Friday, March 23, 2018


Orange County Public Healthcare Update: OC In+Care

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

Orange County In+Care Goals:

  • Increase the proportion of newly diagnosed individuals linked to clinical care within three months of diagnosis.
  • Increase the proportion of PLWH who are in continuous care.
  • Increase the proportion of PLWH with suppressed viral loads (less than 200 copies per mL).

Barriers to Treatment Adherence


Although a patient's ability to commit to a treatment plan should be assessed prior to initiating treatment, unexpected changes in the patient's life can disrupt treatment adherence. There may be many barriers that prevent a patient from adhering to their treatment regimen. Some barriers that may arise are:
* Active substance abuse (drugs and/or alcohol)
* Patient feels healthy
* Food requirement
* Forgot or busy
* Away from home
* Traveling
* Change in daily routine
* Side effects
* Depression or illness
* Lack of interest
* Desire to have a drug "holiday"
* Treatment fatigue 

Strategies to Treatment Adherence


It is important for the medical provider to understand and be aware of the patient's overall situation. During the appointment, ask the patient if there are any changes in their lifestyle or daily routine that may affect their medication intake. Education should include potential consequences of not adhering strictly to the treatment plan. Let them know that changes in lifestyle may disrupt their treatment plan and remind them of their treatment regimen. Emphasize the importance of committing to the plan even with these changes.
A common reason for why many patients discontinue their treatment regimen is because they do not feel sick. Encourage patients to continue their medication even when they are physically feeling well.
Communication between the doctor, case manager, and pharmacist (with appropriate release of information) is key to helping them continue to commit to their treatment plan.
Some patients may find using a diary or medication log useful in remembering what medications to take and when to take them.

The patient can include individuals to support them in their treatment plan. This can be a family member, peer, or friend whom they feel comfortable with and have disclosed their HIV/AIDS status.

The Pharmacist's Role
The pharmacist's role in HIV care is essential. A patient may see multiple providers with prescribing privileges, but typically goes to one pharmacy. Because of this, their pharmacy becomes the "hub" for the patient's care. As noted before, it is important for doctors, pharmacists, and case managers (if applicable) to have a good relationship. Doctors should contact the pharmacy to follow up on a patient's treatment plan and more importantly, learn of any other drugs the patient is taking that may lead to drug-drug interactions.
Pharmacists should contact the doctor if a patient's treatment plan may lead to adverse effects. Contacting the doctor or case manager may also be necessary if patients are not picking up their medications (non-adherence). 

Orange County Resources
Check out HIV THRIVE (, for information on living with HIV/AIDS and improving overall wellness.
Peer Support Services (PSS) offers support to individuals who are living with HIV/AIDS. For more information on PSS, contact Bobby Avalos at (714) 868-1829 or e-mail 

Click here to the view the full OC In+Care newsletter.

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.
Click here to subscribe to the OC In+Care newsletter.
If you have feedback or topic suggestions for future newsletters, please contact Melissa Corral at


Award Created for OCMA Past President

The first Standiford Helm, M.D., award bestowed upon Dr. Helm last Saturday

Orange County – The California Society of Interventional Pain Physicians (CASIPP) presented Standiford Helm, M.D., M.B.A., with an award that was also named in his honor on Saturday, September 21, 2013. 

The Standiford Helm, M.D., award will be presented to individuals who demonstrate outstanding service in promoting and protecting the specialty of Interventional Pain Management. Recipients of the award will be chosen by the board of directors based on an exceptional record of commitment to advancing the field of Interventional Pain Management through scholarly activity and advocacy on behalf of the specialty. 

“I am both humbled and honored to have such an award named after me,” Dr. Helm said. “I have dedicated my career to ensuring that patients suffering from chronic pain conditions have access to safe, quality care that allows them to live as fully as possible. CASIPP’s creation of an award recognizing that work will hopefully encourage other physicians in the specialty to keep working toward better solutions for patients.” 

Dr. Helm is a past president of CASIPP, the Immediate Past President of the Orange County Medical Association (OCMA), and a member of the Board of Trustees of the California Medical Association (CMA), representing over 37,000 physicians statewide. He was named one of the “Top Docs” by US News & World Report in 2012.

“We are lucky to have physicians like Dr. Helm as part of CMA and in the workforce treating patients,” said Paul R. Phinney, M.D., CMA president. "The management of chronic pain is complex but vitally important for affected patients and their families, all of whom stand to benefit greatly by Dr. Helm's tireless commitment."   

Dr. Helm has been practicing interventional pain management since 1982 and both works and lives in Orange County. He is the Medical Director at The Helm Center for Pain Management. The presentation of this first Standiford Helm, M.D., Award took place during the Annual Meeting of CASIPP at the Terranea Resort in Ranchos Palos Verdes. 

