Friday, March 23, 2018


Communicable Disease News: Pertussis Epidemic in OC & Ebola Virus Update

Update on California's Pertussis Epidemic

Pertussis activity continues at epidemic levels in Orange County and statewide.
As of 8/16/2014, 250 pertussis cases have been reported in Orange County, compared with 43 cases at this time last year. Pertussis peaks in incidence every 3-5 years as the number of susceptible people in the population increases; the last epidemic in California was in 2010.

Infants under 12 months of age are at highest risk for severe infection and death. To protect this vulnerable population the following is recommended:

  • Immunize pregnant women with Tdap during every pregnancy at 27-36 weeks gestation. This dose protects mom and provides the infant with high levels of protective transplacental antibodies.
  • Encourage close contacts of infants to be up-to-date with their pertussis vaccine (cocooning).
  • Vaccinate infants and children with DTaP followed by Tdap according to the childhood immunization schedule:

Diagnostic Testing: Suspect pertussis cases should be tested by nasopharyngeal PCR. PCR is most sensitive within 3 weeks of the onset of the cough (up to 6 weeks for infants). Consider obtaining a CBC: a WBC count that is ≥ 20,000/mm3 with ≥ 10,000 lymphocytes/mm3 in a young infant with a cough illness is strongly suggestive of pertussis infection.

Management of Cases:

  • Treatment: Antimicrobial treatment should begin as soon as possible after diagnosis, particularly in infants. Treatment may lessen symptoms if begun early during illness and will shorten the period of infectivity.
  • Prophylaxis: The CDC and AAP recommend post-exposure prophylaxis for all close contacts of a pertussis case. However, during widespread community outbreaks, OCHCA will focus its efforts on postexposure prophylaxis for high-risk contacts, including infants under 1 year of age, pregnant women, and their contacts.
  • Infection control: Health care workers should use standard and droplet precautions, including a surgical or procedure mask and eye protection when evaluating suspect pertussis patients. Droplet precautions should be maintained until 5 days after the patient is placed on effective therapy, or if no treatment until 21 days after cough onset.
  • Management of cases in school settings: Cases should be excluded from childcare settings until completion of 5 days of antibiotic treatment, from K-12 grade schools until completion of 3 days of antibiotics, and for 21 days if no antibiotic treatment.


General pertussis info for clinicians:
Tdap for pregnant women:

Click here for full Pertussis Newsletter.

Ebola Outbreak In West Africa

West Africa has been experiencing a large outbreak of Ebola Virus Disease (EVD) since December of 2013. As of August 15, 2,127 confirmed or suspect cases of disease including 1,145 suspected case deaths have been reported in Guinea, Liberia, Sierra Leone and Nigeria. It was reported last night (August 19) that Kaiser Permanente in Sacramento is testing a patient for suspected Ebloa Virus, aside from that, two United States citizens were transported to Emory University for further care after contracting the disease while caring for patients with EVD in Liberia. Though the risk of Ebola to the United States or Orange County is small, the potential exists for imported disease in persons traveling from countries where EVD is active. Medical providers should keep up to date on this outbreak and know which patients merit evaluation for EVD.

Providers should contact Orange County Public Health at 714-834-8180 (714-628-7008 after hours) immediately upon identifying any patient with potential EVD. Orange County Public Health can assist with assessment and testing of any case meeting the CDC-defined criteria for a Person Under Investigation, which includes:

1. Clinical criteria:

a. Fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and
b. Additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage


2. Epidemiologic risk factors within the past 21 days before the onset of symptoms, such as:

a. Contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD or
b. Residence in-or travel to-an area where EVD transmission is active* or
c. Direct handling of bats, rodents, or primates from disease-endemic areas.

Persons who have had direct contact with Ebola cases through healthcare work or social exposure in West Africa are at particularly high risk for developing disease. For further description of risk factors and clinical recommendations to prepare for or manage Ebola, see

*As of August 15, countries where EVD is active include Guinea, Liberia, Sierra Leone and Nigeria.

