Saturday, February 17, 2018

OCMA Blog

Best Practices for Creating an Accountable Care Organization

The U.S. health care system is moving toward Accountable Care Organizations (ACOs), groups of health care providers who agree to be accountable for the quality, cost, and overall care of Medicare patients. According to the Future of Health Care Survey conducted by The Doctors Company, the nation’s largest medical malpractice insurer, 57 percent of doctors are either undecided or need more information regarding ACO participation.


In a video series at www.youtube.com/doctorscompany, health care industry thought leaders recommend the following best practices when forming ACOs:

1.    Create a readiness checklist.

“A readiness checklist ...involves things like patient-centered medical homes and the attributes that primary care physicians have,” said Robert J. Jackson, MD, MMM, president and medical director, Accountable Healthcare Alliance in Michigan. “It talks about, ‘How well do we deal with data? Do we have patient registries? Do we have patient care plans? Do we have transition of care issues developed?’”

2.    Meet patients’ specific needs.

“The key is designing the care management tools, resources, people, and interventions to manage the specific needs of that patient,” said Laura P. Jacobs, MPH, executive vice president, The Camden Group in California.

3.    Develop clinical integration.

“Make sure all the providers are engaged in real-time information sharing so a care plan can be developed within a very quick period of time and all the providers know their roles and the timelines in which they have to perform their services,” said Michael H. James, JD, president and CEO of Genesys PHO, a pioneer ACO, and Genesys Integrated Group Practice in Michigan.

4.    Engage the community.

“The community has to…support programs that improve health and improve the way patients live because health care goes beyond just acute care,” James said. “It involves the patients’ safety, whether they have enough to eat, their transportation, education, business opportunities or employment opportunities.”

5.    Select the right board members.

“A pioneer ACO requirement is to expand the board with a patient and a community advocate,” James said. “Genesys…selected the leader of their volunteer group. He is 72 years old and is very engaged and involved in community studies on how to improve access to care. The community advocate is the executive director of a group of nursing homes.”

Contributed by The Doctors Company. For more risk tips, patient safety tips, and physician practice tips, visit www.thedoctors.com.


Physician Killed by Patient at Hoag Health Center

A recent shooting at Hoag Health Center in Newport Beach has resulted in the death of Ronald Franklin Gilbert, MD. A troubled patient shot the physician in an exam room, however it has not been confirmed if the patient was under the care of Dr. Gilbert. In response to the terrible event, Orange County Medical Association (OCMA) President Standiford Helm II, MD, issued the following statement:

"It is with deep remorse that my colleagues at OCMA and I recognize the tragic incidence that occurred on Monday, January 28 at the Hoag Health Center in Newport Beach. We extend our sincerest condolences and sympathies to the family members, friends, patients and colleagues of Dr. Gilbert.

"This devastating occurrence has shocked and confused many of us and although we will never fully understand the chain of events, we can only hope for better awareness and preparation to avoid such circumstance in the future.

"Physician groups in California, including the California Medical Association (CMA) and OCMA, have a long history of carefully evaluating issues related to gun control and safety, and have thoroughly debated policy for decades. We believe that open communication and education about firearm safety should be available for physicians and their patients, and that public health officials and physicians work together on these tough issues.

"In light of recent events, OCMA is taking a proactive approach and has partnered with ARIXMAR, a firm that is owned and operated by former FBI Special Agents, to provide Orange County physicians with a seminar series on "Work Place Violence Prevention & Response."

"Dr. Gilbert will be greatly missed by his loved ones, his friends, his many patients and the entire Orange County medical community."

2013 Physician of the Year Nominations

Now Accepting Nominations: 2013 OCMA Physician of the Year

DEADLINE: February 22, 2013


The Orange County Medical Association is now accepting nominations for the 2013 OCMA Physician of the Year. This award, which was established in 1983, recognizes a physician who, throughout his/her career, has exemplified what it means to be an accomplished physician. All OCMA members are encouraged to participate by nominating a fellow physician for his/her hard work and dedication, exceptional professional competence, and good rapport with patients. The award also acknowledges the physician for being a motivator, educator and community leader. If you would like to nominate a fellow physician colleague, please send your recommendation letter including:

  • Name and title of nominee 
  • Description of the nominee's accomplishments and contributions. Supporting documents such as a CV, newspaper clippings, etc. are encouraged 
  • Name, title and signature of nominator
Nominees are not required to be OCMA members.

