JANUARY / FEBRUARY 2017
ALSO INSIDE: • Member Benefits and Services • A 5G Wireless Future: Will It Give Us A Smart Nation or Contribute to an Unhealthy One?
VOLUME 23 | NUMBER 1
Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society
700 Empey Way • San Jose, CA 95128 • 408/998-8850 • www.sccma-mcms.org
MEMBER BENEFITS Billing/Collections CME Tracking
Feature Articles 8 2017 New Healthcare Laws 14 CMA Federal Update: Healthcare Reform and MACRA
20 A 5G Wireless Future: Will It Give Us A Smart Nation or Contribute to an Unhealthy One?
30 Member Benefits and Services
Health Information Technology
46 Employment Related Recap for 2017
Human Resources Services
6 Message From the SCCMA President
House of Delegates
Legal Services/On-Call Library Legislative Advocacy/MICRA Membership Directory APP for the iPhone Physicians’ Confidential Line Practice Management
7 Message From the MCMS President 16 CMA ON-CALL Online Health Law Library 18 CMA 43rd Annual Legislative Advocacy Day 19 American Medical Women’s Association Annual Meeting 24 Trouble Getting Paid?
Resources and Education
26 Medical Times From the Past
43 Get Compliant
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52 CMA Education
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THE SANTA CLARA COUNTY MEDICAL ASSOCIATION OFFICERS President Scott Benninghoven, MD President-Elect Seham El-Diwany, MD Past President Eleanor Martinez, MD VP-Community Health Cindy Russell, MD VP-External Affairs Kenneth Blumenfeld, MD VP-Member Services Ryan Basham, MD VP-Professional Conduct Vanila Singh, MD Secretary Seema Sidhu, MD Treasurer Anh Nguyen, MD
CHIEF EXECUTIVE OFFICER
William C. Parrish, Jr.
El Camino Hospital of Los Gatos: Lewis Osofsky, MD El Camino Hospital: Vacant Good Samaritan Hospital: Vinit Madhvani, MD Kaiser Foundation Hospital - San Jose: Hemali Sudhalkar, MD Kaiser Permanente Hospital: Martin Wong, MD O’Connor Hospital: Michael Charney, MD Regional Medical Center: Erica McEnery, MD Saint Louise Regional Hospital: Faith Protsman, MD Stanford Health Care / Children's Hospital: John Brock-Utne, MD Santa Clara Valley Medical Center: Clifford Wang, MD
CMA TRUSTEES - SCCMA Thomas M. Dailey, MD (District VII) Kenneth Blumenfeld, MD (District VII)
Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society
THE MONTEREY COUNTY MEDICAL SOCIETY
Printed in U.S.A.
Managing Editor Pam Jensen
Opinions expressed by authors are their own, and not necessarily those of The Bulletin, SCCMA, or MCMS. The Bulletin reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted in whole or in part. Acceptance of advertising in The Bulletin in no way constitutes approval or endorsement by SCCMA/ MCMS of products or services advertised. The Bulletin and SCCMA/MCMS reserve the right to reject any advertising. Address all editorial communication, reprint requests, and advertising to: Pam Jensen, Managing Editor 700 Empey Way San Jose, CA 95128 408/998-8850, ext. 3012 Fax: 408/289-1064 firstname.lastname@example.org © Copyright 2017 by the Santa Clara County Medical Association.
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President Craig Walls, MD PhD President-Elect Maximiliano Cuevas, MD Past-President James Hlavacek, MD Secretary Alfred Sadler, MD Treasurer Steven Harrison, MD
CHIEF EXECUTIVE OFFICER William C. Parrish, Jr.
DIRECTORS Valerie Barnes, MD David Holley, MD William Khieu, MD Eliot Light, MD
Phillip Miller, MD David Ramos, MD James Ramseur, MD
NORCAL MUTUAL RISK MANAGEMENT INSIGHT
4 Tips for Safeguarding Your Digital Practice The common factor in 90% of all data breaches is people being careless or behaving badly, including losing unsecured laptops and thumb drives, clicking malicious email links, downloading viruses and malware, and other errors.16 Through user training, communication, and common sense policies, you can build a culture of security in your practice.
1. 2. 3. 4.
Secure Connected Medical Devices: Internet-connected devices like health monitoring devices, radiology imaging systems and video conferencing systems are easily hacked since attackers can obtain default device passwords on the Web. Once on your network, attackers can then steal user passwords for other systems, install malware and steal financial and patient records.13 Secure connected devices with custom user names and passwords. Lock Down Your Systems and Data: Advanced security measures can help protect your systems and sensitive data. Consider enabling login verification (with security cards or fingerprint scans), timed user log outs and user lockout after failed login attempts. Also, encrypting emails, text messages and patient health information (PHI) helps protect sensitive data after a breach and may prevent the need for a HIPAA notification.12 Actively Monitor Your Data: A data activity monitoring system monitors your systems for unusual or suspect activity and alerts system administrators to potential security threats. This can help you identify threats and possibly avoid a breach. The HHS OCR HIPAA Audit Protocol is a good place to start for determining monitoring protocols.14 Develop a Breach Response Plan: You likely have response plans in place for medical emergencies or severe weather events. Take this same care and develop a plan for how to respond to a data breach with staff roles and communication protocols clearly defined. In short, expect a breach and plan accordingly.15
For the full report visit data-theft.norcalmutual.com.
Numbered references available at data-theft.norcalmutual.com
Copyright ÂŠ2016 NORCAL Mutual Insurance Company. All rights reserved.
President, Santa Clara County Medical Association
SCOTT BENNINGHOVEN, MD
MESSAGE FROM THE
Scott Benninghoven, MD is the 2016-2017 president of the Santa Clara County Medical Association. He has a general surgery practice in the South County and practices at Saint Louise Regional Hospital, Regional Medical Center of San Jose, as well as O’Connor and Good Samaritan Hospitals.
The 21st Century Cures Act
n December 13, 2016 without much interest, except by those effected by the bill, President Obama signed into law the most significant legislation passed by Congress since the ACA. The $6.3 billion 21st Century Cures Act has been working its way through Congress for the past two years, with bipartisan support, and was sent to the President passed by a vote of 392 to 26 in the House and 94 to 5 vote in the Senate. This legislation has had very little publicity for such an important bill. In fact, my awareness of this Act came to me through an SCCMA Award Recipient, Janice Bremis. Her involvement was solely related to eating disorders and funding towards physician education and how best to be effective in treating this mental disorder. Specifically, related to eating disorders, this Act allows the Secretary of Health and Human Services (HHS) to provide information and educate the public on signs and symptoms of eating disorders. In addition, HHS is charged with identification of model programs and materials for educating and training health professionals to identify individuals with eating disorders, provide early intervention services, and refer patients to appropriate treatment. After hearing Ms. Bremis and her passion regarding this Act, I decided to investigate and read more about how it impacts the overall practice of medicine. The 21st Century Cures Act addresses many areas of healthcare regulation that have needed improvement for some time. The Act provides funding for multiple programs in the National Institutes of Health (NIH) and Food and Drug Administration (FDA), to improve regulatory oversight, to speed the process of approval of drug and device approval, and for the first time to provide specific language in Federal Law regarding eating disorders. The Act addresses hundreds of issues in healthcare regulation. Below are some positive attributes of this Act and providing funding for: • Over $4.8 billion over 10 years to the NIH for the Precision Medicine Initiative, the Brain Research Through Advancing Innovative Neurotechnologies Initiative, cancer research, and regenerative medicine using adult stem cells. • $500 million to the FDA over 10 years to implement provisions in Title III to move drugs and medical devices to patients more quickly, while maintaining the same standard for safety and effectiveness. • $1 billion over two years for grants to states
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to supplement opioid abuse prevention and treatment activities, such as improving prescription drug monitoring programs, implementing prevention activities, training for health care providers, and expanding access to opioid treatment programs. The Act moves the 21st century towards improving medical delivery of care in a number of ways by: • Encouraging the Secretary of HHS to carry out a “Precision Medicine Initiative” to augment efforts to address disease prevention, diagnosis, and treatment. • Creating a “Next Generation of Researchers Initiative” in the Office of the Director at the NIH to coordinate, develop, modify, and prioritize policies and programs to improve opportunities for new researchers. • Reducing the burden of documentation on physicians, improves EHR interoperability, and development of patient-centered EHRs that improve patient access and security. However, having listed several positive attributes of the 21st Century Cures Act, I am concerned that there are many attributes to this Act that may have less than a positive impact on medicine in areas: • Requires FDA to hold a public meeting and issue guidance documents that would assist sponsors in incorporating adaptive designs and novel statistical modeling into new drug applications. • Allows FDA to grant accelerated approval for regenerative therapeutic products and consider the unique characteristics of these products and provide a rationale with a determination of whether or not to grant accelerated approval. • Establishes that devices used with a regenerative therapeutic product will be considered moderate risk devices, unless the Secretary determines that the device or intended use requires a higher risk classification. This nearly 1,000 page Act was passed with bipartisan support and with heavy lobbying by special interests, including pharmaceutical corporations, NIH and FDA that on the surface isn’t necessarily bad, but does encourage one to look deeper for their self-interests. Having given you a small taste of what is in this Act, I encourage each and every one of you to seek out your own investigation and awareness of this Act. For those interested, I would be happy to direct anyone to more resources.
President, Monterey County Medical Society
CRAIG A. WALLS, MD PhD
a framework that involves understanding, recognizing, and responding to the effects of all types of trauma. All physicians can and should employ it with their patients. Sure, you have heard this kind of stuff all before, you say. Violence begets violence and the cycle grinds on from generation to wounded generation. But, no, this is different and here is how: Trauma informed care affirms that our youth are not broken! Rather, the bad behaviors they display do not represent who these young people are innately, but rather how they have learned to react to the world. Their aggression, withdrawal, and neglect are all seen as natural survival responses they employ in response to the life-threatening trauma they survived as children. In this paradigm, all youth should be approached with unconditional love and high expectations. When we stop telling them that they are broken and start understanding that they are a member of a species that has evolved to survive trauma, we create a real opportunity to generate insight and even change. According to Dr. Ginsburg, this approach can be applied to the whole healthcare and social system to allow for supportive healing without retraumatizing children. A systemic implementation of trauma informed care in a community increases understanding of the connection between behaviors, symptoms, and past trauma history. When an entire system becomes trauma informed, every part of its organization, management and service delivery is assessed and potentially modified to include a basic understanding of how trauma impacts the lives of those seeking services. CHOICE is Monterey County’s first and only hospital-linked violence intervention and prevention program and it is housed at the county’s trauma center. It is modelled on UCSF’s Wraparound Project at San Francisco General Hospital which has demonstrated a decade of consistent reductions in retaliation, re-injury, and criminal activity among youth and young adult victims of violence. CHOICE is embracing trauma informed care and bringing it to the bedside of our youth victims of violence. No matter what field of medicine you practice in Monterey County, you can lend your hand in unplugging the trauma generator by realizing that many of your patients are adaptive survivors of traumatic childhood.
MESSAGE FROM THE
very system is perfectly designed to get the results it gets.” This quote is widely attributed to Dr. Paul Batalden, MD, Senior Fellow at the Institute for Healthcare Improvement (IHI) and Professor Emeritus at Dartmouth Medical School. I was fortunate to recently attend the IHI’s annual conference and heard these words repeated multiple times. On returning to Salinas, where I work as an emergency physician and hospital administrator, the sentiment had me reflecting on the violence in our communities. Chicago’s homicide rate was in most news reports I heard over the New Year holiday weekend but for a small city, we give them a run for their money. Chicago had 24 murders per 100,000 people in 2016. In Salinas, the rate was 26 per 100,000 in 2015. Is there a system that generates these levels of trauma and resulting homicide? Surely not a system that was intelligently designed to do so, but what systemic factors contribute? There is enough written on this subject to fill a library, yet the problem persists. Drugs, poverty, weapons, parenting, gangs, and morals are a few of the usual suspects. These are the cogs in the trauma-generating machine. What are doctors supposed to do about it? Is there anything we can do about it? Does it help to have the bearded man in the white coat give the young violence victim a lecture on these various subjects while inserting his thoracostomy tube? “Why don’t you get a life, kid?!” I have met a doctor who might know part of a real answer. Kenneth Ginsburg, MD, is a pediatrician who specializes in adolescent medicine at the Children’s Hospital of Philadelphia and is an expert on trauma informed care. He wrote the American Academy of Pediatrics’ text Reaching Teens: Strength-Based Communication Strategies to Build Resilience and Support Healthy Adolescent Development, and I believe he is worth hearing. Ginsburg developed his thinking while directing health services at Covenant House, the organization that provides shelter, food, immediate crisis care, and an array of other services to homeless, runaway and marginalized youth. He writes about how adverse childhood events, or childhood trauma, has life-long consequences. Trauma takes control away from children, and many of their later, unhealthy and dangerous behaviors are adaptations that give them back some control. One of the greatest gifts we can give a young person is to help restore a real sense of healthy control. Trauma informed care is
Unplugging the Trauma Generator
Craig A. Walls, MD PhD, is the 2016-2017 president of the Monterey County Medical Society. He is an Emergency Medicine doctor with the California Emergency Physicians Medical Group and is currently practicing with Natividad Medical Center in Monterey.
JANUARY / FEBRUARY 2017 | THE BULLETIN | 7
New Healthcare Laws
What They Mean for You, Your Practice & Your Patients
BY MARION WEBB PNN STAFF WRITER
T H I S Y E A R , A N U M B E R O F C A L I F O R N I A B I L L S will take effect that could have a significant impact on you, your practice and your patients. Below, we have listed the ones we think will warrant your attention and generate some discussion with other healthcare providers and with your patients. Reprinted with permission from Physician News Network 8 | THE BULLETIN | JANUARY / FEBRUARY 2017
New Healthcare Laws
AB 1668 | Investigational Drugs, Biological Products and Devices
AB 38 | Mental Health: Early Diagnosis and Preventive Treatment Program
AB 1668 addresses the national “right to try” movement, which seeks to expand access to not-yet-approved treatments for people who fail to get into clinical trials. AB 1668 authorizes the manufacturer of an investigational drug, biological product, or device not yet approved by the U.S. Food and Drug Administration (FDA) to make the investigational product available to an eligible patient with a serious or immediately life-threatening disease or condition, as specified, when that patient has considered all other treatment options currently approved by the FDA, has been unable to participate in a relevant clinical trial, and for whom the investigational drug has been recommended by the patient’s primary physician and a consulting physician.
AB 38 establishes the Early Diagnosis and Preventive Treatment (EDAPT) Program Fund in the state Treasury to provide funding to the Regents of the University of California for the purpose of providing reimbursement to an EDAPT program using an integrated system of care for early intervention, assessment, diagnosis, treatment plan and necessary services for individuals with severe mental illness and children with emotional disturbances.
SB 1177 | Physician and Surgeon Health and Wellness Program This California Medical Association (CMA)-sponsored bill authorizes the Medical Board of California (MBC) to establish a Physician and Surgeon Health and Wellness Program for early identification and appropriate interventions to support a physician or surgeon in his or her rehabilitation from substance abuse. It requires the Board to contract for the program’s administration. Program participants are required to pay for services, including expenses related to treatment, monitoring and laboratory tests, as provided. It creates an account to support the program and prohibits funds in the account from being used to cover costs of participation.
