December Fax Facts
December 21, 2011
*Available in PDF version by download above
REMINDER ABOUT MEANINGFUL USE REQUIREMENTS FOR PHYSICIANS WHO HAVE APPLIED FOR MEDICARE EHR INCENTIVES IN 2011
CMA wants to remind physicians who have attested to meaningful use for the Medicare EHR incentive program in 2011 that they are required to collect data for a full year in their second year of use. This means they have to start collecting data January 1 and continue through December 31. The data will then be submitted to the Centers for Medicaid & Medicare Services (CMS) in early 2013.
Physicians who did NOT attest in 2011 will only collect data for 90 days in 2012. They must begin by October 3, 2012, in order to have 90 days completely within the calendar year.
According to CMS, physicians cannot “miss” a year. If physicians received their $18,000 this year, but they don’t report meaningful use the second year, the maximum incentive available is $32,000.
Contact: David Ford, (916) 551-2554 or dford@cmanet.org.
GOLD COAST HEALTH I.T. LOCAL EXTENSION CENTER
The evening of Tuesday, December 13, the House of Representatives passed H.R. 3630, the “Middle Class Tax Relief and Job Creation Act of 2011,” by a vote of 234 to 193.
In addition to proposals to extend the pay-roll tax cut and Unemployment Insurance (UI) programs, the bill included a proposal to provide two years of Medicare SGR relief with one percent increases in each year.
The Senate Democratic leader has indicated that the House proposal does not have the support to prevail in the Senate. Additionally, the White House today announced that should the President be presented with the bill, he would veto it. Senate and White House objections mostly revolve around provisions used to pay for the House bill as well as a provision requiring the President to make a determination on the future of the controversial Keystone pipeline.
The AMA did not support the House bill. The noted in a statement issued last week by AMA President Peter Carmel, MD, that the two year extension and modest updates would provide needed stability for physicians. However, the continued utilization of so-called “cliff financing” to hold the cost of the SGR provision to $39 billion would result in a 2014 payment cut of 37% and increase the cost of repealing the SGR by more than $60 billion to a total of greater than $350 billion.
The AMA has made it clear that Congress must come together in a bipartisan manner and repeal the SGR once and for all. We cannot embrace actions that make that goal less attainable, especially in the light of a fiscal climate that is more challenging with each passing year.
In the coming days, the Senate will likely unveil their proposal to address the pay-roll tax, UI, and the SGR. We will continue to provide you with updates as the final days of the current session of Congress wind down.
Like the AMA, CMA is also concerned with the “cliff financing” of the Medicare SGR that increases the SGR cuts in future years to pay for the stop-gap this year. We were also opposed to the raiding of the prevention and public health fund.
CMA is in close contact with our Senators as they develop the Senate alternative this week. Please continue those calls and emails to Senators Feinstein and Boxer. Please ask your Medicare patients to make calls as well by using the CMA patient flyer on the CMA website cmanet.org, or email request to marycarr@venturamedical.org for a pdf poster you can print out and post. Congress cannot go home without stopping the Medicare SGR fee-for-service payment cut!
KEEP THE PRESSURE ON CONGRESS TO STOP THE MEDICARE FEE-FOR-SERVICE SGR PAYMENT CUT! KEEP MAKING THOSE CALLS AND SENDING EMAILS.
Please use the AMA hotline at (800) 833-6354. Enter your ZIP code and it will automatically connect you to your Representative. Please call the hotline again to reach Senators Boxer and Feinstein. You can also send emails via https://writerep.house.gov, www.boxer.senate.gov and www.feinstein.senate.gov. The sheer volume of calls is important so Congress knows you are watching closely and they must act.
Tell your Representatives and Senators Boxer and Feinstein that:
1.The Medicare SGR cut must be stopped before the end of the year.
2.The cuts will harm access to care for 5 million California seniors.
3.The cuts will wreak havoc on physician practices.
4.Congress should not go home and think it’s OK to stop the cut retroactively in January.
5.Physicians should not be forced to finance the Medicare program because of Congress’s irresponsibility.
Contact: Elizabeth McNeil, (415) 310-2877 or emcneil@cmanet.org.
HISTORY OF SGR(excerpted from article by Joanne Kenen, staff writer for Politico): “Doc Fix” is Washington shorthand for the Sustainable Growth Formula, a mouthful of a payment plan wrapped into a 1997 budget law. It was supposed to be a so-smart way of linking physician’s costs, Medicare enrollment and the GDP. Only it didn't work. And everyone knows it.
The irony is that this annual scramble still occurs even though pretty much everyone in Washington — Democrats, Republicans, politicians, policymakers and the medical establishment itself — have concluded that the SGR system is broken beyond repair and should be replaced. A few years ago, the cost of fixing SGR was around $50 billion. Now, the full cost of all those delayed cuts amounts to around $300 billion over 10 years. Double that in another five.
To come up with a new payment system, the American Medical Association favors a five-year transition fee scale that allows time to test new approaches to delivering health care, some of which are already being developed as part of the health care reform law.
“During this time a variety of new payment models designed to enhance care coordination and quality while reducing costs can be tested and would form the basis for a new Medicare physician payment system,” AMA President Dr. Peter Carmel wrote recently.
But the congressional focus on short-term “doc fixes” blunts the momentum for long-term change.
STATE BUDGET SHORTFALL TO EXTEND MEDI-CAL CUTS
When the California Legislature passed the 2011-12 State Budget in June, they assumed a sizable ($10 billion) increase in revenue based on projections of an improving economy. But early projections show the state will face a $12.8 billion deficit for the coming fiscal year.
To account for the uncertainty of tax revenue, the Legislature included a set of automatic “trigger” cuts that would be implemented if revenues fell short. The trigger cuts were divided into two tiers, depending on how far revenues fell short.