The winner will be announced at the OCMA General Membership Dinner in May, details to come.


Nomination submission:

Attention Holly Appelbaum 2013 OCMA Physician of the Year
Orange County Medical Association
17322 Murphy Avenue, Irvine, CA 92614
(949) 398-8100 ext 106
Fax: (949) 398-8120
Email: happelbaum@ocma.org
DEADLINE: February 22, 2013




2013 Physicians of Excellence Reception Pictures

Pictures from the January 23, 2013 Physicians of Excellence Reception are up on the OCMA Facebook page.

Visit https://www.facebook.com/media/set/?set=a.10152478454530721.955051.250822655720&type=1&l=60016902fd to view them. Feel free to tag yourself, your friends and your colleagues.

Photos by www.lisareneephotography.com

Don't forget to "like" the OCMA Facebook page!


OCMA Needs Your Help with an Important Survey Regarding Dual Eligibles

Your participation is needed! Please consider taking a short, 10 question survey regarding the dual eligibles demonstration project.

Those who participate in this survey may enter to win one of three $100 Visa gift cards. By leaving your name at the end of the survey, you will be entered in the drawing! OCMA staff will contact the winners on or before February 7, 2013. 

The CalOptima board of directors is scheduled to make a critical decision regarding dual eligible patients (eligible for both Medicare and Medi-Cal) in Orange County at their February 7 board meeting. The decision could impact many physicians and their dual eligible patients. Your immediate input is necessary.

 

The OCMA has been working with CalOptima to advocate that the board adopt a very open health care delivery model for the duals patients; a delivery model that includes contracted health plans and individual physicians, via individual contracts. The broad health care delivery model will allow for patients to continue seeing their individual physician even if that physician is not affiliated with a CalOptima health plan for the purposes of Medicare managed care.

 

In order to effectively advocate for the physicians providing Medicare services, we need accurate and current information to share with the CalOptima staff and board members. This survey will enable us to provide a substantial portion of the important information that we need. The CalOptima board is uncertain, at this time, on the type of health care delivery model they will utilize for the duals patients in Orange County, so your immediate response is requested and will be of great value. Thank you for your time and participation.


For a more detailed update on the duals demonstration in Orange County, please go to the OCMA web site under the Local Advocacy section.

 

To continue to the survey, click the link below.


Survey Link: 

https://www.surveymonkey.com/s/CB9QHJR


UPDATE: Congress stops Medicare cuts for one year as part of fiscal cliff legislation

This morning (Jan. 3) CMS released instructions to contractors for implementation of the revised fee schedule.  In order to allow sufficient time to develop, test, and implement the revised 2013 Medicare physician fee schedule, Medicare contractors have been instructed that they can hold claims with January 2013 dates of service for up to 10 business days. CMS expects these claims to be released into processing no later than January 16, 2013.  The claim hold should have minimal impact on physician cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 for paper claims) after the date of receipt. Based on prior history of similar fee schedule updates, CMA believes that physicians may expect to see claims paid in approximately 21 days, rather than the usual 14 days. Medicare contractors will be posting the new payment rates on their websites no later than January 23, 2013. 

Congress stops Medicare cuts for one year as part of fiscal cliff legislation

HR 8 is a prime example of the need for physicians to speak with a unified voice through your local and state medical association. Clearly, the work is not over as these are merely temporary fixes. A strong physician perspective is critical in further debates. To the members of OCMA/CMA, thank you for your support and participation in important efforts such as this - it does make a difference. If you are not a member of OCMA/CMA, we need to add your voice to strengthen our advocacy on behalf of doctors and the patients you serve. 