SB 1261 | Physicians and Surgeons: Residency Fee Exemption SB 1261 amends the Medical Practice Act that provides for the licensure and regulation of physicians and removes the requirement that a physician and surgeon reside in California in order to receive a license fee waiver when the license is for the sole purpose of providing voluntary and unpaid services.
AB 2024 | Critical Access Hospitals: Employment AB 2024 lifts a century-old ban on direct physician employment. It allows California’s smallest and most remote hospitals to directly employ physicians rather than hire them as independent contractors. AB 2024 will apply only to critical access hospitals, small hospitals with 25 or fewer beds that are typically located in remote areas of the state, and has been in effect since Jan. 1.
YOUR PRACTICE AB 1676 | Employers: Wage Discrimination Existing law prohibits an employer from paying an employee at wage rates less than the rates paid to employees of the opposite sex in the same establishment for equal work and establishes exceptions to the prohibition based on any bona fide factor other than sex. This bill specifies that prior salary cannot, by itself, justify any disparity in compensation under the bona fide exception to the above prohibition.
SB 482 | Controlled Substances: CURES Database SB 482 requires a prescriber to consult the Controlled Substance Utilization Review and Evaluation System (CURES) no earlier than 24 hours or the previous business day prior to prescribing a Schedule II, III and Schedule IV controlled substance to the patient for the first time and at least once every four months thereafter, if the substance remains part of the patient’s treatment. This bill would exempt a veterinarian and a pharmacist from this requirement. It would also exempt healthcare practitioners from this requirement under specified circumstances including if prescribing, ordering, administering or furnishing a controlled substance to a patient receiving hospice care, to a patient admitted to a specified facility for use while on facility premises, or to a patient as part of a treatment for a surgical procedure in a specified facility if the quantity of the controlled substance does not exceed a non-refillable fiveday supply of the controlled substance. The measure seeks to crack down on a practice called “doctorshopping” in which addicts use multiple providers to obtain prescriptions for narcotic painkillers.
JANUARY / FEBRUARY 2017 | THE BULLETIN | 9
New Healthcare Laws
SB 482, sponsored by Sen. Ricardo Lara (D-Bell Gardens), seeks to prevent opioid overdose deaths, which, according to state officials, have increased by 200% since 2000. California is the first of 49 states that currently have prescription drug monitoring programs.
AB 72 | Healthcare Coverage: Out-of-network Coverage AB 72 requires a healthcare service plan contract or health insurance policy issued, amended or renewed on or after July 1, 2017, to provide that if an enrollee or insured receives covered services from a contracting health facility and covered services by a non-contracting health provider, the enrollee would be required to pay the non-contracting provider only the “in-network cost-sharing amount.” The bill would prohibit the insured from owing the non-contracting health provider anything more than the in-network cost-sharing amount. The bill makes an exception from this prohibition if the insured provides written consent that satisfies specified criteria. The bill would require a non-contracting health provider who collects more than the in-network cost-sharing amount from the insured to refund any overpayment to the enrollee or insured, as specified, and would provide that interest on any payment not refunded to the enrollee or insured accrue at 15% per annum, as specified. Shortly after Gov. Jerry Brown signed the law in October 2016, the Association of American Physicians and Surgeons (AAPS) filed a lawsuit in the U.S. District Court requesting the court to block the new law. According to court documents, the complaint by AAPS names the governor and the head of the state Department of Managed Health Care as defendants and states that the law violates the U.S. and California constitutions in at least three ways. PNN reported the Act violates the Due Process Clauses of the U.S. and California constitutions by delegating rate-setting authority to private insurance companies with respect to physicians who are not under any contract with the insurance companies. It also says the Act is unconstitutional under the Due Process Clauses by requiring arbitration for the out-ofnetwork physicians for their reimbursements, thereby denying them their due process rights in court for their claims. Furthermore, PNN reported, the Act violates the Takings Clause of both the U.S. and California constitutions because the Act empowers private insurance companies to deprive outof-network physicians of the market value of their services, and arbitrarily denies them just compensation for their labor. The Act also reportedly violates the Equal Protection Clause of both the U.S. and California constitutions by having a disparate impact on minority patients for whom the availability of medical care will sharply decline as out-of-network physicians are coerced by the Act to withdraw services from predominantly minority communities. Others see the Act as protecting patients and their well-being. 10 | THE BULLETIN | JANUARY / FEBRUARY 2017
AB 1671 | Confidential Communications: Disclosure Distributing secret recordings involving healthcare conversations will become a crime in California in 2017. Introduced by Los Angeles Assemblyman Jimmy Gomez in the wake of an undercover Planned Parenthood investigation, AB 1671 makes it a crime for a person who unlawfully eavesdrops upon or records a confidential communication with a healthcare provider to intentionally disclose or distribute the contents of the confidential communication in any manner, in any forum, including on Internet websites and social media, or for any purpose without the consent of all parties to the confidential communication unless specified conditions are met.
AB 2828 | Personal Information: Privacy: Breach Data breach notification will now be required for instances when encrypted personal information of California residents has been breached and certain conditions are met, according to this newly amended law. Previously, California’s data breach notification law required organizations to notify individuals only if unencrypted personal information was reasonably believed to have been acquired by an unauthorized third party.
AB 2745 | Healing Arts: Licensing and Certification AB 2745 specifies that a physician or surgeon licensee who is otherwise eligible for a license but is unable to practice some aspects of medicine safely due to a disability is authorized to receive the limited license if specified described conditions are met, including payment of the appropriate fee. The bill clarifies the Medical Board of California’s authority to revoke, suspend or deny a license for licensees and applicants who are guilty of unprofessional conduct, expands the Board’s authority to request medical records of deceased patients, and authorizes specified disciplinary actions for licensed midwives, research psychoanalysts and certified polysomnographic technologists.
SB 1478 | Committee on Business, Professions and Economic Development. Healing Arts. Existing law requires the Medical Board of California to keep a copy of a complaint it receives regarding the poor quality of care rendered by a licensee for 10 years from the date the board receives the complaint, as provided. This bill deletes that requirement. Existing law requires a CURES fee of $6 to be assessed annually, at the time of license renewal, on specified licensees to pay the reasonable costs associated with operating and maintaining CURES for the purpose of
SB 482 requires a prescriber to consult the Controlled Substance Utilization Review and Evaluation System (CURES) no earlier than 24 hours or the previous business day prior to prescribing a Schedule II, III and Schedule IV controlled substance to the patient for the first time and at least once every four months thereafter, if the substance remains part of the patient’s treatment.
regulating those licensees. This bill, beginning July 1, 2017, except as specified, exempts licensees issued a license placed in a retired or inactive status from the CURES fee requirement. The bill also creates changes to statutes related to dentists, podiatrists, opticians, licensed marriage and family therapists, licensed professional clinical counselors and clinical social workers. It also deletes obsolete provisions, makes conforming changes and other non-substantive changes.
AB 2503 | Workers’ Compensation: Utilization Review AB 2503, backed by CMA, requires a physician providing treatment to an injured worker to send any requests for authorization for medical treatment, with supporting documentation, to the claims administrator for the employer, insurer or other entity, according to rules adopted by the Administrative Director of the Division of Workers’ Compensation.
SB 1175 | Workers’ Compensation: Requests for Payment. SB 1175 requires that, for treatment provided on or after January 1, 2017, the medical provider must submit the request for payment within 12 months of the date of service or 12 months of the date of discharge for inpatient facility services. The bill also requires that for medical-legal services or expenses, to submit the request for payment to the employer within 12 months of the date of service. Unless otherwise allowed, any request for payment and bills for medical-legal charges are barred unless timely submitted.
YOUR PATIENTS AB 1823 | California Cancer Clinical Trials Program
JANUARY / FEBRUARY 2017 | THE BULLETIN | 11
New Healthcare Laws
AB 1823 establishes the California Cancer Clinical Trials Program to increase access to cancer clinical trials for patients, especially women and under-represented communities. This makes the state the first in the country to legally recognize the financial burdens afflicting cancer patients seeking treatment in clinical trials. The new law distinguishes between inducement and reimbursement. It recognizes ancillary costs as a barrier to clinical trial participation, encourages industry support of these costs, and identifies the allowable expenses that can be reimbursed to patients. The California Cancer Clinical Trials Program will be administered by the University of California, which will raise funds and distribute privately funded grants aimed at reducing barriers to trial participation. The funds will be used to help connect patients with appropriate clinical trials and to cover expenses stemming from participation in those trials. It will authorize industry, public and private foundations, individuals and other stakeholders to donate to the program directed by UC, as well as to other nonprofit corporations and public charities that specialize in the enrollment, retention and increased participation of patients in cancer clinical trials.
“The California Cancer Clinical Trials Program will transform how we connect patients with cancer trials in California and engage with industry and businesses in the oncology field,” said Assemblywoman Susan Bonilla (D-Concord), the author of the bill. “Research and clinical trials are keys to treatment success, but just as important is the access and participation to those trials by a diverse population.”
8 Key Changes to the 2017 Medicare Fee Schedule In November, CMS released its final 2017 Medicare physician fee schedule aimed to improve Medicare payments for services provided by primary care doctors with a focus on chronic care management and behavioral health. Bakers Hospital Review published eight key changes that doctors need to be aware of.
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1. Data on post-operative visits: Starting July 1, 2017, doctors in practices with 10 or more physicians must report data on post-operative visits for high-volume/high-cost procedures. 2. Screening: Providers and suppliers must be screened and enrolled in Medicare to contract with a Medicare Advantage organization to provide items and services to those enrolled in Medicare Advantage health plans. This provision will start two years after publication of the final rule and will be effective on the first day of the plan year. 3. Telehealth services: Additional codes include those for end-stage renal disease-related dialysis, advanced care planning and critical care consultations. The critical care consultations provided via telehealth will use the new Medicare G-codes. 4. Improve data transparency: Medicare Advantage organizations use a bidding process to apply to participate in the Medicare Advantage program. The bids reflect the organization’s estimated costs to provide benefits to enrollees. Under the final rule, Medicare Advantage organizations are required to release data associated with these bids every year. CMS also requires Medicare Advantage organizations and Part D sponsors to release medical loss ratio data on a yearly basis to help beneficiaries make enrollment decisions. 5. Geographic practice cost indices: CMS adjusts payments under the physician fee schedule to reflect local differences in practice costs using geographic practice cost indices, which will also overhaul California’s outdated geographic payment localities. This reform will raise payment levels for 14 urban California counties classified as rural while holding the remaining rural counties permanently harmless from cuts (the hold harmless provisions will take place in 2018). 6. Expansion of Medicare Diabetes Prevention Program (MDPP): The MDPP expanded model seeks to help prevent onset of type 2 diabetes among Medicare beneficiaries diagnosed with pre-diabetes, CMS said. Payment for MDPP services will begin in 2018. 7. Billing codes: Among the changes are new codes to pay primary care practices that use interprofessional care management resources to treat patients with behavioral health conditions. 8. Pay increase: Physician payment rates will increase by 0.24% in 2017 compared to 2016, accounting for a 0.5% increase required by the Medicare Access and CHIP Reauthorization Act and mandated budget neutrality cuts, according to the American Hospital Association. For more information, visit the CMS.gov page at: https://goo.gl/D2xu7l
New Healthcare Laws
MACRA What You Need to Know
With the Centers for Medicare and Medicaid Services’ (CMS) finalized rule last year for the Medicare Access and CHIP Reauthorization Act (MACRA), the landmark payment system for Medicare physician fees, qualifying physicians need to become familiar with its new rules and initialisms and make important decisions. MACRA, which replaces the sustainable growth formula, will pertain to healthcare providers who bill more than $30,000 a year for Medicare Part B services or provide care for at least 100 Medicare patients. For providers new to Medicare in 2017, participation is not required. Under the new rule, there will be some leniency for 2017 with “pick your pace options” to take part in the new MACRA Quality Payment program. The final rule includes two pathways for provider participation: the Merit-based Incentive Payment System, or MIPS, and the Advanced Alternative Payment Model, or APM. MIPS aims to align three currently independent programs — quality reporting (what physicians know now as PQRS), Advancing Care Information (now known as EHR Meaningful Use), and cost (now known as the value-based modifier) and adds a fourth component, Improvement Activities, aimed at promoting practice improvement and innovation. APMs typically offer shared savings, flexible payment bundles and other desirable features. There are two APM participation classifications — Advanced APMs, which have their own reporting requirements and are exempt from MIPS reporting, and MIPS APMs. CMS reportedly signaled it plans to create additional pathways for participating in the APM track, including a new accountable care organization Track 1+ model, Comprehensive Care for Joint Replacement and the Medicare Diabetes Prevention Program. CMS plans to add these programs in 2017 or 2018. CMS made adjustments to help small, independent practices participate. Besides the exemption for providers who fall below the $30,000 Medicare Part B charges or 100 Medicare patients to participate this year, CMS offers small practices and solo physicians the opportunity to join together in virtual groups and submit combined MIPS data. Except for those qualifying for the low-volume threshold, physicians who don’t report any performance data in 2017 will be subject to a -4% payment adjustment when the new adjustments take effect in 2019. Those who provide partial or full reporting may be eligible for positive payment adjustments. The final rule also allots $20 million a year for five years for training and educating physicians in practices of 15 or fewer and those who work in underserved areas.
For more information on MACRA, visit the American Medical Association page at:
JANUARY / FEBRUARY 2017 | THE BULLETIN | 13
CMA Federal Update:
Health Care Reform and MACRA
By Elizabeth McNeil, VP, Federal Government Relations HEALTH CARE REFORM
With the election of Donald Trump to the U.S. Presidency and Republicans in control of both the U.S. House of Representatives and Senate, Republican leaders are moving swiftly to fulfill a cornerstone campaign promise to repeal the Affordable Care Act (ACA).
ACA REPEAL Senate and House Pass a 2017 Budget Resolution Laying the Groundwork for ACA Repeal On Friday, January 13, the House followed the Senate in passing a non-binding budget resolution (S Con Res 3) that sets 2017 spending targets and provides instructions to the Congressional Policy Committees to: 1. Develop a majority-vote Budget Reconciliation bill that repeals the ACA by late February; 2. Achieve savings from the ACA repeal legislation; and 3. Develop an ACA replacement plan. The budget reconciliation bill would repeal the ACA, but it would not take effect for 2-3 years while Congress works on a replacement plan. Under House and Senate rules, Budget Reconciliation bills can only include budgetary items and be adopted by a simple majority vote (rather than the usual 60 votes required for passage in the Senate), thereby circumventing a Senate Democratic-led filibuster.
