Saturday, December 16, 2017

OCMA Blog

MACRA Implementation: A Review of CMS’ Final Rule

WEBINAR:  November 30, 2016 | 12:15pm - 1:15pm

This webinar offers 1 free AMA PRA Category 1 Credit™ for CMA members. This webinar is also available to nonmembers for $99.*

This webinar will provide an overview of the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program, authorized by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  Our speaker will provide key details and dates you’ll need to know and information about how to prepare for the start of the program on January 1, 2017. We will also review key elements of the Merit Based Incentive Payment System (MIPS) pathway and provide a comparison to the other pathway in the program, Advanced Alternative Payment Models (APM). Finally, we will review the flexibilities clinicians have to pick how and when they begin this program during the 2017 transitional year, and review available resources currently available for clinicians seeking technical support.

Featured Presenter: Ashby Wolfe, M.D., MPP, MPH, is a board-certified family physician who currently serves as Chief Medical Officer for California, Arizona, Nevada, Hawaii and the Pacific Territories for CMS. Her focus is on implementation of the many facets of the Affordable Care Act and its role in providing access to high-quality care and improved health at a lower cost.

Participants should register at least one hour before the webinar. If you do not register an hour before the webinar start time, we cannot guarantee your attendance.

To register, click here

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Contact: CMA Member Help Center (800) 786-4262 or memberservice@cmanet.org.


*The California Medical Association/Institute for Medical Quality (CMA/IMQ) is accredited by the Accreditation Council on Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The California Medical Association/Institute for Medical Quality (CMA/IMQ) designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Provider approved by the California Board of Registered Nursing, Provider Number CEP370, for 1 contact hours.

On-demand webinars are not available for CEU or CME credits.



Highlights from the OCMA Board of Directors meeting on November 10, 2016

By:  Darla S. Holland, M.D., President, OCMA

The OCMA Board of Directors met on Thursday, November 10.   The following highlights the major discussions and actions that took place at that meeting: 

The Resident Representative, Dr. Duy Nguyen, indicated that the Resident Physicians in Orange County are interested in Physician Wellness Programs geared toward physicians in training.  A resolution addressing burnout in Medical Students was discussed at the CMA Board of Trustees meeting in October.    The Board is very supportive of sponsoring and supporting such activities for the Medical Students and Residents in programs in Orange County.   
There was vigorous discussion about the CMA's role in the passage of Senate Bill 72.   Many hospital based physicians are affected by this legislation, slated to take effect on January 1, 2017.   A recommendation was made to have the Legislative Leadership Committee recommend language to be submitted through the Resolution process to the House of Delegates year round process.     
The Building Committee made a presentation recommending that OCMA purchase a building as leasing continues to deplete our reserves.   The principles guiding the building search involve the following priorities: 1) To have a location convenient for most members to access; 2) To invest in a manner that generates revenue for both operating expenses and special projects that and will grow to at least keep pace with inflation so that the value of the principle does not diminish over time; 3) To allow OCMA staff to function most of their time on activities that support the core mission of the organization.    These principles will be incorporated into the building search.   
The Physicians of Excellence Reception will be on January 25, 2017.


2016 Election Results are In

 

California Medical Associaiton: 2016 Election Results


ELECTION Night 2016:
One for the history books!

Once again, the California Medical Association took on tough fights and prevailed.

We won all of our statewide ballot measure endorsements, including three local initiatives in the Bay area.

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MACRA before and after

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Together, we voted to…

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· Invest in Medi-Cal. (Yes on Prop. 56, 55 and 52)

· Save lives, reduce smoking rates and prevent thousands of children from starting in the first place. (Yes on Prop. 56)

· Triple the funding for California's anti-smoking programs. (Yes on Prop. 56)

· Provide more essential services like medical check-ups, immunizations, prescriptions and dental/vision care for 13 million low-income Californians, including seven million children. (Yes on Prop. 52)

· Prevent an increase in state prescription drug costs, as well as preserve patient access to medications. (No on Prop. 61)

· Protect public health and clarify the role of physicians in controlling and regulating the adult use of cannabis. (Yes on Prop. 64)

· Reduce sugar intake to prevent diabetes and obesity. (Yes on Measures V (San Francisco), HH (Oakland) and O1 (Albany))

· Break down barriers and removed outdated bilingual education mandates to better reflect California's diverse society. (Yes on Prop. 58)

· Ensure critical infrastructure projects – including hospitals and medical facilities – aren't subject to delays or loss of local control. (No on Prop. 53)

· Strengthen California's ability to prevent gun violence. (Yes on Prop. 63)

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Voters made health care a priority

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In the coming months, we'll work to ensure the new revenue reaches the communities most in need of access to health care and improved services.

Voters sent a clear signal that they are willing to support investments in public health andthat they are tired of Sacramento chronically underfunding health care. CMA's alignment with voters further demonstrates our strength and ability to fight for physicians throughout the state and in all modes of practice.

And on the national front – there are more questions than answers, but one thing is clear: we could be facing a major shake-up.

