Tuesday, March 20, 2018


CalOptima Ranked Top Medi-Cal Plan in California

National Committee for Quality Assurance (NCQA) honor recognizes CalOptima’s overall quality of care for more than 600,000 Orange County residents

ORANGE, Calif. (September 18, 2014) — CalOptima is California’s top-ranked Medi-Cal health plan, according to the NCQA’s Medicaid Health Insurance Plan Rankings 2014–2015.

CalOptima is 1st in the state and 29th nationwide among the 136 Medicaid plans that were ranked. The NCQA rankings are based on standardized, third-party-audited data regarding health care quality and customer satisfaction, as well as NCQA accreditation scores. CalOptima’s ranking is due to a Board of Directors and executive leadership decision last year to collect and share the full set of NCQA measures so nationwide comparison would be possible in 2014.

“CalOptima’s commitment to quality for our members is reflected in the NCQA recognition,” said Mark Refowitz, Chairman of the CalOptima Board of Directors. “Our ranking is confirmation that Orange County’s most vulnerable residents are healthier because of CalOptima and our provider partners. We share this honor with the thousands of dedicated doctors, health care providers, hospitals and other facilities that deliver care to our members daily.” 

CalOptima CEO Michael Schrader said that the 2014–2015 NCQA rankings of Medicaid plans come at an important time of expanded access to such plans for low-income people across the nation. In Orange County through CalOptima, nearly 200,000 people have gained health coverage since January 2014, he said. “Our new members can rely on CalOptima and feel confident that the care they receive is among the best in the state,” Schrader said. “CalOptima is a mission-driven organization focused on providing all members with access to quality health care delivered in a cost-effective and compassionate manner. The NCQA ranking affirms that we are truly living our mission.”

NCQA assesses plan quality based on 46 clinical measures related to both preventive care and treatments. Preventive measures report whether members are getting services to keep them healthy, such as well-child visits, immunizations, nutrition counseling and breast cancer screenings. Treatment measures gauge whether members are receiving appropriate care and medications in response to acute illnesses and chronic diseases, including diabetes and high blood pressure. NCQA also evaluates plan quality based on 11 customer satisfaction dimensions, such as getting care quickly and how well doctors communicate. Further, CalOptima is NCQA accredited with “commendable” status through 2015, which also contributes to the agency’s new high ranking in California.  

Orange County Supervisor and CalOptima Board Member Janet Nguyen, whose supervisorial district has the highest concentration of Medi-Cal members in the county, said: “All of the efforts we have engaged in are paying off, resulting in better services for members. I am proud of our staff, nurses and doctors for the fine work they have done to earn CalOptima the distinction of being the top-ranked Medi-Cal plan in California.” 

CalOptima is nearing its 20th anniversary, with the first members served in October 1995.  Founding Board Member Peter Anderson, M.D., an emergency physician in Fountain Valley, sees the NCQA ranking as reward for the efforts invested by the community at the beginning and still today. “CalOptima was founded in response to difficulties in providing local Medi-Cal members with consistent access to quality care,” Dr. Anderson said. “The NCQA ranking proves that CalOptima has more than met that challenge. It has risen to new heights in serving our community. I congratulate all the CalOptima team members for achieving this lofty goal.”

About CalOptima
A county organized health system, CalOptima provides publicly funded health care coverage for low-income children, adults, seniors and people with disabilities in Orange County, Calif. CalOptima’s mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner. In total, CalOptima serves more than 600,000 members with a network of more than 6,600 primary care doctors and specialists, as well as 30 hospitals. Learn more about CalOptima in this video here.

About NCQA
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. Learn more about the NCQA rankings here.

OCMA Board Member talks with radio station about Joan Rivers' death and administering anesthesia to the elderly

Based on the news of Joan Rivers' death, CSA President and OCMA Board member Paul Yost, MD talked with KFI AM 640 about the risks and considerations for administering anesthesia to elderly patients.