Infection Prevention and Control
Standard, contact and droplet precautions are indicated for suspected EVD. Personal protective equipment (PPE) should include gloves, gown, eye protection (goggles or face shield) and facemask. Additional PPE is necessary if copious blood or other fluid is present in the environment, including double gloving, disposable shoe covering, and leg covering. PPE should be discarded on leaving room taking care to avoid contamination when removing.

Laboratory Testing
The diagnostic test of choice for EVD is PCR testing of the blood. The virus is generally PCR-detectable from 3-10 days post-onset of symptoms. If the onset of symptoms is less than 3 days prior to specimen collection, a subsequent specimen will be required to completely rule out EVD. Testing is available through the CDC. Orange County Public Health can assist with assuring appropriate transport of specimens.

For updated information on the outbreak, including countries where EVD is active, go to:

Contact Orange County Public Health at 714-834-8180 with any questions.

Noridian incorrectly denies 300,000 claims for E&M services

Last fall, the Centers for Medicare and Medicaid Services (CMS) experienced some editing issues with new patient E&M codes that resulted in incorrect claim denials. These problems started in October 2013, and was thought to have been corrected in late January 2014. The California Medical Association recently learned, however, that some claims continued to be paid incorrectly through July 15, 2014.
Noridian, California's Medicare contractor, in January began making mass adjustments and correcting claims subjected to overpayment recovery. Unfortunately, while implementing the corrections, Noridian inadvertently subjected established patient E&M codes to incorrect editing, resulting in incorrect denial of codes 99211- 99215.
Noridian has corrected the editing for both the new patient codes and the established patient codes, and claims received by Noridian on and after July 16, 2014, should be processing correctly. Noridian is now beginning the process of mass adjustments to the incorrectly denied claims. Due to the number of claims involved (~300,000 claims back to October of 2013), this process could take a month or so to complete.
Physicians do not need to do anything to have their claims adjusted and they should NOT resubmit the claims. The claims will be automatically adjusted.
For more information, see Noridian's notice on this issue.
Contact: Mitzi Young, OCMA Physician Advocate (888) 236-0267 or

MICRA Alert and Prop 46 Resources for Physicians

In less than 100 days, voters will be asked to weigh in on the MICRA health care lawsuit measure known as Prop. 46, which will hugely jeopardize the privacy of patients' personal prescription medical information.
The initiative will force doctors and pharmacists to use a massive statewide database known as the Controlled Substance Utilization Review Evaluation System (CURES), which is filled with patients' personal prescription drug information. Though the database already exists, it is underfunded, understaffed and technologically incapable of handling the massively increased demands that this ballot measure will place on it.

Most concerning, the massive ramp up of this database will significantly put patients' private medical information at risk and the ballot measure doesn't contain any provisions or funding to help upgrade the system or increase the database's security standards. As many of you know, the CURES database contains highly sensitive patient information including personal and potentially stigmatizing details about their health. Prescription information including medication used to treat obesity, narcolepsy, conditions related to cancer and AIDS, asthma and other sensitive information are all contained within the CURES database. 

In recent weeks and months, the coalition to oppose the MICRA health care lawsuit initiative continues to grow. Teachers, health care workers, local community groups and hundreds of others have pledged to vote NO in November because they too understand the implications this measure would have on patients, taxpayers and consumers across the state.

We know that if this measure passes, it won't just be putting patients' personal medical information at risk, but malpractice lawsuits and payouts will also skyrocket, adding "hundreds of millions of dollars" in new costs to state and local governments, according to an impartial analysis conducted by the state's Legislative Analyst. State and local governments face higher costs in two ways: 
  • They provide health care for current and retired employees;
  • They provide health care for low-income residents through Medi-Cal and other locally run health care programs like community clinics and hospitals.

