Saturday, June 23, 2018

OCMA Blog

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. 

 


"Risk Tip" from The Doctors Company - Be Aware of Risks for BRCA-Based Breast Cancer

Avoid Missed or Delayed Diagnosis by Being Aware of Risks for BRCA-Based Breast Cancer

Recent news coverage has brought BRCA gene-based breast cancer into the spotlight. Actress Angelina Jolie's decision to get a preventive double mastectomy after testing positive for the BRCA gene may cause patients to ask physicians if they are at risk. Physicians should be aware of the risk factors for BRCA gene-based cancer in order to identify those who need testing and to avoid delayed or missed diagnosis.
 
A recent malpractice case highlights the failure of missing an early diagnosis. A 33-year-old woman had two female relatives, including her mother, who had breast cancer in their forties. At 31, she began getting annual screening mammograms, which showed dense breasts. She complained of a small palpable mass. However, no mass was seen on a mammogram, and the diagnosis was fibrocystic changes. No additional tests were ordered. Within six months, the mass was enlarging, and she was diagnosed with infiltrating ductal cancer that had advanced from a Stage I to a Stage III. Based on her history, she should have been tested for the BRCA mutation and given various treatment options. Additionally, no ultrasounds or MRIs were done, which possibly could have detected the cancer at an earlier treatable stage.
 
A woman's risk of developing breast and/or ovarian cancer greatly increases if she inherits a BRCA1 or BRCA2 gene mutation. Widespread screening is not required because together these mutations account for only 5-10 percent of breast cancers. Those with the BRCA1 mutation have a 55-65 percent chance of developing breast cancer by age 70, and those with the BRCA2 mutation have a 45 percent chance. Women have about a 2 percent chance of getting ovarian cancer, but if they have a BRCA2 mutation, that risk increases to 40-60 percent.
 
Physicians should watch for the following BRCA mutation risk factors and discuss genetic testing with patients at risk:

  • Maternal or paternal blood relatives with breast cancer diagnosed before the age of 50.
  • Certain cancers in a patient's family, such as pancreatic, colon, or thyroid.
  • Both breast and ovarian cancer in a patient's family, especially in one individual.
  • Women in a patient's family with cancer in both breasts.
  • Patient with Ashkenazi Jewish heritage.
  • A male in the patient's family with breast cancer.     
  • Relative with BRCA1 or BRCA2 mutation.

If the patient does test positive for the BRCA mutation, it is essential to remind her that this does not indicate she will get cancer. Patients can reduce risks of cancer with prophylactic surgery, hormonal treatment, and lifestyle changes.
 
Contributed by The Doctors Company. For more patient safety articles and practice tips, visit  www.thedoctors.com/patientsafety.


ALERT: You May have Automatically been Contracted into an Exchange Plan

Open enrollment began October 1st for Covered California (California's Health Benefits Exchange). The OCMA has received many calls from members confused as to whether they are contracted to see these patients. 
  

Many doctors were automatically put into contracts, and are unaware that they are on the plan directory for exchange plans with payers. These physicians have to opt out of that part of their contract if they do not wish to participate in the Exchange. The easiest way to confirm your participation is by calling the provider relationship department of the three plans in Orange County who are contracted to see Exchange patients.  

  • Anthem Blue Cross:  (855) 238-0095
  • Blue Shield Of California:  (800) 258-3091
  • HealthNet:  (800) 641-7761

For additional questions about Covered California or any practice management issue, OCMA / CMA members may call OCMA Physician Advocate Mitzi Young directly at (888) 236-0267 or myoung@cmanet.org.


OCMA Internist and Addiction Specialist Receives Gary Nye, MD Award

Max A. Schneider, M.D., an Orange County internist and addiction specialist, was given the Dr. Gary Nye Award at the 2013 at the California Medical Association (CMA) House of Delegates held this weekend in Anaheim. The award is given annually to a CMA member physician who has made significant contributions toward improving physician health and wellness.

Dr. Schneider for over 40 years has helped educate medical students, residents and physicians on addiction as a disease and the specific risks it poses for physicians. 

He was instrumental in establishing addiction medicine as part of the medical school curriculum at University of California, Irvine School of Medicine.

Dr. Schneider helped establish the concept of physician well-being committees and has served on the well-being committees for the Orange County Medical Association, St. Joseph’s Hospital, Children’s Hospital of Orange County and Chapman Hospital.

A fellow and past president of the American Society of Addiction Medicine, he also is past chairman of the Board of Directors of the National Council on Alcoholism and Drug Dependence and has served as a consultant to the Drug and Alcohol Advisory Committee of the U.S. Food and Drug Administration.

Dr. Schneider graduated from the University of Buffalo, School of Medicine in 1949. He practiced internal medicine in his native Buffalo for 11 years until 1964 and since 1964 has practiced in Orange County.

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 (hivthrive.com), 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 bobbyonstage@hotmail.com 

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 MCorral@ochca.com.

 


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 www.marshhealthoptions.com).  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: http://www.dol.gov/elaws/esa/flsa/scope/screen24.asp 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: http://www.camgma.com/.  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 www.thedoctors.com/patientsafety

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