Sunday, December 10, 2017

OCMA Blog

Summer 2017 OC In+Care Newsletter

Summer 2017 OC In+Care Newsletter for providers serving people living with HIV in Orange County.

InCare Newsletter Issue 10 Summer 2017.pdf


Physician Volunteers Needed for Free UCI Health Fair

U.C. Irvine's Alpha Epsilon Delta and Free Clinic Project are recruiting physicians to volunteer for a free health fair scheduled for Saturday, May 13 from 10:00 a.m. to 3:00 p.m. at 12741 Main Street, Garden Grove.  At least 150 people are expected to attend,speaking primarily Spanish, Vietnamese, or English. 

It is our honor to invite physicians of the Orange County Medical Association to participate by providing free consultations. Much of the Garden Grove population lives with minimal access to adequate health care and as a free clinic, our goal is bridge this gap. We can provide ample boothing space for you with outlets You would not be required to stay the entire time if your schedule does not permit. If you are willing to volunteer your time, please contact Oluwaseun Adegbite at oadegbit@uci.edu where more information will be provided! 


We look forward to hearing from you.  Thank you.. 

 




Californians with Medi-Cal face hurdles to see specialists throughout the state

Californians with Medi-Cal face hurdles to see specialists throughout the state
http://www.cmanet.org/news/detail/?article=californians-with-medi-cal-face-hurdles-to-see

California’s communities face a severe shortage of physicians, which is expected to get exponentially worse as the population continues to grow and our aging physician workforce moves toward retirement.

Medi-Cal enrollment has surged since 2014, but the percentage of California physicians serving Medi-Cal patients has dropped, a trend that is hampering access to care for enrollees. One in every three Californians (14 million) is dependent on Medi-Cal for health care, so this disparity also negatively impacts a patient’s ability to access needed treatment, according to a recent study by the California Health Care Foundation.

There is a fundamental problem with Medi-Cal that is hindering patient access to care, and to specialists in particular – Medi-Cal physician reimbursement is so low that physicians cannot cover the cost of providing care. Currently, California has some of the lowest reimbursement rates for providers ($18 for an office visit), creating an unsustainable disparity between the number of Medi-Cal patients and the physicians who are able to accept them as patients.

"Specialists are paid so poorly that they don't want to take Medi-Cal patients," said Mark Dressner, M.D., a Long Beach clinic family physician and former president of the California Academy of Family Physicians. "We're really disappointed and concerned with what it's going to do for patient access."

The volume of poor and uninsured patients that need to see specialists has overwhelmed the health care system in Los Angeles causing appointment delays.

Dr. Dressner says he is extremely frustrated with the problem. “If I have patients that need a rheumatology consultation, it can take two years for them to get an appointment,” he explains. Some of his patients have to travel over 50 miles to see specialists who will take Medi-Cal because none of the specialists in the immediate area will.

Not only are physicians frustrated with the lack of access to care, the patients themselves are frustrated with their treatment. Barbara Appling, a 56-year-old diabetic, was referred to an orthopedist in the Los Angeles area near her home.

“I called the office repeatedly for an appointment. It took four months to get one. Then, when I went to the office, I was there for 40 minutes waiting to be seen – until the office manager told me they could not see me.” Appling has both Medi-Cal and Medicare insurance. The office staff member told her the doctor didn’t take either.

“I’m very frustrated that I cannot see a doctor when I need to. People have refused to take Medi-Cal since I got it,” she said. Due to low Medi-Cal reimbursement rates, physicians who see Medi-Cal patients often do so at a financial loss to their practices. In order to maintain viable practices that can continue to serve their communities, physicians who take Medi-Cal often need to limit the number of Medi-Cal patients that can be treated in their practice.

Because they do not have ready access to physicians, Medi-Cal patients are more likely to postpone needed care due to long appointment wait times. They are also twice as likely to use emergency room visits to access specialty care (compared to individuals with private insurance or Medicare).