Someone will have to pay for these increased costs, and that someone is you (physicians), taxpayers and consumers/patients.
The campaign opposed to the initiative - "Patients and Providers to Protect Access and Contain Health Costs" - is a diverse and growing coalition of trusted doctors, community health clinics, hospitals, family-planning organizations, local leaders, public safety officials, businesses, and working men and women formed to oppose this costly, dangerous ballot proposition that would make it easier and more profitable for lawyers to sue doctors and hospitals. A full and updated list of groups opposing the campaign can be found here.
United as one voice, advocating for patients across the state, we can defeat this ballot measure in November, but we need everyone to commit and become engaged along the way. Thank you in advance for all that you do and all that you'll continue to do. 

Join the Fight

CMA and the campaign to defeat Prop. 46 need each and every one of you to help spread the word and educate your colleagues about the critical importance of MICRA. To that end, CMA has developed a MICRA Commitment Card.

We ask that you fill out one of these cards and pledge that you will vote no on the anti-MICRA measure known as Prop. 46.

Campaign Materials

The CMA can provide your office with campaign materials such as patient brochures, posters, buttons, campaign stickers and more. Just fill out the No on 46 order form.

More information

Visit these websites in order to learn more about MICRA so that you can educate your colleagues, friends, peers and family:

- The CMA website

- No on 46 campaign website

- Californians Allied for Patient Protection (CAPP) Website

What else can you do to support MICRA?

- "Like" the No on 46 Facebook page

- Follow the No on 46 Twitter page

- Visit the offical campaign website at

CDC Health Advisory: Guidelines for Evaluation of US Patients Suspected of Having Ebola Virus Disease


The Centers for Disease Control and Prevention (CDC) continues to work closely with the World Health Organization (WHO) and other partners to better understand and manage the public health risks posed by Ebola Virus Disease (EVD). To date, no cases have been reported in the United States. The purpose of this health update is 1) to provide updated guidance to healthcare providers and state and local health departments regarding who should be suspected of having EVD, 2) to clarify which specimens should be obtained and how to submit for diagnostic testing, and 3) to provide hospital infection control guidelines.
U.S. hospitals can safely manage a patient with EVD by following recommended isolation and infection control procedures. Please disseminate this information to infectious disease specialists, intensive care physicians, primary care physicians, hospital epidemiologists, infection control professionals, and hospital administration, as well as to emergency departments and microbiology laboratories.

CDC is working with the World Health Organization (WHO), the ministries of health of Guinea, Liberia, and Sierra Leone, and other international organizations in response to an outbreak of EVD in West Africa, which was first reported in late March 2014. As of July 27, 2014, according to WHO, a total of 1,323 cases and 729 deaths (case fatality 55-60%) had been reported across the three affected countries. This is the largest outbreak of EVD ever documented and the first recorded in West Africa.  

EVD is characterized by sudden onset of fever and malaise, accompanied by other nonspecific signs and symptoms, such as myalgia, headache, vomiting, and diarrhea. Patients with severe forms of the disease may develop hemorrhagic symptoms and multi-organ dysfunction, including hepatic damage, renal failure, and central nervous system involvement, leading to shock and death. The fatality rate can vary from 40-90%. 
In outbreak settings, Ebola virus is typically first spread to humans after contact with infected wildlife and is then spread person-to-person through direct contact with bodily fluids such as, but not limited to, blood, urine, sweat, semen, and breast milk. The incubation period is usually 8-10 days (ranges from 2-21 days). Patients can transmit the virus while febrile and through later stages of disease, as well as postmortem, when persons touch the body during funeral preparations. 

Patient Evaluation Recommendations to Healthcare Providers
Healthcare providers should be alert for and evaluate suspected patients for Ebola virus infection who have both consistent symptoms and risk factors as follows: 1) Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND 2) Epidemiologic risk factors within the past 3 weeks before the onset of symptoms, such as contact with blood or other body fluids of a patient known to have or suspected to have EVD; residence in-or travel to-an area where EVD transmission is active; or direct handling of bats, rodents, or primates from disease-endemic areas. Malaria diagnostics should also be a part of initial testing because it is a common cause of febrile illness in persons with a travel history to the affected countries.
Testing of patients with suspected EVD should be guided by the risk level of exposure, as described below:

CDC recommends testing for all persons with onset of fever within 21 days of having a high-risk exposure. A high-risk exposure includes any of the following:

  • percutaneous or mucous membrane exposure or direct skin contact with body fluids of a person with a confirmed or suspected case of EVD without appropriate personal protective equipment (PPE),
  • laboratory processing of body fluids of suspected or confirmed EVD cases without appropriate PPE or standard biosafety precautions, or
  • participation in funeral rites or other direct exposure to human remains in the geographic area where the outbreak is occurring without appropriate PPE.

