November 2010 November 1, 2010 MMS News Briefs November 2010 0 Full house for MMS dinner with past Surgeon GeneralNew state law mandates Tdap booster for students in grades 7-12Impending 30% cut in Medicare rates by January 1Medicare claims will not be paid if provider is not in PECOS by Jan. 3CMA House of Delegates adopts ACO principlesDoctors invited to Nov. 18 event honoring physician volunteersResolutions by North Bay physicians adopted by CMA HouseChildren’s Health Initiative and LifeLong Medical receive $500,000 in grantsPEOPLEHOSPITALS & CLINICSRESOURCESCLASSIFIEDSABOUT MMSFull house for MMS dinner with past Surgeon General About 50 MMS members, spouses and guests packed into the San Francisco Yacht Club in Belvedere on Oct. 28 to hear past Surgeon General Dr. Richard Carmona speak about the role of organized medicine in disaster preparedness planning. Drawing eloquently on his experience with Hurricane Katrina during his 2002-2006 term as Surgeon General, Carmona offered compelling examples of what works in disaster planning and what doesn’t. The room was filled to capacity despite the World Series game taking place across San Francisco Bay. MMS president and dinner host Dr. Peter Bretan, who attended UCSF with Carmona, noted that 50 physicians have already volunteered for the MMS Disaster Preparedness Group, which is helping formulate local plans for responding to earthquakes, disease outbreaks and other disasters. Carmona repeatedly emphasized the need for such local planning in his own remarks. He observed that American disaster planning has evolved from a “single threat” (nuclear warfare) model during the Cold War to the current “all hazards” model, with threats coming from all directions, including bioterrorism and cyber warfare. He said it is imperative to calculate surge capacity properly and establish an incident command system. According to Carmona, a major problem with the response to Hurricane Katrina was political interference with the command system. Politicians rather than qualified incident commanders ended up in positions of authority, and the results were catastrophic. Political intrigues were a recurring theme of Carmona’s speech. He described how then Sen. Ted Kennedy warned him during his Senate confirmation hearings that, “When you come to Washington, DC, if you want a friend, you need to bring a dog.” After experiencing Washington for a few years, Carmona saw Kennedy again and told him that his advice should be amended to, “Bring two dogs because one may turn on you.” Carmona also noted that recovery efforts are just as important as the initial disaster response. “The public health sequelae always exceed the initial body count,” he said, illustrating this maxim with examples from Hurricane Katrina, where many people died after the initial flooding. The audience, which listened to Carmona’s speech in rapt attention, peppered him with questions afterwards. Topics ranged from threats posed by underground gas lines to which kinds of communications systems work best during disasters. Physicians interested in joining the MMS Disaster Preparedness Group should contact Dr. Bretan at bretan.surgery@usa.net or 415-892-0904.New state law mandates Tdap booster for students in grades 7-12 In response to the pertussis epidemic, Gov. Schwarzenegger recently signed a law that makes a pertussis booster (Tdap) mandatory for all students in grades 7-12, starting in fall 2011. State public health officials are also recommending that seniors and women in their childbearing years receive the booster shot. Because pertussis immunity from previous infection or vaccination wanes over time, even fully immunized children become susceptible to pertussis by adolescence. Unfortunately, immunization rates are low for the recommended Tdap booster vaccine, which has been available since 2005. The most recent CDC survey data indicates that 44 percent of adolescents in California and only 6 percent of adults nationwide had received a Tdap booster shot by 2008. Public health officials are urging physicians to offer Tdap booster shots to all adolescents (10 years and older) and adults who haven't yet received it. Give Tdap now to your unimmunized adolescent patients to protect them against the current threat and to meet the forthcoming school requirement. As a reminder, the new Cal/OSHA Aerosol Transmissible Disease (ATD) standard requires all health care entities, including medical offices, to offer Tdap vaccines to their employees. For more information on the ATD standard, see CMA On-Call document #1842, “Protecting Employees from ATDs in the Health Care Workplace.” On-Call documents are free to CMA members on the Member Login tab at www.cmanet.org. Nonmembers can purchase On-Call documents for $2 per page in the CMA bookstore. CMA is also hosting a webinar on the ATD standard on Nov. 10 from 12:15 to 1:15 