Congress on January 1 passed HR 8, the American Taxpayer Relief Act, narrowly averting the so-called "fiscal cliff." The bill includes a one-year Medicare fee-for-service physician payment freeze, meaning the 26.5 percent sustainable growth rate (SGR) cut has been averted, for now. The 2 percent sequestration cuts have also been deferred for two months.

 

The one-year fix comes with a $25 billion price tag. The cost of physician payment reform has been growing over the years as Congress continues to enact frequent short-terms fixes. As recently as 2005 the cost of permanent reform would have been $48 billion, but today it is estimated to be nearly $300 billion over the next 10 years. If action is not taken soon, the cost will continue to escalate to $500 billion in only a few short years.

 

The one-year freeze will be paid for with cuts to the Affordable Care Act's (ACA) new CO-OP program and other health care programs ($15 billion of the cuts impacting hospitals). At CMA's urging, the ACA's Medicaid increase for primary care physicians was not used to pay for this temporary fix, despite earlier attempts to do so.

The Medicare fix is being paid for by:

  • Cuts to the ACA's CO-OP program (unobligated funds)
  • Extending the statute of limitations for recouping overpayments.
  • Adjusting the equipment utilization rate for Advanced imaging services.
  • Rebasing end stage renal disease payments based on utilization of drugs.
  • Equalizing stereotactic radiology hospital outpatient services with physician services.
  • Rebasing of Disproportionate Share Hospital payments.
  • Reducing multiple procedure payments when more than one therapy procedure is provided on the same day.
  • Eliminating funding for the Medicare improvement fund.
  • Eliminating the ACA long term care (LTC) CLASS act. (But establishes a LTC commission.)
  • Adjusting Medicare Advantage payments to account for differences in coding practices between fee-for-service and managed care risk adjustment formulas.

Importantly, the bill also lays the groundwork for an alternative Medicare payment system by establishing data systems and a registry for reporting on quality that will help physicians.


What does this mean for physician claims?

 

Because federal law requires Medicare contractors to hold claims for 14 days before releasing payment, there should be little if any impact on physicians' cash flow. Although there has been no official word from the Centers for Medicare and Medicaid Services, claims for services provided in the early days of 2013 will likely be processed under the new 2013 fee schedule. Palmetto, California's Medicare contractor, should have the new fee schedule posted on its website in about 10 days.

 

The 2013 fee schedule will not be exactly the same as the 2012 fee schedule. Although Congress stopped the 26.5 percent SGR cut, there were other components of the fee schedule formula that affect payment that may have changed, such as the relative value units (RVUs).

 

Physicians have the option of holding claims and submitting them after the new fee schedule is released. If you choose to submit claims in the interim, the California Medical Association (CMA) suggests that both participating and non-participating physicians bill their usual and customary fees-for-services to Medicare. Billing at your customary fee ensures that Medicare pays the highest amount possible when the claim is processed.


Orange County Medical Association Selects Farmers & Merchants Bank as Preferred Business Partner

ORANGE COUNTY, Calif., Dec. 19, 2012 -  Farmers & Merchants Bank (F&M) has been selected by the Orange County Medical Association (OCMA) as a Preferred Business Partner for physicians seeking personal and professional banking products and services.

 

"F&M is dedicated to delivering tailored products and services for the medical community," said Daniel K. Walker, F&M's Chairman and CEO. "We have served the community for more than a century and have worked with medical professionals in our Memorial Hospital branch for more than 30 years. This rich history and depth of experience allows us to ensure physicians' banking needs are met with the utmost efficiency and convenience."

 

F&M's Physician Banking Suite of Services provides attentive service and specialized products to the medical community, including concierge services, account analysis, business credit cards, remote deposit capture, lockbox service, online business banking, merchant services and lines of credit and loans. OCMA members will receive a 15 percent credit toward their analysis fees as part of the partnership.

 

F&M and OCMA also will join forces to provide educational seminars and resources geared toward effective financial planning and practice management and will feature insights from some of the region's leading medical and financial professionals.

