9 percent penalties for non-participation next year without any bonus potential.)
  
The second payment track allows physicians to work with the Centers for Medicare and Medicaid Services (CMS) to establish alternative payment models, such as medical homes, that will provide 5 percent bonus payments. To help small practices transition to these models, they have provided a transition period and up to $125 million in funding assistance. The legislation also requires CMS to ensure that the new payment systems work for small practices as well as surgeons/specialists and primary care. 

The legislation meets many of CMA's long-standing goals for Medicare reform, including:

  • Repeal of the SGR;
  • Automatic payment updates before the new models begin;
  • Incentives to participate in new payment models (5 percent bonus);
  • A phase-in period and funding assistance to help small practices transition to new payment models;
  • Retention of a fee-for-service program;
  • Elimination of the current penalties and a consolidation of the current quality reporting programs (Physician Quality Reporting Program-PQRS, EHR Meaningful Use, and the Value Modifier) into a single program with a substantial new bonus pool; 
  • Improvements to the Value Modifier;  
  • Payment for complex chronic care management;
  • Timely data feedback for physicians;
  • Ensures that physicians develop the quality measures and are widely consulted on the new payment programs;
  • Update for the Medicare physician payment localities (California GPCI fix).

In response to CMA's comments, the committees made the following additional improvements:

  • Provides increased funding assistance ($125 million) to ALL small practices, not just rural and HPSA practices;
  • Allows a longer time-frame for physicians to prepare to participate in the new models;
  • Gives special consideration to small practices when developing the clinical improvement activities,  the value modifier methodology and the alternative payment models;
  • Requires the fee-for-service value-based program to reduce administrative burden on physicians and gives credit for improvement rather than just meeting a benchmark;
  • Ensures the Value Modifier will be cost and risk-adjusted;
  • Requires CMS to develop models that are attainable for specialists and surgeons, as well as primary care physicians, and small practices; 
  • Allows physicians to partially qualify for the new alternative payment models;
  • Expands the "total cost of care" data available to physicians to help physicians more efficiently manage their practices;
  • A study to examine total Medicare program cost savings (Part A, Part B and Part D) achieved by physicians.
  • Allows physicians to report data on the group level, including virtual groups, to improve the accuracy of the data.
  • Improvements to the Relative Value Unit process; 
  • Ensures that any practice guidelines or payment policies do not establish a standard of care for medical liability actions.

In a last-minute change, the Ways and Means bill now provides a stabilizing 0.5 percent automatic update each year for three years until the new payment models begin. The Ways and Means bill also includes the California geographic payment locality update ("GPCI fix"), which would transition the outdated payment localities to the current and regularly updated metropolitan statistical areas used to calculate payments to hospitals. This transition would take place over 6 years and guarantees that rural counties are not negatively impacted by the change. This GPCI fix would provide an additional $400 million to California physicians over 10 years.

The Senate Finance Committee bill does not, however include an automatic payment update in the first three years. The Senate Chairmen want to wait until the Congressional Budget Office scores the legislation and they negotiate funding sources before adding any payment updates. The Senate bill also does not include the California GPCI fix, as the committee has stated it wants to keep state-specific issues out of the committee mark-up. However, both Senate Finance Committee Chairman Max Baucus and Ranking Member Orrin Hatch have pledged to address the CMA GPCI issue during the January negotiations.  


The Doctors Company Risk Tip: Medical Clearance Does Not Clear the Patient or Physician of Risks

“Medical clearance” is when a surgeon requests clearance from an assessing physician before performing surgery on a patient. Cardiac risk is the number one reason to request medical clearance, but other risks that call for medical clearance include congestive heart failure, pulmonary embolism, anticoagulation, obesity, and high blood pressure. 

Anticoagulants, for example, are often an issue in surgical claims. If the patient is taking anticoagulants, the surgeon and the physician should agree on the best approach for that specific patient. They may discuss changes in medical management that should be made to decrease risk. If they believe the patient is at risk from a respiratory perspective, the focus may be on early mobilization, incentive spirometry, and respiratory treatment.

