Sunday, December 10, 2017

OCMA Blog

CalOptima Seeks Candidates to Participate on its Provider Advisory Committee (PAC) 2014-2016

The CalOptima Board of Directors welcomes input and recommendations from the provider community regarding issues concerning CalOptima programs. For this reason, the CalOptima Board encourages providers to become involved through an advisory group known as the Provider Advisory Committee (PAC).

The Provider Advisory Committee advises the CalOptima Board of Directors and staff. The CalOptima PAC is composed of 14 members representing diverse provider constituencies. These include but are not limited to health plans, hospitals, physicians, nurses, allied health professionals, long-term care services and community health centers. The charge of the committee is to:
 
  • Provide advice and recommendations to the CalOptima Board on issues concerning CalOptima programs as directed by the CalOptima Board;
  • Engage in study, research and analysis of issues assigned by the Board or generated by thecommittee;
  • Serve as a liaison between interested parties and the Board;
  • Assist the Board in obtaining public opinion on issues relating to CalOptima programs;
  • Initiate recommendations on issues for study to the CalOptima Board for their approval and consideration; and
  • Facilitate community outreach for CalOptima and the Board.

At this time, CalOptima is seeking candidates to participate on its Provider Advisory Committee (PAC). Service on the PAC is voluntary and with no salary. You need to be available to attend monthly meetings and serve on subcommittees. The following two-year seats are available:
 

  • Long Term Care Services Representative (two seats) 
  • Non-Physician Medical Practitioner Representative 
  • Pharmacy Representative 
  • Physician Representative (two seats)

The committee encourages interested individuals with knowledge and support of Medi-Cal and Medicare to apply. To apply or to nominate an individual for the Provider Advisory Committee, please mail, fax, or email the attached candidate application by Friday, April 11, 2014, along with a biography or resume plus two letters of reference to:

CalOptima
Attn: Maria Wahab
505 City Parkway West
Orange, CA 92868
 
Office: 714-796-6143 
Fax: 714-796-6679 
Email: mwahab@caloptima.org
 
If you have any questions, please call Maria Wahab at 714-796-6143.  


MEDICARE SGR ALERT: Physicians: Call Congress Now!

PROTECT ACCESS TO CARE IN CALIFORNIA


DON'T PATCH IT, REPEAL IT!

MEDICARE SGR REPEAL AND PAYMENT REFORM: HR 4015/S 2000

 

Physicians: Call Congress Now! (800) 833-6354 (Takes 2 Min)

UPDATE MARCH 11, 2014:
House Republican leaders have scheduled a vote for this week on H.R. 4015, with a repeal of the ACA individual mandate as the funding source. (If the mandate is repealed, the government will spend less on premium subsidies and thus, a substantial cost savings will occur.)

This repeal of the ACA is not an acceptable, viable funding option in the U.S. Senate. Knowing that the ACA repeal will not be accepted, House leaders have scheduled a second vote at the end of March to adopt another nine-month patch.

CMA is urging Congress to find bipartisan funding sources. We are opposing another nine-month patch. CMA is calling upon Congress to Fix Medicare Now!

A long-awaited and hard-fought bill to permanently repeal Medicare's fatally flawed sustainable growth rate (SGR) formula finally is before Congress. The SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015/S. 2000) offers a fiscally prudent opportunity for lawmakers to repeal the SGR formula and put Medicare on the path toward a stable, 21st-century program that can meet the growing health care needs of the nation's seniors.

This is the most progress Congress has made in a decade. We must seize this opportunity and make a final push to get this bill passed NOW. To sustain the bipartisan momentum, your Congressional representatives need to hear from you.

There are many powerful groups that are pushing back, objecting to Congress' plans for funding the physician payment fix. That's where you come in. To overcome the opposition, Congress needs to hear from a large volume of physicians. Every single physician needs to call and email the California Senators and your Member of Congress NOW!

Congress has a significant opportunity to finally repeal the SGR and enact payment reform. Why?

  • The cost to repeal the SGR is at an all-time low of $116 billion - down from $238 billion.
  • Congress has already spent $154 billion over the last decade adopting short-term patches to stop the SGR cuts - more than the total cost to repeal the SGR. It is fiscally irresponsible to adopt another one-year SGR patch. The Wall Street Journal calls the "patches" a sham.
  • There is a bipartisan, bicameral agreement on legislation to establish a new payment system.
  • The deadline is March 31, 2014, when the next 24 percent SGR cut occurs.

But reform won't happen unless Congress hears from thousands of physicians!