 

The strategic business partnership with F&M Bank reinforces OCMA's commitment to bring added value to its members by aligning with companies who offer specialized services for physicians, allowing physicians to focus their attention on patient care.

.

About Farmers & Merchants Bank


Founded in Long Beach in 1907 by C.J. Walker, Farmers & Merchants Bank has 21 branches in L.A. and Orange counties. The Bank specializes in commercial and small business banking along with business loan programs. Farmers & Merchants Bank of Long Beach is a California state chartered bank with deposits insured by the Federal Deposit Insurance Corporation (Member FDIC) and an Equal Housing Lender. For more information about F&M, please visit the website at www.fmb.com or contact Brian Nakamura, Vice President/Physician's Banking Suite Coordinator  at: 

(714) 472-6611 or brian.nakamura@fmb.com.



How Should You Deal With Negative Online Reviews?

"Had to wait 1 1/2 hours."
"The staff was horrible, rude and unprofessional."
'The doctor misdiagnosed my problem."

In the past, a physician's reputation and practice were built by word of mouth. Today, word of mouth is no longer limited to people talking face-to-face. Websites, such as Yelp.com, AngiesList.com, HealthGrades.com, RateMDs.com and Vitals.com, allow anyone with access to a computer to share his or her opinion about a physician with the public at large.

Physicians tend to focus on the negative comments, but not all comments are negative. A recently published study in the Journal of Internal Medicine found that an overwhelming number (88 percent) of online reviews for physicians were positive. The following is an excerpt of the study:

We identified 33 physician-rating websites, which contained 190 reviews for 81 physicians. Most reviews were positive (88%). Six percent were negative, and six percent were neutral. Generalists and subspecialists did not significantly differ in number or nature of reviews. We identified several narrative reviews that appeared to be written by the physicians themselves.

The CAP Hotline has received an increasing number of calls from physicians asking how to respond to negative comments. So what can a physician do in response to a negative online opinion? Some physicians fear that negative comments may harm their reputation and want to seek legal remedies to battle unsubstantiated online libel and defamation. This may not always be the best solution to the problem. Lawsuits are time consuming, expensive, and may not produce the outcome desired by the physician. Courts may view negative statements made online at review websites as opinion, not fact.

Physicians should accept that rating websites are here to stay, at least for the foreseeable future. An occasional unfavorable review must be seen as a cost of doing business in the age of social media. If a physician desires to respond to a negative comment, much caution and thought should be put into the method and type of response. Some websites, like Yelp.com, have sections in its "Support Center" for business owners which discuss how to respond to comments.

Whether to respond is a personal choice and should be given careful consideration. A response may be made publicly or in private to the individual. All responses should be kept simple, polite, honest, professional, and compassionate. If the criticism is true, it should also describe what changes are being made to prevent this from occurring in the future. You may end your reply by showing that you care by stating: "Thank you. We appreciate all feedback."

What other steps can be taken to address patient opinions?

  • Go online and see what is being said about your practice.
  • Assign a staff member to regularly monitor these sites.
  • Update incorrect demographic information.
  • Personalize your comments with a clear professional photo.
If a comment is not appropriate, consider taking another approach. CAP provides free Patient Satisfaction Surveys to its members. In today's environment, a satisfied patient is an important part of a successful practice and it is better for the feedback to come directly to you and not to the Internet.

If you are a CAP member, we encourage you to take advantage of this free opportunity, by calling 800-252-7706 to request a packet of 100 surveys.

If you are not yet a member of CAP but are interested in learning more about the myriad benefits of membership, including superior medical professional liability coverage, contact Membership Development at 800-356-5672 or request an online quote at www.CAPphysicians.com/join.

Ann Whitehead is a Senior Risk Management & Patient Safety Specialist for the Cooperative of American Physicians, Inc.

CALL TO ACTION: CONTACT CONGRESS AND URGE THEM TO PROTECT HEALTH CARE TODAY!

Congress has three weeks left to stop the 26.5 percent Medicare sustainable growth rate (SGR) physician payment cuts (to take effect on January 1, 2013) before they adjourn for the holidays. The Orange County Medical Association urges physicians to keep the pressure on Congress to stop these cuts.