Listen here: 

Your Input is Needed: Susan G. Komen Breast Health Needs Assessment

OCMA is partnering with Susan G. Komen® in order to help disseminate a survey regarding Orange County's needs assessment for the 2015 Community Profile on Breast Cancer and Breast Health. The goal and purpose of the Community Profile is to communicate the status of breast health and breast cancer in the Orange County community, as well as to inform planning of programs and grants for the next several years.
As part of the data gathering process, Susan G Komen® has developed a brief provider survey to identify existing gaps and barriers to service as well as patients' beliefs and attitudes towards breast health services. Physicians should answer these questions based on their day-to-day interaction/experience with their patients. The survey should take no more than 20 minutes to complete, and all responses to the survey will be kept confidential. As an incentive, providers who complete the survey will have the opportunity to win a $100 gift card.
The last day to complete this survey is Friday, September 19, 2014.
Please follow the survey link below to participate in the survey:

Thank you in advance for your participation.

Arpan Global Charities Mission Moshi, Tanzania

August 10-17, 2014

At the foothills of Mount Kilimanjaro in Tanzania, Arpan Global Charities 16th volunteer medical mission was held in the town of Moshi. This mission was unique for a few reasons: a) there was a relatively smaller team totaling 10 volunteers, including one anesthesiologist, one dentist, two thoracic surgeons, one pediatric orthopedic surgeon, one ophthalmologist, two pediatricians, one nurse and one non-medical volunteer. Of the10 total team members, 5 were from St Joseph Hospital in Orange. b) The team members came from 3 different hospitals, including St Joseph Hospital, Kibosho Eye and ENT Hospital and Machame Lutheran Hospital. The team stayed at Torchbearer Lodge run by Mama Lynn Elliott, who at the same campus also runs a non-profit organization, the Light in Africa, where 166 orphans are cared for. All the children at this orphanage receive shelter, meals, education and treatment for various underlying medical conditions including cerebral palsy, HIV and other acute as well chronic conditions.

During one week at Moshi our team members saw about 650 patients at different locations, including 3 hospitals in Moshi. Masai patients were seen and treated in remote areas in the bush. A total of 55 surgical procedures were performed including 17 eye surgeries, 16 general surgical and pediatric orthopedic procedures and 22 dental procedures. We delivered gifts from the sisters of St. Joseph Hospital in Orange to sister Leiymo of St Joseph Hospital in Soweto Moshi. In addition, our team members also delivered new clothes donated by St. John’s Friendship Quilters in Orange to the orphans at the Light in Africa. Our team dentist donated hundreds of toothbrushes and toothpaste to the local underserved population.

Overall, Mission Moshi in Tanzania was another successful mission for Arpan Global Charities, fulfilling its mission to bring health and hope to the medically underserved population around the world, while providing humanitarian assistance and medical education to those who need it the most.

For more information on Arpan Global Charities, visit http://www.arpanglobal.org/

New guidance from CDC on Ebola

Below message is from the Orange County HCA / Epidemiology & Assessment

Guidance for Safe Handling of Human Remains of Ebola Patients in U. S. Hospitals and Mortuaries (August 25, 2014) 

From Dr. Erin Epson, Assistant Chief / Public Health Medical Officer of the CDPH Healthcare-Associated Infections Program:
CDC has issued Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus, available at: http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html. Although the role of the environment in transmission of Ebola virus has not been established, in this guidance CDC recommends higher levels of precaution to reduce the potential risk posed by contaminated surfaces in the patient care environment “given the apparent low infectious dose, potential of high virus titers in the blood of ill patients, and disease severity.” Disinfection products with higher potency than what is normally required for an enveloped virus such as Ebola are therefore now recommended. Such products include Environmental Protection Agency-registered hospital disinfectants with a label claim for a non-enveloped virus (e.g. norovirus, rotavirus, adenovirus, poliovirus), and would also include bleach solution. In addition, the new guidance recommends that porous surfaces that cannot be made single use (e.g. carpeting, upholstered furniture and curtains) should be avoided in rooms of suspect Ebola virus disease (EVD) patients, and that potentially contaminated textiles (e.g. linens, non-fluid-impermeable pillows or mattresses, and privacy curtains) be discarded as regulated medical waste. This guidance regarding appropriate disinfection products and management of potentially contaminated textiles is different and replaces the environmental infection control elements of the previously issued Infection Prevention and Control Recommendations for Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals.