p.m. To register, visit www.cmanet.org/calendar.Impending 30% cut in Medicare rates by January 1 Payment rates for Medicare services will be reduced 30% by Jan. 1 unless Congress acts when it reconvenes on Nov. 15 for its brief “lame duck” session. These cuts are once again triggered by Medicare’s unfair payment formula, the Sustainable Growth Rate (SGR). AMA and CMA are lobbying Congress vigorously to take action during its brief session in November, but continued debate over Federal expenditures and competing political issues make this an uphill battle. MMS is also communicating and meeting with our Congressional representatives to express grave concerns about the impact these cuts may have on access to care for Medicare patients. MMS members are encouraged to contact their Congressional representatives to inform them of the impact that a 30% cut will have on their medical practices. Call 800-833-6354 and enter your zip code to be connected to your Representative. Senators Dianne Feinstein and Barbara Boxer can also be contacted through this number. Additionally, MMS has prepared the following draft letter you may wish to send to your Medicare patients to solicit their assistance in urging Congress to act. You can also download this sample letter from www.marinmedicalsociety.org/resources. [Physician Letterhead] Dear Patient: As your physician, I value my relationship with you and consider your health and well-being my top priority. Unfortunately, I feel it necessary to inform you that a 30% cut in Medicare payments scheduled to take effect by January 1 may jeopardize my ability to provide care to you and other Medicare patients unless Congress takes action when it reconvenes in mid-November. Congress acknowledges that this payment cut is unfair and that payment levels are virtually unchanged for a decade, but they have not fixed the problem. If nothing is done, these cuts will remain in effect at least into the month of February. To prevent this massive cut in payment for Medicare services from happening, I ask for your assistance by urging your Congressional representatives to address this crisis when they return to Washington in mid-November. Please let them know that a 30% cut in Medicare payments may jeopardize my ability to provide care to Medicare beneficiaries unless Congress acts before the end of this year. You may contact your Representative through a toll-free number, 800-833-6354. Enter your zip code and you will be connected to your Congressional Representative. Please use this number to also contact Senators Dianne Feinstein and Barbara Boxer. Again, I value my relationship with you and reluctantly ask for your assistance to avert this crisis. It is my hope that your help will prompt Congress to take action to properly fund the cost of medical care for seniors. I will inform you of any action I am forced to take if Congress allows the 30% cut to take effect. Respectfully, INSERT PHYSICIAN NAME HERE MMS will keep you informed of further developments. Please feel free to contact MMS at 415-924-3891 or mms@marinmedicalsociety.org with any questions.Medicare claims will not be paid if provider is not in PECOS by Jan. 3 Medicare claims received on or after Jan. 3, 2011, will not be paid if the ordering or referring provider is not enrolled in PECOS (Provider Enrollment, Chain and Ownership System). Physicians should also be aware that PECOS enrollment is required to receive federal EHR incentives under the Medicare program. Beginning in 2011, Medicare providers who demonstrate “meaningful use” of an EHR stand to receive up to $44,000 in incentive payments over five years. Palmetto GBA, California’s Medicare carrier, recently identified 3,500 California providers (physicians and other practitioners who order services) who still do not have a record in PECOS. Over the next several weeks, these providers will receive letters from Palmetto notifying them of the need to enroll. Physicians are urged to complete the application process as soon as possible. Applications are generally processed within 60 days, but can take longer if the application is incomplete or additional information is needed. Physicians who wish to take advantage of the incentive payments available for electronic prescribing, PQRI, and electronic health record program must be enrolled in PECOS. CMA has also developed a step-by-step guide to walk physicians through the process, from determining if they are already in PECOS to helping them navigate the Internet-based PECOS enrollment system. This guide is available at the Member Login tab on www.cmanet.org. CMA also hosted a PECOS enrollment webinar with Palmetto. The previously recorded webinar is available for on-demand viewing at the Member Login tab on www.cmanet.org. Physicians who need help with the enrollment process can contact CMA’s Member Service Center at 800-786-4262 