Call AMA's Grassroots Hotline, (888) 434-6200, to be connected with your members of Congress.

Description

Members of Congress have returned to Washington, D.C. for a Lame Duck Session to address the so-called "fiscal cliff" issues affecting the future of medicine and our country. These issues must be addressed before January 1, 2013 or the following occurs:

  •  26.5 percent Medicare physician fee-for-service rate cut because of the SGR formula;
  • Across-the-board spending cuts known as "sequestration" - $109 billion/year. While Medicaid is exempt from the sequestration cuts, the Medicare program faces 2 percent cuts; Defense takes $500 million in cuts and the rest comes from domestic programs.
  • Expiration of the Bush 2001 and 2003 tax cuts (including individual rates, capital gains, dividends, child tax credit, marriage penalty reduction, and the estate tax).
  • The Alternative Minimum Tax patch expires.
  • The Social Security Payroll tax cut expires.
  • Unemployment benefits extension expires.

It is important that members of Congress work together in a bipartisan way to resolve these vital issues and avoid going over the "fiscal cliff." Most economists speculate that if Congress fails to act, economic growth will drop significantly, unemployment will rise, and the country will slip back into a deep recession. 

CALL your members of Congress and urge them to work together to stop the Medicare SGR physician payment cut of 26.5 percent and the Medicare sequestration cut of 2 percent before they take effect on January 1, 2013.


How to contact members of Congress:

Phone:  Call AMA's Grassroots Hotline, (888) 434-6200, to be connected with your members of Congress. You will be asked to enter your zip code and select your Representative.

Email: Federal legislators must be contacted via the email forms on their websites: www.writerep.house.govwww.boxer.senate.gov and www.feinstein.senate.gov.


Talking Points

Urge California Senators and your member of Congress to:

  • Repeal the Medicare SGR and stop the 26.5% physician payment cut.
  • Stop the Medicare 2% Sequestration Cut.    
  • Adopt long-term Medicare Payment Reform.
  • Update the California Medicare Geographic Payment Localities.
  • Stop Medicaid and Other Health Care Cuts  


Background

Tough decisions will have to be made in the coming weeks but Congress must make Medicare funding a top priority. We can't allow Congress to ignore the nearly 30 percent Medicare cuts facing physicians and patients in California. Such cuts will certainly harm access to doctors for seniors, military families and potentially all California patients because private insurers follow Medicare. 

 

Moreover, comprehensive reform of the Medicare physician payment system is long overdue. Working together, CMA, AMA, the national specialty societies and state medical associations are currently developing an alternative Medicare payment system that will stabilize the Medicare program and promote high quality, high value care. Physicians are leading the way. But first, Congress must act responsibly and stop the scheduled Medicare SGR payment cut of 26.5 percent. Such cuts seriously threaten the viability of California physician practices and your ability to care for patients. Physicians are also important employers crucial to the California economy.

 

In recent days, Senate and House Republicans have forwarded a proposal to cut the Affordable Care Act (ACA) Medicaid (Medi-Cal) physician payment increase as a way to fund the fiscal cliff issues. CMA is opposed to such cuts. California Medi-Cal rates are already some of the lowest in the nation - 50 percent below Medicare. Because of these low rates, 75 percent of physicians cannot afford to participate in Medi-Cal and thus, 50 percent of Medi-Cal patients can't find a physician. Regardless of the ACA, California needs the Medi-Cal rate increase to protect access to care. 

 

CMA will also be working to stop sequestration budget cuts to other vital health care programs, such as public health and graduate medical education (GME).

 

Finally, CMA is pursuing an update to the Medicare physician payment localities in the Medicare/Budget Sequestration legislative package. California's localities have not been updated and thus, 14 urban counties are still designated as rural and physicians in these counties are paid up to 14 percent less than their urban counterparts.  


Home   |   About Us   |   Membership   |   For Physicians   |   News   |   For Patients   |   Advocacy   |   Events
Copyright (c) 2018 Orange County Medical Association