ACA REPLACEMENT PLAN Previous bills introduced by House Speaker Paul Ryan, U.S. Department of Health and Human Services (HHS) Secretary nominee Tom Price, MD and Senate Finance Committee Chairman Orrin Hatch provide insight into the potential health care reform legislation that will replace the ACA. As previously written, none of these proposals provide as much coverage as the ACA. Instead, the proposals only repeal the ACA insurance provisions, individual mandate and Medicaid expansion for low-income 14 | THE BULLETIN | JANUARY / FEBRUARY 2017
adults. They replace the ACA with a private, voluntary health insurance marketplace where insurers may sell insurance across state lines. It is unclear how the individual market would successfully operate. Some bills allow states to establish high-risk pools and expand Health Savings Accounts. Most provide tax credits, and some provide subsidies to help low-income families afford coverage. Several bills allow individuals to deduct the cost of health insurance premiums while eliminating such deductions for employer-sponsored coverage. Most bills repeal the ACA insurance reforms, such as the requirements for insurers to dedicate 85 percent of revenues to patient care and to provide coverage to those with pre-existing conditions. All of the bills eliminate the Medicaid expansion and cap federal funding for Medicaid either through block grants or per capita cap funding in exchange for greater state flexibility. Speaker Ryan’s bill replaces the Medicare defined benefit program with Medicare premium support that provides vouchers to seniors to purchase private health insurance coverage. And finally, several proposals include MICRA-like medical liability reform. Regardless of previous health care reform proposals, the Republican leadership recognizes that a more comprehensive approach is warranted, and they plan to take more time to develop a replacement plan. They have also reached out to state governors and insurance commissioners for their input on the ACA, Medicaid Expansion and Exchanges. Sixteen Republican governors and fourteen Democratic governors expanded their Medicaid programs, and the majority of these governors are asking Congress to maintain the Medicaid funding. Finally, the ACA replacement legislation will require 60 votes in the Senate. Therefore, Republican leaders will need to compromise with at least a handful of Democrats to gain final passage.
CMA ADVOCACY CMA is actively involved in shaping the future of health care reform at the national level and has extensive policy on health care reform issues. Based on that policy, CMA’s overriding goal will be to ensure that Californians who have coverage today do not lose coverage or
access to care. CMA will also work to protect current state and federal health care funding including the Proposition 55 and Prop 56 tobacco taxes. Current CMA policy opposes Medicaid block grants. Moreover, CMA will continue to work to ensure that low and moderate-income families can afford coverage. We have promoted responsible health care financing, including the use of the tax code to help Californians purchase insurance and subsidies to help low-income families afford coverage. An underfunded health care system places unsustainable burdens and unfunded mandates on physicians. It also creates access to care problems, health care delays and economic hardship for patients. CMA will be a voice for patient choice in the new health care system. CMA physicians are committed to the health and well being of our patients. And finally, CMA will fight to maintain the hard-fought insurance reforms that require insurers to dedicate 85 percent of their revenues to direct medical care, community rate and submit premium increases to regulators, as well as prohibit insurers from placing lifetime or annual limits on benefits, blocking coverage for pre-existing conditions or rescinding coverage when a patient becomes ill. CMA has fought health plan mergers over the years to promote an open, competitive health care marketplace in California. CMA also recognizes that the ACA has serious shortcomings that need to be addressed. More than 1 in 3 Californians are now enrolled in the state’s Medi-Cal program yet few have true access to a doctor. Because the Medi-Cal reimbursement rates are among the lowest in the nation, most physicians cannot afford to participate. Moreover, the payment rates and physician networks in the Covered California Exchange are inadequate, and many families continue to express concerns about the affordability of insurance in the Exchanges. The individual market needs more stability, and while the ACA significantly expanded coverage, it did not expand access to care for many Californians. Based on CMA policy, we have developed overarching health care reform principles to guide CMA’s advocacy through the debate. CMA’s overriding goal is to ensure that Californians maintain access to quality, meaningful, affordable coverage.
CMA’S CORE PRIORITIES FOR THE FUTURE OF FEDERAL HEALTH CARE REFORM: 1. 2. 3. 4. 5.
Ensure Californians do not lose coverage or access to care. Improve access to care. Protect state and federal health care funding for Californians. Support appropriate and broad-based health care financing. Continue tax policies and subsidies that help low-moderate income patients afford coverage. 6. Advocate for broad patient choice of physicians, plans and coverage through Health Savings Accounts, private contracting, private insurers and health plans, as well as government programs. 7. Maintain the important insurance reforms that protect physicians and their patients, such as coverage for pre-existing conditions. 8. Stabilize the individual insurance market. 9. Provide access to affordable prescription drugs. 10. Medical liability reform that does not undermine California’s MICRA law.
MEDICARE MACRA UPDATE BACKGROUND
mula and established two Medicare payment tracks from which physicians can choose to participate. The first track allows physicians to participate in Alternative Payment Models (APMs) with a 5 percent bonus for meeting certain EHR and quality standards. APMs must also assume some downside financial risk, except Primary Care Medical Homes. The legislation also allows innovative, alternative Physician-Focused Payment Models to be approved through another regulatory process. The second track is the traditional Medicare fee-for-service payment track with four performance-reporting programs: 1. Quality (formerly known as the Physician Quality Reporting System-PQRS); 2. EHR Advancing Care Information (ACI) (formerly known as the Meaningful Use program); 3. Cost (formerly known as the Value Modifier Program); 4. New category called Improvement Activities (comprised of activities most physicians are already doing). These fee-for-service reporting programs have been consolidated and simplified under a new program: the Merit-Based Incentive Payment System (MIPS). For the MIPS reporting categories, Congress reinstated substantial bonuses and reduced the penalties from current law. The Centers for Medicare and Medicaid Services (CMS) issued the final MACRA implementing rule in October 2016. The new MACRA law and the final rule represent a significant improvement over the previous system. Moreover, CMS is providing a longer transition path for practices to get ready for MACRA. CMA and AMA successfully advocated for a Medicare program that is less burdensome than existing law. Improvements include: • Exempts 30 percent of Medicare physicians. • Longer transition path: Physicians can start reporting on January 1 or October 1, 2017. • No penalties in 2017 if physicians report on one quality measure. • Reduces penalties after 2017. • Reinstates bonus payments. • Eliminates all duplicative quality measures. • Reduces the number of measures by HALF. • Report on six quality measures, five EHR measures, and 2-4 improvement activities. • Fewer requirements for small/rural practices and provides a transition path. • Only need to report on 50 percent of patients for quality. • Eliminates Pass/Fail: Proportional credit given for measures that are met. • More ways to report (claims, EHR, web, QCDR). • Greater selection of applicable national specialty society measure sets. • Funding to help small and rural practices transition. • Allows Alternative Models with reduced financial risk. • Greater enforcement on EHR vendors who are not interoperable. CMA will continue advocacy efforts to relieve physicians from Medicare reporting burdens and for greater accountability and penalties on the EHR vendors that do not meet MACRA requirements. Congress is not likely to take major action on the bipartisan MACRA law in 2017 because CMS delayed MACRA in 2017 and made significant improvements. However, CMA and AMA will continue to be actively engaged with Congress and the Administration to reduce the regulatory burdens on physicians. CMA will also continue to offer programs to educate and assist our members so they can successfully participate. Please see the CMA MACRA Resource Center at www.cmanet.org/MACRA.
In 2015, Congress passed the Medicare Access and Children’s Health Reauthorization Act (MACRA), which eliminated the Medicare SGR forJANUARY / FEBRUARY 2017 | THE BULLETIN | 15
CALIFORNIA MEDICAL ASSOCIATION
CMA ON-CALL ONLINE HEALTH LAW LIBRARY With new laws and regulations passed every year, running a medical practice can be complicated. While the California Medical Association (CMA) works hard every
day to lighten unnecessary burdens and streamline information, we are also your best source of knowledge to effectively answer difficult questions about practicing medicine in California. CMA’s online health law library contains over 5,400 pages of CMA On-Call documents and valuable information for physicians and their staff. Access to the library is free to members.
Have you ever asked… What is the process for terminating the physician-patient relationship?
I’m having issues with a member of my staff—what are the legal steps required to terminate employment?
What restrictions apply to electronic prescribing of controlled substances?
What can I do regarding a negative online review about my practice?
How long do I have to retain medical records?
How can I challenge my quality rating in a pay-for-performance program?
I’m looking to grow my practice—are there laws that govern physician advertising?
www.cmanet.org/cma-on-call Access to CMA’s health law experts is a FREE, members-only benefit. Need help? Call (800) 786-4262 or visit cmanet.org. 16 | THE BULLETIN | JANUARY / FEBRUARY 2017
COMPLETE CMA ON-CALL SUBJECT LIST: ADA/Discrimination
Expert Witness Issues
Medicare and Medi-Cal
Fraud and Abuse
Fraud and Abuse: Referral Issues
Managed Care: Contracting
Allied Health Professionals
Managed Care: Overview
Managed Care: Risk Arrangements
Managed Care: Utilization Review & Management
Medical Board: Discipline & Licensing
Reimbursement: From Patients
Medical Board: Reports
Reimbursement: From Private & Public Payors
Medical Practice: Workforce Issues
Reimbursement: Other Issues
Medical Practice: Physician Practice Models
Medical Records: HIPAA
Reporting Diseases, Conditions, & Events
Medical Records: Management
Medical Records: Requests for Access
Medical Records: Special Confidentiality Requirements
End of Life Issues
Actual On-Call documents:
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uary 20 unsel, Jan
MCMS / SCCMA / CMA Presents:
Tuesday, April 18, 2017 • Sheraton Grand Ballroom, Sacramento T ENTATIVE AGE NDA
8:00 a.m. Registration and
Continental Breakfast 9:00 a.m. CMA Welcome & Remarks Ruth E. Haskins, MD, President, CMA Dustin Corcoran, Chief Executive Officer, CMA
9:45 a.m. Group Photo in front of the State Capitol 10:00 a.m. Meetings with Legislative Offices 11:45 a.m. Buffet Lunch (Sheraton Grand) 12:30 p.m. Announcements 12:45 p.m. Political Panel 1:30 p.m. Meetings with Legislative Offices (scheduled by county medical societies)
In preparation for Legislative Advocacy Day, CMA’s Center for Government Relations will host a special webinar advocacy training on March 29, 2017, from 7 to 8:00 p.m. This webinar will review in detail CMA’s list of bills to be lobbied and effective advocacy tips, as well as covering other relevant program information. Register on CMANET.ORG
“FAX BACK” 408/289-1064 RSVP TODAY!
MCMS/SCCMA Student, Resident, Alliance, and Physician members are invited to attend CMA’s 43rd Annual Legislative Advocacy Day at the Sheraton Grand Hotel on Tuesday, April 18, 2017. We will meet with local legislators to discuss pending resolutions/bills that will affect the future of medicine. This is your chance to make your voice count and to see what CMA is doing for you! MCMS/SCCMA will provide transportation to and from Sacramento on a chartered bus. Breakfast and lunch also provided. (You can meet us there if you prefer.) To RSVP for Legislative Day and/or a seat on the chartered bus, please fax RSVP ASAP to Jean Boileau Cassetta, Membership Director, 408/289-1064. (We will leave from the SCCMA parking lot at 6:00 a.m. and return at approx. 6:30 p.m. Seats are limited. Agenda packets will be mailed to you prior to April 18, 2017. Any questions, call Jean at 408/998-8850 Ext. 3010 or 831/455-1008 Ext. 3010.
Please Mark Appropriate Box:
I will meet you there
18 | THE BULLETIN | JANUARY / FEBRUARY 2017
I will ride on the chartered bus
Legacy Wealth Advisors Managing the reserve investment accounts of the Santa Clara County Medical Association (SCCMA) and the Bureau of Medical Economics (BME) since 2000 1900 The Alameda Suite 510 San Jose, CA 95126 P: (408) 452-7700 F: (408) 452-7470 Email: Info@lwallc.com
Legacy offers a broad range of wealth management services to SCCMA and MCMS physician members and their families. Such services include: • Financial Planning, Risk Management, Educational & Retirement Planning Projections • Liquidity Management and Cash Flow Analyses • Estate Tax and Charitable Planning • Existing Portfolio Analysis • Design and Implementation of Investment Strategies
Member Savings! Legacy offers a one-hour complimentary financial planning check-up to Association members (this is a $500 savings). For more information, please call Lawrence Pizzella at (408) 452-7700 or email email@example.com
Join the American Medical Women’s Association Annual Meeting in San Francisco, March 30-April 2, 2017 at the Embassy Suites SFO Waterfront. Highlights: Talks from luminary women physician leaders, speed networking, mentoring, free CV review, free professional coaching, over 24 CME credits. First time attendee discount code: AMWAGrant. www.amwa-doc.org/amwa102 JANUARY / FEBRUARY 2017 | THE BULLETIN | 19
A 5G WIRELESS
FUTURE WILL IT GIVE US A SMART NATION OR CONTRIBUTE TO AN UNHEALTHY ONE?
Dr. Cindy Russell SCCMA V.P. Community Health
t would greatly extend FCC’s current policy of the mandatory irradiation of the public without adequate prior study of the potential health impact and assurance of safety. It would irradiate everyone, including the most vulnerable to harm from radiofrequency radiation: pregnant women, unborn children, young children, teenagers, men of reproductive age, the elderly, the disabled, and the chronically ill.” —Ronald Powell, PhD, Letter to FCC on 5G expansion (7)
BRAVE NEW WORLD OF COMMUNICATION
The use of mobile wireless technologies continues to increase worldwide. A new faster 5th generation (5G) telecommunication system has recently been approved by the Federal Communications Commission(FCC) with new antennas already being installed and tested in Palo Alto and Mountain View. While it may give us uber automation and instantaneous “immersive entertainment” a lot of questions remain with regards to public health and safety of wireless devices. Will the adoption of this new 5G technology harm directly or indirectly the consumers and businesses it hopes to attract? 5G is the new promised land for wireless technology. It could connect us in our homes, workplaces and city streets to over a trillion objects around the world. (96) The Internet of Things (IoT) is primed to give us self-driving cars, appliances that can order their own laundry soap, automation hubs that pay your bills, not to mention fast movie downloads and virtual reality streaming from anywhere when you are on the go. Companies are already asking local cities and counties to move forward to create “Smart Cities” which have comprehensive digital connectivity by installing a massive wireless sensor network of almost invisible small cell antennae on light posts, utility poles, homes and businesses throughout neighborhoods and towns in order to integrate IoT with IT. They state it will improve services, the economy and quality of life. This communication network will 20 | THE BULLETIN | JANUARY / FEBRUARY 2017
form an expanded electromagnetic microwave blanket above each city and county, permeating the airspace and providing seamless connectivity where people and things will exchange data. Former Federal Communications Commission (FCC) chair Tom Wheeler called this a “National Priority” and thus ushered in approval for the addition of this new pervasive network of high frequency short wave millimeter broadband for commercial use first planned in urban areas.
DEVELOPING A “SMART” WORLD?
Engineers and physicists are busy working out the details of carrier frequencies and the architecture of the new network. Manufacturing industries are already developing commonly used products that feature wireless integration that will connect to the densely clustered antennas. Marketing companies are now pushing ads for “smart” devices for “smart” people in “smart” cities. Even the healthcare industry is anticipating using some of these wearable devices for patients with cardiac conditions or to do remote surgery in other parts of the world. Opening up 5G Spectrum access hopes to drive an explosion of new products. The economic opportunities are obvious and business will be booming in the tech industry. Concerns continue to rise however about the basic safety of our current use of wireless technologies not to mention adding layers of newer microwave frequencies that have not been tested for short term or long term safety. Important questions have not been addressed while industry and government policy have already moved forward. • Why is the FCC streamlining permitting of 5G high frequency when they have not completed their investigation on health effects nor updated safety limits for low-intensity radio frequency radiation? • Is the widespread “deployment” of this pervasive higher frequency small cell distributed antennae system in our cities and on our homes safe for humans and the environment? • Will it add to the burden of chronic disease that costs our nation over a trillion dollars annually? (105) • Are we already digitally over connected, outsourcing our grey matter and becoming a dysfunctional addicted nation because of it? (136,137,138) • How will this affect our privacy, cyber security and the security of medical records? • Will we as physicians be able to recognize the emerging adverse health effects of new millimeter technology and wearable technology let alone that of current wireless devices?