CDC has also updated a poster depicting the sequence for putting on and removing personal protective equipment (PPE), available at: http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf. This updated poster emphasizes guidance to perform hand hygiene between steps if hands become contaminated, in addition to immediately after removing all PPE. 

There are multiple acceptable sequences and methods for removing PPE. Regardless of the sequence or method used, the important principles are that the most contaminated items are removed first, and that the person removing PPE does not contaminate themselves or others during the process. If two pairs of gloves are used, the most contaminated outer gloves can be removed first and the inner gloves last, in order to limit additional contamination of remaining PPE during removal.  Performing hand hygiene between steps, and especially prior to removal of a mask or respirator, can help prevent contaminating one’s eyes and/or mucous membranes while removing the mask or respirator. Healthcare personnel should familiarize themselves and practice methods of donning and removal of any PPE used, in advance of the time when PPE will be needed. 

Availability of PPE supplies, hand hygiene, and appropriate waste containers at the point needed can be facilitated by placing any suspect EVD patient in a room with an anteroom.  An anteroom is particularly helpful if airborne isolation is implemented and respirators must be removed after leaving the patient room and closing the door. If a room with an anteroom is unavailable, a suspect EVD patient can be placed in a room that is spatially separated from other occupied patient rooms in a low traffic area (e.g., at the end of a hallway), with a designated area for hand hygiene and waste containers outside the room and separate from other patient care areas.

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

Covered California Provider Education News: Know Your Participation Status

Covered California: Know Your Participation Status

In late April 2014, the California Medical Association (CMA) surveyed physicians about their contracting experience with Covered California plans. Eighty percent of respondents reported that they had been confused about their participation status in a Covered California plan and that they believed such confusion had negatively impacted patient care.

Unfortunately, checking your practice's participation status is not as straightforward as it might seem. Plagued with inaccuracies, Covered California took down its cross-plan provider directory earlier this year. Add to that the fact that some exchange plans have used vague contract terms and amendments that rope physicians into participating in their exchange networks, often without their express consent or knowledge, and you'll see that "do you take my insurance" is not always an easy question to answer. 

CMA has developed a toolkit to assist physicians with checking their participation status within Covered California. Click here to download the Know Your Status toolkit.

Meet your Covered CA Provider Educator, Karli Nevarez

Karli is available to provide and distribute multilingual patient education materials for your practice or medical group, as well as appear in person to facilitate a brief presentation or answer questions for your staff. These presentations are for physicians and their staff to gain a better understanding of Covered California and the products offered through the exchange. Karli's services are available to both members and non-members of OCMA.

If you would like Karli to come to your practice or medical group to deliver materials and/or present to your staff, you may contact her at: (310) 818-6998 or knevarez@thecmafoundation.org.  
You can also fill out the Covered CA Information Request Form and fax or email the form back to the OCMA. 

Mental Illness and the ACA — Expanding Behavioral Health Benefits and Fighting Stigmas

By Donald Sharps, M.D.
CalOptima Behavioral Health Medical Director

The phrase, “people fear what they do not understand,” is true when dealing with the stigma that surrounds mental illness. In the media, behavioral health is often blamed for irrational behavior and acts of violence. In schools and offices, you can hear name-calling using words like crazy, insane or psycho. A lack of awareness continues to spread this stigma and it can be a barrier for people to get behavioral health services to improve their quality of life. 

Just as diabetes is a disease of the pancreas, mental illness is a disease of the brain. People are not their diseases. Be aware and do not label a person as schizophrenic or bipolar. A person can have schizophrenia or a bipolar disorder, just as a person can have diabetes. It is important that people increase their awareness of mental health and wellness to reduce the stigma of mental illness. To accept and cope with having a mental illness is difficult enough. It is even harder when a person feels there is a stigma associated with mental illness. Treatment is available for behavioral health issues and it is possible for people to achieve and maintain recovery.