Notice: Due October 1: Employee Notices - Health Insurance Exchange

One of the provisions of the ACA requires employers to provide their employees notice of the new state health insurance exchange (Covered California). Regardless of whether or not your practice offers employees health insurance, employers subject to the Fair Labor Standards Act (FLSA) are required to provide notification of purchasing options and subsidies available through the Covered California health exchange by October 1, 2013 (model notices are available at  Generally employers with one or more employees who generate sales of $500,000 or more annually are required to provide the notice. There is one notice for employers who provide their employees with health insurance and one notice for employers who do not provide health insurance to their employees. Since the FLSA applies broadly, most employers are subject to the requirement. 

A Department of Labor online compliance tool: can help employers determine whether they are covered by the law. 

Your Participation is Requested - 2013 Employee Salary Survey

The California Medical Group Management Association (CAMGMA) is coordinating their 2013 salary survey. They are using a dynamic new instrument which provides real-time results back to the participants, along with customized reports.
Data entry and support is being coordinated for OCMA members by Jay Wikum, CPA (Business Partner - HMWC CPAs and Business Advisors).
The link to the online instrument can be found at:  The data entry period is scheduled to run through September 30, 2013
If you have any questions on the survey or the instrument, feel free to contact Jay Wikum at (714) 505-9000.
Click here to access the form directly.

Lyme Disease: Delayed Diagnosis Is Greatest Risk for Healthcare Providers

Risk Tip by The Doctors Company

Lyme disease, a bacterial tickborne disease, is one of the fastest-growing infectious diseases in the U.S. Summer is peak season, and most people are bitten by blacklegged ticks, which are small and difficult to see. Lyme disease progresses in phases: early localized disease with skin rash and flu-like symptoms, followed by disseminated disease with heart and nervous system involvement (palsy and meningitis), then late disease with severe fatigue, neurocognitive symptoms, and severe joint and muscle pain leading to physical disability. The challenge is diagnosing this disease in the early phases, when treatment is typically curative.

A claims review found that the main liability risk for Lyme disease is system issues that result in delayed diagnosis. The chief system issue is communication failure in reporting test results to the healthcare provider. In one case, the patient had ongoing headaches, nausea, and vomiting. Although the patient did not recall a recent tick bite, the patient lived in an area with a high incidence of Lyme disease. The provider ordered a Lyme screen, which was positive. A confirmatory test was also positive. The lab faxed the report to the provider and contacted the health department. However, the provider claimed he had not received test results.

The flu-like symptoms of early Lyme disease mimic a viral syndrome, so providers need to consider Lyme disease in their differential diagnosis whenever they see patients with this presentation. 

Tips to help make an early diagnosis include:

  • Because most people do not recall a tick bite, ask about recent travel or outdoor activities.
  • According to the Centers for Disease Control and Prevention (CDC), in 2011 96 percent of cases came from Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Vermont, Virginia, and Wisconsin.
  • In the early phases, 70 to 80 percent of patients will get a red, spreading rash that can appear anywhere on the body.
  • The classic rash has a bulls-eye appearance with a red outer ring surrounding a clear area, but the rash may not have this appearance.
  • Fatigue, chills, fever, swollen lymph nodes, headache, muscle, and joint aches are common early symptoms.
  • Early phase blood tests are typically negative because antibodies have not yet developed. Therefore, a negative test does not rule out Lyme disease.
  • Those patients who develop a rash should be treated with antibiotics.
  • Remain current on CDC guidelines regarding diagnosis and treatment.
  • Oral antibiotics commonly used with adults include doxycycline, amoxicillin, and cefuroxime axetil. For children younger than 8 years old, amoxicillin is recommended.
  • Have a system in place for following up on lab test results.
  • Advise patients to avoid tick-infested areas, use insecticides containing DEET, and conduct daily exams for ticks on themselves, their children, and their pets.
  • If they find a tick, advise patients to gently remove it with tweezers and save it for identification.
Contributed by The Doctors Company. For more patient safety articles and practice tips, visit

Upcoming CalOptima Provider Forum on Duals Demonstration

On July 10, the OCMA, CalOptima and the Health Networks in the CalOptima health care delivery system co-hosted a forum for physicians to learn about the contracting options for the upcoming "duals demonstration."  The demonstration will entail enrolling the dual-eligible (Medicare/Medi-Cal) beneficiaries in Orange County into CalOptima. OCMA has been advocating that physicians and their dual-eligible patients have multiple options for participating in the demonstration, including an option that allows physicians to contract directly with CalOptima. 


On Wednesday, August 14, CalOptima will host another forum which will include the Health Networks to once again reach out to physicians and educate them on the various contracting options the CalOptima board of directors will consider at their next board meeting.  If you missed the July 10th forum, OCMA strongly encourages you to attend the forum on August 14.  It is imperative that CalOptima and the Health Networks hear from the physicians that are caring for the dual-eligible patients in Orange County. The invitation to the August 14 forum is attached.


Note: this forum will be held at CalOptima. See invitation for full details.


Thank you for your attention to this matter.

Resources to Assist Physicians with the Medicare Contractor Transition

Goal:   Provide members with information and resources to prepare their practices for the transition of Medicare contractors from Palmetto to Noridian on September 16 (Part B).