Physicians must call Congress to fix Medicare now!
To overcome the partisan funding proposals and the other opposition, Congress needs to hear from a large volume of physicians. Every physician needs to call and email the California Senators and your Member of Congress NOW! Please make as many calls and send as many emails as possible. Every one makes a difference! We are asking physicians to call/email the following individuals:

  • Your local congressional representative (use your local zip code)
  • California Senator Barbara Boxer
  • California Senator Dianne Feinstein
  • House Republican Whip Kevin McCarthy (zip code 93309)
  • House Democratic Leader Nancy Pelosi (zip code 94103)

To contact members of Congress:
Call AMA's Grassroots Hotline, (800) 833-6354, to be connected with your members of Congress in Washington. You will be asked to enter your zip code and select your representative. You are also encouraged to call your representatives in their local district offices (click here to download a current telephone roster).

You may also email your federal legislators via the AMA's "Fix Medicare Now" grassroots website. Utilizing the sample letter provided, it takes no more than two minutes.

Urge Congress to tell their House and Senate leadership to:
1. Protect access to care in California and enact Medicare physician payment reform NOW.
2. The cost to fix the Medicare SGR is at an all-time low and there is bipartisan agreement on the legislation.
3. Use bipartisan funding sources.
4. Oppose another one-year SGR patch.

Ask your patients to help:
AMA has also prepared a flyer that you can use to get your patients involved in the fight to protect Medicare. Distribute the AMA's "Fix Medicare Now" flyer to your patients and ask them to call their representatives, too.

Additional information:


Member Resource: Surviving the Third Month of Covered CA

As of February 15, Covered California reports that more than 828,000 individuals have enrolled in exchange plans, which surpasses its original target. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff know what to expect.
 

To help answer some of the more common questions, the California Medical Association (CMA) offers this third tip sheet to help physicians survive the third month of Covered California.

Additionally, CMA has just published a document physicians can provide to their patients to address the most common patient questions. The document is available free for members in CMA's exchange resource center at www.cmanet.org/exchange. If you would like patient materials delivered to your office or patient training for your office staff, please fill out a Covered CA Information Request form and fax or email it back to OCMA. 
 
Still have questions?
Visit CMA's exchange resource center at www.cmanet.org/exchange. There you will find all of CMA's exchange resources, including CMA's comprehensive exchange toolkit, "CMA's Got You Covered: A Physician's Guide to Covered California, the state's health benefit exchange." OCMA members and their staff also have FREE access to your Physician Advocate, Mitzi Young for reimbursement assistance and questions about the exchange. Members can contact Mitzi at (888) 236-0267 or myoung@cmanet.org.


Physician Advocate Tip of the Month: Verifying your patients' eligibility and benefits

March Tip:

Verifying your patients' eligibility and benefits in 2014 may save your practice thousands of dollars

The beginning of a new year means calendar year deductibles and visit frequency limitations start over. Remember, with open enrollment there may be changes to patients' benefit plans, or they may even be insured through a new payor. Physicians are urged at this time of the year to be diligent in verifying patients' eligibility and benefits to ensure that you will be paid for services rendered.
 
And don't forget that under the ACA, patients receiving premium assistance through federal tax subsidies are given a 90-day grace period in which to pay their portion of the premium. During the first 30 days of the grace period, the plans must pay for services incurred. However, during days 31-90 of the grace period, plans are allowed to suspend the patient's coverage
 
Don't get stuck with unnecessary denials or an upset patient. Do your homework before the patient arrives by obtaining updated insurance information at the time of scheduling, if possible, and making copies of the insurance card at the time of the visit. 

Receiving practice management guidance from Mitzi 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
myoung@cmanet.org


Member Materials from OCMA Event: The Exchange - What Physician Practices Need to Know

If you would like to access the presentation from the OCMA seminar that occurred on February 27, 2014 regarding the California health benefit exchange, you may download the presentation below. This is a member-only benefit, so you will need to log-in in order to download the presentation. 

If you do not know your log-in information, please contact Ashley Buchwald, OCMA Marketing/Communications Coordinator at abuchwald@ocma.org or (949) 398-8100 ext. 105

Presentation: The Exchange - What Physician Practices Need to Know


March 14 is early bird deadline for 2014 Leadership Academy; Register today and save $100

Register today for the 17th annual Western Health Care Leadership Academy (formerly the California Health Care Leadership Academy) and save $100. You won't want to miss out on this year's dynamic conference and our very special keynote speaker! 

This year's conference will be held at the beautiful San Diego Convention Center on April 11-13, 2014. 

Continuing its tradition of programming excellence, the conference will examine the most significant operational, financial and environmental challenges facing health care today and present proven models and innovative approaches that will enable you to transform your organization’s care delivery and business practices.  