or memberservice@cmanet.org.CMA House of Delegates adopts ACO principles At the annual House of Delegates last month, CMA adopted principles for physicians to follow in evaluating accountable care organizations (ACOs) and medical foundations. One key element of health care reform involves establishing ACOs as a new model of care. Under the new law, groups of physicians who see Medicare patients and agree to work together—meeting certain government requirements to qualify as an ACO—would be eligible for bonuses if they meet spending benchmarks for caring for their patient population and other criteria. Many in the health care industry see ACOs as an opportunity to capitalize on health reform, realign and boost overall cost effectiveness, but exactly how ACOs will work remains unclear, as the federal government still must spell out regulations. Physicians need to make prudent decisions in the near future about their interest in participating, if they are to take advantage of the opportunities created by new health care reform laws and regulations. CMA’s adopted principles include: Guiding principle. The goal of an ACO is to increase access to care, improve quality of care and ensure efficient delivery of care. Within an ACO, a physician’s primary ethical and professional obligation is the well-being and safety of the patient. ACO governance. ACOs must be physician-led and encourage an environment of collaboration among physicians. ACOs must also be physician-led in order to ensure that a physician’s medical decisions are not based on commercial interests but rather on professional medical judgment that puts patients’ interests first. Voluntary participation. Patient participation in an ACO should be voluntary rather than a mandatory assignment by Medicare. Any physician organization (including an organization that bills on behalf of physicians under a single tax identification number) or any other entity that creates an ACO must obtain the written affirmative consent of each physician to participate in the ACO. Physicians should not be required to join an ACO as a condition of contracting with Medicare, Medi-Cal or a private payor or being admitted to a hospital medical staff. Savings used for patient care. The savings and revenues of an ACO should be retained for patient care services and distributed to the ACO participants. An ACO’s savings and revenues should not go to insurers. Flexibility in patient referral and antitrust laws. The federal and state anti-kickback and self-referral laws and the federal Civil Monetary Penalties (CMP) statute (which prohibits payments by hospitals to physicians to reduce or limit care) should be sufficiently flexible to allow physicians to collaborate with hospitals in forming ACOs without being employed by the hospitals or ACOs. This is particularly important for physicians in small and medium size practices who may want to remain independent but otherwise integrate and collaborate with other physicians (i.e., so-called virtual integration) for purposes of participating in the ACO. For more detailed information, visit www.marinmedicalsociety.org/resources to read the full report from CMA’s Physician-Hospital Alignment Technical Advisory Committee. CMA will continue to keep members apprised of all significant developments concerning ACOs and federal health care reform.Doctors invited to Nov. 18 event honoring physician volunteers Operation Access and the Specialty Access Coalitions of Marin and Sonoma counties invite local physicians to a festive Celebration of Medical Volunteerism featuring live Brazilian music and chair massages, along with complimentary drinks and hors d’oeuvres. The event, to be held in Novato on Nov. 18, will honor San Rafael surgeons Dr. Mary Mockus and Dr. Crystine Lee, along with two Sonoma County physicians, for their work with uninsured patients. The Celebration runs from 5:30 to 7:30 p.m. at Homeward Bound of Marin, 1385 N. Hamilton Parkway, Novato. RSVP by Nov. 10 to rsvpms@operationaccess.org or to Daniel Rabkin at 415-733-0004.Resolutions by North Bay physicians adopted by CMA House Several resolutions authored or co-authored by North Bay physicians were adopted by the CMA House of Delegates during its annual meeting in October. The resolutions asked CMA to: • Urge component medical and specialty societies to encourage more women physicians to participate in leadership and consider holding a periodic Women in Medicine conference (Dr. Catherine Gutfreund). • Strengthen the alignment between CMA and component medical societies to ensure mutual effectiveness (Dr. Peter Bretan). • Convene a Technical Advisory Committee to recommend policy on marijuana legalization (Drs. Larry Bedard and Gerald Rogan). • Urge that marijuana’s status as a Schedule I drug be reviewed to facilitate clinical research (Drs. Bedard and Rogan). A complete