Saturday, December 16, 2017

OCMA Blog

Another Trial-Lawyer Backed Health Care Initiative

MICRA isn’t the only ballot issue facing California doctors this year – a health care rate regulation initiative threatening provider reimbursements is also on the November ballot. The same trial lawyer-backed group pushing to change MICRA is sponsoring a separate rate regulation ballot measure that would give the Insurance Commissioner new powers to approve or reject insurance rates, benefit levels, co-pays and deductibles, which would impact payments to providers and limit patient access to care. 

The Orange County Medical Association (OCMA) joins the California Medical Association (CMA) in opposition to this initiative. We are encouraging our members to join the official campaign opposed as individual physicians. 

The measure
  • Gives the elected State Insurance Commissioner new powers to set insurance rates at levels which don’t meet the cost of providing care, resulting in lower reimbursements to providers and ultimately reduced access to care for patients.  
  • Gives one politician the power to approve or reject benefits, interfering with care decisions that are better made between doctors, healthcare providers and patients. 
Not surprisingly, the proponents drafted the measure without any input from physicians, patients, hospitals, or other health care providers – even though it will create a massive new layer of health care regulation in California.

Of course, the real motive of the proponents is found buried in its language – a provision which opens up a new mechanism that allows the proponents and their trial lawyer backers to file lawsuits in rate proceedings, bleeding off invaluable health care dollars to line their own pockets.

We know defeating the MICRA initiative is a top priority. But we urge you to join us in also fighting this measure as it will have a significant impact on provider reimbursements and patient access to care.

Please join OCMA and a broad coalition of doctors, hospitals and health care providers in opposing this measure. 

If you would like to join the campaign’s media training webinar on May 8, please contact Kyle Griffith via email at kgriffith@bcfpublicaffairs.com

MEDICARE SGR ALERT: Physicians: Call Congress Now!

PROTECT ACCESS TO CARE IN CALIFORNIA


DON'T PATCH IT, REPEAL IT!

MEDICARE SGR REPEAL AND PAYMENT REFORM: HR 4015/S 2000

 

Physicians: Call Congress Now! (800) 833-6354 (Takes 2 Min)

UPDATE MARCH 11, 2014:
House Republican leaders have scheduled a vote for this week on H.R. 4015, with a repeal of the ACA individual mandate as the funding source. (If the mandate is repealed, the government will spend less on premium subsidies and thus, a substantial cost savings will occur.)

This repeal of the ACA is not an acceptable, viable funding option in the U.S. Senate. Knowing that the ACA repeal will not be accepted, House leaders have scheduled a second vote at the end of March to adopt another nine-month patch.

CMA is urging Congress to find bipartisan funding sources. We are opposing another nine-month patch. CMA is calling upon Congress to Fix Medicare Now!

A long-awaited and hard-fought bill to permanently repeal Medicare's fatally flawed sustainable growth rate (SGR) formula finally is before Congress. The SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015/S. 2000) offers a fiscally prudent opportunity for lawmakers to repeal the SGR formula and put Medicare on the path toward a stable, 21st-century program that can meet the growing health care needs of the nation's seniors.

This is the most progress Congress has made in a decade. We must seize this opportunity and make a final push to get this bill passed NOW. To sustain the bipartisan momentum, your Congressional representatives need to hear from you.

There are many powerful groups that are pushing back, objecting to Congress' plans for funding the physician payment fix. That's where you come in. To overcome the opposition, Congress needs to hear from a large volume of physicians. Every single physician needs to call and email the California Senators and your Member of Congress NOW!

Congress has a significant opportunity to finally repeal the SGR and enact payment reform. Why?

  • The cost to repeal the SGR is at an all-time low of $116 billion - down from $238 billion.
  • Congress has already spent $154 billion over the last decade adopting short-term patches to stop the SGR cuts - more than the total cost to repeal the SGR. It is fiscally irresponsible to adopt another one-year SGR patch. The Wall Street Journal calls the "patches" a sham.
  • There is a bipartisan, bicameral agreement on legislation to establish a new payment system.
  • The deadline is March 31, 2014, when the next 24 percent SGR cut occurs.

But reform won't happen unless Congress hears from thousands of physicians!

