Saturday, December 16, 2017

OCMA Blog

Mental Health Services Access Hotline for Patients and Physicians

The Orange County Mental Health Plan has a hotline available to help Orange County patients locate mental health services. This includes outpatient mental health services provided by mental health professionals and psychiatric inpatient services. Physicians can also utilize the number to locate services for patients. 

Click here for more information.

Orange County Mental Health Plan:

1-800-723-8641


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.


2015 Young Physicians Patient Safety Award

The Doctors Company Foundation is now accepting essays for the 2015 Young Physicians Patient Safety Award. The annual award recognizes six third- and fourth-year students attending U.S. medical schools who write winning essays about the most instructional patient safety event they have experienced in a clinical rotation. Winners each receive a $5,000 award from The Doctors Company Foundation,which co-sponsors the contest with the Lucian Leape Institute of the National Patient Safety Foundation.
 

For more information on the award and how to apply, please visit www.tdcfoundation.com/2015ypawards. Essays are due by Monday, February 2, 2015 (5:00 PM PST).


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.


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Each issue of The Doctor’s Practice features a new article or video in a simple, one-click e-mail. These articles feature expert tips to help you reduce malpractice risk, avoid claims, and make the practice of medicine more rewarding.

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The insightful content in The Doctor’s Practice is part of The Doctors Company’s commitment to defending, protecting, and rewarding the practice of good medicine.


OCMA Collaboration with CalOptima Secures Reimbursement Increase for ER Physicians

Emergency room physicians in Orange County will see an increase in reimbursement by CalOptima due to successful efforts by the Orange County Medical Association (OCMA).

OCMA worked in close collaboration with CalOptima to address the issue of ER physician payments. Since January 1, the full implementation of federal health reform and resulting increase in health insurance coverage has led to increased use of emergency rooms throughout the county as the system faces a growing demand for services.

Although there has been significant growth in utilization, emergency room physicians had not seen an increase in their payment rates for a number of years. This is despite the fact that Orange County ER physicians have seen a greater percentage of high-acuity cases in ERs after the implementation of health reform and the expansion of Medi-Cal and CalOptima coverage to OC residents.

ER physicians initially attempted to secure an increase from the Medi-Cal plan, but were unsuccessful. “At that point we saw that we needed help. The funding was critical to our specialty, but we realized we couldn’t get it alone, so we reached out to the OCMA,” said Dr. Peter G. Anderson, head of the ER physician team at Fountain Valley Regional Medical Center.

OCMA worked closely with executives and staff at CalOptima to develop a proposal that addressed the physicians’ needs and was financially prudent for the plan.

“We have a great relationship with the Orange County Medical Association, and work closely with them on initiatives directly impacting our physician provider partners,” stated Javier Sanchez, chief network officer for CalOptima. “The solution we put together with them on the ER rate issue is just the most recent example of that.”

The increase applies to services rendered to CalOptima patients on and after Sept. 1, 2014. The case rate was increased from $85 to $95, and physician critical care services outside of the case rate will now be reimbursed at 133% of the Medi-Cal fee schedule, up from the previous 123%.

These increases will be provided to both CalOptima Direct as well as Shared Risk Groups (SRGs) and Physician-Hospital Consortia (PHCs) working through the health networks.

The proposal was adopted by the CalOptima Board of Directors at their regular monthly meeting on Sept. 4.

“OCMA was pleased to have been able to help secure this rate increase for our ER physician members,” said Robert McCann, CEO of the Orange County Medical Association. “OCMA is proud of our advocacy on behalf of all of our physician members. We will continue to strive to do all we can to assist them in their efforts to serve the healthcare needs of the Orange County community.”

Specialty physicians received a reimbursement increase from CalOptima in December 2013, but ER physicians were exempted and did not get an increase. ER physicians are also not eligible for the reimbursement increase to primary care physicians included in federal health reform, so the recent increase was a great win for ER physicians.

Read full article in Physicians News Network - Orange County.


DHCS Releases Online UCR Attestation Form for ACA Primary Care Rate Increase

The federal Affordable Care Act (ACA) included an increase in reimbursement to eligible primary care physicians for specified services provided from January 1, 2013 through December 31, 2014. Payments for services rendered to Medi-Cal patients will be reimbursed at Medicare rates for the two-year period.
 
However, according to DHCS and CMS policy, total payment for services rendered may not exceed a provider's billed charges. Due to system limitations at the DHCS, providers may be restricted from billing their usual and customary rates on the PM-160 billing form. In most cases, providers have adapted to this restriction by billing at the expected Medi-Cal reimbursement rate for services provided to Child Health and Disability Prevention Program (CHDP) participants. This has created a problem for physicians anticipating the higher reimbursements, as according to DHCS and CMS policy, the providers have been paid at billed charges and are not owed additional ACA reimbursement.  As a result, millions of dollars in payments to California physicians have not been released.
 
CalOptima and other California managed care plans have been working with the DHCS for several months to develop a solution that wouldn't require physicians to re-bill all eligible CHDP claims in order to obtain the increase. At the urging of physician advocacy groups such as CMA, OCMA and other stakeholders, the DHCS has agreed to a workaround that would allow these practices to be paid at the higher rate without the inconvenience of rebilling each claim. 
 
DHCS recently released an online form where providers may attest to their usual and customary rates for CHDP services, allowing the practice to receive the higher reimbursement intended by the ACA rate increase. This attestation must be completed by November 28, 2014. The form may be found online at: http://files.medi-cal.ca.gov/pubsdoco/ACA/articles/acanews_23115_1.asp
 
DHCS recently announced it intends to make an interim payment on CHDP claims in December, with a true up to occur in 2015.

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.


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