Monday, December 18, 2017

OCMA Blog

Make Sure your Practice Isn't Penalized under the New Provider Directory Accuracy Law

The new law (SB 137) not only requires payors to maintain accurate and current directories, but it also requires physicians to do their part in keeping the information up-to-date. Failure of practices to comply with the new requirements may result in payment delays, removal from directories and even contract termination.

For more information, sign up for CMA’s April 27 webinar on SB 137, at www.cmanet.org/webinars. Or you may call Mitzi Young, OCMA Physician Advocate, at (888) 236-0267.

The webinar will provide an overview of SB 137 and a pilot program, launched by America’s Health Insurance Plans, to ensure provider directories comply with the new law, while reducing the administrative burden for physician practices.



CMA-Western Health Care Leadership Academy - New Workshop Series

Continuing its mission of providing information and tools needed to succeed in today’s rapidly
changing health care environment, the Western Health Care Leadership Academy is pleased
to introduce a new series of workshops designed specifically for organizational leaders.
The academy’s “Organizational Leadership Principles” track will give you the skills you need
to be a successful leader in the workplace, whether that is a medical practice, medical
association, hospital medical staff or other organized health care group or business.

For more information on all sessions and to register, visit www.westernleadershipacademy.com

The Road Ahead: Diagnosis and Treatment of Breast Cancer

Cancer. Just hearing the word can bring you down. For many women, a breast cancer diagnosis is a reality they have to face. The thought of receiving a diagnosis can cause much distress and anxiety in women on top of all the stresses they experience every day. Fortunately, there have been great strides in breast cancer research, treatment and diagnosis. Breast cancer is no longer a death sentence, and more women are living healthy and happy lives after their diagnosis. With death rates down 34% since 1990, breast cancer is no longer a death sentence, and more women are living healthy and happy lives after their diagnosis.

The road to recovery begins with diagnosis. So, how do we do so with confidence and accuracy? Physicians employ a variety of breast imaging services including mammography, ultrasound and MRI to detect breast cancer, depending on various patient factors. However, breast cancer screening guidelines have become somewhat confusing in recent years, with multiple organizations offering different recommendations. The most common advice from radiologists and breast surgeons is for an annual mammogram starting at the age of 40. For women with denser breast tissue, tomosynthesis (3D) mammography may be beneficial and/or consideration of screening breast ultrasound. Those women whose lifetime risk of breast cancer exceeds 20% would also be screened with annual MRI. Still, I find it helpful for women to have a general sense of what is normal for them. For instance, if a new breast lump is identified by a patient that does not go away within one menstrual cycle, it is worth exploring with at least an ultrasound.  In a postmenopausal woman, a new lump warrants diagnostic breast imaging including ultrasound.
  

Once breast cancer is detected, the next step to recovery is treatment. There are three main forms available: medications, radiation therapy and surgery. Which one or ones are right for you is dependent on the type and severity of the cancer. Medications used for breast cancer include chemotherapy agents, hormone blocking drugs like tamoxifen or aromatase inhibitors, and immunotherapy. The biology and behavior of the cancer tend to influence which drugs, if any, would work best for a particular cancer. With radiation therapy, doctors take into account a patient’s age, surgery performed, and pathology characteristics to assess whether radiation is indicated, and if so, what course might be best suited for the patient. Breast surgery procedures range from lumpectomy, which conserves breast tissue, to mastectomy, which removes the majority but not all of the breast tissue. In determining which surgery is best for an individual, several factors are taken into consideration, including the size and location of the cancer, personal and family history, and the patient’s personal preferences. More and more women are benefiting from the use of oncoplastic surgery, where oncologic principles of taking out cancer with, ideally, widely clear margins, are combined with plastic surgery closure techniques. Oncoplastic breast conserving procedures and mastectomy reconstruction options have really revolutionized breast surgery, allowing women to boost their self-confidence and feel more like their usual selves. 