For persons with a high-risk exposure but without a fever, testing is recommended only if there are other compatible clinical symptoms present and blood work findings are abnormal (i.e., thrombocytopenia <150,000 cells/µL and/or elevated transaminases) or unknown.  

Persons considered to have a low-risk exposure include persons who spent time in a healthcare facility where EVD patients are being treated (encompassing healthcare workers who used appropriate PPE, employees not involved in direct patient care, or other hospital patients who did not have EVD and their family caretakers), or household members of an EVD patient without high-risk exposures as defined above. Persons who had direct unprotected contact with bats or primates from EVD-affected countries would also be considered to have a low-risk exposure. Testing is recommended for persons with a low-risk exposure who develop fever with other symptoms and have unknown or abnormal blood work findings. Persons with a low-risk exposure and with fever and abnormal blood work findings in absence of other symptoms are also recommended for testing. Asymptomatic persons with high- or low-risk exposures should be monitored daily for fever and symptoms for 21 days from the last known exposure and evaluated medically at the first indication of illness. 

Persons with no known exposures listed above but who have fever with other symptoms and abnormal bloodwork within 21 days of visiting EVD-affected countries should be considered for testing if no other diagnosis is found. Testing may be indicated in the same patients if fever is present with other symptoms and blood work is abnormal or unknown. Consultation with local and state health departments is recommended.  
If testing is indicated, the local or state health department should be immediately notified. Healthcare providers should collect serum, plasma, or whole blood. A minimum sample volume of 4 mL should be shipped refrigerated or frozen on ice pack or dry ice (no glass tubes), in accordance with IATA guidelines as a Category B diagnostic specimen. Please refer to for detailed instructions and a link to the specimen submission form for CDC laboratory testing. 

Recommended infection control measures
U.S. hospitals can safely manage a patient with EVD by following recommended isolation and infection control procedures, including standard, contact, and droplet precautions.  Early recognition and identification of patients with potential EVD is critical.  Any U.S. hospital with suspected patients should follow CDC's Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals ( These recommendations include the following:

  • Patient placement: Patients should be placed in a single patient room (containing a private bathroom) with the door closed. Healthcare provider protection: Healthcare providers should wear: gloves, gown (fluid resistant or impermeable), shoe covers, eye protection (goggles or face shield), and a facemask.  Additional PPE might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to double gloving, disposable shoe covers, and leg coverings.
  • Aerosol-generating procedures:  Avoid aerosol-generating procedures. If performing these procedures, PPE should include respiratory protection (N95 filtering facepiece respirator or higher) and the procedure should be performed in an airborne isolation room.
  • Environmental infection control: Diligent environmental cleaning and disinfection and safe handling of potentially contaminated materials is paramount, as blood, sweat, emesis, feces and other body secretions represent potentially infectious materials. Appropriate disinfectants for Ebola virus and other filoviruses include 10% sodium hypochlorite (bleach) solution, or hospital-grade quaternary ammonium or phenolic products. Healthcare providers performing environmental cleaning and disinfection should wear recommended PPE (described above) and consider use of additional barriers (e.g., shoe and leg coverings) if needed. Face protection (face shield or facemask with goggles) should be worn when performing tasks such as liquid waste disposal that can generate splashes. Follow standard procedures, per hospital policy and manufacturers' instructions, for cleaning and/or disinfection of environmental surfaces, equipment, textiles, laundry, food utensils and dishware. 

MICRA lawsuit measure assigned proposition number

Via the California Medical Association-

The unprecedentedly broad and diverse coalition working to defeat the trial lawyers’ MICRA lawsuit measure is now officially the “No On 46” campaign, following the assignment of proposition numbers to qualified ballot measures by the Secretary of State’s Office on Monday.