Registrations received on or before March 14 receive a $100 discount. Additional discounts available for multiple registrations (five or more individuals from the same medical practice, medical group or medical staff). Visit http://www.westernleadershipacademy.com for more details.

New this year, registrants have the option to select the "VIP Upgrade" for a more up close and personal experience. Register with the VIP Upgrade and enjoy express onsite check-in, preferred seating, a private off-site cocktail reception and more! Upgrades are available in a limited number on a first-come, first-served basis, so register today!

Contact: Roger Purdy, (800) 795-2262 or rpurdy@cmanet.org.

Former Secretary of State Hillary Rodham Clinton will headline the 2014 Leadership Academy

The 17th annual Western Health Care Leadership Academy is thrilled to welcome keynote speaker Hillary Rodham Clinton, Former Secretary of State and Former U.S. Senator from New York. This year's Academy (formerly the California Health Care Leadership Academy), is scheduled for April 11-13, 2014, at the San Diego Convention Center.  

Top thinkers and doers will share strategies and resources for accelerating the shift to a more integrated, high performing, and sustainable health care system. The conference will examine the most significant challenges facing health care today and present proven models and innovative approaches to transform your organization’s care delivery and business practices. Topics will include leadership development, ACA implementation and practice management.

Click here for the flyer and registration form. 


The County of Orange, Health Care Agency is seeking an experienced Public Health Medical Officer I

Program Emphasis:

The Public Health Medical Officer I provides culturally sensitive, medically indicated care (and supervision of clinical services provided by Family Health nurse practitioners), including clinical assessments, physical exams, diagnostic and medical management, and coordination of case management. The Public Health Medical Officer I also supports on-site program activities in other co-located ambulatory care clinics.

LOCATION:

Santa Ana - 1725 W. 17th St., Santa Ana, CA 92706 

The Opportunity:

The County of Orange, HEALTH CARE AGENCY is seeking an experienced Public Health Medical Officer I who can utilize their education and skills to:

  • Examine, diagnose and treat pediatric patients for both acute care and periodic health screenings (CHDP) seen in our Family Health Clinics (Child Health, Immunizations)
  • (In the case of a family medicine physician) provide in the Family Planning Clinic individual reproductive health education and counseling; initiation and management of all FDA-approved methods of contraception, including emergency contraception; clinical and preventive services to maintain reproductive health
  • Prescribe medications to suitable patients; initiate and/or continue medical regimes for new patients; chart treatment records and monitor results; provide medical patient consultations/referrals to other physicians in the community
  • Provide clinical supervision and consultations to nurse practitioners in Child Health (Pediatric or Family Medicine Physicians) and Family Planning (Family Medicine Physicians only)
  • Consult with other program clinical staff regarding care of patients and treatment given
  • Conduct nurse practitioner peer reviews, patient care-coordination and case management
  • Develop, review and update clinical policies and procedures, clinical practice guidelines, developmental screenings
  • Provide clinical oversight of travel immunization clinic, provide consults (including malaria) for travelers; monitor travel and/or health-related advisories
  • Present in-service education and trainings to clinic staff (including new and updated policies and procedures, vaccines)
  • Stay current with care and treatment guidelines; ensure compliance with requirements from Childhood Prevention and Disability Program (CHDP), Family Planning (FPACT), Vaccines for Children (VFC) Program
  • Review billing records for accuracy and appropriate documentation.
  • Participate in staff meetings, problem solving groups, and continuing education programs sponsored by the clinic or other designated agencies.
  • Identify client's medical or psychosocial issues that fall outside the scope of Family Health and refer such cases to appropriate resources for treatment with follow-up.
  • Participate in quality improvement activities, review charts for compliance with established standards, policies, and procedures.

MINIMUM QUALIFICATIONS:


License Required:
  • Possession of a valid Physician's and Surgeon's Certificate issued by the Board of Medical Examiners of the State of California.
Education:
  • Possession of a masters degree in public health from an accredited school of public health (one year of experience as a Medical Officer in a public health agency with a generalized program may be substituted for the masters degree).

 

For more information and to apply, click here.


The Doctors Company Risk Tip: Undiagnosed Heart Disease in Women

Differences in the early symptoms and signs of an impending heart attack in women may make diagnosis more difficult compared to men. 

In a study of closed medical malpractice claims involving undiagnosed heart disease in women, The Doctors Company found that in 61 percent of claims the patient died when her heart condition was not correctly diagnosed and 33 percent had heart muscle damage from myocardial infarction. 

