Saturday, December 16, 2017

OCMA Blog

Physician Financial Transparency Reports (Sunshine Act) Begins August 1, 2013

Tracking of Industry Gifts to Physicians Begins in August

Don't miss your chance to challenge false or misleading data before it goes public!

Beginning August 1, 2013, manufacturers of drugs, medical devices and biologics that participate in federal health care programs must begin tracking and reporting certain payments and items of value—including consulting fees, travel reimbursements, research grants and other gifts—given to physicians and teaching hospitals. The new law, known as the Sunshine Act, also requires manufacturers and group purchasing organizations (GPOs) to report certain ownership interests held by physicians and their close family members.

The intention of the law is to increase transparency and reduce the potential for conflicts of interest that can influence research, education and clinical decision making.

The reports will be submitted to the Centers for Medicare and Medicaid Services (CMS) on an annual basis. The majority of the information contained in the reports will be made available on a public, searchable website beginning in September 2014. Physicians will, however, have the right to review their reports and to challenge any information that is false, inaccurate or misleading. By statute, physicians are provided, at a minimum, 45 days to review the transparency reports and make corrections before they are made public.

“Data accuracy is the number one goal of our program,’’ said Anita Griner, CMS’s deputy director for the Data Sharing and Partnership Group, speaking to the American Medical Association's House of Delegates in June. “We do not want to perpetuate any false information about a physician or teaching hospital…. And that will come from you tracking your own transfers and checking the website before it goes public.’’

 

 

The Sunshine Act covers all physicians who have an active state license, even if they do not participate in federal health care programs, but excludes residents and medical students.

Payments of less than $10 do not need to be reported unless the aggregate amount exceeds $100 annually. The $10 threshold will increase every year, based on the Consumer Price Index.

How to challenge false, inaccurate or misleading reports

Physicians will have 45 days after the annual reports are completed to challenge the data before it is made public. The reports will be available to physicians for their review via an online portal sometime after the close of the calendar year. The portal will also facilitate contact between a physician with a dispute and the manufacturer/GPO that submitted the disputed information.

 

Manufacturers then have 15 days to correct any misinformation. If a resolution is not reached within the allotted time period, the disputed information will be flagged, but the report will be posted on a public webpage. Physicians will, however, have two full years to contest or seek corrections to data contained in the reports, even after it has been made public.

 

Physicians are encouraged to proactively check with any manufacturer from which they have received payments or any items of value to see what information they are tracking and intend to report. If you hold any ownership interests, you should also check to ascertain what they intend to report. (Ownership or investment interests in publicly traded securities and mutual funds are excluded from reporting.)

What you can do now to prepare for the Sunshine Act

Update your disclosures regularly. Ensure that all financial disclosures and conflict of interest disclosures required by employers, advisory bodies and entities funding research, for example, are current and updated regularly.

If you have an NPI, update the information and ensure your specialty is correctly designated. Physicians who have a National Provider Identifier (NPI) should ensure all information in the NPI enumerator database is current and regularly updated as needed. This information will be used by industry reporters, among other unique identifiers, to ensure that they have accurately identified you.

Inform your industry contacts that you want ongoing notice of what they report to the government. Ask all manufacturer and GPO representatives with whom you interact to provide you with notice and an opportunity to review and, if necessary, correct all information that they intend to report before it is submitted to the federal government.

For more information

 

Physicians are encouraged to register for the CMS Open Payments listserv to receive periodic email updates about the program. To register, visit http://go.cms.gov/openpayments. Questions about the program can be sent to openpayments@cms.hhs.gov.

Some information in this article was republished with permission from the American Medical Association. For more information, visit www.ama-assn.org/go/sunshine.

 

Sidebars

Key Dates

August 1, 2013: Manufacturers begin collecting and tracking payment, transfer and ownership information.

January 1, 2014: CMS is expected to launch the physician portal that allows physicians to sign up to receive notice when their individual consolidated report is available for review. This portal will also allow physicians to dispute the accuracy of a report.

March 31, 2014: Manufacturers/GPOs report 2013 data to CMS.

June 2014: CMS is expected to provide physicians with access to their individualized consolidated reports for the prior calendar year. Physicians will be able to access the reports online and will be able to seek correction or modification by contacting the manufacturer/GPO via the web portal.

September 30, 2014: CMS will release most of the data on a public website.

Exemptions

The Sunshine Act includes a number of exemptions from the reporting requirements; among them are:

  • Samples intended for patient use, including coupons and coupons to obtain samples
  • Certified and accredited continuing medical education activities funded by manufacturers
  • Educational materials ultimately intended to be used with patients (for example, wall models or anatomical models)
  • Buffet meals, snacks, soft drinks, or coffee generally available to all participants of large-scale conference or similar large-scale events
  • The loan of a medical device for a short-term trial period
  • Discounts (including rebates)
  • In-kind items used for the provision of charity care
  • A dividend or other profit distribution from a publicly traded security or mutual fund

ACA Self Attestation Form Now Available

July 22, 2013


The ACA Self Attestation Form is now available on the ACA Increased Medicaid Payment for Primary Care Physicians page of the Medi-Cal website. Providers must use this form to self-attest that they are eligible for the increased payment available under the Affordable Care Act (ACA). Providers can reference the Primary Care Physician Self Attestation Form Completion Instructions for step-by-step instructions and additional information about the form.


