Friday, December 15, 2017

OCMA Blog

OCMA Collaboration with CalOptima Secures Reimbursement Increase for ER Physicians

Emergency room physicians in Orange County will see an increase in reimbursement by CalOptima due to successful efforts by the Orange County Medical Association (OCMA).

OCMA worked in close collaboration with CalOptima to address the issue of ER physician payments. Since January 1, the full implementation of federal health reform and resulting increase in health insurance coverage has led to increased use of emergency rooms throughout the county as the system faces a growing demand for services.

Although there has been significant growth in utilization, emergency room physicians had not seen an increase in their payment rates for a number of years. This is despite the fact that Orange County ER physicians have seen a greater percentage of high-acuity cases in ERs after the implementation of health reform and the expansion of Medi-Cal and CalOptima coverage to OC residents.

ER physicians initially attempted to secure an increase from the Medi-Cal plan, but were unsuccessful. “At that point we saw that we needed help. The funding was critical to our specialty, but we realized we couldn’t get it alone, so we reached out to the OCMA,” said Dr. Peter G. Anderson, head of the ER physician team at Fountain Valley Regional Medical Center.

OCMA worked closely with executives and staff at CalOptima to develop a proposal that addressed the physicians’ needs and was financially prudent for the plan.

“We have a great relationship with the Orange County Medical Association, and work closely with them on initiatives directly impacting our physician provider partners,” stated Javier Sanchez, chief network officer for CalOptima. “The solution we put together with them on the ER rate issue is just the most recent example of that.”

The increase applies to services rendered to CalOptima patients on and after Sept. 1, 2014. The case rate was increased from $85 to $95, and physician critical care services outside of the case rate will now be reimbursed at 133% of the Medi-Cal fee schedule, up from the previous 123%.

These increases will be provided to both CalOptima Direct as well as Shared Risk Groups (SRGs) and Physician-Hospital Consortia (PHCs) working through the health networks.

The proposal was adopted by the CalOptima Board of Directors at their regular monthly meeting on Sept. 4.

“OCMA was pleased to have been able to help secure this rate increase for our ER physician members,” said Robert McCann, CEO of the Orange County Medical Association. “OCMA is proud of our advocacy on behalf of all of our physician members. We will continue to strive to do all we can to assist them in their efforts to serve the healthcare needs of the Orange County community.”

Specialty physicians received a reimbursement increase from CalOptima in December 2013, but ER physicians were exempted and did not get an increase. ER physicians are also not eligible for the reimbursement increase to primary care physicians included in federal health reform, so the recent increase was a great win for ER physicians.

Read full article in Physicians News Network - Orange County.


Prop 46 Update for Physicians: Proposition 46 isn’t the CURE(S)

Today in California, trial lawyers are waging an aggressive campaign to overturn California's landmark Medical Injury Compensation Reform Act (MICRA).
 
On November 4, voters will be asked to weigh in on Proposition 46, a costly and deceptive measure funded and sponsored almost exclusively by trial lawyers. In addition to raising health care costs and reducing access to quality medical care, Prop. 46 could put patient prescription drug history at risk of being hacked and would force physicians and pharmacists to use an unworkable database.
 
The Controlled Utilization Review and Evaluation System, or CURES, is a statewide, government-run database that allows physicians to know which medications patients are taking. In concept, it could be a helpful tool in ensuring that patients don't "doctor shop" - or visit several doctors to get multiple prescriptions for controlled substances.
 
Though the database already exists, it is underfunded, understaffed and technologically incapable of handling the massively increased demands this ballot measure will place on it. In its current form, the CURES database is plagued with system errors and major deficiencies. The state staffer in charge of CURES recently testified that the database is "not sufficient enough to carry out the mission that we need." To see excerpts of his testimony, click here
 
In fact, in evaluating Prop. 46 the independent, non partisan Legislative Analyst noted, "Currently CURES does not have sufficient capacity to handle the higher level of use that is expected to occur when providers are required to register beginning in 2016."
 
Despite all of this, Prop. 46 includes a provision that would mandate physicians and pharmacists check the CURES database before prescribing Schedule II or III drugs - a list of medications that is far too long for this newsletter. This "CURES mandate flaw" puts physicians in the untenable position of either breaking their professional oath to give patients the best possible care or breaking the law.
 