In areas where the numbers of specialists are low, physicians are more likely to report difficulty obtaining referrals for Medi-Cal patients than for privately insured patients.

Debra Lupeika, M.D., a family physician providing care through the Shasta Community Health Center in Redding, says some of the most difficult issues she faces are getting her sickest patients referrals to specialty providers.

The frustration of not being able to refer wears on her – like the time her patient suffered without an appointment. “She had complicated medical problems, and she was homeless,” Dr. Lupeika says. “She had a cancer on her face that had been partly removed, but it came back. We couldn’t get a biopsy. It is really hard to get our patients into specialist due to insurance issues.”
Lack of access to specialists also plagues San Diego County.

“The challenge that we face is that reimbursement to physicians is the third-lowest in the country. So that limits access to specialty care,” says Patrick Tellez, M.D., MPH, a pediatric allergy and immunology specialist and Chief Medical Officer for North County Health Services, which provides health care to a diverse community of low-income patients at 13 health centers in North San Diego and Riverside counties.

“Our mission, as a primary medical, dental and behavioral health practice attending to over 65,000 patients annually, is to assure that our patients are able to access and receive needed primary and specialty care that meets the high standards that everyone of us expects when we are the patient," says Dr. Tellez. "However, when the reimbursement for specialty care is so low, specialists can only afford to accept a small percentage of patients that truly need and deserve the care."

"So, while in an average month we as primary care providers may make about 2,500 or more referrals to specialty care, due to affordability, wait times and constrained access, less than half are able to be seen. As a result, this has the long-term adverse impact of increasing the cost of care for everyone. Improving access to specialty care has been shown to help prevent preventable complications of chronic disease, which lowers the long-term cost of care…it acts like a rising tide that floats all boats.”

Of California’s 58 counties, Merced County has the 43rd worst physician-to-patient-ratio, with just 45.4 family physicians per 100,000 residents. That’s far less than California’s statewide ratio of 77.3 doctors per 100,000 residents. According to the Merced County 2016 Community Health Assessment, the entire county is considered a health-professional shortage area.

Eduardo T. Villarama, M.D., family physician and regional medical director of Golden Valley Health Centers in Merced, says he is aware of many instances when patients who needed to see a specialist were turned away. “We have more than 70 percent Medi-Cal patient population, and specialty care providers regularly turn them away or are not able to accommodate the demand because the specialists are not reimbursed appropriately.”

He says a few of his patients, “one with seizure disorder and the other we suspect to have multiple sclerosis,” have had to wait for at least six months to be seen by a specialist in neurology. “I know for a fact that the patients being insured by Medi-Cal played a role in our abilities to get them in sooner.”

Ample research demonstrates that the Medi-Cal system is struggling from chronic underfunding. Last year, the California Medical Association (CMA) co-sponsored the Proposition 56 tobacco tax to raise money to improve access to and quality of medical services for all Californians – especially our most vulnerable communities who rely on Medi-Cal.

The language was clear – tobacco tax revenues must be used to increase access to health care by providing improved payments for treatment and services. However, Governor Jerry Brown's $120 billion budget proposal for the 2017-18 fiscal year takes $1.2 billion of the Prop. 56 tobacco tax money to cover existing state budget obligations in Medi-Cal.

With 14.3 million Californians – and over 50 percent of all the state’s children – relying on Medi-Cal programs to provide basic and specialty care for serious diseases, the stakes are high.

The Governor’s proposed budget simply adds more patients to the back of the line and maintains the status quo, which does nothing to help patients gain needed access to doctors and dentists.

“People voted overwhelmingly in support of improving payments for programs and providers to ensure that patients can see a doctor when and where they need one,” says CMA President Ruth Haskins, M.D. “We must honor the will of the voters and use the estimated $1.2 billion in new health care revenue for its intended purpose, instead of writing a blank check to the general fund.”

CMA and the California Dental Association are calling on the legislature to uphold the will of Prop 56 voters and use the tobacco tax revenues to increase Medi-Cal patient access to doctors and dentists. Our plan strengthens Medi-Cal and Denti-Cal, which will lead to healthier patients and long-term financial savings to the state.