summary of House of Delegates actions is available on the “members only” section at www.cmanet.org.Children’s Health Initiative and LifeLong Medical receive $500,000 in grants Two local medical projects have received $250,000 each in grants from the Sutter Access to Care Fund, which is administered by the Marin Community Foundation. The first project, the Marin Children’s Health Initiative, will use the funds to pay medical insurance premiums for about 900 local children who do not qualify for publicly funded programs. Funds for the other project, Lifelong Medical Care, will be used to deliver health services to senior citizens at a care center in Novato. The grants are the second to be awarded from the $10 million Sutter fund, which was established earlier this year. More information about applying for grants is available on the Community Foundation website at www.marincf.org.PEOPLE Former MMS President Dr. Dan Chaffin, a psychiatrist who practiced in Marin for several decades, has given the medical society a dozen lithographs depicting physicians and surgeons throughout history. He acquired the lithographs while in medical school during the 1950s and subsequently hung them in his waiting room, where patients often admired them. The lithographs are now adorning the walls in the MMS lobby. The Buck Institute in Novato has received a $6 million grant from the California Institute for Regenerative Medicine to fund research by faculty member Dr. Xianmin Zeng to get a stem cell-derived treatment for Parkinson’s disease ready for testing in human subjects. The institute will share the award with another California research center, City of Hope, located in Duarte. The facilities will combine efforts with the goal of submitting Parkinson’s treatments to the FDA for approval as Investigational New Drugs prior to clinical trials.HOSPITALS & CLINICS The Breast Diagnostic Center at Marin General Hospital has received a Breast Imaging Center of Excellence award from the American College of Radiology. Radiologist Dr. Vida Campbell, medical director of the breast center, noted, “This award assures our patients that Marin General Hospital is fully accredited in mammography, stereotactic breast biopsy, breast ultrasound and ultrasound-guided breast biopsy.” The breast center is one of only 11 facilities in California to have received the award.RESOURCES The latest issue of CMA Practice Resources is now available online at www.cmanet.org/news/cpr. This free bulletin is full of tips and tools to help physicians and their office staff improve practice efficiency and viability. Topics in the current issue include unfair payment practices, consult code reimbursement policies, and health plan requests for medical records. CMA will be hosting three free webinars during November: Introduction to “just culture” for physicians (Nov. 4); Compliance with the Aerosol Transmissible Disease standard (Nov. 10); and Document, document, document (Nov. 17). Each seminar is scheduled for 12:15 to 1:15 p.m. To register, visit www.cmanet.org/calendar. The CMA Foundation has published an Antibiotic Awareness Toolkit for physicians and other clinicians. The toolkit contains an array of clinical resources and patient education materials to help reduce inappropriate antibiotic use. For a free copy, visit aware.md. Enrollment in the MarshAffinity group dental plan sponsored by MMS is open until Dec. 31. The plan offers annual benefits of $2,000 per person for dental care (using network providers), $50 per person calendar year deductible ($100 for families), and no deductible on oral exams, x-rays and routine cleanings. For more information, call MarshAffinity at 800-842-3761 or visit www.MarshAffinity.com/cmadownload.html.CLASSIFIEDS Medical office space Medical office building for lease. 5,370 sq ft or divisible. Brand new, upscale and located directly across from the Queen of the Valley Medical Center in Napa. Please visit www.1103trancas.com or call Mark at 707-290-0636 for more information. Medical office space to share Dermatology practice seeks full- or part-time physician to share medical space in San Rafael. Office is a beautifully remodeled building in great location. Two exam rooms with exam tables are available and use of additional rooms is negotiable. Shared restrooms and staff lounge. Contact Kathleen at 415-259-0131 or kdupirak@yahoo.com. How to submit a classified ad To submit a classified ad for MMS News Briefs or Marin Medicine, contact Erika Goodwin at erika@scma.org or 707-548-6491. The cost is one dollar per word.ABOUT MMS The Marin Medical Society, a 501(c)(6) nonprofit association, supports local physicians and their efforts to enhance the health of the community. We are affiliated with the California Medical Association and the American Medical Association. © MMS 2010 PO Box 246 Corte Madera, CA 94976 Comments are closed.