Tuesday, August 21, 2018

OCMA Blog

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, www.noon46.com.


COMING THIS NOVEMBER TO A BALLOT NEAR YOU: ANOTHER FLAWED GOVERNMENT-RUN DATABASE MANDATE WITH NEW THREATS TO PERSONAL PRIVACY

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: www.StopHigherHealthCareCosts.com.

-# # #-

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 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. 

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