California Governor Jerry Brown announced that, while revenues are higher than last year, they are not high as projected. He therefore pulled the budget trigger on the “Tier 1” cuts.
Of the scheduled reductions, the extension of the March 2011 cuts to Medi-Cal managed care plans – expected to yield a $15 million reduction to the Medi-Cal program – is the most likely to affect physicians.
In early January 2012, the Governor will release his budget proposal for 2012-13. Governor Brown indicated at his press conference that next year’s budget will include a similar trigger mechanism, pending the result of a November 2012 ballot initiative to raise state taxes.
Contact: David Ford, (916) 551-2554 or dford@cmanet.org.“CERTIFIED MEDICAL OFFICE MANAGER” COURSE
January 25, February 1, 8, 15, 2012
This program is recommended for experienced medical office managers who want to take their skills to the next level. Learn to initiate policies and protocols that will improve, protect and stabilize the financial security of the practice.
When: Four Wednesdays
9:00a.m. – 4:00p.m
Where: VCMA Conference Room
601 E. Daily Dr. #129. Camarillo, CA 93010
Cost: for VCMA member physicians/staff
Earlybird $649(registration received w/ payment by 12/23/11)
Member Price after 12/23/11: $749 (new 2012 rate)
Includes certification exam.
LIMITED TO FIRST 20 REGISTRANTS
Presented by Practice Management Institute and hosted by the Ventura County Medical Association and the California Medical Association.
For a registration form or more information, please call VCMA at 805-484-6822.
DHCS ANNOUNCES PLANS TO RECOUP PROVIDER PAYMENTS FOR MED-CAL
On December 2, 2011, the Department of Health Care Services announced it intends recoup a 10 percent reduction in Medi-Cal provider payments retroactive to June 1, 2011, as part of the California Budget Act of 2011. CMA met with DHCS immediately after its announcement in an effort to understand how this news will impact physicians.
DHCS is currently evaluating provider claims and payments to determine which providers must repay the state and by how much. DHCS said it intends to alert all impacted providers by January 2012. CMA will continue to meet with DHCS in an effort to provide updated information to physicians and ensure that the state stands by its statement that recoupment will occur over an extended period of time.
CMA believes that DHCS has violated a federal law that requires that Medi-Cal in California patients have the same access to physicians and other health care providers as the general insured public. A recent study showed that this is not the case for approximately 50 percent of Medi-Cal patients, even before the cuts go into place.
Contact: Frank Navarro, (916) 551-2046 or fnavarro@cmanet.org.BLUE CROSS ANNOUNCES CHANGES TO PRUDENT BUYER CONTRACT
Anthem Blue Cross will soon be notifying its contracting physicians of impending changes to its Prudent Buyer Participating Physician Agreement, which will become effective April 1, 2012. The amendment, scheduled to be mailed December 14, includes an expanded confidentiality provision and several modifications to Exhibit F, which pertains to the Blue Cross Medicare Advantage PPO product.
Physicians are urged to carefully review and assess the impact the contract changes will have on their practices. Questions and concerns should be directed to the Blue Cross provider care department at (800) 677-6669.
If you do not wish to participate in this product, you can opt out by providing 180 days written notice, which should be sent via certified mail with return receipt to Anthem Blue Cross Prudent Buyer Plan Contract Processing, Mail Station 8A, P.O. Box 4330, Woodland Hills, CA, 91365-4330.
To help physicians understand their rights when it comes to health plan contract amendments, CMA has published "Contract Amendments: An Action Guide for Physicians." Additional guidance on negotiating and managing complex third-party payor agreements is also available in CMA’s contracting toolkit, "Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations – A Focus on Payor Contracting." Both resources are available free to members in the CMA Resource Library. Nonmembers can purchase the contracting toolkit for $100 in the CMA Resource Library.
Contact: CMA reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org.MEMBERS OF HOSPITAL MEDICAL STAFFS NEED TO KNOW THEIR RIGHTS
Self-governing medical staffs are vital to providing quality patient care in California’s hospitals, but with fewer physicians practicing in hospitals and the increasing demands of cost-conscious delivery systems, this can be difficult.
Under state law and Medicare regulations, hospitals are required to have an independent, self-governing medical staff charged with the professional work of the hospital. The medical staff works with the hospitals to ensure quality of care and can serve to insulate medical decision makers from the potential of undue influences driven by profit motives or other reasons unrelated to patient care.
To preserve this autonomy, medical staffs have a variety of rights provided for under California law, including the ability to retain legal counsel, elect leadership, conduct peer review and manage a separate bank account dedicated to medical staff funds.
Medical staff associations also have the option to sue a hospital, should they feel their right to self-governance has been violated.
For more information visit the Medical Staffs section of CMA’s medical legal library by clicking here.
Contact: CMA member help center, (800) 786-4262 or medstaffhelp@cmanet.org.CALENDAR OF EVENTS
December 26-30, CMA and VCMA offices closed for the holidays. We will reopen Monday, January 2nd.
UPCOMING CMA WEBINARS
FREE live webinars. Space is limited so register soon.
Go to: www.cmanet.org/calendar and choose to Filter by Event Type-Webinar
or contact:
CMA Member Help Center, (800) 786-4262, memberservice@cmanet.org.
February 1, Key Financial Ratios to Increase Profitability
12:15pm - 01:15pm
February 15, HIPAA Risk Analysis for Meaningful Use
12:15pm - 01:15pm
March 21, HIPAA Update 2012
12:15pm - 01:15pm
These and more Webinars are available on demand.
CMA Practice Resources (CPR)is a free monthly e-mail 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 NOW:Sign up now for a free subscription at cmanet.org
ARCHIVES: past issues of CPRare available at cmanet.org