A GOOD READ: FEDERAL COMMUNICATIONS COMMISSION 5G LETTERS
Letters to the FCC in 2016 responding to the 5G roll out with the addition of new high frequencies were mixed. Industry generally applauded the FCC for its efforts and discussed the growing demand for this technology along with a need for flexible regulation to implement it. Some expressed concerns about interference with other satellite systems. Some felt there should be maximum spectrum usage opening up even higher frequencies that are only experimental now in order to help “the underserved”. Others argued about opening this up to licensed versus unlicensed uses. Industry did not mention any potential public or environmental health hazards regarding the use of these new frequencies.
RAISING A RED FLAG TO PUSH THE PAUSE BUTTON ON 5G
Private citizens and Phd’s, however did raise a red flag at the FCC, recommending a halt to infrastructure plans and more testing for health and environmental reasons. They questioned the current FCC standards
which are outdated and not protective of human health. They asked “How will it affect children, pregnant women and the elderly who are the most vulnerable in our population?” While scientists gave ample evidence that precaution should prevail, I found the most compelling letters were from those who describe their fear as electro-sensitive people in an already dangerously high electromagnetic environment for them.
GIMME SHELTER: NO ESCAPE FOR ELECTRO-SENSITIVE INDIVIDUALS
Linda K., a Michigan resident, explained how she became increasingly sensitive to EMF after a cell tower was placed within 1000 feet of her house. She experienced insomnia at first and did not know there was a cell tower until several years later when she then associated the timing of its placement with her symptoms. After smart meters were installed in her area (but not on her house) she became sensitive to her laptop on wireless and her cell phone. Comcast then placed a Wi-Fi hotspot within 400 feet of her house and she stated her symptoms increased to the point that if she was outside in her yard more than 20 minutes she developed increasing fatigue, headaches, heart palpitations and high pitched ringing in her ears. These are all reported effects in those sensitive to EMF from wireless devices. She wrote about her concerns and that the new frequencies may add to her symptoms and inability to leave her house. (54) In another letter Veronica Z. noted “This is a notice of survival. What many of us deal with currently is trying to survive in an environment that is hostile to us biologically. We have lost all of our rights, our finances, our homes, our ability to earn a living due to this ubiquitous exposure. We are being tortured every second of every day and have been reduced to simply trying to survive the moments we are alive. Others have been unable to do so and have opted to not stay living on this planet of torture...There is no escape for people with severe sensitivities to this deadly radiation.” (55)
ASK NASA: IS ELECTRO-SENSITIVITY REAL OR IMAGINED?
Are these people telling the truth? Is this just psychological? You may wonder, however, more and more people from all ages, professions and walks of life are relating similar symptoms in the presence of wireless devices. Some children reported these symptoms when their school adopted WiFi. Dr. Scott Eberle, a well respected Petaluma hospice physician, eloquently described his development of electro-sensitivity in the November 2016 issue of the SCCMA Bulletin. He goes to great lengths to continue his profession, interact with his collegues and maintain a healthy existence. (67) We are exposed to increasing levels of microwave EMF in our daily lives. More scientific evidence links biologic effects with increased reports of health related effects including electrosensitivity. In 1971 Russian scientists Gordon and Sadchikova from the Institute of Labor Hygiene and Occupational Diseases described a comprehensive series of symptoms which they called ‘microwave sickness” and presented this at an international WHO meeting. (109) In a 1981 NASA report, “Electromagnetic Field Interactions: Observed Effects and Theories” microwave sickness was also described. The symptoms recorded were headaches, eyestrain, fatigue, dizziness, disturbed sleep at night, sleepiness in daytime, moodiness, irritability, unsociability, hypochondriac reactions, feelings of fear, nervous tension, mental depression, memory impairment, pulling sensation in the scalp and brow, loss of hair, pain in muscles and heart region, breathing difficulties, increased perspiration of extremities. (63) JANUARY / FEBRUARY 2017 | THE BULLETIN | 21
THE SCIENCE OF ELECTRO-SENSITIVITY
Belpomme, in 2015, completed the most comprehensive study of electrosensitivity, investigating 1216 people: 71.6% with EHS, 7.2% with CS, and 21.2% with both. They found an elevation in several reliable disease biomarkers—each occurring within a range of 23% to 40% of all cases— which prompted their conclusion that these sensitivities can be objectively characterized and diagnosed and “appear to involve inflammation-related hyper-histaminemia, oxidative stress, autoimmune response, capsulothalamic hypoperfusion and pathologic leakage of the blood-brain barrier, and a deficit in melatonin metabolic availability” (68)
THE SCIENCE OF EMF BIOLOGICAL HARM
The scientific literature abounds with evidence of non-thermal cellular damage from non-ionizing wireless radiation for several decades. There are likely several mechanisms both direct and indirect. Oxidative damage is one that has been well studied. Effects have been demonstrated on cell membranes causing a shift in the voltage gated calcium channels. Sperm studies have consistently found genotoxic, morphologic and motility abnormalities in the presence of cell phone radiation. DNA damage, blood brain barrier effects, melatonin reduction, nerve cell damage, mitochondrial disruption and memory disturbances have been revealed. The Bioinitiative Report (139) has chronicled these effects and a growing wave of PEER reviewed studies is building on that base daily. In 2011, the International Agency for Research on Cancer classified radiofrequency as 2B carcinogen and “possibly carcinogenic to humans”, the same category as DDT, lead and other pesticides.
THE LATEST SCIENCE: NATIONAL TOXICOLOGY PROGRAM STUDY ON CELL PHONES AND CANCER
tute of Environmental Health Sciences (NIEHS) and designer of the study states, “The NTP tested the hypothesis that cell phone radiation could not cause health effects and that hypothesis has now been disproved. The experiment has been done and, after extensive reviews, the consensus is that there was a carcinogenic effect.” (124,125,126,127)
HEALTH EFFECTS OF MILLIMETER 5G WAVELENGTHS
The term "millimeter waves" (MMW) refers to extremely highfrequency (30-300 GHz) electromagnetic radiation. Millimeter Waves (MMW) used in the next-generation of high-speed wireless technologies have shallow penetration thus effect the skin surface, the surface of the eye or on bacteria, plants and small life forms. Surface effects, however, can be quite substantial on an organism as stimulation of skin receptors can affect nerve signaling causing a whole body response with physiological effects on heart rate, heart rhythm, and the immune system. In a 1998 review article, Pakhomov (123) looked at the bio-effects of millimeter waves. He reviewed dozens of studies and cites research demonstrating profound effects of MMW on all biological systems including cells, bacteria, yeast, animals and humans. Some effects were clearly thermal as millimeter microwaves are rapidly absorbed by water which is abundant in living organisms. When microwaves are absorbed the energy can cause tissue heating. Many of the millimeter frequency studies however showed effects without heating of tissues and at low intensities. Research was variable and showed both regenerative effects and also adverse effects depending on frequency, power and exposure time.
“Over the past century, this natural environment has sharply changed with introduction of a vast and growing spectrum of man-made EM fields.” Adey (135)
The most recent and compelling evidence has come from the 2016 National Institutes of Health, National Toxicology Program. Called the NTP Toxicology and Carcinogenicity Cell Phone Radiation Study, the 10 year $25 million research revealed conclusively that there was a harmful effect from cell phone microwave radiation. (124,125) The frequencies are similar to other wireless devices we commonly use. The studies were robust, collaborative, well controlled and with double the number of rats required to reveal a significant effect, if present. The preliminary results of the study showed that RFR caused a statistically significant increase in two types of brain tumors, gliomas and schwannomas. These were the same two types of tumors shown to increase in human epidemiological studies on long term use of cell phones. Dr. Lennart Hardell and others have demonstrated a consistent pattern of increased incidence of ipsilateral (same side) acoustic neuromas (vestibular schwannomas) and gliomas with each 100 hours of cell phone use. (112-118) Another telling finding was that the control rats had much lower than expected cancer rates. It is believed due to the fact the control rats were in a controlled faraday cage and not exposed to normal ambient EMF that could contribute to cancer. Ron Melnik, PhD, Senior Toxicologist and Director of Special Programs in the Environmental Toxicology Program at the National Insti22 | THE BULLETIN | JANUARY / FEBRUARY 2017
Chernyakov induced heart rate changes in anesthetized frogs by microwave irradiation of remote skin areas. Complete denervation of the heart did not prevent the reaction. This suggested a reflex mechanism of the MMW action involving certain peripheral receptors.(28)
HEART RATE VARIABILITY
Potekhina found certain frequencies from 53-78 GHz band (CW) changed the natural heart rate variability in anesthetized rats. He showed that some frequencies had no effect (61 or 75 GHz) while other frequencies (55 and 73 GHz) caused pronounced arrhythmia. There was no change in skin or whole body temperature. (69)
One study of MMW teratogenic effects was performed in Drosophila flies by Belyaev. Embryos were exposed to 3 different GHz frequencies for 4-4.5 hours at 0.1 mW/cm2. He found that irradiation at 46.35 GHz, but not at 46.42 or 46.50 GHz, caused marked effects including an increase in morphological abnormalities and decreased survival. It was felt the MMW disturbed DNA-protein interactions at that particular frequency.(65)
BACTERIAL AFFECTS AND ANTIBIOTIC RESISTANCE
Bulgakova in over 1,000 studies with 14 different antibiotics showed how MMW exposure of S. aureus affects its sensitivity to antibiotics with different mechanisms of action. The MMW increased or decreased antibi-
otic sensitivity depending on the antibiotic concentration. (134) Pakhomov warns, “Regardless of the primary mechanism, the possibility of significant bio-effects of a short-term MMW irradiation at intensities at or below current safety standards deserves consideration and further study. The possibility of induction of adverse health effects by a local, low-intensity MMW irradiation is of potential significance for setting health and safety standards and requires special attention.” He called for replication of studies especially long term effects of MMW. His conclusions: 1. Individuals or groups in a population, which would usually be regarded as uniform, may react to MMW in rather different or even opposite ways. 2. There seem to exist unknown and uncontrolled factors that determine the MMW sensitivity of a specimen or a population. Irradiation could increase antibiotic resistivity in one experiment and decrease it in the next one. 3. Increased sensitivity and even hypersensitivity of individuals to MMW may be real. Depending on the exposure characteristics, especially wavelength, a low-intensity MMW radiation was perceived by 30 to 80% of healthy examinees. (123)
Prost in 1994 studied millimeter microwave radiation on the eye. He noted that microwaves of different wave-lengths can induce the development of cataracts. (13) His research found that low power millimeter waves produced lens opacity in rats exposed to 10mW/cm2, a predisposing indicator of cataracts.(74)
Kolomytseva, in 2002, looked at the dynamics of leukocyte number and functional activity of peripheral blood neutrophils under whole-body exposure of healthy mice to low-intensity extremely-high-frequency electromagnetic radiation (EHF EMR, 42.0 GHz, 0.15 mW/cm2, 20 min daily). The study showed that the phagocytic activity of peripheral blood neutrophils was suppressed by about 50% in 2-3 h after a single exposure to EHF EMR.(131)
Gapeve in 2003 showed for the first time that low-intensity extremely high-frequency MMH electromagnetic radiation in vivo causes effects on spatial organization of chromatin in cells of lymphoid organs. Chromatin is a complex of DNA and proteins that forms chromosomes within the nucleus of eukaryotic cells. He exposed mice to a single whole-body exposure for 20 min at 42.0 GHz and 0.15 mW/cm2. (132)
Habauzit in 2013 looked at gene expression in keratinocytes with 60GHz exposure at upper limit of current guidelines and concluded “In our experimental design, the high number of modified genes (665) shows that the ICNIRP current limit is probably too permissive to prevent biological response. (73)
GAPS IN DATA FOR LAUNCHING 5G MILLIMETER DEVICES
or Alzheimer’s. We have too many toxins to sort it all out. Research shows that wireless microwave radiation adds yet another dose of toxic exposure to our daily lives. We cannot hear it or smell it or feel it. Yet it affects our biology and our wellbeing with perhaps subtle affects. If we are electro-sensitive then we are more likely to avoid exposure. Trees are even susceptible to EMF harm and they cannot move away. (128) What about birds and bees and us?
CLOSE ENCOUNTERS: GOOGLE GLASS, VIRTUAL REALITY AND WEARABLE WIRELESS DEVICES
If we are concerned about putting a cell phone to our ears for long periods of time after reading about the NTP study then why aren’t we concerned about other wearable devices? While very cool to use Google Glass and Virtual Reality may have dangerous consequences to our eyes, brain function or immune systems with long term use, especially to children. What are the frequencies in these devices? 3G, 4G, 5G or a combination of zapping frequencies giving us immersive connection and entertainment but at a potentially steep price.
5G RESEARCH AND POLICY
Safety testing for 5G is the same as other wireless devices. It is based on heat. This is an obsolete standard and not considering current science showing cellular and organism harm from non-thermal effects. There is a large gap in safety data for 5G biological effects that has been demonstrated in older studies including military.
NEW RECOMMENDATIONS TO PROTECT PUBLIC HEALTH
1. Do not proceed to roll out 5G technologies pending pre-market studies on health effects. 2. Reevaluate safety standards based on long term as well as short term studies on biological effects. 3. Rescind a portion of Section 704 of the Telecommunications Act of 1996 which preempts state and local government regulation for the placement, construction, and modification of personal wireless service facilities on the basis of the environmental effects so that health and environmental issues can be addressed. 4. Rescind portions of The Spectrum Act which was passed in 2012 as part of the Middle Class Tax Relief and Job Creation Act, which strips the ability city officials and local governments to regulate cellular communications equipment, provides no public notification or opportunity for public input and may potentially result in environmental impacts. 5. Create an independent multidisciplinary scientific agency tasked with developing appropriate safety regulations, premarket testing and research needs in a transparent environment with public input. 6. Label pertinent EMF information on devices along with appropriate precautionary warnings.
A full list of references used in this article are available at www.sccma-mcms.org.
Commercial production often precedes research on consumer protection and health effects. We have too many toxins that have escaped premarket safety protocols for too long—lead, asbestos, smoking and our modern unregulated nanoparticles to mention just a few. These affect our long term and short term health in ways we do not even know. If we become ill, we do not question or identify the daily or weekly chemical exposures that could have contributed to that cancer or arthritis or lung disease JANUARY / FEBRUARY 2017 | THE BULLETIN | 23
TROUBLE GETTING PAID?
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Here’s what our members have said: “The value that our medical associations’ reimbursement experts bring to physician practices cannot be understated. In addition to the support we receive resolving payor issues, my staff and I rely on the wide range of member-only tools and services to keep my practice running smoothly. Membership is not a cost to my practice - it’s an investment. I couldn’t run my practice without it.”