In the following case, failure to diagnose acute myocardial infarction resulted in death:

A 47-year-old obese woman presented to her PCP complaining of a burning sensation in her chest after eating. The patient reported a similar episode the prior day after eating lunch as well as increased heartburn over the last few weeks.

A review of the medical record reflected elevated blood pressures over the past six months and an elevated cholesterol level of 237 (mg/dl). On the day of the exam, her blood pressure was 160/90. She smoked, drank alcohol socially, and was unaware of a family history of coronary artery disease. A heart exam revealed normal rate and rhythm. The physician noted that the patient appeared diaphoretic; however, she wasn’t in acute distress and was pain-free throughout the examination. An ECG revealed a left bundle branch block. Prior ECGs were not available for comparison. Suspecting reflux esophagitis (heartburn), the PCP advised the patient to take an antacid and to return if the symptoms continued.

Two days later, the patient called her PCP’s office stating that her chest burning sensation continued. The nurse advised her to continue taking the antacid and scheduled an office appointment for the following day. The nurse advised the patient to go to the ED if she developed chest pain. 

That night, the woman awoke with chest pain, nausea, and vomiting. She was taken to the ED for emergeny coronary angiography, but died shortly after arrival. 


To avoid such risks:

 

  • Rule out myocardial infarction before arriving at a GI-related diagnosis such as gastric reflux as the cause of chest pain or discomfort. 
  • Consider cardiac risk factors such as obesity, smoking, hypertension, and hyperlipidemia. 
  • Offer patients same-day appointments when they complain of continued symptoms for which they were recently seen. If this is not possible, send them to the ED and document this in the medical record.
  • Develop a written chest pain protocol. 

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.


CMA Resource: Surviving the Second Month of Covered California

As of January 15, Covered California reports that more than 625,000 individuals have enrolled in exchange plans. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff know what to expect.

To help answer some of the more common questions, the California Medical Association (CMA) offers a second tip sheet as a members-only benefit to help physicians survive the second month of Covered California. To access the full Covered CA tip sheet, click here or visit  http://www.cmanet.org/resource-library/detail/?item=surviving-the-second-month-of-covered.


Upcoming AME Symposium – Under the Influence: Medicine in the post Physician Payment Sunshine Act World – Changes, Challenges and Confusion

Friday, February 28, 2014 – 1 pm – 5 pm

Beckman Center,
100 Academy Drive
Irvine, CA 92617


The Association for Medical Ethics and the University of California, Irvine School of Medicine are pleased to host the upcoming AME Symposium – Under the Influence – Medicine in the post Physician Payment Sunshine Act World – Changes, Challenges and Confusion, to be held from 1 pm to 5 pm on Friday, February 28, 2014 at the Beckman Center in Irvine, Calif., with a cocktail reception to follow.

The afternoon will feature physicians, researchers, attorneys and medical industry professionals as they present and discuss the latest information on state of medicine today and in the future, as the implementation of the Physician Payment Sunshine Act impacts the medical community.

Physicians attending the AME UCI Symposium may earn Continuing Medical Education credits. This activity is approved for AMA PRA Category 1 Credits™. The course fee is $40 per person.

 Featured Speakers

  •     Terry Belmont, Chief Executive Officer, University of California, Irvine Medical Center, Associate Vice Chancellor for Medical Center Affairs, University of California, Irvine
  •     Charles Burton, MD, President of the Association for Medical Ethics, Neurosurgical Spine Specialist and Medical Director, Sentinel Medical Associates, Editor, Burtonreport.com, Former Board Member and past President NASS
  •     Erwin Chemerinsky, JD, Dean of the School of Law, University of California, Irvine
  •     Howard Gillman, PhD, Provost and Executive Vice Chancellor, University of California, Irvine
  •     Ranjan Gupta, MD, Chair of the Department of Orthopaedic Surgery and Professor of Orthopaedic Surgery Anatomy & Neurobiology and Biomedical Engineering, University of California, Irvine
  •     Zeev Kain, MD, MBA, Associate Dean for Clinical Operations, Chair of the Department of Anesthesiology & Perioperative Care, and Professor of Anesthesiology & Pediatrics & Psychiatry & PM&R, University of California, Irvine
  •     Allan Korn, MD, Former Chief Medical Officer at Blue Cross Blue Shield
  •     Scott Lederhaus, MD, Association for Medical Ethics Board Member and Neurosurgeon, Inland Neurosurgery Institute and AME Board Member
  •     Charles Rosen, MD, Co-Founder of the Association for Medical Ethics, Clinical Professor of Orthopaedic Surgery University of California, Irvine

For more information and to register visit http://www.ethicaldoctor.org/symposium.


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