Reconstruction is an option for the vast majority of patients undergoing mastectomy and allows women to retain a natural, feminine appearance after surgery. Two main forms of reconstruction are available: reconstruction with implants and reconstruction with tissue. Reconstruction with implants is the most common technique used in breast reconstruction. It often involves the initial placement of a tissue expander to maximize the ability of the skin to heal, while allowing flexibility in the size of the reconstructed breast, followed by later removal and replacement with a formal implant. Some women may prefer to use their own tissue for reconstruction. In this case, tissue is taken from another part of the body, most commonly the abdomen or the back, and transferred to the mastectomy site, creating a natural texture to the reconstructed breast. 
The thought of being diagnosed with breast cancer can be frightening. Fortunately, great strides have been made in breast cancer research, and new technologies help women get back to their normal lives more quickly. 

For more information on breast cancer imaging, treatment and diagnosis, visit breastlink.com. 


Webinar: Coordinated Care Initiative: Key Information for O.C. Physicians

The Coordinated Care Initiative:  Key Information for Orange County Physicians occurs several times:

Wednesday, April 27, 2016, 12:00 noon - 1:00 p.m.

Wednesday, May 25, 2016, 12:00 noon - 1:00 p.m.

Wednesday, June 22, 2016, 12:00 noon - 1:00 p.m.

Please register for the date and time that works best for you:  https://attendee.gotowebinar.com/rt/6054087317243662596

Program Description:  This webinar is designed for physicians and will cover the Coordinated Care Initiative (CCI) and the programs within the initiative including Cal MediConnect, known as OneCare Connect in Orange County.

The CCI is a new program designed to help provide extra support for low-income seniors and people with disabilities in California, including those who are dually eligible for Medicare and Medi-Cal.

Webinar topics include:  

1.  Overview:  How the CCI is changing health care for dual eligible patients;

2. Continuity of Care:  How to keep seeing your patients if they join OneCare Connect;

3. Care Coordination:  How OneCare Connect can help support physicians in coordinating care for patients, including in-home and community based services;

4. Billing Processes: How billing works under the CCI for patients who join OneCare Connect and for those who remain in  fee-for-service Medicare and join the CCI for Medi-Cal services.

Speakers:  Rita Cruz Gallegos & Joe Garbanzos, Provider Outreach Specialists, Harbage Consulting; and Laura Grigoruk, Director of Direct Networks - CalOptima.

 


CURES On-Demand Webinar

July 1, 2016 is the deadline for mandatory CURES registration for all physicians with an active medical license and a Drug Enforcement Agency certificate. In order to help prepare physicians, CMA hosted a webinar on the CURES 2.0 registration process, which was presented by the Department of Justice. The webinar is now available on-demand in the CMA Resource Library and is free for both members and non-members. Please click here to view the CURES 2.0 webinar


Measles Outbreak Update

Measles has now been confirmed in 22 Orange County (OC) residents, signaling ongoing transmission in the community and at the Disneyland Parks. Thirteen of these cases spent time at the Disneyland Parks since mid-December, 2014. In California, as of today, 59 cases of measles have been confirmed since the end of December; 42 of these had an exposure in December at Disneyland or California Adventure Park. Additional cases have been identified that were at the park while infectious in January, including within the last week. Nine of the OC cases have no Disney or other known measles exposure. Additional cases are expected in Orange County.
 

Of the 22 Orange County cases, five are children, of whom four were not vaccinated and two were hospitalized. Although some of the confirmed cases occurred in people with a history of vaccination, their illness is generally milder and typically not as infectious. Vaccination is critical to prevent the ongoing spread of disease.

  • Although the overall risk of getting measles in Orange County remains low, residents who have not received any measles-containing vaccine should get a dose of MMR vaccine.
  • Two doses of measles-containing vaccine (MMR vaccine) are more than 99% effective in preventing measles. The first dose is routinely given at 12-15 months of age, with the second dose usually at age 4-6 years. The second dose may be given any time ≥28 days after the first dose.
  • All healthcare workers (HCW) should have two documented doses of MMR or serologic evidence of measles immunity. HCW who are exposed to a case of measles may be excluded from work until they provide evidence of immunity.
  • If exposed to measles, all, children and school/child care staff without documented immunity will be removed from work/school/child care from day 7 after the first exposure to day 21 after the last exposure.