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Pioneer Physicians of Los Gatos By Gerald E. Trobough, MD Leon P. Fox Medical History Committee There were three notable pioneer physicians who assisted Los Gatos in becoming a thriving township in the mid 1800’s. Los Gatos had its beginnings when a flour mill was built on the Los Gatos Creek in 1851 by James Alexander Forbes. Forbes, a Welshman, was Vice-Counsel of the British Government and was living in Santa Clara during the gold rush. At the time, there was a great demand for flour to make bread for the miners in the gold fields. The Forbes Mill was the first building and business established in Los Gatos. Even though the mill was not very successful, it brought attention to the beautiful area at the base of the Santa Cruz Mountains and attracted many settlers.
DR. WILLIAM S. MCMURTRY
The first physician to settle in the Los Gatos area was Dr. William S. McMurtry. Born in Kentucky in 1818, Dr. McMurtry took his medical training in Ohio, Kentucky and Indiana. As a young Medic, he enlisted in the army to fight in the Mexican War. When he found out his regiment was to participate as Infantry, he left the army and joined the Texas Rangers and fought in the Battle of Monterey. Dr. McMurtry was to begin a medical practice in Baton Rouge, Louisiana in 1848. That year gold was discovered in California and like many others he “caught the gold bug.” With a party of 30 men, he traveled through Mexico and arrived in San Francisco on May 24,1849. He immedi26 | THE BULLETIN | JANUARY / FEBRUARY 2017
Dr. Frank Knowles
ately went to work at the gold mines but had only mediocre success. After a short stint in the quartz mines in Grass Valley, Dr. McMurtry migrated to the Southern Santa Clara County town called Lexington (now covered by the Lexington Reservoir) and established a successful lumber business. In 1868, McMurtry moved to Los Gatos and with a partner (J. W. McMillan) bought a half interest in the Forbes Mill. They remodeled the mill and made it 20 feet taller allowing the mill to produce 100 barrels of flour a day. The price of flour, which was $50 a barrel when the mill opened, dropped to $5 a barrel and the business was not profitable. McMurtry was an important businessman in the early years of Los Gatos and along with Dr. Knowles and Dr. Gober, he signed the documents to incorporate Los Gatos. The Town of Los Gatos was incorporated on August 10, 1887. Prior names of Los Gatos were Redwood Township, Forbestown and Forbes Mill. In 1895, McMurtry opened an office to practice medicine on East Main Street. Dr. McMurtry died on December 8, 1904 at the age of 86.
DR. FRANK KNOWLES
Dr. Frank Knowles was the first full time physician to practice in Los Gatos. He arrived in 1883. Dr. Knowles was born on March 2, 1858 in Illinois and trained at Rush Medical College in Chicago. After graduation, he established a medical practice in Los Gatos. At that time, there were few people in Los Gatos. Many of his patients lived in the Santa Cruz mountains, that he accessed with horse and buggy. When the brush was too thick, he would unhitch the buggy and travel on horseback, or on foot, to reach his patients. His devotion to his patients, his profession, and his work in the community made him extremely popular. His office was located over Green’s Pharmacy. Knowles also loved farming. He established a 42-acre orchard in the
Leon P. Fox Medical History Committee The Leon P. Fox Medical His-
current Vasona Lake area raising apricots, prunes, peaches and grapes. He was an original shareholder, director and vice-president of the First National Bank of Los Gatos. Dr. Knowles died in November, 1936.
DR. FRANK GOBER
Dr. Frank Gober came to Los Gatos in 1884. He was born in Sacramento on November 24,1858. His medical training included one year at Cooper Medical School in San Francisco. He left the west coast and completed his schooling in New York graduating from Belview Medical College in 1884. He married Annette Bean, daughter of John Bean who invented a spray pump. Bean’s manufacturing company later became known as FMC, a major industry in the Santa Clara Valley. The Gober’s built a beautiful home on the corner of Bean and Santa Cruz Avenues in Los Gatos. After 35 years of marriage, Annette died in 1921 leaving two children. The stately mansion was razed in1938 in order to build a supermarket. Gober established several medical offices in downtown Los Gatos, but a large part of his practice was in the Saratoga mountains. He, like Dr. Knowles, traveled by horseback or horse and buggy to diagnose and treat patients. His medical “territory” ranged from Los Gatos and Saratoga to Boulder Creek in Santa Cruz County. Often he was in the mountains for days at a time doing surgery and providing post-operative care or waiting to deliver a baby. For Dr. Gober to find his way, the residents would hang lanterns on the roads or trails. When he reached the last lantern, he would yell out and someone would come to him and lead him to the ill patient. He was lovingly referred to as “Los Gatos’ Horse and Buggy Doctor.” Dr. Gober practiced medicine in Los Gatos for 58 years and retired in 1935. He died in 1942, at the age of 84.
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Nurse Practitioners ~ Physician Assistants
chival material, memorabilia, and artifacts representing the medical history of Santa Clara County. A guest speaker gives a historical presentation at each of the meetings, which is then transcribed for SCCMA’s Medical History archives. If you are interested in joining this committee, please contact Pam Jensen at SCCMA at (408) 998-8850 or firstname.lastname@example.org.
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MEMBER BENEFITS & SERVICES
SCCMA/MCMS members are entitled to a host of discounts from both local and national vendors that provide a wide range of products and services. Enhance your personal and professional life, while saving time and money, by being familiar with our member benefits and services. Listed below is a summary of the benefits and services currently available, as well as a list of the vendors (with contact information) who provide the special services and/or discounts to members.
PRACTICE MANAGEMENT ASSISTANCE Practice & Liability Consultants, LLC Debra Phairas, 415/764-4800, or email csm@ practiceconsultants.net. Amerinet Health Resource Services (HRS) 1/800/842-6663 A Group Purchasing Organization (GPO) whose primary focus is negotiating discounts on many of the products and services that you use every day. As a member of Amerinet, you will have access to contracts that will help you reduce your overhead without changing how you are currently doing business. By becoming a member of Amerinet/HRS, you will also receive a 22% discount on Verizon Wireless for your business and employees’ personal lines. Additional discounts given from Staples, Office Max, Sprint, CDW, Southern Computer Warehouse, SHI, FedEx, and Ups, to name a few. All this is available at no cost to you. For more information, just complete the request form at http://amerinet-hrs.com/santaclara or call Jennifer Brons, at 800/8426663 or 206/583-6516.
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Members receive $10 off the regular hourly consulting fees. Since 1985, Practice & Liability Consultants have worked with over 1,800 practices as practice management and malpractice prevention specialists. Services include practice assessments, valuations, practice sales/brokerage (see information below), benchmarking, mergers, operations/personnel issues, manager recruitment, partnership/group, formation/improvements, and seminars. Benefits include greater productivity, increased gross and net income, greater patient satisfaction, and a more pleasant work environment. Fees are based on either a flat fee or hourly basis and, where possible, a minimum and maximum fee is quoted. Please call 415/764-4800, or contact email@example.com. Website: www.practiceconsultants.net.
Medical Practice Purchasing Group 714/469-5296
Members receive preferred pricing and a FREE working interview. When your office is short staffed, are you getting the help you really need? RenKriss is your employment remedy! We specialize in placing medical assistants, receptionists, transcriptionists, and records clerks, as well as biller/collectors, coders, and office managers. Whether you require full or part-time professionals, permanent, or temporary placements, vacation or maternity leave coverage – THEY CAN HELP! RenKriss provides: pre-screened candidates with health care backgrounds and the specific skills your office requires. Call Kristin Biernat, RenKriss Managing Partner at 510/256-5266.
Medical Practice Purchasing Group (MPPG) provides our members with free membership in its physician group purchasing services. MPPG, founded by a practicing California physician, provides discounts on goods and services from over 20 suppliers for small and medium size medical practices. Significant discounts are available to your practice including: vaccines, medical and surgical supplies, merchant services, medical liability coverage and many other services. Utilizing MPPG discounts will save your practice thousands of dollars. Examples of discounts include a 22% discount on cellular service through Verizon, AT&T; and many discounts on vaccines and practice items. To become an MPPG member and obtain access to MPPG contracts go to www.MPPG.net. You can join online or download a membership form. Simply indicate the vendors you would like to use, sign, and return. Please refer to www.MPPG.net for a full explanation of benefits and discounts on the myriad of services now available to your practice.
TPO Human Resource Management Melissa Irwin at 831/647-7292 or melissai@tpohr. com. TPO is an award-winning HRconsulting firm serving primarily the Bay Area. Typical services include general HR consulting, employee handbook development, neutral third-party investigations into employment matters including harassment, managerial training on HR regulatory and leadership skill-building, and helping employers maintain current best HR practices. How they work with SCCMA and MCMS members: Over the past 17 years, TPO has provided HR support to SCCMA, as well as the members of SCCMA and MCMS. TPO has facilitated numerous HR training programs for members to attend and has provided many resource articles throughout the years. SCCMA/MCMS members receive a free initial consulting call ($50 savings) and then 10% off the initial work, products, and services with TPO. Contact Melissa Irwin, SPHR-CA, Sr. Consultant: 831/647-7292 or firstname.lastname@example.org.
CREDIT CARD PROCESSING/ FINANCIAL SERVICES
MEMBER BENEFITS & SERVICES
RenKriss Healthcare Staffing and Recruitment Kristin Biernat, RenKriss Managing Partner at 510/256-5266
360 Payment Solutions Jesse Meddaugh at 408/637-1160. 360 Payment Solutions is a merchant credit card processor located in San Jose. The company was founded on the beliefs and core values of honesty and integrity. The credit card processing industry is very competitive and can be confusing for business owners. This is why 360 Payment Solutions focuses on teaching their clients to understand the fees by taking a consultative, educational, and service-driven approach. In the health care industry, costs continue to rise and patients become increasingly dependent on the use of plastic as a form of payment. This has made accepting credit cards an imperative asset to growing your Practice. 360 Payment Solutions has negotiated special pricing for SCCMA/ MCMS members and is able to match or beat any processors’ fees. For a FREE review, for more information, or to set up an appointment, contact Jesse Meddaugh at 408/637-1160, www.360paymentsolutions.com.
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AUTOMOBILE REPAIR Legacy Wealth Advisors, LLC: Ed Ryu at 408/452-7700 Provides financial planning, retirement planning, professional money management, and more! Members receive a one-hour complimentary consultation (over a $300 savings). For more information, call Lawrence Pizzella at 408/452-7700.
Autobahn Los Gatos Dave Lee or Gary Cassetta at 408/356-5985 to set up your appointment today. Specializing in BMW and Mercedes Benz repair, members, their families, and staff receive a 10% discount on labor. Call Dave or Gary at 408/356-5985, to set up your appointment today. (Don’t forget to mention you are a SCCMA/MCMS member.)
MEMBER BENEFITS & SERVICES
SCCMA/MCMS PUBLICATIONS Bureau of Medical Economics (BME) For more information regarding BME’s collection services and rates, call Karen Jorgenson at 408/286-6219. Receive no less than a 5% discount off the basic commission rate. No fee until there is a recovery. For more information regarding BME’s revenue recovery services, call Karen Jorgenson at 408/286-6219.
PROFESSIONAL DEVELOPMENT SCCMA/MCMS Seminar/Webinar Series Member physicians and their office staff often attend FREE-of-charge seminars covering legal issues, HIPAA, risk management issues, contract negotiations, reimbursement, billing, OSHA compliance, how to open/close/how to determine the value of a medical practice, HR requirements/guidelines, and much more. Check out www.sccma-mcms. org/TheBulletin for more information.
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The Bulletin Members receive a FREE subscription to SCCMA/MCMS’s bi-monthly publication, which includes medical articles, classifieds, member benefits, coding/billing/collection advice, CME classes, seminars, and webinars, and information on our upcoming events!
SCCMA/MCMS Membership Directory Call our office at 408/998-8850 or 831/455-1008 for details or to place an order. Appear in SCCMA/MCMS’s annual pictorial membership directory! Receive a complimentary copy of our directory each year ($65.00 value) and 50% discount off each additional directory purchase.
MEMBER RESOURCES Mailing Lists/Labels Pam Jensen, SCCMA/MCMS, at 408/998-8850 or 831/455-1008 ext. 3012.
Copyland/Zip 2 Print Frank Ettefagh: 408/971-2722 or email@example.com. 2342 Stevens Creek Blvd., San Jose, CA 95128 Members receive excellent customer service with a 10% discount on all quality printing, from prescription pads, new practice announcements, brochures, medical forms, post cards with mailing service, etc. FREE shipping or delivery depending on your office location. For more information, please call or email Frank Ettefagh at 408/971-2722 or firstname.lastname@example.org. Of course you’re always welcome to visit us at our new location at: 2342 Stevens Creek Boulevard, San Jose, CA, 95128, or check web site at: www. zip2print.com.
MEDICAL PROFESSIONAL LIABILITY INSURANCE
NORCAL Mutual Insurance Company For more information, www.norcalmutual.com or 844/466-7225.
To send new practice announcements, inform your colleagues of a particular legislation or upcoming event. Members can order mailing labels by specialty, zip code, or total membership. Members receive a 50% discount by calling Pam Jensen, SCCMA/MCMS, at 831/455-1008 or 408/998-8850 Ext. 3012.
Physician Referral Service Jean Cassetta, SCCMA/MCMS, at 408/998-8850 or 831/455-1008 ext. 3010 for a “Physician Referral Service Participation Agreement” or to sign up today. Our physician referral service provides 1200 referrals online and handles around 1200 calls per month. Patients can select a physician by city, specialty, language, Medicare, or Medi-Cal, and gender. Call Jean Cassetta, SCCMA/MCMS, at 831/455-1008 or 408/998-8850 Ext. 3010 for a “Physician Referral Service Participation Agreement” or to sign up today.
Discounted Tickets & See’s Candies Certificates Leslie Sorensen at 408/998-8850 or 831/455-1008 ext. 3008. Discounted tickets available for members, their staff, and families online at: California’s Great America, Gilroy Gardens, Disney Theme Parks, Santa Cruz Beach Boardwalk, Monterey Bay Aquarium, Raging Waters, Roaring Camp, Universal Studios, Six Flags Discovery Kingdom, and many more! Gift certificates also available for See’s Candies. For more information go to: http://www.sccma-mcms.org/ to the Membership Tab, then click on Discounted Ticket to purchase the tickets or call Leslie Sorensen to purchase See’s gift certificates, 408/998-8850 Ext. 3008.
MEMBER BENEFITS & SERVICES
Since 1975, NORCAL Mutual Insurance Company has been a policyholder-owned and physician-directed medical professional liability insurance (MPLI) carrier dedicated to ensuring the availability of affordable and relevant coverage. NORCAL offers versatile coverage, an A.M. Best “A” (Excellent) rating and over 40 years of strength and stability to physicians, health care extenders, medical groups, hospitals, community clinics and allied healthcare professionals across the nation. Our award-winning risk management solutions and CME resources provide continuing education and support to help safeguard your practice. For more information, visit http://www.norcal-group.com/hello or call 844.4NORCAL. JANUARY / FEBRUARY 2017 | THE BULLETIN | 33
CALIFORNIA MEDICAL ASSOCIATION
MEMBER BENEFITS & SERVICES
Contact CMA Today!
When you join CMA, you hire a powerful professional staff to protect the viability of your practice. By protecting your practice from legal, legislative, and regulatory intrusions, your CMA membership lets you focus on what’s really important: your patients.