How has the Affordable Care Act changed the way people access behavioral health services and treatment for mental health disorders?

As of January 1, 2014, the Affordable Care Act (ACA) expanded health care benefits to include behavioral health services. However, many people still do not access services for reasons ranging from lack of awareness, to the fear of being labeled and being treated differently. By reducing the stigma of behavioral health issues, we can assist people in getting the needed treatment that is available to them.
With ACA, Medi-Cal has expanded so that more people are eligible, by providing coverage for people who earn up to 138 percent of the federal poverty level (about $15,800 for an individual). It has also increased coverage among non-elderly adults by extending Medi-Cal eligibility to childless adults and increasing Medi-Cal eligibility for parents who lose access when their income fluctuates and slightly exceeding the poverty level.

The ACA also ensures that all health plans offer a comprehensive package of services, known as essential health benefits, which includes Mental Health and Substance Use Disorder Services. 

These Behavioral Health Services are now available to all Medi-Cal members:

  • Individual and group psychotherapy
  • Psychological testing to evaluate a mental health condition
  • Psychiatric consultation and ongoing treatment, that cannot be managed at the primary care level of health care
  • Screening, Brief Intervention, and Referral to Treatment (SBIRT) provided in a primary care setting for alcohol misuse
  • Drug Medi-Cal Services

Members can call the Orange County Mental Health Plan Access Line at 1-800-723-8641 for screening and referral to services. Primary care providers, network providers, community-based organizations and county programs can also call the Access Line. This line is available 24 hours a day, 7 days a week.

To get information regarding the Drug Medi-Cal County Alcohol and Other Drug Program (AOD), call the OC LINKS behavioral health services and referral line at 1-855-OC-LINKS (1-855-625-4657).

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 myoung@cmanet.org.

Physician Advocate Mid-Year Report: 127,000 Reasons to be Member


The California Medical Association's (CMA) Center for Economic Services' (CES) reimbursement specialists have recouped $127,168 on behalf of physician members of OCMA since the beginning of 2014!

Mitzi Young is OCMA's Physician Advocate from CMA's CES team. Since the start of 2014, Mitzi has met with over 43 physician practices to assist with practice management needs and perform complimentary practice assessments. 

Your Personal Physician Advocate
Meet Mitzi Young, staff member and CMA Center for Economic Services (CES) Physician Advocate for the OCMA. Mitzi is dedicated to handling your practice management issues and is only a phone call away!

Mitzi brings 21 years of practice management experience and expertise in the health care industry. She has worked in numerous health care settings including county organized health programs, surgery centers and specialty health care practices. 
Mitzi understands the needs of physicians and their staff, the challenges that face medical practices, and is very passionate about advocating on behalf of doctors in the ever-changing healthcare environment.


When do you call Mitzi?

  • When you have questions about Covered California
  • When your claims are not being paid in a timely manner
  • When you are not being paid according to your contract
  • When your claims are being denied after obtaining prior authorization or verifying eligibility
  • When you receive unreasonable requests for medical records or untimely requests for refunds
  • When you are having difficulty obtaining fee schedules and/or payment rules
  • When your claims are denied despite timely filing
  • When you've been presented with a managed care contract and you're not sure if the terms are consistent with California law
  • When you've done everything you can to resolve an issue with a payor and have been unsuccessful
  • When you need help evaluating your practice
  • When you need ANY practice management guidance

Would you like a FREE Practice Assessment?

Find opportunities to increase revenue through the billing process, accounts receivable and collections. Increase efficiency with patient scheduling, appointments and check-in process and discuss all of your practice-related concerns. Contact Mitzi to schedule your member-only practice assessment.
Receiving practice management guidance from Mitzi Young is a FREE OCMA member benefit!
Contact Mitzi to schedule a one-on-one consultation to discuss your practice management needs: 
Mitzi Young
Physician Advocate, CMA Center for Economic Services
(888) 236-0267

Not a member?

Join today!  
Contact Mark Morones, Director of Membership:
(949) 398-8103

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.

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