To avoid malpractice risks, consider the following tips when dealing with medical clearance:

  • Determine which patients need medical clearance. The surgeon should assess the type of surgery and its associated risks and the health of the patient. Healthy patients with no underlying conditions who are undergoing fairly low-risk procedures don’t routinely need medical clearance. 
  • Provide appropriate information. Problems can arise when the surgeon does not provide enough information to the assessing physician about the surgery being proposed. The surgeon should provide information to the assessing physician about the type of surgery, how long it will take, what kind of anesthesia is anticipated, how long the patient will be immobile, what is involved in rehabilitation, and what the recovery period looks like. The assessing physician should take that information into consideration, along with exam results and knowledge of the patient, to determine if the patient is at increased risk.
  • Develop a plan to mitigate risks. The surgeon and the assessing physician should work together to determine the steps to take to mitigate risk preoperatively, intraoperatively, and postoperatively. For example, they should agree about which medications to stop preoperatively and which to continue. 

There is no standard medical clearance process. Physicians should be aware of when a medical clearance would be indicated and have a good process to ensure it’s done.

Medical clearance is a misnomer because it implies that the patient is cleared and there are no risks. No patient is free of risk when undergoing a procedure. The goals of the assessment are to determine the level of risk and to identify opportunities to mitigate risk—with the surgeon and the assessing physician working in concert. The decision about whether to proceed with the operation belongs to the surgeon and the patient.

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


Competition Opens for Young Physicians Patient Safety Award

Medical Students and Residents Encouraged to Submit Essays for $5,000 Awards


Napa, California—November 18, 2013
—Entries are now being accepted for the 2014 Young Physicians Patient Safety Award, The Doctors Company Foundation announced today. Medical students and residents are eligible to compete for six $5,000 awards. Winners will also receive travel to the Association of American Medical College’s Integrating Quality meeting in Chicago June 12–13, 2014, where the awards will be presented.

Entrants must be third- or fourth-year medical students or first-year residents who were in a hospital setting as of June 2013. Entrants must submit a 500- to 1,000-word essay describing an instructional patient safety event they experienced during a clinical rotation that resulted in a personal transformation. Essays are due by 5:00 PM (ET) on Monday, February 3, 2014. Online entry forms are available at http://bit.ly/PtSafetyAward.

The contest is sponsored by The Doctors Company Foundation in partnership with the Lucian Leape Institute at the National Patient Safety Foundation (NPSF). Entries will be judged by a panel selected by the NPSF.

“One of the missions of our Foundation is to support patient safety education for healthcare professionals,” said Leona Egeland Siadek, the Foundation’s executive director. “The Young Physicians Patient Safety Award is a key to this mission. These essays bring to the forefront the importance of making the culture of safety an integral part of the culture of medicine.” 

Past winning essays can be read at http://npsfcongress.org/young-physicians-essays/2013-winners-one/.

About The Doctors Company Foundation
The Doctors Company Foundation was created in 2008 by The Doctors Company, the nation’s largest physician-owned medical malpractice insurer. The purpose of the Foundation is to support patient safety education for healthcare professionals, patient safety research with clinically useful applications, and medical professional liability research. In this context, patient safety is defined as a healthcare discipline that minimizes the incidence and impact of adverse events by redesigning systems and processes using human factors principles to reduce errors.

### 
Contact: Alina Gomez, agomez@the doctors.com

Prescription Drug Abuse – What to Look For

By Ann Whitehead, JD, RN
Vice President of Risk Management & Patient Safety Cooperative of American Physicians, Inc.

The Centers for Disease Control and Prevention (CDC) has classified prescription drug abuse as an epidemic. A staggering statistic from the National Drug Abuse Institute reveals prescription drugs are the second most abused drug, behind marijuana, by seniors in high school. The CDC finds overdoses from prescription painkillers resulted in more deaths in 2010 than heroin and cocaine combined.1

Prescription drug abuse affects all age, race, gender, and socioeconomic classes. Here are two examples: the patient on an antidepressant prescribed by his psychiatrist was also taking a narcotic prescribed by an orthopedist. In a drug-induced haze, the man threw himself down a flight of stairs, breaking his neck; or the 83-year-old patient who recently came to the office for morphine who later tested positive for cocaine. Both patients create liability and treatment issues for their physicians. 