(800) 786-4262 www.cmanet.org/ groupdiscounts
Members can offset the price of their annual dues when using CMA membership services and discounts. Thanks to CMA’s group buying power, members receive deep discounts on everything from magazines to office supplies to insurance products. From auto insurance to retirement plans, CMA’s discount programs will save you time and money. Many CMA members save more than their annual dues!
Legal Services CMA On-Call: CMA’s health law library, CMA On-Call, contains 46 chapters of legal information, including current laws, regulations, and court decisions related to the practice of medicine. Accessible to members at www.cmanet.org/ cma-on-call or by calling (800) 786-4262. Legal Services: CMA’s legal department provides members with information and resources about laws and regulations that impact the practice of medicine. While CMA staff cannot provide individual legal advice, our research associates, with the support of CMA legal counsel, will help you find legal information and resources on a multitude of health-law related issues. Call (800) 786-4262.
Professional Development CME Tracking/Credentialing: CMA’s Institute for Medical Quality certifies CME activity for credentialing purposes to the Medical Board of California, as well as to hospitals, health plans, specialty societies, and others. CME Certification is $33 a year for CMA members, $57 for nonmembers. IMQ, (415) 882-5151 or www.imq.org.
CMA: Member Benefits
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Seminar Series: CMA experts travel to local county medical societies throughout the state, holding live seminars for members and their staff on a variety of issues. Contact your local county medical society for more information. ICD-10 Resources and Training: In an effort to help practices navigate the transition to ICD-10, CMA has developed several resources, including a robust FAQ document and tip sheet. Additionally, CMA has partnered with the largest and most respected coding organization, AAPC, to provide our members with a complete suite of ICD-10 solutions at steeply discounted rates. For more information, visit www.cmanet.org/icd10. Certified Professional Coder Program: CMA members and their staff receive big discounts on Certified Professional Coder (CPC) training and certificates from AAPC. AAPC’s CPC credential is the gold standard for medical coding in physician office settings. Contact your local county medical society for more information.
Practice Management CMA Reimbursement Help Center: Trouble getting paid? In the past seven years, CMA’s practice management experts recouped over $13 million from payors on behalf of physician members. CMA provides members and their staff with FREE one-on-one assistance with individual practice management, reimbursement, and contracting related issues. Reach CMA’s practice management experts at (888) 401-5911.
CMA: Member Benefits
CMA Payor Contract Analysis: CMA members have free access to objective written analyses of major health plan contracts at www.cmanet.org/ces. Each analysis is designed to help physicians understand their rights and options when contracting with a third party payor, as well as which contract provisions are prohibited by California law.
CMA produces a number of publications to keep members up-to-date on the latest health care news and information affecting the practice of medicine in California. Subscribe to any of these newsletters online at www.cmanet.org/newsletters. CMA Alert: CMA’s bi-weekly e-newsletter provides up-to-date information on many issues of critical importance to California physicians. CMA Practice Resources (CPR): A free monthly e-mail bulletin from CMA’s practice management experts that focuses on critical payor and health care industry changes and how they directly impact the business of a physician practice. Each issue includes tips on reimbursement and contracting related issues along with information on the latest practice management news. CMA’s Press Clips: CMA’s daily news roundup, provides a quick but meaningful overview of the day’s health care news.
MEMBER BENEFITS & SERVICES
Webinar Series: Through its robust webinar series, CMA gives physicians and their staff the opportunity to watch live presentations on important topics of interest and interact with practice management, legal and financial experts, to name a few, from the comfort of their homes or offices. The webinars are free to CMA members and members’ staff and provide the timely information needed to help run a successful medical practice. What’s more, all webinars are available ondemand immediately following the live airing, providing an ever-growing resource library accessible at any time. For more details, visit www.cmanet.org/webinars.
Insurance Mercer Insurance Services: As the primary insurance advisor for CMA and its affiliated county organizations, Mercer Health & Benefits Insurance Services LLC offers a wide variety of sponsored insurance plans and services for members. From solo practicing physicians to small, medium and large groups, Mercer provides savings, safety, service and stability no matter the size of your practice. Designed to cover a multitude of insurance needs for your practice and personal needs, the sponsored insurance plans include medical, workers’ comp, long term
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disability, long term care, level term life, business overhead expense insurance and more. and more. For additional information on Mercer’s sponsored benefit program, visit www.countyCMAmemberinsurance.com or call (800) 842-3761. Auto and Homeowners Insurance: Discounted auto and homeowners insurance for CMA members. Mercury Insurance Group, (888) 637-2431 or visit www.mercuryinsurance.com/cma.
MEMBER BENEFITS & SERVICES
Other Supplies and Resources Medical Waste Disposal and Regulatory Compliance: EnviroMerica offers CMA members heavily discounted medical waste removal and regulatory compliance services. Through EnviroMerica, CMA members can protect themselves from regulatory fines, receive compliance consultations and properly dispose of medical waste at a fraction of the cost charged by competitors. Find out more at www.enviromerica.com or by calling (650) 655-2045. DocBookMD: CMA members are eligible for a free download of the DocBookMD smart phone app, which allows them to securely send messages directly from their iPad, iPhone and Android devices. Find out more at www.cmanet.org/docbookmd or by contacting your county medical society. Mobile Physician Websites: Save up to $1,000 on unique website packages through Mayaco Marketing & Internet. Contact Mayaco at (209) 957-8629 or visit www.cmanet.org/mayaco. HIPAA Compliance: PrivaPlan offers CMA members discounted rates on HIPAA privacy and security compliance resource kits custom tailored to California’s regulations. Visit www.privaplan.com for more information.
COLA: COLA is a physician-directed organization whose purpose is to promote excellence in laboratory medicine and patient care through a program of voluntary education, consultation and accreditation. This member benefit provides a 15% savings on COLA’s Laboratory Accreditation Program and its educational products and services. CMA members also receive free online support and a complimentary basic quality lab course and may be eligible for a discount on AAFP and ACP proficiency testing programs. Visit www.cmanet.org/cola to access the members-only discount code. MedicAlert: MedicAlert is a nonprofit foundation with over 50 years of lifesaving experience identifying and providing vital medical information to emergency personnel for over 4 million members worldwide. CMA members and their patients save $10 on new adult enrollments and $2.95 on Kid Smart Enrollments. www.cmanet.org/medicalalert or (800) 253-7880. Security Prescriptions: Get 15% off tamperresistant security prescription pads and printer paper. www.cmanet.org/rxsecurity. Magazine Subscriptions: Consumer Subscription Services is proud to offer CMA members deep discounts on magazine subscriptions. Ordering magazines for your home, office, waiting room and patient rooms is easy! From People, InStyle and Redbook to TIME, Sports Illustrated and Health—CMA members get up to 89% of the cover price of hundreds of popular magazines. To access the discount link, visit www.cmanet.org/magazines. Car Rentals: Save up to 25% on car rentals for business or personal travel. Membersonly coupon codes are required to access this benefit. Get your code at www.cmanet.org/groupdiscounts.
StaplesAdvantage: Save up to 80% on office supplies and equipment from Staples, Inc. Visit www.cmanet.org/staples to access the members-only discount link.
CMA: Member Benefits
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PROTECTING THE PRACTICE OF MEDICINE CMA’S COMMITMENT TO THE PHYSICIANS OF CALIFORNIA The Recognized Voice of California Physicians
CMA and its county medical societies have represented California’s physicians for 160 years as the recognized voice of the house of medicine. CMA also partners regularly with the specialty societies of California, and together we stand taller, our combined voices stronger, fighting for the future of medicine and our noble profession. A Major Player in Health Care’s Top Issues: CMA prides itself on providing our members the opportunity to establish how medical care is provided in California. We do this by giving our members – from physicians to residents to medical students – direct access to our state’s and nation’s political leaders. Through aggressive legislative and regulatory advocacy, CMA has positioned itself as one of the most vocal stakeholders in the development and implementation of health policy. A Record of Success: CMA is an effective and masterful advocate in the State Capitol. Our large lobbying team is highly regarded with a track record of success. CMA was the principal mover on a number of items that will benefit the physicians of California. These include: Physician Workforce: We are committed to expanding funding for graduate medical education (GME) to ensure that there are enough residency slots to train physicians in regions where health care services are needed most. CMA was able to secure $100 million in the 2016-2017 state budget to expand the Song-Brown Program to create more residency slots in California and to open the program to all primary care specialties.
CMA: Protecting The Practice of Medicine
Medical School Debt: CMA sponsored legislation to create the Steven M. Thompson Loan Repayment Program, which provides physicians with up to $105,000 to repay educational loans in exchange for a three-year service commitment in a medically underserved area of the state. Scope of Practice: Every year, CMA defeats attempts to expand nonphysicians’ scope of practice. CMA strongly believes allowing practitioners to perform procedures they aren’t trained to do can only lead to unpredictable outcomes, higher costs and greater fragmentation of care.
MEMBER BENEFITS & SERVICES
CALIFORNIA MEDICAL ASSOCIATION
Medi-Cal Funding: CMA is a lead participant in the “We Care for California” coalition, a group working to help state leaders understand how the severe underfunding of Medi-Cal harms millions of children, seniors in nursing homes, pregnant women and people with disabilities, all of whom have difficulty getting access to the health care they need because of low Medi-Cal rates. CMA is also backing Prop. 55 on the November 2016 ballot, which will maintain the taxes on the wealthiest Californians to prevent billions in cuts to education and provide up to $2 billion annually to fund the Medi-Cal program.
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MEMBER BENEFITS & SERVICES
Taking on Big Tobacco: CMA helped launch the new “Save Lives California” coalition, committed to raising the state’s tax on tobacco. The coalition is working to strengthen the state’s anti-tobacco policies to prevent death from tobaccorelated diseases and reduce the costs of smoking on California’s health system. In 2016, we successfully passed a sweeping series of tobacco control bills—including raising the legal age to purchase tobacco from 18 to 21—an action that will undoubtedly save countless California children from a deadly, lifetime addiction to nicotine. Medicare Payment Reform: CMA was integral in the passage of federal legislation to reform the badly broken Medicare physician payment system. This legislation will stabilize the physician payment system and is worth hundreds of millions of dollars to physicians nationwide over the coming decade. CMA was also key to the passage of the long overdue “California GPCI fix,” which will update the Medicare localities and
increase payments to physicians in many counties by more than $400 million in the next 10 years. MICRA: CMA and its county societies led the successful fight against the trial lawyers’ Proposition 46, in one of the most contentious and high-stakes ballot fights in California history. Had it passed, the ballot measure would have decimated the landmark Medical Injury Compensation Reform Act (MICRA), which has kept access to affordable health care a reality for patients across the state. CMA stalwartly defends this landmark law year after year. Reimbursement Assistance: Members receive one-on-one assistance from CMA’s reimbursement experts, who have recouped $13 million from payors on behalf of CMA physicians in the past seven years. These monies represent actual physician reimbursements that would have likely gone unpaid without CMA intervention.
WE ARE HERE FOR YOU • CMA and its county medical societies – representing 41,000 physicians, residents and medical students – influence public policy at the state and federal levels. • Members have free access to valuable professional resources, including over 350 documents containing legal information related to the practice of medicine in CMA’s online health law library. • Our extensive network of benefit partners makes it so that your membership can easily pay for itself. • CMA is only a phone call away! Our live-person call center is available Mon-Fri during business hours at (800) 786-4262. • Join today to activate your personal web account at www.cmanet.org.
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TOOLS AND RESOURCES TO EMPOWER PHYSICIAN PRACTICES
CMA’s Reimbursement Helpline (888) 401-5911 Through this FREE members only service, CES provides one-on-one educational assistance and advocacy to physician members and their staff. Practices can call on CMA’s Center for Economic Services reimbursement experts to discuss economic issues affecting their practice, including but not limited to billing and collections, coding and documentation, and managed care contracts.
CMA’s Center for Economic Services (CES) is staffed by practice management experts with a combined experience of over 125 years in medical practice operations. Our goal is to empower physician practices by providing resources and guidance to improve the success of your practice. Whether it’s identifying and fighting unfair payment practices or improving the efficiency of your practice, CMA has tools and resources to help. Learn more at www.cmanet.org/ces.
Practice Management Bulletin CMA Practice Resources (CPR) is a free monthly e-bulletin from CMA’s practice management experts that focuses on critical payor and health care industry changes and how they directly impact the business of a physician practice. Each issue includes tips on reimbursement and contracting related issues along with information on the latest practice management news. Visit www.cmanet.org/cpr to sign up.
MEMBER BENEFITS & SERVICES
CALIFORNIA MEDICAL ASSOCIATION
CMA hosts a series of free monthly webinars to educate physicians and their staff on a range of topics from health information technology to reimbursement issues. CMA members can access archived webinars on demand and the upcoming webinar calendar on our website at www.cmanet.org/webinars.
To help physicians understand the MACRA payment reforms, and what they can do now to start preparing for the transition, CMA has published a MACRA resource center at www.cmanet.org/macra. There you will find an overview of MACRA, and a comprehensive list of tools, resources and information on the Medicare payment reforms.
CMA: Tools and Resources to Empower Physician Practices
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Under the Affordable Care Act, millions of Californians are now covered by private insurance through Covered California, a health insurance exchange purchasing pool. CMA has developed several resources to help educate physicians on the exchange and ensure that they are aware of important issues related to exchange plan contracting. Visit www.cmanet.org/exchange.
Practice Empowerment Resources Most resources listed below can be located on our website at www.cmanet.org/ces.
MEMBER BENEFITS & SERVICES
Payor Profiles CMA has compiled critical information for interacting with the major payors. On each of the payor profiles you will find important contact numbers, addresses and links for quick reference for payor interactions. These documents are updated annually. Contract Renegotiations: Making Your Business Case When submitting a request to open up a contract renegotiation discussion, best practice is to present a “business case” as to why the payor wants to keep your practice in the network. Learn how to prevent the “auto-reply” and be thoughtful in renegotiation requests. Directory Accuracy Law On July 1, 2016, a new law took effect that requires plans to ensure that their physician directories are accurate and upto-date. CMA has published a guide to help physicians understand the new provider directory accuracy law, and what they need to do to avoid penalties. Get more info at www.cal.md/directory-accuracy. Contract Amendments: An Action Guide for Physicians This guide is designed to help physicians understand their rights and options when a health plan notifies them of a material modification to a contract, manual, policy or procedure.