What's more, the CURES mandate comes without any increased security to ensure that the database is up and running efficiently, effectively and safely before legally making health care professionals check it.

That's a risky gamble in these days of massive data breaches.   

In the few weeks left between now and Election Day, I cannot stress enough how important it is to spread the word about the dangers of Prop. 46.    As you've read in previous issues of this publication, Prop. 46 is really three measures carelessly thrown together by trial attorneys with the hopes that adding "sweetener" provisions - including the CURES piece discussed above  - will trick voters. The real intention is to increase the cap on medical malpractice payouts, which will increase health care costs for everyone and decrease access for those who need it most. Prop. 46 will result in money being pulled directly out of the health care delivery system and put into the pockets of trial attorneys at the expense of voters everywhere.  


How can you get engaged in the final stages of the No on Prop. 46 campaign?


- "Like" the No on 46 Facebook page

- Follow the No on 46 Twitter page

- Visit the offical campaign website at www.noon46.com


FREE Campaign Materials

OCMA has campaign materials at our offices available for physicians to pick up, including yard signs, campaign buttons, patient brochures, office posters and bumper stickers.

You can also order these materials to be sent straight to your office (yard signs only available for pick-up at OCMA). Just fill out the No on 46 order form.


No on 46 "Take Action" Contest

Take action in the No On 46 fight now through October 19, 2014 and your practice could win $500! 

Click here for information on the contest.


More information

Visit these websites in order to learn more about MICRA and Prop 46 so that you can educate your colleagues, friends, peers and family:

- The CMA website

- No on 46 campaign website

- Californians Allied for Patient Protection (CAPP) Website

 


OCMA CEO Advocacy & Legislative News Update


Local: CalOptima

Thanks in part to OCMA advocacy, in March, the CalOptima Board of Directors approved establishing a 'Community Network', allowing direct contracts with physicians in order to provide greater access to services for CalOptima enrollees.
 
Also in March, the County Board of Supervisors modified the county ordinance governing CalOptima to require an additional supervisor be added to the CalOptima Board of Directors. As a result, Supervisor Todd Spitzer has joined Supervisor Janet Nguyen on the CalOptima Board. 
 
For details and resources on the state's Coordinated Care Initiative (CCI) - Dual Eligibles Demonstration, please click here.

State: Health Care Bills

SB 1215 (Hernandez): Healing arts licensees: referrals (CMA Position: OPPOSE) - which aimed to eliminate the in-office exception to the self-referral law for advanced imaging, anatomic pathology, radiation therapy, and physical therapy. This bill would have been a major blow to the integrated care model, resulting in increased costs as these services would have been driven toward the more expensive hospital setting and inhibit the development of practices that integrate and coordinate care. We have successfully managed to defeat this harmful bill in committee.
 
SB 1000 (Monning) the Sugar-Sweetened Beverages Safety Warning Act (CMA Position: SPONSOR)  - passed the Senate Floor after receiving 21 yes votes. Facing significant opposition from the beverage industry, it was a hard-won vote. 
 
AB 1771 (V.M. Perez) Telehealth Reimbursement (CMA Position: SPONSOR)  - was approved through a 76-1 vote. This bill seeks to require health insurance companies licensed in the State of California to pay contracted physicians for telephone patient management. 
 
AB 2400 (Ridley-Thomas) Health care coverage: provider contracts (CMA Position: SPONSOR) - was approved through a 55-8 vote. If signed into law, this bill will prohibit contracts issued, amended or renewed after January 1, 2015, from including a provision that terminates a provider if he or she exercises the right to negotiate, accept or refuse a material change to the contract. It would also prohibit plans from requiring participation in unspecified current and future products or product networks, unless the plan discloses the reimbursement rate, method of payment and any other contract terms that are materially different from those of the underlying commercial agreement. 

National: Medicare SGR

Over CMA's strong opposition to another short term patch, on March 31, the night before the SGR cut, the House and Senate voted on the 17th patch in a decade.  With the President's signature, the bill takes effect and provides the following: 

  • Stops the 24% Medicare physician payment cut for 1 year until April 2015.
  • Provides a 0.5% payment increase through Dec 31, 2014; 0% through April 1, 2015.
  • Delays the burdensome ICD-10 coding system until October 2015.
  • Permanently Reforms the California physician payment localities. 


For the full OCMA CEO Advocacy & Legislative Report, click here.


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