Monday, December 18, 2017

OCMA Blog

OCMA Member Update on Dual Eligibles Demonstration Project

February 25, 2013

 

Over the last 8 months as CalOptima has been building the foundation for the duals demonstration in Orange County, the OCMA has worked consistently and diligently to represent the interests of physicians and their patients.  The critical decision during this early stage of the demonstration was CalOptima board approval of a health care delivery system to serve the duals patients.

Click here for detailed background information.

 

The OCMA strongly advocated that individual physicians, currently serving the duals patients, be included in the delivery system.  A number of these physicians see their duals patients through Medicare Fee-for-Service, and it is important that duals patients continue to have access to their current physicians.

 

OCMA sent a letter to the CalOptima CEO outlining the reasons for the individual contract option.  This letter is the culmination of months of work and summarizes the many points we carried to individual CalOptima board members and their senior staff.  

Click here for the letter to sent to the CalOptima CEO on behalf of OCMA. 

 

We are very pleased to inform our members that the CalOptima board approved a health care delivery system that will include the individual physicians.  At the February meeting of the board, they considered a number of options and, in the end, agreed to develop a network model that will offer an individual contract option to physicians.  

Click here for the approved actions that were passed by the CalOptima board.

 

There remain a number of other important decisions relative to the duals demonstration, but we have achieved the major milestone noted above.  The OCMA will continue to be an active participant in the duals demonstration, decision-making processes and will continue to update the membership as we reach other critical decision points.


Orange County Doctors give Testimonials in Honor of Outstanding Service Provided by Preferred Business Partner, The Doctors Company


“We have used The Doctors Company for our insurance needs for the past 10 years. We began with their medical malpractice coverage, which they did a tremendous job maintaining and always fighting for us to get the best possible rate. We later utilized their services in providing us with our business personal property, workers compensation, employment practices liability and professional liability for our facility. Their customer service is outstanding and I know if I ever need anything I only need to call. They are a vital part of our organization and we look forward to working with them for many years to come.” 

Kimberly Massoudi
Chief Operating Officer

Outpatient Healthcare, Inc.


“Our practice has been a client of The Doctors Company for several years.  They have always met our needs and had our best interests at heart.  They have been devoted to our practice and our physicians.  The Doctors Company’s representatives are supportive and always there to assist our practice in any way they can.  We are pleased to have The Doctors Company as a vital part of our practice.” 


Michael Muhonen, M.D.
WCP Neurosurgical Associates


“Over the past 10 years, we have experienced tremendous growth in our two long-term groups that contract with our ministry, with the addition of over 100 physicians in 13 new specialties.  Additionally we have added five distinct new medical groups to our organizational model across the state.  In every case and step of our journey, The Doctors Company’s leadership has been supportive and insightful and demonstrated a true partnership approach in meeting our needs.  Account management has been flawless, and the whole team at The Doctors Company is sincerely viewed as partners by our physicians and senior management team.”

C. R. Burke 
President and CEO
St. Joseph Heritage Healthcare


“Whether it be for a major problem, or merely for some sage advice, The Doctors Company is always there when you need them. In our experience, one telephone call results in an expeditious and appropriate response. The staff and management are outstanding, friendly and caring. I recommend The Doctors Company to any physician or medical care organization."

Arthur Goldstein, MD
President & CEO
Women’s Healthcare Physicians


How are Business Partners Selected?

After a potential Business Partner has been identified, either by an OCMA staff member's research or via referral, the vetting process begins. The vetting process is rigorous, thorough, and all final decisions regarding approval or denial are made by the OCMA Services Committee.

The OCMA Services Committee only approves those relationships that benefit you while refusing those of questionable value. In order to add value to your membership with OCMA, you can count on us to provide only business partnerships which offer unique and exclusive discounts on products and services, or preferential status in service delivery. 

OCMA's Business Partners help you accomplish your goals of being a successful physician, and running/maintaining an effective practice.  


OCMA Specialty Spotlight: Doctor Recognizes a Need for Fewer Loopholes in the Delivery of Healthcare in California

Recently Dr. Johnson took on a complicated case involving a 13 year old male suffering from a symptomatic left mandibular cyst.

 

The young patient complained of swelling, pain and recurrent headaches. Before finding Dr. Johnson the patient had been turned away from treatment due to insurance. After initial consultation with the patient, Dr. Johnson found he was unable to treat the patient's urgent condition due to insurance constraints.  The patient was referred back to his insurance for definitive care. Later, the patient's mother and father called, frustrated with the inability of the insurance company to properly refer to a surgeon for definitive and prompt care.

 

The patient was re-examined and noted to have increasing pain, swelling and was now damaging other dental structures. Dr. Johnson's staff subsequently called the insurance company on behalf of the family, urging them to assign a person responsible to get their son treated. Unfortunately this took several months, and many phone calls from Dr. Johnson's staff to get the required approval to treat the patient in a hospital setting.

 

Once the services were approved, Dr. Johnson was able to perform the initial recommended biopsy and decompression at Mission Hospital in Mission Viejo.  The pathology report showed an inflamed dentigerous cyst with a prominent hyperplastic follicle and segments of dental papilla.  There was no evidence of malignant growth histologically.  

Cyst-pre operative tennis ball sized 

.

Home and office care continued over the next several months from the initial decompression, sometimes referred to as marsupialization, proved successful as the size of the cyst was reduced by approximately half its original size. The tooth and periodontal structures which were initially compromised by the growth of the cyst began to heal.  The boy's headaches and jaw pain improved over the next several months.    