Although many types of prescription drugs are abused, there is currently a growing, deadly epidemic of prescription painkiller abuse. Nearly three out of four prescription drug overdoses are caused by prescription opioid painkillers. The U.S. Drug Enforcement Administration (DEA) and the California Department of Justice are aggressively prosecuting individuals who prescribe opioids illegally and those who operate “pill mills.” Physicians face challenges when trying to spot the patient who may be abusing prescription drugs or possibly improperly sharing them with others. The following are some suspicious behaviors that may raise the red flag. 

The patient may:

• Refuse to grant permission to obtain old records or communicate with previous physicians.
• Demonstrate reluctance to undergo comprehensive histories, physical examinations, or diagnostic testing, especially urine drug screenings.
• Request specific drugs (often because of the higher resale value of brand names).
• Profess multiple allergies to recommended medications.
• Resist certain treatment options.
• Threaten doctors or display anger during visits.
• Consistently target appointments at the end of the day or during off hours.
• Repeatedly lose prescriptions.
• Request escalation in dosages.
• Demonstrate noncompliance with prescription instructions.

A helpful tool for physicians is the “Opioid Overdose Toolkit: Information for Prescribers” recently released by the Substance Abuse and Mental Health Services Administration (SAMHSA).2 This guide offers tips on safe prescribing and preventing opioid overdose including: assessment, state drug monitoring programs, medication selection, prescription writing tips, use of naloxone, and deciding when to stop opioid.

Lastly, if you get a call from the DEA or local law enforcement, contact the CAP Hotline for assistance.

For more information about CAP, or to request additional information or risk management publications, please contact us at: MD@CAPphysicians.com, or call 800-356-5672. You can also visit our website at: www.CAPphysicians.com.


1 Centers for Disease Control and Prevention (CDC). CDC grand rounds: Prescription drug overdoses – A U.S. epidemic. MMWR Morb Mortal Wkly Rep.2012; 61(1):10-13.
2 Substance Abuse and Mental Health Services Administration. SAMHSA Opioid Overdose Toolkit” Information for Prescribers. HHS Publication No. (SMA) 13-4742. Rockville, MD: Substance Abuse and Mental Health Administration, 2013.


OCMA Selects Credential Protection LLC as Preferred Business Partner

Southern California tech company will assist OCMA physician members in battling and improving their online reviews and cyber reputation.

Irvine, Calif., Nov. 4, 2013 - The Orange County Medical Association is pleased to announce another benefit of membership. The OCMA has designated Credential Protection LLC (CP) to assist members in protecting and improving their online reputation.
 
OCMA members may receive complimentary consultations and discounted rates on every reputation and review package that Credential Protection offers.
 
The company was born from the mind of a practicing physician who received some negative reviews before opening his practice! Dr. Doan set out to create a solution for physicians to combat negative reviews without compromising their ethics or costing them their valuable time. "The solution to pollution is dilution." According to Andrew Doan, M.D., PhD, founder and managing partner of Credential Protection. "I chose the name because we spend so much time earning our credentials only to have them smeared online from a couple of angry people with an ax to grind. It seemed like happy patients wouldn't review me even though I handed out campaign cards in the office. So my staff came up with a creative and honest way to give our happy patients a voice online, and this is still the backbone of CP's system. It's really cool to watch it grow and help other physicians."
 
Credential Protection offers a unique and effective way to harvest reviews and get them online for your marketing benefit. CP also offers a suite of other services to help you challenge negative reviews on other sites, track your reputation and grab more spots in the SERP (search engine results pages) for your practice.
 
"No Black hat SEO or astroturfing here," said Daniel Hunt, CEO of Credential Protection. "We have trademarked the Verified Review®. The only certifiably authentic review from your patients that can be digitized and optimized to the front page of the search engines. Many companies offer to place reviews out there on the web for you, but we actually oversee a medical review site with over 20,000 unique visitors a month. Moreover we keep a physical copy of each review our doctors send us. Every review must be signed by the patient and legible to be verified.  Every year we add about 12,000 of these reviews to our website... that's a lot of filing."
 