BACKGROUND

The Patient Protection and Affordable Care Act (PPACA), as amended by the H.R. 4872-24 Health Care and Education Reconciliation Act of 2010, Section 1202, requires payments to be increased to the Medicare equivalent for certain primary care services. The increased payments are retroactive for dates of service on or after January 1, 2013, for both fee-for-service and managed care programs.

 According to the final rule, physicians must meet the following criteria to be eligible for increased payments:


  • A physician as defined in 42 Code of Federal Regulations (CFR) 440.50, with a specialty designation of family medicine, general internal medicine, pediatric medicine or a subspecialty within one of the listed specialties.

AND

  • Meeting at least one of the following qualifications:

o    Board certified in a specialty or subspecialty as recognized by the American Board of Medical Specialties, the American Osteopathic Association and the American Board of Physician Specialties.

OR

o    At least 60 percent of the services billed to Medi-Cal for the most recently completed calendar year fall within the Evaluation and Management (E&M) or vaccine administration codes covered by the regulation.


Services provided at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are not eligible and will continue to receive their prospective payment system (PPS) rate. Physicians must attest online to be eligible for the increased payments.

The Department of Health Care Services (DHCS) is working with Xerox State Healthcare, LLC, (Xerox) the DHCS Fiscal Intermediary (FI), to make the necessary system changes. Upon complete implementation of the system, DHCS will initiate payment corrections for eligible services provided on or after January 1, 2013. Eligible providers will receive the increased payments for future claims as defined in the Centers for Medicare & Medicaid Services (CMS) Final Rule.


State Offering Webinar on Coordinated Care Initiative

The California Department of Health Services is offering two more educational webinars on the Coordinated Care Initiative (CCI) in July. It is important to note that these webinars will NOT be recorded or available for on-demand playback.


Physicians and their staff in affected counties are encouraged to participate in one of the live webinars, Tuesday, July 23 or Tuesday, July 30.

 

The initiative, also known as "CalMediConnect," was authorized by the Assembly in July 2012 in an effort to save money and better coordinate care for the state's low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that will transition more than 450,000 of the state's dual eligible beneficiaries - those eligible for both Medicare and Medi-Cal - into managed care plans.

 

Enrollment begins no sooner than January 2014 in 8 counties (Alameda, San Mateo, Santa Clara, Los Angeles, Orange, San Diego, Riverside and San Bernardino).

 

Physicians, other providers and their staff are invited to participate in one of the July webinars:

  • Tuesday, July 23 at 6:00pm (Click here to register)
  • Tuesday, July 30 at 5:00pm (Click here to register)

Each webinar will include a 30 minute overview of the program, including continuity of care provisions, and 30 minutes of Q&A. Note that the content of the overview will be the same on both dates. Additional webinars will be scheduled as enrollment nears.

For more information on the initiative, please visit http://www.CalDuals.org


OCMA Specialty Spotlight: Specialty Care for Hernia Repair

Specialty Care for Hernia Repair

by:


About Hernia Surgery

Hernia surgery today is much more advanced than even five years ago. The use of laparoscopic surgery techniques and the newest, lightweight meshes (if needed), often allow patients to heal faster, in less pain, and have a more cosmetic outcome. Healthcare providers who are deciding on where to refer hernia patients should make sure that their surgeon has all the tools available to offer the most state-of-the-art techniques and mesh to their patients.

 

About Hernia Symptoms

Hernia symptoms vary dramatically from one patient to the next. One of the most common symptoms of a hernia is therapid onset of pain at the hernia site. When internal fat or internal organs press through a hole in the muscle, a hernia develops. These internal organs and fat cause the skin over the hernia to 'bulge' out. In rare cases, a piece of intestine can become trapped inside a hernia causing strangulation (see image). This is a rare, but serious concern. 



Open versus Laparoscopic Hernia Repair 

The two major types of hernia surgery are traditional open surgery, and laparoscopic surgery. No one approach is suitable for every patient. Patients with certain types of hernias may benefit from open hernia surgery while another similar patient may need laparoscopic hernia repair. The size of the hernia, the location, and whether it is unilateral or bilateral influences the best approach (see comparison chart). At California Hernia Specialists, we develop treatment plans for individual patients to suit their medical needs, their overall medical condition, and their preference when possible. 

 

Open Hernia Repair

Laparoscopic Hernia Repair

Most common technique

used for hernia repair.