Current CMA Resources


1. CMA’s Medicare Transition webpage – CMA has created a dedicated Medicare transition webpage,, offering practices the ability to access updates and important information regarding the transition in one easy-to-access to location. All resources related to the Medicare transition will be accessible through this site.

2. CMA’s Medicare Transition Guide: What physicians need to knowThis guide, which members can download free from the CMA website, includes an FAQ that includes information on the transition dates, what will remain the same with the transition and what will change, Noridian’s online provider portal, what practices can do to prepare for the transition, and links to additional resources and way to stay apprised of new information on the transition.

3. CMA Practice Resources (CPR)CMA Practice Resources is a free monthly newsletter from CMA’s practice management experts that focuses on critical payor and health care industry issues, including the Medicare transition, and how these issues directly impact the business of a physician practice. To sign up, visit the CMA website or contact CMA Member Services at (800) 786-4262.

4. CMA webinarAt the request of CMA, Noridian has agreed to conduct a webinar for CMA members on August 7 from 12:15-1:30pm.  The other webinars Noridian is offering is open to all provider types in California, Nevada, Hawaii, and the U.S. territories of American Samoa, Guam and the Northern Mariana Islands. However, the August 7 webinar will be limited to CMA members and will give attendees an opportunity to ask their specific questions. This webinar will be held at the OCMA Conference Center during a "Lunch & Learn." 
During the gathering, we will participate in the "live" CMA Medicare Transition webinar and then discuss any questions. To register for the Lunch & Learn, click here.

For those who miss the live webinar, it will be available on-demand via the CMA website.


5. Content alert updates - The CMA website allows registered users to create custom content alerts on the top­ics that are of interest to you. Once signed up, you will be notified any time there is new content posted in one of your interested areas, including Medicare issues. To sign up, users should visit their account dashboard on the CMA website and click on “my alerts,” then select “Insurance Reimbursement -> Medicare.”


CMA Resource in Development


  • Practice preparation checklist indicating all of the steps practices should take to prepare for the transition to Noridian. This document will be added to the Medicare Transition Guide.


MEC Engagement


The Priority Assistance Committee recommends that MEC proactively educate members about the resource available from CMA to help navigate contracting with the exchange.

  • Promote CMA Medicare transition website
  • Promote CMA’s Medicare transition guide
  • Promote Aug 7 Medicare transition webinar (promo from CMSS coming)
  • Include articles and announcements in CMS publications and communications
  • Alert CMA’s Michele Kelly 213/226-0338 of any issues related to the transition. 

Additional Resources

  • Noridian’s transition website: The Noridian transition website includes information on what’s new/changing and what will remain the same during and after the transition.
  • Paul O’Donnell, Noridian (701) 277-2401.  NOTE: MEC are welcome to contact Mr. O’Donnell directly; however, it is important to keep CMA/Michele Kelly in the loop so that she is aware of issues as they arise.


Additional Medicare-related Resources


1.      Medicare Enrollment Guide for Physicians - This document guides  physicians through the enrollment process and assists enrolled physicians who are making changes or who must revalidate their enrollment.

2.      Getting Started with the Medicare Physician Quality Reporting System (PQRS) – this guide assists physicians with understanding and complying with PQRS.

3.      Medicare Electronic Prescribing Overview: Payment Incentives and Payment Reductions – Overview of electronic prescribing (eRX) program, including incentive payments for physicians who e-prescribe and payment penalties for physicians who do not.

4.      Medicare Part B Important Changes: What they mean to your practice

5.     Medicare Audit Guide for Physicians – Guide for preparing and responding to a Medicare audit.

6.      Various Medicare webinars available on demand at

7.      Numerous Medicare-related CMA On-Call documents can be downloaded at

Announcement: Medicare SGR and GPCI Bill Clears Committee

On Wednesday, July 31, the House Energy & Commerce Committee voted UNANIMOUSLY to approve H.R. 2810, the bill to repeal and replace the Medicare SGR. Included in that bill is a California Medicare locality reform (known as the "California GPCI Fix") which will update payments for the urban physicians in Locality 99 and Locality 3 while holding the rural physicians in these localities harmless from payment cuts. 


OCMA and CMA are pleased with this herculean effort to move Medicare SGR legislation on a bipartisan basis as well as update the outdated Medicare physician payment localities.  CMA physicians have cleared the first hurdle in a long legislative process. The Medicare SGR and GPCI Locality  issues will now be taken up by the House Ways & Means Committee as well as the Senate Finance Committee.   


While there are several aspects of the bill that concern CMA, including the downside penalties and lack of adequate updates, the bill meets many of the goals that CMA advocated to Congress to eliminate the annual threat of nearly 30% SGR payment cuts, 5 years of stable updates, a continuation of the Fee-for-Service (FFS) program with opportunities for updates, and incentives to help physicians transition to new payment and delivery models. There is still much work to be done on the entire bill and Congress recognizes that.  


If you would like further details on this matter, please contact OCMA.

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 Questions about the program can be sent to

Some information in this article was republished with permission from the American Medical Association. For more information, visit



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.


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.


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.


  • 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.


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.

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