Serve Medi-Cal patients? Please send your experience and perspective to communications@cmanet.org. CMA wants to highlight the access to care challenges facing you, your patients and community.


AMA Code of Medical Ethics

In 1847, physicians representing 22 states and the District of Columbia came together to establish America’s first national professional association for physicians, the American Medical Association (AMA).

As one of its first acts, the AMA created the first national codification of ethics for any profession anywhere in the world. As the first of its kind, the 1847 AMA Code was reprinted by medical societies in Berlin, London, Paris, Vienna, and around the world. Throughout the rest of the 19th century, it was the most commonly printed medical document in the English language. Today, the AMA Code remains the only codification of professional conduct for all US physicians regardless of their medical specialty, practice type or location.

Ethics guidance is regularly added or amended in the AMA Code to reflect changes in medical science and societal expectations. As with any “living” document that is authored by different individuals over many decades, the AMA Code became fragmented and unwieldy. 

To address these issues, the AMA embarked on a multi-year “modernization” project to comprehensively review and update the AMA Code. After much deliberation and debate, the AMA House of Delegates adopted the modernized AMA Code last June.

“The modernization project ensures that the Code of Medical Ethics will remain a useful and effective resource that physicians can continue to rely on, while remaining faithful to the virtues of fidelity, humanity, loyalty, tenderness, confidentiality and integrity enshrined in the original Code,” AMA Immediate Past President, Steven J. Stack, MD, said.

A commemorative, leather-bound edition of the modernized AMA Code is available.


March 28 is Diabetes Alert Day: Diabetes prevention programs reduce costs, improve patient outcomes

Sugar. It’s the sweet, grainy staple surging through the foods so many of your patients love but can’t entirely kick. Yet the effect of these seemingly innocuous treats has become as deeply rooted as a cavity in the lives of sick patients and the U.S. health care system, according to a recent study on prediabetes and medical expenditures.

Published in Population Health Management, the study demonstrates how preventing the onset of type 2 diabetes can reduce annual health care costs by thousands of dollars per patient and generate large positive returns on investment (ROI) for health systems, insurers and employers.

Researchers in the study used individual-level claims data from more than 8,000 commercially insured adults to estimate medical expenditures among individuals with prediabetes. Data on expenditures were combined with findings from previous studies to estimate net savings and ROI if they were to participate in a Centers for Disease Control and Prevention (CDC)-recognized diabetes prevention program (DPP). 

Based on an analysis of the data, researchers found that: 

Patients who develop diabetes are very costly. Expenditures during the one-to-three-year period following HbA1c screening are one-third higher for those who develop diabetes. That amounts to an annual average of $2,671 per patient. 

Preventing diabetes is more than a vital public health solution—it’s an effective financial strategy. Because the annual cost differential for patients who develop diabetes is significant, “The three-year ROI for a National DPP is estimated to be as high as 42 percent,” wrote the study’s authors, Tamkeen Khan, Ph.D., Stavros Tsipas and Gregory Wozniak, Ph.D., all of the American Medical Association (AMA).

Diabetes prevention programs are still one of the best solutions for improving health outcomes and reducing burdensome medical expenditures. In fact, patient participation in a CDC-recognized DPP in a community-based or primary care setting costs between $400 and $500 per person—far less than the average annual medical care expenditure savings. Not to mention previous research confirms that the impact of these programs extends beyond dollar signs: People who complete DPPs are one-third less likely to develop type 2 diabetes after 10 years.

Using results from this analysis and findings in previous studies, the study authors estimated just 14 percent of patients who complete a DPP will be diagnosed with diabetes within three years, compared with 29 percent of those who do not participate.
DPPs in California: The California Medical Association's plan to prevent diabetes 

These recent findings underscore precisely why AMA and the California Medical Association (CMA) have partnered to advance patient participation in DPPs throughout our state and galvanize support for community-based interventions. 