If approved by voters, Proposition 46 would increase health costs, reduce access to care and threaten patient privacy, all to make it easier and more profitable for lawyers to sue doctors and hospitals. In addition to increasing the overall number of medical lawsuits and the cost of health care across the board, Proposition 46 contains a number of unrelated provisions designed to mislead and deceive voters – including a little-discussed mandate relying on a massive expansion of a government-run prescription drug database, which third-party analysts say cannot be implemented as written and will leave personal medical information vulnerable to privacy breach.

For these reasons, health providers, education groups, labor unions, business organizations, working men and women, and community clinics have all announced their opposition to Proposition 46.

On Monday, two additional groups – the State Building and Construction Trades Council of California (SBCTC) and the California NAACP – joined the “No On 46” campaign, pointing out the devastating effects it would have on California.

“This initiative will cost state and local governments hundreds of millions dollars and raise health costs for everyone,” said Robbie Hunter, President of the SBCTC. “That hurts job creation and will negatively impact California’s future.”

According to California’s independent Legislative Analyst, the proposed measure could increase state and local government health costs by “hundreds of millions of dollars annually.”

“This measure is terribly flawed and will reduce access to quality health care for underserved communities,” said Alice Huffman, President of the California NAACP. “At a time when we’re working hard to cover as many Californians as possible under the ACA, Proposition 46 takes us in the wrong direction. Proposition 46 will disproportionately hurt minority communities. It’s bad medicine for California.”

These two organizations join the growing list of California public entities and private organizations that have announced their formal opposition. For a complete list, please visit the campaign website,


Experts Agree MICRA Measure Mandate “Won’t Work” While Opening Floodgates to Personal Prescription Drug Records of Millions of Californians with No Additional Security Safeguards 

SACRAMENTO – A coalition of business, medical, labor and civil liberties organizations have come together to fight a misguided, deceptive initiative that would increase health costs, reduce health access, and rely on a government-run computer system that isn’t close to fully functional – all while putting the prescription drug histories of millions of California patients at privacy risk with no additional security protections.

The initiative, which qualified for the November ballot on May 15, 2014, is written and funded by trial attorneys and their allies.  In addition to increasing the overall number of medical lawsuits and the cost of health care across the board, it contains a number of unrelated provisions designed to mislead and deceive voters – including a little-discussed mandate relying on a massive expansion of a government-run prescription drug database, which third-party analysts say cannot be implemented as written and will leave personal medical information vulnerable to privacy breach.   
“We always knew this flawed measure was bad for the pocketbooks of everyday Californians, but the more they read the fine print, the more they realize it’s equally bad for their personal privacy,” said Jim DeBoo, campaign manager for the broad-based coalition of Californians formed to oppose the initiative.  “If this measure passes, it will mandate a database that isn’t properly working and open the privacy floodgates to the sensitive personal medical data of millions of Californians with no increased security safeguards or funding.  It’s a hacker’s dream – and a privacy nightmare.”

The so-called MICRA (“Medical Injury Compensation Reform Act”) initiative requires health care practitioners and pharmacists to consult a government-run prescription drug database (known as CURES) prior to prescribing or dispensing Schedule II or III controlled substances to patients.

The mandate relies on the uploading of personal prescription drug records of millions of California patients onto the database – accessible by hundreds of thousands of users.  But the initiative fails to add new funding for its expedited expansion or require any additional security standards or safeguards to prevent hacking, theft or improper access by non-medical personnel.

What’s more, experts say the CURES mandate will not work as required by the measure, will not be operational by the law’s effective date and will put doctors in the impossible position of choosing between violating their oath as health providers or violating the law.

“The CURES mandate on physicians cannot be implemented as written.  CURES needs to be updated and modernized and nothing in the initiative does that.” said Tim Gage, former California Finance Director and Principal at Blue Sky Consulting.  “Therefore, the initiative will put health providers in the untenable position of either violating the new law or withholding necessary treatment from patients unless the law is suspended.”