Managed Care Contracting CMA offers members free access to objective analyses of several health plan participating provider contracts. While these analyses are not intended to be exhaustive, they are designed to draw a physician’s attention to issues which may warrant further inquiry or clarification. Surviving Covered California Tip Sheets CMA has compiled critical information to help physicians understand their participation status, which products are being offered, which provider networks those products are associated with, how to navigate the federal grace period and how to survive Covered California, in general. Covered California FAQs With the launch of California’s health benefit exchange, Covered California, millions of Californians are now eligible to purchase insurance through this new online marketplace. Understandably, patients and providers have many questions. CMA has created two FAQs – one designed to provide answers to the most common patient questions and one addressing provider questions. Covered California: Understanding the Grace Period for Subsidized Enrollees Federal law allows Covered California enrollees who receive financial subsidies to keep their health insurance for three months, even if they have stopped paying their premiums. This is known as the “grace period.” This document contains answers to frequently asked questions such as how practices can identify patients in the grace period, what their options are if a patient presents with suspended coverage, and how to identify whether the patient or the plan is responsible for paying a claim for a patient in the grace period. Covered California: Know Your Participation Status Unfortunately, checking your practice’s participation status is not as straightforward as it might seem. Some exchange plans use vague contract terms and amendments that rope physicians into
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Updating Provider Demographic Information with Payors It is important that physicians update their practice demographic information with contracted payors to ensure payment and other vital notices are received and to reduce the potential for delayed or denied payments. CMA surveyed the major payors in California on their process for updating provider demographic information. The information is compiled in this document. Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations Payor contract negotiations can be difficult. This guide is designed to guide physicians and their office staff through the contract evaluation and negotiation/ renegotiation process. A Physician’s Guide to Implementation of SB 866: The new standardized prescription drug prior authorization form A new law has taken effect that aims to streamline and standardize the prior authorization process for prescription drugs. It requires all insurers, health plans (and their contracting medical groups/ IPAs) and providers to use a standardized two-page form for prior authorizations on prescription medications. CMA has developed this FAQ to address common questions about the new form and process. Know Your Rights Series CMA has created a series of one-page documents that summarize California’s prompt pay legislation and educate practices on their rights under the law. Best Practices – A guide for improving the efficiency and quality of your practice This toolkit offers a series of proven steps that solo and small-group practices can take to improve many facets of their practice, including the delivery of betterquality medical care.
PQRS and Value-Based Modifier Getting Started Guide The Medicare Physician Quality Reporting System (PQRS) has used a combination of incentive payments and payment reductions to promote reporting of quality information by eligible professionals. PQRS is closely tied to another congressionally enacted program known as the valuebased modifier (VM). Successful reporting of PQRS will provide quality data for determining tiering calculations for VM payment incentives or penalties. Medicare Incentive and Penalty Programs: What physicians need to know Over the past few years Congress has created a number of programs that call for payment incentives and reductions that impact physicians and their practices. At their inception, most of these programs offered an incentive to participate. However, most of the programs are entering their penalty phases, with complex and potentially conflicting requirements and implementation processes. This document provides an overview of these programs. Cal MediConnect Physician FAQ In an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities, the 2012 California state budget authorized a three-year demonstration project, the Coordinated Care Initiative (CCI). CCI contains two main components (1) Cal MediConnect, which transitions individuals who are eligible for both Medicare and Medi-Cal (dual eligibles) away from feefor-service and into a single managed care and (2) integration of long term supports and services into managed care. This FAQ provides what you need to know about keeping your patients and billing for the dual eligible population.
MEMBER BENEFITS & SERVICES
participating in their exchange networks, often without their express consent or knowledge—making “do you take my insurance” not always an easy question to answer.
Financial Impact Worksheet It is important that physicians understand how a fee schedule can affect their practice’s bottom line so that they can make informed decisions about participation in a payor’s network before contracts are signed. CMA has developed a simple worksheet to help physicians
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analyze proposed fee schedules and assess the impact fee schedule changes may have on physician practices based on commonly billed CPT codes.
MEMBER BENEFITS & SERVICES
Medi-Cal Survival Guide: Important Changes and What they Mean to Your Practice There have been a number of changes for Medi-Cal patients and for the physicians who treat them over the past few years. To help physicians understand the impact these changes will have on their practices, CMA has published a Medi-Cal Survival Toolkit. The toolkit contains a summary on many of the changes, important dates, options for physicians and links to important resources. Medicare Enrollment Guide for Individual Physicians Medicare enrollment processes have changed considerably over the years, and even more so with the introduction of national provider identifiers. CMA has developed this document to guide new physicians through the enrollment process, and to assist enrolled physicians who are making changes or who must revalidate their enrollment. Medicare Audit Guide for Physicians The Centers for Medicare and Medicaid Services (CMS) is tasked with preventing inappropriate Medicare payments and preserving the trust fund for the future. Much of the responsibility for this duty is defined in Title 18 of the Social Security Act, Medicare Contract Reform and other regulations enacted over the years.
Review of appropriate billing is conducted by Medicare Administrative Contractors (MAC’s) and other agencies contracted by CMS. This guide describes some of the audits that may impact your practice. Special Investigations Unit Audit Guide This guide will help physicians understand their rights and responsibilities when it comes to health plan refund requests. Payor Solvency Checklist This checklist will help physicians monitor the financial health of their contracted payors. Timely Access Regulation Guide Department of Managed Health Care Timely Access regulations require HMO patients to be seen within certain timeframes for various levels of care. CMA has published a toolkit to help physicians understand these new regulations and what they could mean for their practices. Sample Termination Letter – Patient If the terms of a proposed contract are not acceptable or sustainable, physicians have the right under California law to terminate their agreement with the payor. Physicians who decide to exercise their right to terminate their agreement with a payor are encouraged to communicate their decision to with their patients. CMA has prepared a sample letter physicians can use to notify patients of their decision to terminate their contract.
CMA: Tools and Resources to Empower Physician Practices
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GET COMPLIANT DEAR MEMBERS: ARE YOU AND YOUR PRACTICE AT RISK?
The law requires that all physicians be compliant for MBC, DOH, OCR, HIPAA/HITECH Act, and CAL-OSHA Regulations. The law requires that all employers be compliant for: CAL-OSHA Regulations, EPA, and HIPAA/OCR.
THESE ARE NOT OPTIONAL, THEY ARE MANDATORY AND CARRY STIFF FINES FOR FAILURE TO COMPLY.
HOW MUCH DOES IT COST TO BE COMPLIANT?
Medical compliance (OSHA, BLOOD Borne pathogens, etc.) costs on the average of $200-$400/month. Plus over time, lost practice time of 5-10
hours per year, management, recordkeeping, etc. Employer compliance (sexual harassment, employee rights, mandatory postings, etc.) costs on the average of $200-$2,000. Plus over time or lost practice time of x5-10 hours per year, management, recordkeeping, etc.
GET COMPLIANT NOW…SCCMA-MCMS/ CMA CAN HELP
SCCMA-MCMS/CMA has negotiated a statewide price to get you and keep you in total compliance, both as a physician and as an employer. This is a turnkey program that requires no work or effort on your part. The member benefit price is only $29 per month…a saving of over $200 per month. Please contact us today to begin this member only benefit and/or get a demonstration. 408/998-8850 JANUARY / FEBRUARY 2017 | THE BULLETIN | 43
COMPLIANCE MADE EASY
COMPLIANCE MANAGEMENT APPLICATION For a low monthly fee you receive: Secure online access to the enviroportal The user friendly Dashboard tool will allow you to easily manage, track and assign tasks and training for your employees and monitor your facility’s safety & compliance. All in one easy to use place. The portal gives you complete access to Manifest & Tracking documents, customizable service frequencies, complete OSHA, HIPAA & SDS manuals, required signs & labels, labor posters, online Bloodborne Pathogens training, and access to a complete library of safety videos online. Protect your facility and its employees. With the enviroportal you will be able to set up medical waste pick-ups, regulatory e-mail alerts, customize safety plans, manage and track employee compliance tasks with forms/documents that support their efforts. These training programs include specific quizzes and a unique certificate of completion.
Turnkey Solutions For Waste Management & Compliance
To receive an immediate, “No-Obligation”quote, please visit www.enviromerica.com and utilize our pricing CALCULATOR or call 888.323.0583 to speak to a Customer Care rep 24/7
View and subscribe to our interactive compliance portal at www.enviromerica.com 44 | THE BULLETIN | JANUARY / FEBRUARY 2017
What our clients are saying... Why did the CMA choose Enviromerica? Simple, straightforward benefits • Special discount for CMA members • Transparent pricing
"We have worked with Enviromerica for the past 10 years. They have saved us over 30% on our medical waste and their compliance consulting and implementations have been invaluable." Cristine Klag, Administrator at Los Robles Professional Group / South Bay Pulmonary Medical Group.
”We have saved over 40% on waste management from what we paid with our prior vendor.” Stacey Robinson, Clinical Director, Monterey Peninsula Surgical Center
• No hidden or miscellaneous surcharges • Non-restrictive agreements • Excellent customer service • True protection against risks When The California Medical Association (CMA) was looking for a meaningful benefit to offer its 37,000 plus members, they chose Enviromerica. Why? Because we have a 15 year track record of delivering a premium service with no restrictive, longterm contracts, now offered exclusively as a members-only discount that could completely offset the cost of membership. Enviromerica is honored to be selected as CMA’s exclusive vendor of choice. ®
Turnkey Solutions For Waste Management & Compliance
Enviromerica is the exclusive vendor of choice for medical waste management and compliance services for the California Medical Association (CMA). CMA Members are eligible for exclusive discounts. For more information about this benefit or how to become a CMA member, please contact Enviromerica or the CMA directly: www.enviromerica.com | 888.323.0583/650.6552045 or www.cmanet.org | 800.786.4262 JANUARY / FEBRUARY 2017 | THE BULLETIN | 45
Employment-Related Recap for 2017 Melissa Irwin, SPHR-CA, SHRM-SCP TPO – The HR Experts
New CA Laws and Regulations (effective 1/1/2017 unless noted) 1. Minimum Wage Increases (SB3) – Increases from the current $10.00 per hour to ultimately $15.00 per hour on 1/1/2022 through yearly increases. Employers with 25 or fewer employees have an extra year to comply with the increase. •
NEW Poster: https://www.dir.ca.gov/IWC/MW-2017.pdf
CA Salary Threshold Increases: To meet the exemption from overtime, breaks, meals and other wage and hour provisions, employees in Administrative, Executive and Professional exemptions must earn a weekly salary equivalent to at least 2 times the current minimum wage. As of 1/1/2016 at $10.00 per hour, that amounts to $800.00 weekly, $3,466.66 monthly, or $41,600 annually. Subsequent increases: 1. 2. 3. 4. 5. 6.
$10.50 $11.00 $12.00 $13.00 $14.00 $15.00
1/1/2017 1/1/2018 1/1/2019 1/1/2020 1/1/2021 1/1/2022
$ 840.00 weekly, $ 880.00 weekly, $ 960.00 weekly, $1,040.00 weekly, $1,120.00 weekly, $1,200.00 weekly,
$3,640.00 monthly, $3,813.33 monthly, $4,160.00 monthly, $4,506.66 monthly, $4,853.33 monthly, $5,200 monthly,
$43,680 annually $45,760 annually $49,920 annually $54,080 annually $58,240 annually $62,400 annually
2. State-run Retirement Plan (SB1234) – A state-run retirement program for workers who don't have an employer-sponsored plan. It requires employers with 5 or more employees to automatically enroll workers and deduct money from each paycheck, though workers can opt out or set their own savings rate. The account could also be carried from job to job, allowing them to accumulate larger balances in a single account. Due to many prerequisites that must be met before this program is ready to roll-out, the implementation date is not yet known. 3. Equal Pay, Gender Salary History (AB1676) – Prohibits that prior salary, by itself, as a justification of any disparity in compensation under the bona fide factor exception to the prohibition on gender pay discrimination. 4. Equal Pay, Race or Ethnicity (SB1063) – Expands CA’s equal pay statute, prohibiting an employer from paying any of its employees at wage rates less than the rates paid to employees of another race or ethnicity for substantially similar work. 5. New-Hire Notice Requirements (AB 2337) – Requires that employers provide a written notice to new-hires and employees upon request that provides information on leave rights (for medical treatment or legal proceedings) as a possible victim of domestic violence, sexual assault, or stalking. The Labor Commissioner is charged with providing an appropriate form by 7/1/2017 and employers are not required to comply until the form is available. 6. All-Gender Toilet Facilities (AB 1732) – Starting 3/1/2017, all single-user toilet facilities in any business establishment, place of public accommodation, or government agency to be identified as all-gender toilet facilities. Make sure to update your signage! 7. Juvenile Criminal History (AB1843) – Prohibits employers from inquiring into any “adjudication” made by the juvenile court. “Adjudication” is a final determination by a court as to whether the juvenile committed the crime of which he or she is accused. Exceptions for health care facilities exist. 8. E-Cigarettes and Vaping (SBX2-5) – The new legislation will treat the use of e-cigarettes and vaping devices that contain nicotine as “smoking” – thus extending existing smoking bans to cover such products. 9. Arbitration (SB1241) – Employers cannot require employees who primarily reside and work in California to 1) adjudicate a claim in another state when the claim arises in CA, or 2) apply another state’s law to a controversy that arises in CA. ©TPO - The HR Experts 46 | THE BULLETIN | JANUARY / FEBRUARY 2017
All Rights Reserved.
10. Expanded Paid Family Leave (PFL) Insurance (AB908) - Starting 1/1/2018 CA PFL insurance payments will increase to 60% of wages, capped at $1,100 a week (previously the amount was 55% capped at $1,011 a week). A new provision has been added that will allow for 70% of wages for earning $20,000 or less annually. FEDERAL 1. The Department of Labor (DOL) Change to Exempt Salary Threshold on HOLD. As of 11/22/2016, the US District Court in Texas issued a preliminary injunction blocking the U.S. Department of Labor from implementing the revised FEDERAL salary threshold increase that was to increase to $913 per week ($47,476 annually) beginning 12/1/2016. Still unknown is if the DOL will appeal the decision to the US Court of Appeals for the Fifth Circuit and also unknown is the position of the incoming administration of President Trump. 2. The Equal Employment Opportunity Commission (EEOC) Revised EEO-1 Report. The EEOC has approved a revised EEO-1 report that will require large private employers including federal contractors and subcontractors with 100 or more employees to report summary pay data. The first deadline for the new 2017 EEO-1 report will be March 31, 2018. The EEO-1 report will be due every March 31 after that — a change from the long-standing previous September 30 deadline. HR Items of Interest 1.
CA November Ballot, Recreational Marijuana Use. Recreational marijuana is now legal for individuals over the age of 21. From an employment standpoint, it will not: • restrict the rights and obligations of public and private employers to maintain a drug and alcohol-free workplace; • require an employer to permit or accommodate the use, consumption, possession, transfer, display, transportation, sale, or growth of marijuana in the workplace; • affect the ability of employers to have policies prohibiting the use of marijuana by employees and prospective employees; or • prevent employers from complying with state or federal law.
2017 Exemption (from overtime, breaks and meal period) Increases: •
Computer Software Exemption: Minimum $42.39/hour, $7359.88/month or $88,318.55 annually.
Licensed Physician or Surgeon Exemption: Minimum $77.23/ hour.
TPO is an HR Consulting Firm providing general HR consulting, employee handbook development, neutral thirdpart investigations into employment matters including harassment, managerial training on HR regulatory and leadership skill-building, and helping employers maintain current best HR practices.
How we work with SCCMA and MCMS Members: Over the past 22 years, TPO has provided HR support to
SCCMA as well as the members of SCCMA and MCMS. TPO has facilitated numerous HR training programs for members to attend and has provided many articles throughout the years.
SCCMA/MCMS Members receive a FREE initial telephone consulting call (up to 15 minutes)! Examples of Common Consulting Calls: • “An employee is pregnant and says she gets 7 months off…is that right?” • “I have an employee with poor performance…how do we get him “on-board”? • “I want to terminate an employee, but am not sure if we can…help!” • “An employee is demanding back overtime pay…but we paid him a salary!” Contact Melissa Irwin, Sr. Consultant: (831)647-7292 or email@example.com ©TPO - The HR Experts
All Rights Reserved.