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

About Credential Protection
Credential Protection is a young tech company based in Temecula, California enjoying its third year in business.  It was awarded a top 5 spot in the Vator Splash Los Angeles competition for tech start up companies in 2012. Credential Protection's SEO team is Google Adwords and Analytics certified as of June 2013.  Its designers are Adobe Certified (ACA & ACE) in Photoshop, Illustrator and Indesign. www.credentialprotection.com


ATTN OCMA Members: Amendment to Bylaws for Review

Dear OCMA Membership,

 

 

The Bylaws Committee of the Orange County Medical Association has been meeting over the last year and a half for the purpose of carefully reviewing and updating the organization's by-lawsThe revisions have been approved by the Board of Directors and now need to be approved by the general membership. Therefore, for the next two months (November and December 2013) you may review the revised Bylaws by clicking here. These proposed changes will be available for review until December 31, 2013.

Please submit any comments in writing via email to ocma@ocma.org or mail to 17322 Murphy Avenue, Irvine, CA 92614 and indicate whether you approve the changes.



OCMA Member Profile: Theodore Benderev, M.D.

World Vasectomy Day (WVD), which took place on Friday, October 18, 2013, is the largest male-oriented global family planning event. The goal was to perform 1,000 vasectomies by at least 100 doctors across 25 countries in 24 hours. 

 

OCMA member Theodore Benderev, M.D., founder of Vasectomy.com, led the charge for World Vasectomy Day in Southern California. In honor of this international day, Dr. Benderev has submitted an educational piece on the No-Needle No-Scalpel Vasectomy (below).


The No-Needle No-Scalpel Vasectomy

"As Good as it Gets"

About Vasectomy Surgery 
 
The No-Scalpel Vasectomy was brought over from China in 1987. A procedure that was initially thought to be "gimmicky", the minimally invasive technique with minimal manipulation of tissue via special instrumentation was studied and found to indeed reduce the risk of bleeding and infection. In the hands of experienced surgeons, this sometimes challenging surgical procedure can be done through a 1 cm opening usually in less than 15 minutes. Though vasectomy has been the number one procedure performed on men in the U.S. (500,000/yr), there are twice as many tubal ligations done. Not surprising, nightmare stories of inadequate anesthesia have kept more men from taking the lead in permanent sterilization. 
 
That was so until approximately 10 years ago when a high powered anesthetic jet spray was found to provide superior deep local anesthesia without a needle - hence, a virtually pain free experience for the patient. 

As with nearly all surgical procedures, experience of the surgeon correlates with success. The smoothness and confidence of the surgeon is particularly important when men are awake and someone is working on a part of the body that men are hard-wired to protect. Combine the anxiety of the man with a Cremaster muscle that pulls the testicles out of harm's way (think George Castanza in Seinfeld) and within easy reach of the surgeon and one understands that the words "gentle and efficient technique" have a special meaning with vasectomies.
 
What issues must be considered? 
 
Before each vasectomy, there is a consultation session with the patient and, preferably, with their partner to fully discuss the pros and cons of a vasectomy. The great benefit of a vasectomy is that the only better form of contraception is abstinence. Patients are thrilled with the freedom from contraception - fondly called "The Bedroom Bonus". The risks, though uncommon in experienced hands, are bleeding, infection and pain.
 
What is the patient to expect post-operatively?

Post operative pain is so uncommon that patients frequently forget that they have limitations and must remember to restrict their activity for the first few days after the procedure. In general, when patients have the procedure done on a Friday, they usually return to work on Monday. By the beginning of the second week, they can usually return to normal activity, except that sex without contraception must wait until at least one negative semen analysis. 
 
What if there is a change of mind?

While vasectomies can be reversed in most cases during the first few years postoperatively, assurance must be obtained by the surgeon in the pre-operative consultation that the couple is in full agreement for permanent contraception. Despite excellent vasectomy reversal surgical technique and artificial reproductive technologies, in the 5-10% of couples who choose reversal later, there are cases when pregnancy may be difficult to achieve. 