“The consequences of mandating the use of a government-run website that experts say won’t work when required before physicians are allowed to prescribe needed medication is nothing less than a recipe for disaster,” said Dr. Richard Thorp, M.D., President of the California Medical Association.    
The CURES database mandate problem comes at a time of widespread reports of illegal hacking, much of it involving digital medical records. Studies show that public fears about personal privacy are at an all-time high.  Last month, it was reported the FBI had taken the extraordinary step of warning that the entire health sector was particularly vulnerable to “attacks by hackers searching for Americans’ personal medical records” (Reuters, April 23, 2014). 
Since 2009, the U.S. Department of Health and Human Services has reported 991 separate incidences of medical data breaches involving 500 people or more, affecting a total of 30 million patients.  While many states are moving to increase protections for online prescription drug data, this measure would have the opposite effect in California.

“The public and lawmakers are really starting to understand what kinds of threats to privacy come when you start centralizing great quantities of sensitive personal information in giant electronic databases,” said Nathan Wessler, an attorney with the American Civil Liberties Union, last week to the Wall Street Journal (May 7, 2014).

As proposed, the CURES database maintains an accessible online record of every dispensed prescription of a Schedule II or III controlled substance, including highly sensitive and potentially stigmatizing details about a person’s health.  This prescription information could include medicines used to treat anxiety, insomnia, obesity, narcolepsy, drug detoxification, pain, epilepsy, conditions related to cancer and AIDS, asthma, chronic infection, and other sensitive medical conditions.

The MICRA lawsuit measure which qualified today is formally opposed by (partial list):   

  • AFSCME California PEOPLE
  • International Brotherhood of Electrical Workers, Ninth District
  • International Brotherhood of Electrical Workers, Local 477
  • Service Employees International Union (SEIU) California
  • Union of American Physicians and Dentists (UAPD), AFSCME Local 206
  • California Medical Association
  • California Dental Association
  • California Hospital Association
  • California Pharmacists Association
  • American Congress of Obstetricians and Gynecologists
  • American College of Emergency Physicians, California Chapter
  • California Association of Physician Groups
  • California Association for Nurse Practitioners
  • Planned Parenthood Affiliates of California
  • Community Clinics Association of Los Angeles County
  • La Clínica de La Raza
  • California Association of Rural Health Clinics
  • Central Valley Health Network
  • California Chamber of Commerce
  • California Black Chamber of Commerce
  • California Hispanic Chamber of Commerce
  • City of Long Beach
  • American Civil Liberties Union of California 

To learn much more about the myriad hidden costs, consequences and flaws in the trial-lawyer-supported MICRA lawsuit initiative, visit the “Stop Higher Health Care Costs/Protect Access to Care” website at:

-# # #-

The Doctors Company Alert: Windows XP Use May Trigger HIPAA Non-Compliance

Alert from The Doctors Company:

Now that Microsoft has stopped supporting the Windows XP operating system, physician practices using Windows XP face threats from viruses, Trojans, and other potential security breaches. All PC workstations and laptops using Windows XP that contain Protected Health Information (PHI) are no longer compliant with HIPAA and the HITECH Act. This includes devices used to access PHI via the Internet. HIPAA Security Rule section 164.308(a)(5)(ii)(B) states that practices must implement “procedures for guarding against, detecting, and reporting malicious software.” This is no longer possible with Windows XP.

If your practice system currently runs on Windows XP, follow these tips immediately to bring your practice into HIPAA compliance:

  • Identify all at-risk workstations and laptops.
  • Analyze the hardware in all at-risk computers to determine if they are capable of running a new operating system, such as Windows 7 or 8.
  • Upgrade all at-risk computers identified as capable of running a new operating system.
  • For computers that cannot be upgraded, either replace the hardware or purchase new computers.
  • Create a transition plan for upgrading or replacing computers.
Internet Explorer 8 is also no longer supported—if your practice is running Windows XP and using Internet Explorer 8, you may be exposed to additional threats.

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

MEDICARE SGR ALERT: Physicians: Call Congress Now!





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.  

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