Cyst-now golf ball sized (about 1/2 the initial size)

The recommended treatment was extraction of tooth #17, supernumerary tooth and cyst under general anesthesia.  During surgery, the original tumor and the initial cyst was identified. The cyst components, including soft cystic material as well as osseous material, mass and other hard tissues appearing to look like teeth were all removed.  The area was examined for any residual areas of cyst.  The remaining osseous structure in the jawbone appeared to be intact without any evidence of infiltration or fracture.  The boy, now 14, has continued to heal, although now a consultation with a dental orthopedist is recommended to evaluate for a dento-facial skeletal deformity.

 

The case illustrates the need for fewer loopholes in the delivery of healthcare in California. The difficulties with case assignment, surgeon contact, treatment authorization and follow-up care were all compromised in this situation.  There were several unnecessary dental/doctor consultations, as well as visits to the emergency department in order to finally alert the insurance company of the urgency of the patient's needs.  The insurance company also failed to find a treating surgeon in-network within a 50 mile radius.  It seems unimaginable that a qualified, contracted surgeon could not be secured in a timely manner.  The delay in treatment  likely caused the need for more extensive care, causing missed days at school and work days for the parents.

 

Arthur Johnson, III, DDS, MD  

 Arthur Johnson, III, DDS,MD earned his degree in dentistry at the University of Michigan in 1993.  He continued his studies at the University of Pennsylvania, where he earned a degree in medicine in 1998.  Dr. Johnson completed his residency program at Johns Hopkins Hospital.  He maintains hospital affiliation at Mission Hospital in Mission Viejo. Sustaining a private practice in Southern California for more than ten years, Dr. Johnson has volunteered with Health Care International since 1993, where he provides medical and dental care to the underserved regions of Jamaica. He is a member of the Laguna Niguel Rotary Club whose mission is service, volunteerism and goodwill.  He's an active member of the California Medical Association and Diplomat of the American Board of Oral and Maxillofacial Surgery.

 

Dr. Johnson's concern with a patient's dental health expands beyond tooth removal. Dr. Johnson takes pride in helping to change or improve a patient's smile with bone grafts and implants and correcting facial and jaw abnormalities or traumatic injuries with reconstructive surgery.  His attention to detail and philosophy of providing optimal, quality care with the least amount of invasive surgery has earned him the trust from patients and confidence from referring doctors.  


Best Practices for Creating an Accountable Care Organization

The U.S. health care system is moving toward Accountable Care Organizations (ACOs), groups of health care providers who agree to be accountable for the quality, cost, and overall care of Medicare patients. According to the Future of Health Care Survey conducted by The Doctors Company, the nation’s largest medical malpractice insurer, 57 percent of doctors are either undecided or need more information regarding ACO participation.


In a video series at www.youtube.com/doctorscompany, health care industry thought leaders recommend the following best practices when forming ACOs:

1.    Create a readiness checklist.

“A readiness checklist ...involves things like patient-centered medical homes and the attributes that primary care physicians have,” said Robert J. Jackson, MD, MMM, president and medical director, Accountable Healthcare Alliance in Michigan. “It talks about, ‘How well do we deal with data? Do we have patient registries? Do we have patient care plans? Do we have transition of care issues developed?’”

2.    Meet patients’ specific needs.

“The key is designing the care management tools, resources, people, and interventions to manage the specific needs of that patient,” said Laura P. Jacobs, MPH, executive vice president, The Camden Group in California.

3.    Develop clinical integration.

“Make sure all the providers are engaged in real-time information sharing so a care plan can be developed within a very quick period of time and all the providers know their roles and the timelines in which they have to perform their services,” said Michael H. James, JD, president and CEO of Genesys PHO, a pioneer ACO, and Genesys Integrated Group Practice in Michigan.

4.    Engage the community.

“The community has to…support programs that improve health and improve the way patients live because health care goes beyond just acute care,” James said. “It involves the patients’ safety, whether they have enough to eat, their transportation, education, business opportunities or employment opportunities.”

5.    Select the right board members.

“A pioneer ACO requirement is to expand the board with a patient and a community advocate,” James said. “Genesys…selected the leader of their volunteer group. He is 72 years old and is very engaged and involved in community studies on how to improve access to care. The community advocate is the executive director of a group of nursing homes.”

Contributed by The Doctors Company. For more risk tips, patient safety tips, and physician practice tips, visit www.thedoctors.com.


Physician Killed by Patient at Hoag Health Center

A recent shooting at Hoag Health Center in Newport Beach has resulted in the death of Ronald Franklin Gilbert, MD. A troubled patient shot the physician in an exam room, however it has not been confirmed if the patient was under the care of Dr. Gilbert. In response to the terrible event, Orange County Medical Association (OCMA) President Standiford Helm II, MD, issued the following statement:

"It is with deep remorse that my colleagues at OCMA and I recognize the tragic incidence that occurred on Monday, January 28 at the Hoag Health Center in Newport Beach. We extend our sincerest condolences and sympathies to the family members, friends, patients and colleagues of Dr. Gilbert.

"This devastating occurrence has shocked and confused many of us and although we will never fully understand the chain of events, we can only hope for better awareness and preparation to avoid such circumstance in the future.

"Physician groups in California, including the California Medical Association (CMA) and OCMA, have a long history of carefully evaluating issues related to gun control and safety, and have thoroughly debated policy for decades. We believe that open communication and education about firearm safety should be available for physicians and their patients, and that public health officials and physicians work together on these tough issues.

"In light of recent events, OCMA is taking a proactive approach and has partnered with ARIXMAR, a firm that is owned and operated by former FBI Special Agents, to provide Orange County physicians with a seminar series on "Work Place Violence Prevention & Response."

"Dr. Gilbert will be greatly missed by his loved ones, his friends, his many patients and the entire Orange County medical community."

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