 Dr. Theodore Benderev founded Vasectomy.com 17 years ago and was the first known urologist to perform the No-Needle No-Scalpel Vasectomy in California. Dr. Benderev has performed over 2000 of these procedures. In addition, he has developed numerous surgical techniques and technologies with over 35 patents in various areas of urology. A board-certified urologist, he practices primarily in Mission Viejo and is a Clinical Professor in the Department of Urology at UCI.  Besides his focus on vasectomies, Dr Benderev is Board sub-certified in Female Pelvic Medicine and Reconstructive Surgery and is Medical Director of the Incontinence and Pelvic Support Institute.
 
 Dr. Benderev is a graduate of University of Maryland. He completed his urology residency training at Northwestern University in Chicago to prepare for an academic career. After a period as faculty member at UCI, he established a specialized center in south Orange County that to this day retains that special personal attention from each of his specially trained staff. 
 
A resident of Orange County since 1985, Dr. Benderev raised his family here and enjoys hiking and biking for leisure. When not on call, he looks forward to working about his cabin in Mariposa. 

Please contact Dr. Benderev at 888-VASECTOMY (or 949-364-4400) for any further information

OCMA continues to profile and highlight our valued members. These profiles provide a forum for physicians to share information among their colleagues. It is important for members to be aware of one another. Maintaining a close community of engaged physicians is beneficial for both OCMA and the medical community.  This is open to any current OCMA member. If you are interested in submitting an article and profile, please contact: 
 
Ashley Buchwald, OCMA Marketing/Communications Coordinator at abuchwald@ocma.org or (949) 398-8100 ext. 105. You may also contact Holly Appelbaum, Managing Editor, OCMA Bulletin, at happelbaum@ocma.org or (949) 398-8100 ext 106.

National Prescription Drug Take-Back Day is This Saturday

It's Time to Get Rid of Expired, Unused and Unwanted Medications

The next National Prescription Drug Take-Back Day is Saturday, October 26th from 10:00 am - 2:00 pm.  It is sponsored by the U.S. Drug Enforcement Administration (DEA) in an effort to help prevent prescription drug abuse and diversion. The majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet.
 
This service is free and anonymous - encourage your patients to dispose of their unwanted medications on Saturday, October 26th.  
  
There are 30 collection sites in Orange County: 

Aliso Viejo

Anaheim

Brea

Buena Park

Corona Del Mar

Costa Mesa

Cypress

Dana Point

Fountain Valley

Fullerton

 

Garden Grove

Huntington Beach

Irvine

La Habra

Laguna Beach

Laguna Hills

Laguna Niguel

Lake Forest

Mission Viejo

Newport Beach

 

Orange

Placentia

Rossmoor

San Clemente

San Juan Capistrano

Santa Ana

Seal Beach

Tustin

Westminster

Yorba Linda


To find the location of a Take Back collection site near you visit the DEA website at 
www.justice.gov/dea or call (800) 882-9539.


CMA launches Covered California Provider Education Program

The California Medical Association (CMA) and the CMA Foundation have been awarded a $1.5 million grant from Covered California, the state's new health benefit exchange. The grant application was submitted in partnership with the Latino Physicians of California, the American Academy of Pediatrics and a number of CMA's component medical societies.
 
The grant is being used to establish the CMA's "California Health Benefit Exchange Outreach and Education Program." The goal is to help medical professionals across the state and their health care teams to educate their patients about the new coverage options available through Covered California and the financial assistance available to help pay for them. The program will focus more intensive outreach to physicians working in communities with a large number of consumers eligible for Covered California.
 
Physicians are powerful and effective messengers to deliver information to patients. We will be working to educate not only physicians, but also the office and health care teams that support physician practices. We will work with registered nurses, medical assistants, nurse practitioners, physician assistants, office managers and other physician practice staff in the targeted geographic areas that have the highest number of newly eligible exchange enrollees. All staff working in a practice or clinic will have an opportunity to learn more about Covered California insurance plans to fully utilize their skills and potential in educating patients about exchange eligibility and enrollment.