How will the next Congress and Trump's administration handle the Affordable Care Act? Rising drug prices? Health and Human Services secretary? Medicaid expansion? Mega-mergers?

Regardless of what comes next, CMA will continue to keep California's physicians in the driver's seat on health care policy. And we're working ahead to 2018 to ensure the next Governor reflects our values, including the protection of MICRA and investments in public health.

I want to thank each of you for your support and dedication to CMA. Your membership drives this organization to excellence. Together, we stand stronger.


Dustin Corcoran
CMA CEO

By the Numbers


$3 billion
per year in new federal matching funds for Medi-Cal to serve elderly and low-income Californians. (Yes on Prop. 52)


Up to
$2 billion
per year to improve access to health care services, including Medi-Cal, for low-income children and their families. (Yes on Prop. 55)


Up to
$1.7 billion
(plus $1 billion in federal matching funds) for Medi-Cal. (Yes on Prop. 56)


Save
$1.5 billion
in costs for children's health coverage by FY2019-20. (Yes on Prop. 52)


$350 million
per year in support to state and local public hospitals. (Yes on Prop. 52)


$20 million
per year for public schools to enhance smoking cessation programs. (Yes on Prop. 56)


Over-diagnosing Over-diagnosis


By:  John G. West, M.D., Director of Surgery, Breastlink (Breastlink.com)   

A recent article in the L.A. Times by Melissa Healy casts doubt on the value of screening mammography.  Her article is based on publications by Dr. Gilbert Welch, who has been a long-time critic of mammographic screening.

    Dr. Welch’s premise for concluding that mammograms led to unnecessary treatments is based on his observation that screening leads to the detection of a large number of small breast cancers without a corresponding reduction in the number of advanced breast cancers.  His assumption is that many of these small cancers would not progress and cause harm.

   The logic behind these assumptions is open to question, because advanced cancers typically are found in underserved populations that have low levels of participation in screening programs.  In populations with high levels of screening, locally advanced cancers are uncommon (1).  

     Dr. Welch bases his conclusions on a study comparing breast cancer outcomes during two time periods.  First was 1977-1979 before screening was routine, and the second was 2000-2002 when screening was widespread. His data source is the SEER program (Surveillance, Epidemiology and End Results), which provides information on the size and stage of breast cancers at the time of diagnosis.  

   What is critically lacking in the SEER data is information on mammographic screening for individual patients.  The fundamental flaw in the study reported by Dr. Welch is that he had no idea which patients received a mammogram and which did not.  This lack of screening data undermines the credibility of his conclusions.

      Studies that have data on who was screened and who was not come to a much different conclusions.  One recent study from Canada evaluated a large group of women who participated in routine screening and found a 40% reduction in breast cancer mortality (1).  A recent autopsy study from Boston found that 65% of women who died of metastatic breast cancer never had a mammogram (2).

   It has also been observed that when screening is introduced into underserved populations, the percentage of advanced cancers drops and there is a corresponding rise in the number of early stage cancers (3).  This is a critical observation since survival with early detection is greater than 95% and survival with advanced cancer is in the range of 50-60%.

   Dr. Welch also states that the biggest harm from screening is over-diagnosis.  In other words, he asserts that screening leads to the detection of small cancers, that if left untreated, would not cause harm. 

     It is correct to point out that some small, low-grade cancers may take years before becoming life threatening.  Thus, older women who have a cancer that is only seen on the mammogram might “outlive” their cancer even without treatment. However, small but rapidly growing cancers in the elderly usually benefit from aggressive treatment. Treating physicians must adjust their treatments based on tumor biology.  

    For younger women, over-diagnosis is a non-issue.  Given time, small, non-aggressive cancers will progress.  Most will spread beyond the breast within a decade or less.  Once this spread has taken place, there is often the need for aggressive surgery and chemotherapy, and the chances for survival are markedly reduced.

   The irony of the case against mammographic screening is that it comes at a time when major progress is being made in early detection.  We now have technology, such as screening ultrasounds and screening MRIs, that can detect cancers not visible on mammograms.  Widespread adoption of advanced screening technology, particularly in high-risk women and women with dense breasts, has the potential to produce dramatic reductions in breast cancer mortality.

    Now is not the time to cut back on screening.  Now is the time to develop less expensive and more effective screening technology.  We must recognize that over-diagnosis is not the problem.  The problem is over-treatment.   Our goal must be to individualize patient care in a manner that maximizes benefits while avoiding the harm associated with over-treatment.

Reference:
1.  Coldman A., Phillips N., Wilson C. et. al. “Pan-Canadian Study of Mammography Screening and Mortality From Breast Cancer,” Natl Cancer Inst  106 (July 2014):1-7.

2.  Webb M.L., Cady B., Michaelson J.S. et. al. “A Failure Analysis of Invasive Breast Cancer: Most Deaths From Disease Occur in Women Not Regularly Screened,” Cancer  120 (Sept. 2014): 2839-2846.

3.  Epidemiologic Study from Orange Co. California:  Making mammographic screening available to the underserved Hispanic population.  





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