Techniques vary widely from surgeon to surgeon

Less common approach for hernia repair. Requires advanced training

Can be done under local

anesthesia with sedation

Requires complete general anesthesia

Hernia is fixed on the

outside by opening the

muscles over the weakness

Hernia is fixed from the inside, behind the muscles where the weakness is located

Requires standard surgical equipment.

Requires advanced

laparoscopic equipment

Recurrence rates of 1-2% and infection rates of <1%

Recurrence rates of 1-2% and infection rates of <1%

Basic preoperative workup is required

Occasionally requires more advanced workup because general anesthesia is used

4-5 cm incision in the groin or bikini area

1-2 cm incision next to belly button, and 2 small punctures below the belly button

Mesh is placed behind the muscle and above the muscle. The mesh is sutured in place

Mesh is placed only behind the muscle, and is secured in place with dissolvable sutures



Tension Free Repair 


The term 'tension free' hernia repair is commonly used to describe hernia surgery. Hernias are caused by a weakening of the abdominal muscles. Some surgeons choose to sew the muscles back together, thus causing 'tension' on the muscles around the hernia. However, the muscles around a hernia are already weak, and over time those muscles tend to pull apart and the hernia can recur, or come back. Therefore, most hernia specialists today utilize a mesh to help strengthen the muscles. When using a mesh, the muscles themselves are not sewn together (see image). Instead, a mesh is placed over or under the hole in the muscle to prevent anything from pushing through the abdominal wall. 



For Referring Physicians


Patients and providers can learn more by visiting our website at www.CaliforniaHerniaSpecialists.com. We work with a large number of primary care, internal medicine, and other physician specialties for hernia care. We take your referrals as the highest compliment we can receive. By choosing to have treatment at California Hernia Specialists, patients and their healthcare providers can ensure the most consistent and highest quality hernia care.


 Todd S. Harris, MD

Dr. Todd S. Harris is board certified in general surgery as well as highly experienced in hernia surgery. Dr. Harris is a Fellow of the American College of Surgeons, one of the highest distinctions for a general surgeon. He is the medical director of California Hernia Specialists and coordinates all clinical functions of the office and surgical center for hernia patients.

Dr. Harris was born and raised in South Carolina and is a graduate of The Medical University of South Carolina. He completed his general surgery training at St. Vincent's Hospital and Medical Center in New York City. After completing his surgical residency, Dr. Harris returned for a cardiovascular and interventional radiology (CVIR) fellowship at the University of Minnesota. After completing his fellowship in 2008, he relocated to Orange County to develop his hernia practice.

Outside of work Dr. Harris enjoys a variety of recreational activities. He is an avid runner and swimmer. He has competed in several triathlons, including the 2012 Malibu International distance race. He balances cardiovascular activities with core and strength training. His interest in fitness allows him to appreciate getting patients back to what they enjoy as quickly and pain free as possible after their hernia surgery.


Orange County Medical Association Welcomes Dr. Kockinis as New President

Article written by Physicians News Network,  

www.physiciansnewsnetwork.com/orange_county 


Last Saturday, July 13, OCMA welcomed doctors to a special installation of OCMA’s new president, Dr. Thomas Kockinis.

Members and guests had a chance to meet and talk to Orange County public officials and members of California legislature, network with each other, and hear about the history of Orange County Medical Association, organized in 1889, back when an increase from two to six beds was considered a major hospital expansion.

Dr. Kockinis said a lot of positive changes during the last year at OCMA were in big part due to the leadership of Dr. Standiford Helm who worked hard during his term as the president of OCMA to take the organization to the next level.

“Membership”, Kockinis said “is now growing at a rapid pace, infused by a new generation of doctors eager to make a positive impact”. Advocacy, according to him, has never been stronger, and OCMA has excellent working relationships with legislators.

Dr. Dennis Jordanides, who is not a member of OCMA but attended the event for the first time as a guest, said that from his perspective “OCMA is becoming increasingly relevant in this era of unprecedented health care reform, and President's dinner was an excellent venue for physicians of all specialities to engage in discussions regarding future collaboration”.

He added that  “the community support of OCMA was clearly evident by the presence of a number of high-profile state and national political representatives."

The main message from the legislators attending the event was that they need to hear from physicians in order to understand the issues that physicians are concerned about. Assembly woman Diane Harkey went as far as give the audience her cell number saying “Call me, text me! Contact me any time, any time at all. I will look into it, we will take care of you because we need you!”

Eric Handler, Orange County Health Officer, told PNN that “partnership of his organization with OCMA has flourished under the current OCMA administration, and OC Health will continue to collaborate with physician community over public health issues, such as hunger, homelessness and prescription drug overdose.

He encouraged physicians to reach out to him and use him as a resource when they have any requests or concerns.

The event was attended by over 200 OCMA members and guests, and was held at the Center Club Costa Mesa.

See pictures from the event on OCMA's Facebook page


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