More than 86 million Americans are living with prediabetes, but most of them are unaware. In California alone, an estimated 13 million adults  have the condition, putting them at high risk of developing type 2 diabetes without intervention.

"The diabetes epidemic is out of control and getting worse. In California, diabetes rates have increased by 35 percent since 2001," says CMA President Ruth Haskins, M.D. "In partnership with AMA we are working hands-on with California's physicians to implement meaningful diabetes prevention efforts to improve the health of Californian's  and ultimately improve the health of people across the country.” 

The partnership is part of Prevent Diabetes STAT, a strategic effort launched by AMA in collaboration with the CDC in 2015 to engage more Americans with prediabetes and slow the progression of type 2 diabetes. 

"The goal of this partnership is to get patients with prediabetes into proven lifestyle change programs that have been shown to cut the risk in half of progressing to type 2 diabetes," said AMA President Andrew W. Gurman, M.D. "By working with a variety of practices and health systems within California, we are learning the best ways to implement processes for screening, testing and referring across different clinical settings. We will use these models in the future to support other states as they adopt a similar process—helping even more Americans stave off or delay type 2 diabetes to improve health outcomes." 
Calculate DPP savings for your patient population

 An online tool from AMA helps employers, insurers, health systems and others to calculate net savings and ROI for their sample populations. Play with this calculator to see how upping the share of your patients who enroll in a DPP can have a sizeable effect on the number who develop diabetes and how much money can be saved through prevention.

To find a CDC-recognized program near you or online, visit https://nccd.cdc.gov/DDT_DPRP/Programs.aspx.
For more diabetes prevention resources from AMA and CMA, visit http://www.cmanet.org/issues-and-advocacy/cmas-top-issues/public-health/diabetes-prevention/



Amended OCMA Bylaws

The Bylaws Committee of the Orange County Medical Association has reviewed and updated the organization's bylaws. The revisions have been approved by the Board of Directors and will be approved at the General Membership Meeting in May.   The revised Bylaws can be found by clicking here

Paul B. Yost, M.D. Elected Chair of CalOptima Board of Directors

During its March 2, 2017 meeting, the CalOptima Board of Directors elected Paul B. Yost, M.D. to serve the remainder of Mark Refowitz’s term as chair of the CalOptima Board of Directors.  Mr. Refowitz previously announced his retirement as Director of the Orange County Health Care Agency, effective March 30, 2017.  He also announced he would be stepping down from the CalOptima Board subsequent to the March 2 regular meeting.  Dr. Yost’s current term as chair will conclude at the end of 4 months, when the next election is scheduled.

Congratulations to Dr. Yost on this tremendous accomplishment.


CHOC was named a 2016 Healthcare Information and Management Systems Society (HIMSS) Enterprise Davies Award recipient

Children’s Hospital of Orange County (CHOC) was named a 2016 Healthcare Information and Management Systems Society (HIMSS) Enterprise Davies Award recipient for achieving improvements in patient care through the use of health information technology. CHOC is the only children’s hospital on the West Coast— and third in the country— to be honored with the award since its inception.
 
Since 1994, the HIMSS Nicholas E. Davies Award of Excellence has recognized the outstanding achievements of organizations that use health information technology to improve patient care while achieving cost savings. As an award recipient, CHOC will share case studies and lessons learned with other health care organizations across the nation.
 
“CHOC has made significant investments in health information technology designed to enhance quality and patient safety – our highest priorities.  We designed and implemented our electronic health record (EHR) with a focus on improving care.  Because building and using an effective EHR is not always easy, and is certainly expensive, it’s gratifying to see measurable improvement from our efforts and investments.  Making kids’ care better— making kids’ lives better—is the ultimate outcome, and proves the value,” says Dr. James Cappon, chief quality officer, CHOC.
 
CHOC received the award from HIMSS based on four case studies that detailed how the use of health information technology and standardized clinical processes has improved patient care. The case studies included: 
 
•       Through education, a standardized care bundle, and EHR-enabled best practice guidance to minimize urinary catheter use and duration, CHOC significantly reduced catheter-associated infections and urinary catheter use. 