Measles is highly contagious and people can be exposed by just being in the same room as a measles case during their infectious period (4 days before onset of rash until 4 days after). Several of the cases have potentially exposed patients in healthcare facilities, resulting in large contact investigations and persons needing immune globulin administration, post-exposure vaccination, or serologic testing for immunity.

  • Any patient suspected of having measles should be masked immediately and promptly moved to a negative pressure room when available. Providers seeing patients in an office or clinic setting should consider options such as arranging to see suspect measles cases after all other patients have left the office, or assessing patients outside of the building to avoid having a potentially infectious patient enter the office.
  • Notify Orange County Public Health Epidemiology immediately at 714-834-8180 (or 714-628-7008 after hours) about any suspect cases. Do not wait for laboratory confirmation before reporting a suspect case. Do NOT refer patients to Public Health without first discussing with one of our staff.
  • DO NOT send potentially infectious suspect measles patients to a reference laboratory for specimen collection.

For more information on measles, see www.ochealthinfo.com/measles.


NOTICE to OCMA Physicians of Excellence Recipients

Congratulations to the recipients of the 2015 Orange County Medical Association Physician of Excellence award!
  
We would like to clarify that the full list of Physicians of Excellence will be published in one of the Orange County Register publications in early spring 2015. OCMA's new partnership with the Orange County Register elevates the stature of the program, broadens the recognition of the physician recipients as well as extends the reach of those who will read the list in Orange County.   
  
Today we learned that Orange Coast Magazine published a January 2015 issue of "top doctors" - this is not a list of OCMA's Physicians of Excellence. This publication is no longer affiliated whatsoever with OCMA. OCMA ended the relationship with Orange Coast Magazine in April 2014. Though we had a productive relationship for many years, OCMA's Board of Directors decided to partner with the Orange County Register beginning in 2015. 
  

Hopefully this clears up any potential confusion.  In addition, more information on the reception for all recipients in April 2015 will be forthcoming soon. We are excited about the new partnership and we look forward to celebrating the many achievements of all the distinguished recipients.


Updated Ebola Guidance from the OC Health Care Agency

The Ebola epidemic of West Africa has led to 13268 cases as of November 7, with 8168 confirmed cases and 4960 deaths. The epidemic seems likely to continue for at least the next several months. There still have been no suspect Ebola cases in Orange County.

To date, there have been no confirmed Ebola cases in California.
 The Orange County Health Care Agency will be monitoring persons returning from countries with widespread Ebola virus transmission (currently Liberia, Guinea, and Sierra Leone) or who have had contact with a confirmed Ebola case within the previous 21 days.  The risk of Ebola in the U.S. remains low, and the risk of a symptomatic (infectious) patient that we are not following presenting unannounced for health care is even lower, but something we all continue to prepare for.  The following recently released documents may be of assistance to you in your preparations:

1)      Algorithm for Ambulatory Care Evaluation of Patients with Possible Ebola Virus Disease – CDC document, modified by OCHCA with Orange County contact information (attached)

2)      Algorithm for Emergency Department Evaluation and Management of Patients with Possible Ebola Virus Disease:  http://www.cdc.gov/vhf/ebola/pdf/ed-algorithm-management-patients-possible-ebola.pdf 

3)      Web-based training- Guidance for Donning and Doffing PPE during Management of Patients with Ebola in US Hospitals:  http://www.cdc.gov/vhf/ebola/hcp/ppe-training/index.html 

Traveler Assessment
Travelers coming from a country experiencing widespread Ebola disease will be assessed upon arrival to one of five airports in the United States. Information about the traveler will be passed on to local public health departments. The Orange County Health Care Agency will monitor any such travelers in our county daily to assess for symptoms. A hospital will be pre-designated for each of these travelers, based on factors such as a patient’s insurance type and proximity to a facility. That facility will be contacted ahead of time, to assure that the patient receives prompt care if needed. However, it is not certain that this system will identify all travelers from the affected areas, so area hospitals need to be prepared in the event that a suspect case arrives at their facility without prior warning.