Regional Outreach

The California Health Benefit Exchange Outreach and Education Program will have four regional Provider Educators, with one assigned to each of the following regions: 1) Fresno, Kern, Tulare and Kings Counties; 2) San Diego, Riverside and San Bernardino Counties; 3) Los Angeles and Orange Counties; and 4) San Joaquin, Santa Clara, Alameda and Contra Costa Counties. For those practices in regions not listed, CMA Foundation staff will provide outreach and education. 

Educational Strategy

The educational strategy will be a multifaceted approach that factors in the different physician practice environments and incorporates multiple strategies to communicate with the physicians and their health care teams. The approach will incorporate group learning sessions, focus groups, educational print medium and one-on-one "touches" supported by newsletters, webinars and e-communication.
 
We will develop learning communities of grantees, sub-grantees and other interested partners to share challenges and best practices and to help us use resources as effectively as possible.
 
Our strategy will also include the following: 

  • Identify the gaps in physician knowledge about the exchange and design educational messaging to address those gaps.
  • Create a master list of existing regularly held meetings of the association members and partners so that we can utilize the already built network and standing meeting schedule
  • Establish lesson plans to ensure consistency in presentations.
  • Identify physician champions to be trained to educate their peers and other health care professionals and staff.
  • Establish a Physician/Health Care Worker Subcommittee to provide message testing, guidance and input on presentations and one-on-one education.
  • Make resources available through the physician practice to patients, helping them understand Covered California.
  • Develop a physician toolkit comprised of essential outreach materials for physician champions and their health care teams to give to patients.
  • Work with hospitals and health plans to book training and education sessions in hospital grand rounds, regularly scheduled patient-support focused meetings and medical staff meetings.

Resources

For the full Covered California Grant Newsletter, click here.

For a list of Health Benefit Exchange resources available to physicians, click here.

All resources are available on the CMA website at  http://www.cmanet.org/issues-and-advocacy/cmas-top-issues/aca/.

OCMA members may contact Physician Advocate Mitzi Young with questions about Covered California and the Health Benefits Exchange at (888) 236-0267 or myoung@cmanet.org

Call to Action from CalOptima Regarding Duals Demonstration

Dear Orange County Physicians:

CalOptima is measuring physician interest in a direct contract model for the dual-eligible demonstration that will launch in Orange County in April, 2014.  If there are not enough physicians interested in the direct contract model, it may be difficult for the CalOptima board of directors to support the model.  See the "Call to Action" below that CalOptima issued to the physician community.  As always, if you have any questions or comments, please contact us.

 

Thomas C. Kockinis, MD                                                   Robert McCann, MHA

President                                                                           CEO / Executive Director


 


Thinking About the Duals Demonstration? 
We Want to Hear From You!


The time for you to respond is now! The CalOptima Board of Directors is exploring the interest level of a direct contracting option with CalOptima for Cal MediConnect (also called the Duals Demonstration). Based on the interest level of the Orange County physician community, the CalOptima Board may grant authority to make this new option available.
 
If approved, the direct network will be based on managed care principles, providing support for your patients who may be difficult to manage through: coordinated care, case management, physical and mental health coordination, as well as home and community-based support services.
 
We need to hear from physicians who are interested in contracting directly with CalOptima, as the window for measuring interest is narrowing. In order for the model to be viable, a substantial number of physicians need to indicate their desire to participate. Currently, we do not have enough physicians displaying an interest to proceed with this option.
 
Orange County is one of eight California counties selected to participate in Cal  MediConnect. With Cal MediConnect, Medicare patients who are 21 years of age or older receiving full Medi-Cal benefits will have the option to transition from fee-for-service Medicare to this Duals Demonstration no sooner than April 1, 2014.
 
If you are a provider interested in directly contracting with CalOptima for this demonstration, please contact our Provider Relations department at 714-246-8600 or providerservices@caloptima.org to let your voice be heard and receive additional information about your contracting options. 

 


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