•       Using embedded, evidence-based care guidelines to control asthma and an alert system that triggered when patients were about to be discharged before a home management plan was created, CHOC drove down the average length of stay for asthma patients from 2.14 days to 1.72 days. Asthma readmissions within 30 days also fell from an average of 1.7 per quarter to 0.7 per quarter.
  

•      CHOC implemented an EHR-enabled Pediatric Early Warning System (PEWS) to trigger a rapid response team for deteriorating patients. As result, approximately 369 children have avoided resuscitation, with potentially as many lives saved.
 
•       CHOC implemented centralized breast milk preparation including barcoding to effectively eliminate feedings of the wrong breast milk. Efficiencies associated with the centralized processes for breast milk preparation resulted in significant annual savings. 
 
“CHOC demonstrates an enterprise-wide approach to collaboratively identifying clinical challenges, selecting IT interventions and developing workflows to address those challenges,” said Jonathan French, senior director of quality and patient safety and Davies program director with HIMSS. “Through using information technology to standardize care and continually look to improve care delivery and outcomes, CHOC has significantly improved the quality and patient safety outcomes for their patients. HIMSS is proud to recognize CHOC as a 2016 Davies Enterprise Award winner.”
 
Named one of the best children’s hospitals by U.S. News & World Report (2016-17) and a 2016 Leapfrog Top Hospital for safe, quality care, CHOC has achieved recognition as a HIMSS Stage 7 EMR (electronic medical record) adoption hospital. CHOC is also a leader in the adoption of population health technologies, and is a recipient of a $17.7 million grant from the Centers for Medicare & Medicaid to help Southern California pediatricians expand their quality improvement capacity, learn from one another and achieve common goals of improved care.
 
“These examples of our institutional quality and safety initiatives are an important part of our mission to nurture, advance and protect the health and well-being of children.  As we now reach out to the larger community with our population health efforts, our focus extends to keeping well children well,  in addition to keeping those who are ill as well as they are able to be,” explains Dr. William Feaster, chief medical information officer, CHOC.
 
CHOC will be recognized as a HIMSS Davies Award recipient at the 2017 HIMSS Conference & Exhibition, Feb. 19-23, in Orlando, Fla.  For more information on the awards program, visit the HIMSS Davies Award website.


CHOC Named One of the Safest Hospitals in the Nation by The Leapfrog Group

CHOC Children’s Hospital has once again been named a “Top Hospital” by The Leapfrog Group for providing the safest and highest quality health care services to patients.  CHOC is one of only nine children's hospitals in the nation—and the only one on the West Coast— to earn the prestigious distinction.  

"CHOC is committed to becoming the world's safest children's hospital. While this is a never-ending journey, being named as a Top Children's Hospital for the eighth time by the Leapfrog Group suggests we are on the right track. Leapfrog has always emphasized patient safety as the top priority, one with which our patients, families and partners would no doubt agree. It's a humbling honor, and serves as both encouragement and motivation to continue our efforts to provide the safest, highest quality care possible,” said Dr. James Cappon, chief quality officer, CHOC.

The selection of Top Hospitals is based on the results of the 2016 Leapfrog Hospital Survey. Performance across many areas of hospital care is considered in establishing the qualifications for the award, including infection rates and a hospital’s ability to prevent medication errors. The rigorous standards are defined in each year’s Top Hospital Methodology

“Being acknowledged as a Top Hospital is an incredible feat achieved by less than three percent of hospitals nationwide,” said Leah Binder, president and CEO of The Leapfrog Group. “With this honor, CHOC has established its commitment to safer and higher quality care. Providing this level of care to patients requires motivation and drive from every team member. I congratulate CHOC’s board, staff and clinicians, whose efforts made this honor possible.”

To see the full list of institutions honored as 2016 Top Hospitals, please visit www.leapfroggroup.org/tophospitals.



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