Healthcare providers should assess all patients for a history of travel to countries experiencing widespread Ebola disease, which includes Guinea, Sierra Leone, and Liberia at this point. Providers should report any suspect Ebola cases to the Orange County Health Care Agency immediately at 714-834-8180 during regular hours, or 714-628-7008 after hours.

All Orange County hospitals need to prepare to isolate and evaluate a potential Ebola patient.

There is no designated Ebola hospital in Orange County. University of California-Irvine Medical Center has indicated that it will accept one confirmed Ebola case. However, suspect cases identified at a different hospital will need to be cared for at that facility until the case is confirmed, which may take from 24-72 hours. For suspect cases that present to an outpatient clinical setting not associated with a hospital, Orange County Public Health will facilitate transfer of the patient to the closest appropriate facility.

Orange County Health Care Agency can assist with testing a patient for possible Ebola disease.

The test of choice for Ebola is serum PCR. Tests can be falsely negative if performed in the first three days of illness. Patients who test serum PCR negative but have a clinical and exposure history consistent with Ebola may need repeat testing performed. This test is currently performed at selected public health laboratories.

For more information, see http://ochealthinfo.com/phs/about/dcepi/epi/disease/ebola . For healthcare worker recommendations, see www.cdc.gov/vhf/ebola/hcp/index.html. A hospital checklist for Ebola preparedness can be found at www.cdc.gov/vhf/ebola/pdf/hospital-checklist-ebola-preparedness.pdf.

Please let us know if you have any questions.

If you have any comments or questions or would like to be added to the distribution list, please email us at epi@ochca.com 

HCA/Epidemiology & Assessment
1719 W. 17th St., Bldg. C/79
Santa Ana, CA 92706
(P) 714-834-8180
(F) 714-834-8196


"No on 46" Campaign Victorious

 

We did it!  A coalition of nearly 1,000 organizations, led by CMA and OCMA, successfully - and resoundingly - defeated Proposition 46.  Here are the results that were posted early this morning:

                                • No: 67.1% / 3,415,996 votes
                                • Yes: 32.9% / 1,671,163 votes

This unworkable proposition would have dramatically altered MICRA by making it easier to file lawsuits against health care providers, increasing health care costs, reducing access to care and ultimately generating more legal fees for lawyers.

Despite the proponents' attempt to confuse voters about Proposition 46, the public decisively voiced its desire to preserve MICRA and all of its protections. This win is proof that Californians agree on the importance of access to quality health care across the state and they won't be fooled by political sweeteners.

OCMA and CMA will continue to stay vigilant in our work with the legislature to ensure that your elected representatives remember what the people said on Election Day 2014. We will continue to work to ensure that MICRA is protected. 
 
Thank you for your hard work, ongoing efforts and financial contributions to defeat Proposition 46!  We couldn't have done it without you.


Ebola Resources from the OC Health Care Agency

The first case of Ebola Virus Disease (EVD) diagnosed in the United States was confirmed on September 30, 2014 in Dallas, Texas. However, the risk of an Ebola outbreak in the United States remains low. Health care providers should remember to obtain a travel history for any patients with febrile illness, and be familiar with Ebola's clinical presentation and infection control requirements.  Any suspect cases meeting the clinical and epidemiologic criteria for EVD should be reported immediately to Orange County Public Health Epidemiology at 714-834-8180. 


For more information, see www.ochealthinfo.com/ebola

For specific health care-related guidance including infection prevention and environmental infection control precautions, see www.cdc.gov/vhf/ebola/hcp/index.html

To receive alerts, updates and newsletters on communicable disease issues affecting Orange County, email epi@ochca.com.


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