JANUARY / FEBRUARY 2017 | THE BULLETIN | 47
HR for Medical Practices Providing HR support to SCCMA and MCMS members for over 23 years Auditing medical office employment practices, providing initial and ongoing updates to bring (and keep!) the operations within regulatory compliance. Creating and/or revising Employee Handbooks and associated HR Administration Forms. Facilitating Staff Development Training programs on communication, teambuilding, patient relations, problem solving and more. Providing on-going expert HR Consulting support for busy medical office managers, owners and physicians to assist with hiring, performance & leave management, employee relations and separation of employment. Conducting CA's legally mandated Harassment Prevention Training for all supervisors, managers and leads for medical practices with 50 or more employees. Presenting Managerial Effectiveness Training to supervisors and managers of medical companies with team leaders. Supporting medical practices with only a few staff up to large hospitals with their HR needs and initiatives. Contact Melissa Irwin, SPHR-CA Senior Consultant/Training Specialist (831)647-7292 or firstname.lastname@example.org
COMPLIMENTARY CONSULTING CALL & 10% Off Initial Work Exclusively for SCCMA/MCMS MEMBERS © TPO – The HR Experts 48 | THE BULLETIN | JANUARY / FEBRUARY 2017
All Rights Reserved
Do you know What, When and How to Report Child Abuse?
FREE ONLINE COURSE! Course developed by the Child Abuse Prevention Center
Approved for 1.25 AMA PRA Category 1 Credits™ Approved for 1.25 CE credits
ALL healthcare providers (MD, DO, RN, PhD, LCSW, MSW) are encouraged to take this valuable course!
Course available 24/7
Register NOW at: http://www.imq.org/education/caprrc.aspx JANUARY / FEBRUARY 2017 | THE BULLETIN | 49
Classifieds OFFICE SPACE FOR RENT/LEASE OFFICE FOR LEASE/SUBLEASE O’Connor Hospital area with office lease/ sublease. Please contact Dr. Maggie Chau at 408/799-7842 for details.
MEDICAL OFFICE SPACE FOR LEASE • SANTA CLARA Medical space available in medical building. Most rooms have water and waste. Reception, exam rooms, office, and lab. X-ray available in building. Billing available. 2,500–4,000 sq. ft. Call Rick at 408/228-0454.
MEDICAL SUITES • GILROY First class medical suites available next to Saint Louise Hospital in Gilroy, CA. Sizes available from 1,000 to 2,500+ sq. ft. Time-share also available. Call Betty at 408/848-2525.
LOS GATOS OFFICE TO SHARE Newly-remodeled office next to ECHLG, including private office, four exam rooms, lab, reception, and waiting areas. Can share staff. Contact Dr. Maia Chakerian at 408/832-3930.
Growing Medical Group seeking Full Time BC / BE Family Medicine Physicians Palo Alto Medical Foundation (PAMF) has openings in the Bay Area for Family Medicine Physicians. Come join an organization which has received the highest possible rating for patient experience from the California Office of the Patient Advocate, and ‘elite’ status by the California Association of Physician groups. • Physician-led and collegial environment • Schedule flexibility and sabbaticals for work-life balance • Relocation allowance • Malpractice tail coverage Contact: Palo Alto Medical Foundation Physician Resources Recruitment Dpt 650-934-3582 MDCareers@pamf.org www.pamfmdjobs.org
MEDICAL OFFICE SPACE TO SHARE • CAMPBELL
smile.amazon.com A great way to support your Alliance
Convenient location. 5+ exam rooms M-F. In-office digital x-ray. Two large private offices, shared waiting room and front office. Total office size 3,000 sq. ft. Available now. Call 408/376-3305 or email@example.com.
When you shop at AmazonSmile, Amazon donates 0.5% of the purchase price to Santa Clara Medical Association Alliance Foundation Inc. Bookmark the link http://smile.amazon.com/ ch/27-1977428 and support us every time you shop. 50 | THE BULLETIN | JANUARY / FEBRUARY 2017
MEDICAL OFFICE SPACE TO SUBLET • MTN VIEW Mountain View Medical Office space to sublet. 1,100 sq. ft. Available three days a week. In large medical complex, behind El Camino Hospital. Basement storage, utilities included. Large treatment rooms, small lab space, bathroom, private office, etc. Call Dr. Klein. Cell 650/269-1030.
BEAUTIFUL MENLO PARK OFFICE TO SHARE New office, upscale and modern – to share with existing pain management practice. Ideal for psychologist or psychiatrist. Contact Dr. Maia Chakerian at 408/832-3930.
OFFICE SPACE FOR LEASE Office space, located at 999 Saratoga Avenue, San Jose, is suitable for medical/ dental office; 2,100 sq. ft. – 2,700 sq. ft. Contact 650/796-1887.
EMPLOYMENT OPPORTUNITY OCCUPATIONAL MEDICINE PHYSICIANS • PRIMARY CARE, ORTHOPEDICS, & PHYSIATRY Our occupational medical facilities offer a challenging environment with minimal stress, without weekend, evening, or “on call” coverage. We are currently looking for several knowledgeable and progressive primary care and specialty physicians (orthopedist and physiatrist) interested in joining our team of professionals in providing high quality occupational medical services to Silicon Valley firms and their injured employees. We can provide either an employment relationship including full benefits or an independent contractor relationship. Please contact Rick Flovin, CEO at 408/228-0454 or e-mail riflovin@ allianceoccmed.com for additional information.
INTERNAL MEDICINE PHYSICIAN NEEDED We are looking for an internal medicine physician for our multi-specialty group. Please email your CV to kaajhealthcare@ gmail.com.
enced staff and EHR. If interested please call 408/710-3008.
OTHER SURGICAL INSTRUMENTS TO DONATE Needle holders, pick ups, dilators, tenacula, etc. to donate. Please call 650/6914840 if interested and can use them.
PEDIATRICS PRACTICE FOR SALE Decent well-established Pediatric solo practice for sale in South Bay with experi-
METRO MEDICAL BILLING, INC.
• • • • • •
Full Service Billing 25 years in business Bookkeeping ClinixMIS web based software Training and Consulting Client References
Contact Lynn (408) 448-9210 firstname.lastname@example.org Visit our Website: metromedicalbilling.com
WHAT DOES AN INSURANCE CAPTIVE HAVE TO DO WITH MY BUSINESS? Basil Hantash, MD, PhD, MBA, from Turlock, Calif., realized the greatest threat to his dermatology practice wasn’t medical malpractice. What kept him and so many other doctors up at night were worries over things like loss of license or hospital privilege, a cyber attack, staffing issues, losing a patient referral source or needing to pay out for legal defense. These are problems that could prove catastrophic to any practice. Dr. Hantash did his research and found a solution. Enter CapAlt, a captive insurance company administrator, specializing in protected captives. Working with CapAlt, Dr. Hantash was able to protect his practice in a way that was not only tailored for his specific needs, but would increase his bottom line. It may sound too good to be true, but here’s how it works. A large commercial insurance company takes your premiums and invests those funds, growing the company’s assets. Through CapAlt, business owners (including physicians) can set up their own captive insurance company and not only protect their business, but make money in the process. Allstate Insurance actually started as a captive. So the idea of a captive isn’t a new insurance model; CapAlt is a new partner for SCCMA and MCMS members. We want you to know that CapAlt went through an extensive vetting process by CMA, the CMA Insurance Committee and SCCMA-MCMS. The result is that, in addition to all the advantages of owning a captive, CapAlt is now offering free SCCMA and MCMS membership to any physician who adopts a captive.
The representatives at CapAlt will take you through a fairly painless process with a risk assessment questionnaire to help determine your exposure and budget. From there, you’ll determine where to invest your premiums and they’ll do the heavy lifting. You don’t have to become an insurance specialist. You may not have heard of insurance captives or been offered this kind of opportunity because captives don’t work for everyone. Physicians and small physician groups can qualify and really benefit from captives. The premium you pay to your captive is tax-deductible and over time this investment acts almost like a 401(k). Captives usually cover claims that have a high payout but a low occurrence rate. This means that your captive keeps you from paying out of pocket and keeps you protected from high-risk situations such as someone hacking into your computer system or if you’re facing the need to defend your reputation. CapAlt recognizes that physicians have specific risks they are working to mitigate. In coming on as a partner with CMA and SCCMA-MCMS, they have developed a comprehensive program for physicians, addressing issues such as HIPAA compliance and licensing. Mark Sims is VP of Business Development for CapAlt. He’s been active in talking to physicians and organizations like CMA. If you’d like to find out more about managing risk and assets through captive insurance, Sims is happy to answer questions and help you determine if setting up a captive is right for you. You can reach him at email@example.com or 404/823-6200.
JANUARY / FEBRUARY 2017 | THE BULLETIN | 51
The California Medical Association (CMA) offers timely, high-quality education programs for physicians and their staff. From interactive in-person seminars to live and on-demand webinars, CMA provides the information needed to help run a successful medical practice. Through the webinar series, physicians and their staff have the opportunity to watch live presentations on important topics of interest and learn from industry experts from the comfort of their homes or offices. The webinars are free to CMA members and members’ staff and are also available on-demand immediately following the live airing.
Webinar Topics Include: • Accounts Receivable
• HIPAA Compliance
• Federal and State Advocacy
• California’s Health Benefit Exchange
• CMA Governance Reform
• Coding for Medical Necessity and Quality Care
• Meaningful Use
• Claims and Reimbursement
• Medicare Rules
• Contracting with Payors
• Medicare Provider Enrollment
• Customer Service
• Personnel Management
• Electronic Health Records Implementation and Incentives
• Patient Satisfaction
• Employment Practices
• Telemedicine • Workers’ Compensation
• Health Care Reform
New webinars and seminars are added regularly. Live webinars are typically held Wednesdays from 12:15 - 1:15 p.m. For the full listing of on-demand and upcoming webinars, please visit www.cmanet.org/webinars.
SIGNING UP FOR WEBINARS IS AS EASY AS 1, 2, 3… 1. Go to www.cmanet.org/events 2. Select the webinar you would like to join 3. Register to attend Once your registration has been approved, you will be sent an email confirmation with details on how to join the webinar. Questions? Call the CMA Member Help Line at (800) 786-4262.
52 | THE BULLETIN | JANUARY / FEBRUARY 2017
In this issue: Aetna to require additional accreditation requirements in order to be paid for certain surgical pathology services 1 Update on two Anthem Blue Cross issues pending with the Department of Managed Health Care 1 Meet Your CMA Center for Economic Services Advocate: Mark Lane
CMA Advocacy at Work
Urgent survey response requested
Aetna erroneously terminates providers from California network
Document, Document, Document
United Healthcare announces extension of HIPAA 5010 enforcement 4
ARE YOU READING CPR? CPR contains the latest in Practice Management Resources, Updates and Information.
What’s a COHS?
Save the Date
Act now to avoid the 2013 e-prescribing penalty 5 Payor Updates
Health plan provider newsletters
When you see this icon, that means there are additional resources available free to California Medical Association (CMA) members at the CMA website. To access any of these resources, visit http://www.cmanet.org/ces.
Medical-Legal Library (Formerly CMA On-Call)
In this publication, you will find references to “medical-legal” documents. The California Medical Association’s (CMA) online medical-legal library contains over 4,500 pages of medicallegal, regulatory, and reimbursement information. Medical-legal documents are free to members and can be found in CMA’s online resource library, http://www.cmanet.org/resource-library. Nonmembers can purchase medical-legal documents for $2 per page.
CMA Center for Economic Services 1201 J Street, #200, Sacramento, CA 95814 firstname.lastname@example.org • 916/551-2061
CMA Practice Resources (CPR) is a free monthly bulletin from the California Medical Association’s Center for Economic Services. This bulletin is full of tips and tools to help physicians and their office staff improve practice efficiency and viability. SUBSCRIBE TO CPR OR ANY OTHER CMA NEWSLETTERS: To stay up to date, sign
up for free subscriptions at www.cmanet.org/newsletters.
SPREAD THE WORD: Please forward this bulletin to your coworkers and colleagues.
Aetna to require additional accreditation requirements in order to be paid for certain surgical pathology services Aetna recently notified physicians that, effective August 1, 2012, practices performing in-office pathology testing will be required to be both Clinical Laboratory Improvement Amendments (CLIA) certified and accredited with the College of American Pathologists (CAP). In a letter to physicians, Aetna claims that the change is consistent with the Centers for Medicare & Medicaid Services (CMS) recognition of CAP as an approved accreditation organization for non-hospital anatomic pathology testing. The California Medical Association has voiced concerns with the implementation of this policy and has asked Aetna to explain the need for dual certification. Although CMS may recognize CAP as an approved accreditation organization, CMS does not require both a CLIA certification and a specialty society accreditation to perform in-office pathology testing services. Further, CMA expressed concerns with the ability of physicians to obtain the CAP accreditation prior to the deadline imposed by Aetna. According to CAP, the accreditation process takes approximately 90 days. Additionally, the process of obtaining a secondary accreditation can be very costly for practices. In addition to their contact with Aetna on this issue, CMA is working closely with the American Medical Association (AMA) and several other state and specialty medical societies. Stay tuned for further details. Practices with questions about the letter can contact Tammy Gaul, senior network manager at Aetna at (215)775-6604. Contact: CMA reimbursement help line, (888) 401-5911 or email@example.com
Update on two Anthem Blue Cross issues pending with the Department of Managed Health Care DMHC claims audit
As previously reported, on Jan. 12, 2012 the Department of Managed Health Care (DMHC) ordered Anthem Blue Cross to reprocess provider claims, with interest, dating back to 2007. The order is based on 2008 DMHC audits of the seven largest health plans in California. These audits found violations of claim payments above the threshold allowed under California law at all seven health plans. As a result, DMHC assessed administrative fines, required the plans to pay providers the money they were owed and mandated that plans demonstrate CPR • May 2012 • Page 1 of 5
CMA’s free monthly e-mail bulletin from CMA’s practice management experts that focuses on critical payor and health care industry changes and how they directly impact the business of a physician practice. Each issue includes tips on reimbursement and contracting related issues along with information on the latest practice management news.
SUBSCRIBE NOW Sign up now for a free subscription to our e-mail bulletin, at www.cmanet.org/cpr
TPO Human Resource Management, the Santa Clara Medical Association & the Monterey County Medical Society presents
Santa Clara County Medical Association
MCMS MONTEREY COUNTY MEDICAL SOCIETY
March 1, 2017, 12:00-2:00 PM (Lunch served at noon) at SCCMA, 700 Empey Way, San Jose March 7, 2017, 12:00-2:00 PM (Lunch served at noon) 60 Garden Court, Suite 100, Monterey (Near the Airport)
SCCMA or MCMS
54 | THE BULLETIN | JANUARY / FEBRUARY 2017
Being a physician can be tough. At CAP, we try to make your job a little easier.
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You give your all to helping others live full, healthy lives. You go the extra mile to seek out answers and cures, knowing that sometimes even your best efforts aren’t enough. You’re a physician, and that’s how you do your job. At CAP, we salute your dedication and support you in every way we can — with protection to reduce the worry of professional liability lawsuits, but also with a host of value-added services to help manage your practice so you can focus on the highest quality professional care. Ask for a no-obligation quote and more information on CAP membership.
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