Physicians must call Congress to fix Medicare now!
To overcome the partisan funding proposals and the other opposition, Congress needs to hear from a large volume of physicians. Every physician needs to call and email the California Senators and your Member of Congress NOW! Please make as many calls and send as many emails as possible. Every one makes a difference! We are asking physicians to call/email the following individuals:

  • Your local congressional representative (use your local zip code)
  • California Senator Barbara Boxer
  • California Senator Dianne Feinstein
  • House Republican Whip Kevin McCarthy (zip code 93309)
  • House Democratic Leader Nancy Pelosi (zip code 94103)

To contact members of Congress:
Call AMA's Grassroots Hotline, (800) 833-6354, to be connected with your members of Congress in Washington. You will be asked to enter your zip code and select your representative. You are also encouraged to call your representatives in their local district offices (click here to download a current telephone roster).

You may also email your federal legislators via the AMA's "Fix Medicare Now" grassroots website. Utilizing the sample letter provided, it takes no more than two minutes.

Urge Congress to tell their House and Senate leadership to:
1. Protect access to care in California and enact Medicare physician payment reform NOW.
2. The cost to fix the Medicare SGR is at an all-time low and there is bipartisan agreement on the legislation.
3. Use bipartisan funding sources.
4. Oppose another one-year SGR patch.

Ask your patients to help:
AMA has also prepared a flyer that you can use to get your patients involved in the fight to protect Medicare. Distribute the AMA's "Fix Medicare Now" flyer to your patients and ask them to call their representatives, too.

Additional information:


ALERT: Legislation aimed at repealing the Medicare sustainable growth rate (SGR) was approved in the Senate Finance & the House Ways and Means Committees

Bipartisan House-Senate Medicare payment reform legislation passes out of committee; Congress includes 3 month patch to stop the 25% SGR cuts in budget deal

The Orange County Medical Association (OCMA) and California Medical Association (CMA) are pleased that legislation aimed at repealing the Medicare sustainable growth rate (SGR) was approved in the Senate Finance Committee and the House Ways and Means Committee yesterday, December 12, 2013. 
 
The Senate Finance Committee and the House Ways and Means Committee this week unveiled revised legislative proposals to repeal the Medicare sustainable growth rate (SGR) and establish a new payment system. Both committees have said that they expect to "mark-up" (pass out of committee) the legislation on Thursday, December 12.  The changes they have made since the initial October "discussion draft" are all positive and address most of the issues raised by the California Medical Association (CMA).
 
Yesterday's committee votes came just before Congress recesses for the holiday, pushing any further action into 2014. Congress has also included a three-month SGR patch-with a 0.5 percent payment raise-as part of the federal budget agreement, which will give lawmakers a little more time to finalize the long-term Medicare payment reforms. The bills are being passed out of Committee without funding sources. When lawmakers return in January, they will begin to marry the funding sources to the Medicare payment overhaul legislation.   
 
"With the drastically reduced price tag of $116 billion, Congress must seize the opportunity to set Medicare on a more stable course for current and future generations of physicians and patients," says CMA President Richard Thorp, M.D. "While the bill still needs work, CMA supports moving the bills through committee to continue to move the process forward. This is the most progress Congress has made on Medicare physician payment reform in a decade and we need to keep the momentum going."  
 
The revised proposals will first and foremost eliminate the badly broken SGR formula that has plagued policymakers and physicians for more than a decade. The legislation also establishes two payment tracks. A fee-for-service payment track coupled with a streamlined reporting program, called the Value Based Performance Program. The bill provides substantial physicians bonuses up to 12 percent. It also includes penalties. (However, existing law includes 8-9 percent penalties for non-participation next year without any bonus potential.)
  
The second payment track allows physicians to work with the Centers for Medicare and Medicaid Services (CMS) to establish alternative payment models, such as medical homes, that will provide 5 percent bonus payments. To help small practices transition to these models, they have provided a transition period and up to $125 million in funding assistance. The legislation also requires CMS to ensure that the new payment systems work for small practices as well as surgeons/specialists and primary care. 

The legislation meets many of CMA's long-standing goals for Medicare reform, including:

  • Repeal of the SGR;
  • Automatic payment updates before the new models begin;
  • Incentives to participate in new payment models (5 percent bonus);
  • A phase-in period and funding assistance to help small practices transition to new payment models;
  • Retention of a fee-for-service program;
  • Elimination of the current penalties and a consolidation of the current quality reporting programs (Physician Quality Reporting Program-PQRS, EHR Meaningful Use, and the Value Modifier) into a single program with a substantial new bonus pool; 
  • Improvements to the Value Modifier;  
  • Payment for complex chronic care management;
  • Timely data feedback for physicians;
  • Ensures that physicians develop the quality measures and are widely consulted on the new payment programs;
  • Update for the Medicare physician payment localities (California GPCI fix).

In response to CMA's comments, the committees made the following additional improvements:

  • Provides increased funding assistance ($125 million) to ALL small practices, not just rural and HPSA practices;
  • Allows a longer time-frame for physicians to prepare to participate in the new models;
  • Gives special consideration to small practices when developing the clinical improvement activities,  the value modifier methodology and the alternative payment models;
  • Requires the fee-for-service value-based program to reduce administrative burden on physicians and gives credit for improvement rather than just meeting a benchmark;
  • Ensures the Value Modifier will be cost and risk-adjusted;
  • Requires CMS to develop models that are attainable for specialists and surgeons, as well as primary care physicians, and small practices; 
  • Allows physicians to partially qualify for the new alternative payment models;
  • Expands the "total cost of care" data available to physicians to help physicians more efficiently manage their practices;
  • A study to examine total Medicare program cost savings (Part A, Part B and Part D) achieved by physicians.
  • Allows physicians to report data on the group level, including virtual groups, to improve the accuracy of the data.
  • Improvements to the Relative Value Unit process; 
  • Ensures that any practice guidelines or payment policies do not establish a standard of care for medical liability actions.

In a last-minute change, the Ways and Means bill now provides a stabilizing 0.5 percent automatic update each year for three years until the new payment models begin. The Ways and Means bill also includes the California geographic payment locality update ("GPCI fix"), which would transition the outdated payment localities to the current and regularly updated metropolitan statistical areas used to calculate payments to hospitals. This transition would take place over 6 years and guarantees that rural counties are not negatively impacted by the change. This GPCI fix would provide an additional $400 million to California physicians over 10 years.

The Senate Finance Committee bill does not, however include an automatic payment update in the first three years. The Senate Chairmen want to wait until the Congressional Budget Office scores the legislation and they negotiate funding sources before adding any payment updates. The Senate bill also does not include the California GPCI fix, as the committee has stated it wants to keep state-specific issues out of the committee mark-up. However, both Senate Finance Committee Chairman Max Baucus and Ranking Member Orrin Hatch have pledged to address the CMA GPCI issue during the January negotiations.  


ATTN OCMA Members: Amendment to Bylaws for Review

Dear OCMA Membership,

 

 

The Bylaws Committee of the Orange County Medical Association has been meeting over the last year and a half for the purpose of carefully reviewing and updating the organization's by-lawsThe revisions have been approved by the Board of Directors and now need to be approved by the general membership. Therefore, for the next two months (November and December 2013) you may review the revised Bylaws by clicking here. These proposed changes will be available for review until December 31, 2013.

Please submit any comments in writing via email to ocma@ocma.org or mail to 17322 Murphy Avenue, Irvine, CA 92614 and indicate whether you approve the changes.



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. 

 


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.


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. 

MICRA ALERT: Trial Lawyers Start Voter Mail Program

The trial lawyers and their front group "Consumer Watchdog" are taking the MICRA battle up another notch. With the start of their direct mail campaign to registered voters, it is clear they are looking to score a victory this year. Below is a photo of their mailer including a "38 Is Too Late" story card and an ever-so-subtle "morgue toe tag." Over the top tactics are to be expected.

Your help is critical to our continued success. Share the details of the trial lawyers efforts with your colleagues. Also, donating to CALPAC to your fullest ability and asking your colleagues to donateCMA/OCMA membership is crucial, so please consider becoming a member to help us with this fight. If you are already a member, we sincerely thank you for your membership.

CMA and our MICRA coalition members at Californians Allied for Patient Protection (CAPP) are fully engaged. With increased legislative visits and the preparation of our own mail and updated materials, we are telling the full story of MICRA and its important role in maintaining access for all. We completed our field poll testing and just received the results. This crucial data will help guide our campaign and ensure we deliver the strongest defense of MICRA at both the legislative level and to the voters of California.

Share this email with others and follow up to join and donate. We don't win unless the physicians of California are united and committed to beating back the trial lawyers. You have the strongest possible message to urge your fellow physicians to join the efforts to protect MICRA. And have no doubt, the fight will get more intense over the coming days and months.

We will win this fight once again because MICRA is a nationally-respected best-practice with overwhelming bipartisan support that has worked successfully in California for decades and, if changed, would result in higher health care costs for every Californian. Your commitment and efforts motivate our incredible staff at CMA. Thank you for all you do and will do. We will be back to you shortly with an update on our latest efforts.



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